RESUMO Objetivos: Conduzir um inquérito multinacional com profissionais de unidades de terapia intensiva para determinar as práticas relacionadas à avaliação e ao manejo do delirium, bem como as percepções e as atitudes relacionadas à avaliação e ao impacto do delirium em pacientes submetidos à ventilação não invasiva. Métodos: Foi elaborado um questionário eletrônico para avaliar o perfil dos respondedores e das unidades de terapia intensiva a eles relacionadas; a realização de avaliação sistemática e a forma de manejo do delirium; e as percepções e condutas dos profissionais com relação à presença de delirium em pacientes submetidos à ventilação não invasiva. O questionário foi distribuído por meio da mala direta de correio eletrônico da rede de cooperação em pesquisa clínica da Associação de Medicina Intensiva Brasileira (AMIB-Net) e para pesquisadores em diferentes centros da América Latina e Europa. Resultados: Foram analisados 436 questionários que, em sua maioria, eram provenientes do Brasil (61,9%), seguidos por Turquia (8,7%) e Itália (4,8%). Aproximadamente 61% dos respondedores relataram não proceder à avaliação de delirium na unidade de terapia intensiva, enquanto 31% a realizavam em pacientes submetidos à ventilação não invasiva. Confusion Assessment Method for the Intensive Care Unit foi a ferramenta diagnóstica validada mais frequentemente citada (66,9%). Com relação à indicação de ventilação não invasiva para pacientes em delirium, 16,3% dos respondedores nunca permitiam o uso de ventilação não invasiva neste contexto clínico. Conclusão: Este inquérito fornece dados que enfatizam a escassez de esforços direcionados à avaliação e ao manejo do delirium no ambiente da terapia intensiva, em especial nos pacientes submetidos à ventilação não invasiva.

ABSTRACT Objective: To conduct a multinational survey of intensive care unit professionals to determine the practices on delirium assessment and management, in addition to their perceptions and attitudes toward the evaluation and impact of delirium in patients requiring noninvasive ventilation. Methods: An electronic questionnaire was created to evaluate the profiles of the respondents and their related intensive care units, the systematic delirium assessment and management and the respondents' perceptions and attitudes regarding delirium in patients requiring noninvasive ventilation. The questionnaire was distributed to the cooperative network for research of the Associação de Medicina Intensiva Brasileira (AMIB-Net) mailing list and to researchers in different centers in Latin America and Europe. Results: Four hundred thirty-six questionnaires were available for analysis; the majority of the questionnaires were from Brazil (61.9%), followed by Turkey (8.7%) and Italy (4.8%). Approximately 61% of the respondents reported no delirium assessment in the intensive care unit, and 31% evaluated delirium in patients under noninvasive ventilation. The Confusion Assessment Method for the intensive care unit was the most reported validated diagnostic tool (66.9%). Concerning the indication of noninvasive ventilation in patients already presenting with delirium, 16.3% of respondents never allow the use of noninvasive ventilation in this clinical context. Conclusion: This survey provides data that strongly reemphasizes poor efforts toward delirium assessment and management in the intensive care unit setting, especially regarding patients requiring noninvasive ventilation.

A Economia Solidária é hoje um movimento dividido em duas correntes teóricas que dão ensejo a dois projetos políticos distintos: um conservador, de inserção de trabalhadores na economia capitalista, e outro radical, de transformação da economia e estabelecimento de novos valores sociais. Com relação ao projeto radical, vários desafios se interpõem no percurso, desafios estes que se ligam, principalmente, à dificuldade de modifi car os valores que sustentam as novas práticas. Nesse sentido, este trabalho busca demonstrar a contribuição da noção de Imaginário Social na mudança de valores e efetivação de um projeto radical de Economia Solidária. Acredita-se que o entrelaçamento entre estrutura e cultura, entre práticas e valores deve ser indissociável, e ter como pano de fundo e força motriz o imaginário social.

Solidary Economy is now a movement divided into two theoretical lines, giving rise to two different political projects: a conservative one with the inclusion of workers in the capitalist economy, and the other radical one, the transformation of the economy and establishment of new social values. With the radical project, several challenges are in the way, and these challenges are linked mainly to the difficulty of changing the values that sustain the new practices. Therefore, this paper aims to demonstrate the contribution of the concept of Social Imaginary in changing values and execution of a project of radical Solidary Economy. It is believed that the links between structure and culture, between practices and values should be inseparable, and have the social imaginary as a background and driving force.

The paper describes how the term euthanasia has served in the course of history to refer to an endless number of concepts related with death, however, this term has moved away from the original concept and even has meant all the opposite to what it etymologically describes. Ambiguity is the distinctive sing of the term and the concept of euthanasia in our times. It is emphasized that when man assesses the dignity of his life, he will assess also the right of each human being to die with dignity, which is the real meaning of euthanasia given by the Greek culture. If euthanasia is understood in this way, then it constitutes an unavoidable ethical demand. It is concluded that the act of dying should be assumed as a transcendental moment in the life of the person, the family and the social group and that for dignifying death, it is essential to firstly dignify the life of each person by offering him/her all the necessary conditions that lead to full enjoyment of life because “all the length of time that we are living, we are taking it away from life

Se expone cómo, a lo largo de la historia, el término eutanasia ha servido para referirse a infinidad de conceptos relacionados con la muerte, separándose de la concepción inicial y llegando incluso a significar todo lo contrario de lo que etimológicamente describe. La ambigüedad es el signo distintivo del término y el concepto de eutanasia en nuestros días. Se hace énfasis en que, cuando el hombre valora la dignidad de su vida, valorará también el derecho de cada ser humano a morir con dignidad, que es lo que la cultura griega denominó realmente como eutanasia, que así comprendida constituye una exigencia ética ineludible. Se concluye que el acto de morir debe ser asumido como un momento trascendente en la vida de la persona, la familia y el grupo social; y que para dignificar la muerte es imperativo dignificar primero la vida de cada persona, ofreciéndole todas las condiciones que conlleven la plenitud de la existencia porque “todo el tiempo que vivimos, se lo quitamos a la vida

Objective. To develop, apply, and evaluate an educational model for the primary prevention of sexually transmitted diseases (STDs) and acquired immunodeficiency syndrome (AIDS) that was based on the sexual knowledge, attitudes, and practices (KAPs) of adolescents and on their perceptions and behaviors in this area, with the ultimate goal of helping develop educational tools to prevent infection with STDs and the human immunodeficiency virus (HIV). Methods. An STD/HIV/AIDS primary prevention model was applied with adolescent schoolchildren (12 to 15 years old) in the canton of Santo Domingo de los Colorados, Ecuador. Two groups with similar characteristics were formed: the experimental group, with 358 students, and the control group, with 288 students. Schools were selected according to inclusion criteria, and adolescents at each school were chosen at random. A discussion guide was applied with 16 focus groups, and the resulting information was used to prepare a KAP survey. After being validated, the KAP survey was applied to the experimental group and to the control group. A prevention education program geared to students and teachers was implemented with the experimental group. Eight months later a second KAP survey was done with the experimental group and the control group. The differences in KAPs before and after the intervention were evaluated using the chi-square test. Results. There were no statistically significant differences between the two groups before the intervention, but afterwards the differences were statistically significant (P = 0.012), with an increase in the knowledge of sexuality and STDs/AIDS in the experimental group, even though the long-term behavior changes have not been evaluated. Conclusions. This study validated a multifactorial STD/AIDS prevention model adapted to the reality of adolescents, and it suggests the possibility of extrapolating this experience more broadly to contexts similar to those of this Ecuador population.

Objetivos. Desarrollar, aplicar y evaluar un modelo educativo de prevención primaria de enfermedades de transmisión sexual (ETS) y síndrome de inmunodeficiencia adquirida (sida) basado en los conocimientos, actitudes y prácticas (CAP) sexuales de los adolescentes y en sus percepciones y conductas al respecto, con el objetivo final de contribuir al desarrollo de herramientas educativas de prevención de las ETS y de la infección por virus de la inmunodeficiencia humana (VIH). Métodos. Se aplicó un modelo de prevención primaria de ETS y VIH/sida a escolares adolescentes (12 a 15 años) de Santo Domingo de los Colorados, Ecuador. Se formaron dos grupos con características similares: el grupo de intervención (grupo I, n = 358) y el grupo de control (grupo C, n = 288). Las escuelas se seleccionaron por criterios de inclusión, y los adolescentes de cada escuela, al azar. Se aplicó una guía de discusión a 16 grupos focales; con esta información se elaboró una encuesta sobre conocimientos, actitudes y prácticas (CAP) que, después de su validación, fue aplicada a ambos grupos. En el grupo I se implementó un programa educativo de prevención dirigido a estudiantes y docentes. Ocho meses más tarde se aplicó una segunda encuesta CAP a los dos grupos. Las diferencias en los CAP antes y después de la intervención fueron evaluadas utilizando la prueba de la ji². Resultados. No existieron diferencias significativas entre los dos grupos antes de la intervención, pero después de ella las diferencias fueron estadísticamente significativas (P = 0,012); se verificó un aumento de conocimientos sobre sexualidad y ETS/sida en el grupo I, aunque todavía no se ha evaluado la modificación de conductas a largo plazo. Conclusiones. Este estudio permitió validar un modelo multifactorial de prevención de ETS/sida adecuado a la realidad de los adolescentes, y sugiere la posibilidad de extrapolar la experiencia a escalas mayores en contextos similares a los de la población investigada.