Resumen El artículo busca mostrar que existe una cierta racionalidad de la violencia que echa sus raíces en el corazón mismo de la subjetividad moderna, y que encuentra nuevas formas de manifestarse en una posmodernidad atravesada por una lógica eminentemente neoliberal. Para ello, se problematizan los compromisos iluministas de los discursos educativos, en la medida en que, en muchos casos, se sigue pensando el núcleo de la acción educativa a partir de la lógica universalizante del sujeto moderno, pero valiéndose, al mismo tiempo, de unos discursos “celebratorios de las diferencias”, vinculados a perspectivas teóricas posmodernas. Sin embargo, tales discursos estarían también siendo usados en el ámbito educativo para configurar subjetividades que encajen perfectamente en el orden neoliberal contemporáneo. Se concluye la persistencia de una racionalidad de la violencia que en la modernidad toma la forma de un paradigma inmunitario, y en la posmodernidad se manifiesta como una violencia de la positividad.

Abstract The present article aims to demonstrate that there is a certain rationality of violence rooted in the very heart of modern subjectivity, and which finds new ways to manifest itself in a postmodernity crossed by an eminently neoliberal logic. Therefore, the illuminist commitments of educational discourses are problematized, to the extent that, in many cases, the core of educational action is still thought of from the universalizing logic of the modern subject, but using, at the same time, “celebratory of differences” discourses, linked to postmodern theoretical perspectives. However, such discourses are also being used in the educational field to configure subjectivities that fit perfectly into the contemporary neoliberal order. The persistence of a rationality of violence is concluded, which in modernity takes the form of an immune paradigm, and in postmodernity manifests itself as a violence of positivity.

Abstract Fundament: Telemedicine for follow-up in heart failure (HF) patients is effective in reducing hospitalizations, total and cardiovascular mortality. However, few studies were conducted in low and middle income, where lower access to technology and illiteracy could impact the results. Objective: To assess the effectiveness of associating telemedicine strategies, when compared to usual care, in reducing hospitalizations related to HF in patients discharged from the hospital due to HF. Methods: Controlled, randomized, multicenter, parallel-arm clinical trial, with an allocation ratio of 1:1, blinded to outcome evaluation, in which 340 patients who were discharged from public hospitals in Belo Horizonte due to HF will be randomized. Patients will be followed for 6 months and the intervention group will receive, in addition to the usual care, Structured Telephone Support (STS) from a nurse, a doctor, and an educational program. Counseling will be according to a clinical decision tree. The level of significance in the statistical analysis will be 5%. Expected results: Reduction in the number of hospital readmissions and/or in hospitalization time, in addition to developing a software with a clinical decision tree for remote follow-up and patient education about HF adapted to local culture. Conclusions: The intention of this study is to develop a telemedicine strategy and assess whether or not, in addition to the usual care, it is effective in reducing hospitalizations and mortality from HF. If effective, the aforementioned strategy could reduce costs and hospital needs in the Unified Health System (SUS, in Portuguese) for patients with HF. These results will be even more relevant considering the pandemic of COVID-19.

Abstract INTRODUCTION: The COVID-19 pandemic has had a great impact on the behavior of individuals and the organization of health systems. This study analyzed the COVID-19 pandemic’s effect on public hospitalizations for cardiovascular diseases (CVD) in a large city in Brazil, Belo Horizonte, MG, with approximately 2.5 million inhabitants. METHODS: In a time-series analysis, this study used administrative data from the national “Hospital Information System” from 2010 to February 2020 to estimate the expected number of hospitalizations for CVD by month during the COVID-19 pandemic in Belo Horizonte in 2020 using the Auto-Regressive Integrated Moving Average model. For CVD, this study compared the expected number of hospital admissions, intensive care use, deaths during hospitalization, and mean length of stay with the observed number during the period. RESULTS: There were 6,517 hospitalizations for CVD from March to December 2020, a decrease of 16.3% (95% CI: 4.7-25.3) compared to the projected. The number of intensive care hospitalizations for CVD fell 24.1% (95% CI 13-32.7). The number of deaths also decreased (17.4% [80% CI: 0 - 0.30]), along with the reduction in hospitalizations, as did the length of stay for CVD hospitalizations. These reductions, however, were not significant. CONCLUSIONS: Hospitalizations for CVD were 16.3% lower than expected in a large Brazilian city, possibly due to the fear of getting infected or going to hospitals. Public campaigns informing how to proceed in case of CVD show that prompt urgent attention is essential to mitigate the indirect effects of the pandemic on CVD.

RESUMEN Este artículo problematiza las posibilidades municipales de hacer frente a la pandemia de COVID-19, a partir de la cooperación técnico-científica entre un municipio y una universidad del norte del estado de Rio de Janeiro, a partir de abril de 2020, que involucró la implementación de una sala de situación, procesamiento y análisis de datos para la toma de decisiones y de información para la población, centro de televigilancia, educación permanente con equipos territoriales de atención y estudio epidemiológico de COVID-19 en el municipio, entre otras acciones. En este análisis se utilizó como soporte conceptual una visión micropolítica de los conceptos de experiencia, pragmatismo, trabajo vivo en acto y deseo. La noción de “planhaciendo” se retomó como una planificación inventiva que solo puede ser narrada a posteriori, un acto imperativo, un gobierno vivo en acto que depende de un movimiento anhelante orientado por la vida, y que solo se da en espacios colectivos de prácticas de gestión y de atención a la salud.

ABSTRACT This article critically analyzes local governments’ abilities to face the COVID-19 pandemic by examining an instance of technical-scientific cooperation between a municipality and a university located in the northern Rio de Janeiro (state) beginning in April 2020. This collaboration included: the implementation of a situation room, data processing and analysis for decision making and for public communication, a telemonitoring center, ongoing training with territorial healthcare teams, and an epidemiological study of COVID-19 in the municipality, among other actions. We situate our analysis within a conceptual framework that adopts a micropolitical view of concepts such as experience, pragmatism, “live work in action,” and desire. The notion of “planning-doing” is deployed as an inventive form of planning that is only narrated a posteriori, as an imperative act, a live government in action that depends on the movement of desire oriented by life, and that only takes place in collective spaces of management practices and health care.

ABSTRACT This article critically analyzes local governments’ abilities to face the COVID-19 pandemic by examining an instance of technical-scientific cooperation between a municipality and a university located in the northern Rio de Janeiro (state) beginning in April 2020. This collaboration included: the implementation of a situation room, data processing and analysis for decision making and for public communication, a telemonitoring center, ongoing training with territorial healthcare teams, and an epidemiological study of COVID-19 in the municipality, among other actions. We situate our analysis within a conceptual framework that adopts a micropolitical view of concepts such as experience, pragmatism, “live work in action,” and desire. The notion of “planning-doing” is deployed as an inventive form of planning that is only narrated a posteriori, as an imperative act, a live government in action that depends on the movement of desire oriented by life, and that only takes place in collective spaces of management practices and health care.

RESUMEN Este artículo problematiza las posibilidades municipales de hacer frente a la pandemia de COVID-19, a partir de la cooperación técnico-científica entre un municipio y una universidad del norte del estado de Rio de Janeiro, a partir de abril de 2020, que involucró la implementación de una sala de situación, procesamiento y análisis de datos para la toma de decisiones y de información para la población, centro de televigilancia, educación permanente con equipos territoriales de atención y estudio epidemiológico de COVID-19 en el municipio, entre otras acciones. En este análisis se utilizó como soporte conceptual una visión micropolítica de los conceptos de experiencia, pragmatismo, trabajo vivo en acto y deseo. La noción de “planhaciendo” se retomó como una planificación inventiva que solo puede ser narrada a posteriori, un acto imperativo, un gobierno vivo en acto que depende de un movimiento anhelante orientado por la vida, y que solo se da en espacios colectivos de prácticas de gestión y de atención a la salud.

Abstract This article intends to establish a dialogue between the French philosophers Jean-Luc Nancy and Jacques Rancière, inasmuch as for the two authors writing constitutes a kind of paradigmatic instance to think of being-in-common as interruption of a certain distribution of the sensible, associated with the logic of the immanence or closure of the sense for Nancy, and the representative regime of literature that has to do with a consensual community, in the case of Rancière. At the basis of both positions two common aspects that are essential can be identified: a critique of subjectivity as an exclusion of otherness, and the idea of a community that always appears, coexists, or already exists within the very heart of that community identical to itself, mythical community or consensual utopia, of which it is its interruption.

Resumen El presente artículo pretende establecer un diálogo entre los filósofos franceses Jean-Luc Nancy y Jacques Rancière, en la medida en que para los dos autores la escritura constituye una suerte de instancia paradigmática para pensar el ser-en-común como interrupción de un cierto reparto de lo sensible, asociado a la lógica de la inmanencia o clausura del sentido para Nancy, y al régimen representativo de la literatura que tiene que ver con una comunidad consensual, en el caso de Rancière. En la base de ambas posiciones se identifican dos aspectos comunes que son esenciales: una crítica a la subjetividad en tanto exclusión de la alteridad, y la idea de una comunidad que comparece, que coexiste, o que existe ya en el seno mismo de esa comunidad idéntica a sí misma, comunidad mítica o utopía consensual, de la cual es su interrupción.

Resumen: Tanto en Platón como en Aristóteles el eros es cuestionado como forma de relación con el otro que conduzca a una vida virtuosa y que permita además pensar la vida en común. En la perspectiva de Platón, tal cuestionamiento se daría en favor de una búsqueda de la Belleza que proveería un determinado modelo de philia −el de la philosofía−. En el planteamiento de Aristóteles, el cuestionamiento del eros por particulares se daría en favor de un modelo de philia −la philia virtuosa− prácticamente limitado a un plano ideal −por cuanto los hombres virtuosos son muy raros de encontrar−. En ambos casos, sin embargo, la forma en que se está pensando la philia proveería, en cierto sentido, un modelo ideal de comunidad.

Abstract: Both in Plato and Aristotle, eros is questioned as a form of relationship with the other that brings us to a virtuous life and enable us to think about life in community. In Plato’s view, such a questioning would be in favor of a search for the Beauty that would offer a particular model of philia −that of philo-sofia−. In Aristotle’s view, the questioning of eros by individuals would be in favor of a model of philia −the virtuous philia− virtually restricted to an ideal level −because it is rare to find virtuous men−. In both cases, however, the way philia is being thought would, in a sense, provide an ideal model of community.

Resumen En virtud del carácter difuso que Foucault atribuye a las relaciones de poder, es posible afirmar que la sujeción de los cuerpos nunca es absoluta, de modo que estos no son algo inexorablemente determinado por el ejercicio del poder. En este artículo se muestra de qué manera el cuerpo, en tanto que blanco principal de un poder preponderantemente físico, puede en forma eventual constituirse en escenario de des-sujeción y resistencia, en el “lugar” desde el cual ese mismo poder puede ser resistido. Esto, gracias a lo que en este artículo se describe como una “condición heterotópica” del cuerpo, que implicaría la excedencia y el desbordamiento de los procesos de sujeción, y que, en última instancia, permitiría hablar del “cuerpo experiencial” como el espacio en el que tendría lugar la puesta en cuestión de la propia subjetividad.

Abstract Considering the diffuse character Foucault attributes to power relations, it is possible to assert that the subjection of bodies is never absolute, so they are not inexorably determined by the exercise of power. This article shows how the body, as the main target of a predominantly physical power, can eventually become the realm of unsubjection and resistance, the “place” from which that power can be resisted. This is possible in virtue of what is described in this paper as a “heterotopic condition” of the body, which would entail the exceedance and the overflow of subjection processes, and which would ultimately enable to speak about the “experiential body” as the space where the questioning of one's own subjectivity would take place.

Resumo Este artigo discute o trabalho do agente comunitário de saúde (ACS) com foco nos problemas éticos enfrentados no cotidiano do trabalho e cuidado, espaço de cuidado e as diretrizes disciplinares sobre sua atividade. A metodologia é de origem qualitativa com utilização da cartografia associada a instrumentos da etnografia (observação participante, caderno de campo e entrevista semiestruturada). O ACS tem sido considerado um trabalhador diferenciado por pertencer à comunidade e à instituição de saúde. Tal característica pode trazer um potencial para a produção de projetos terapêuticos singulares e apontam também para a existência de conflitos na relação trabalhador-usuário e para o exercício de poder e de novas formas de controle. Trabalho e espaços de convivência comunitária não encontram limites precisos. As narrativas dos ACS mostram sua visão a respeito dos usuários, o sentido de vínculo, demonstrando sentimento de solidariedade e compaixão, o que corrobora a proposta da ética do cuidar baseada na responsabilidade pela conexão humana. Há fragilidades na formação do ACS para lidar com as questões de cuidado em saúde. Ser da comunidade interfere na sua própria privacidade e na intervenção excessiva na vida das pessoas, reproduzindo atitude de controle dos corpos.

Abstract This article discusses the work of community health agents (ACS) focusing on the ethical problems in their daily work and care, the space of care and the disciplinary guidelines in their activities. In the scenario of changing care model, ACS have increasingly been considered differentiated workers as they belong to the community and to the health institution. These characteristics can bring a differential and potential for the production of unique therapeutic projects at the same time, which point to the existence of conflicts in the worker-user relationship and to the exercise of power and new forms of control in the primary care setting. Work and community spaces do not find precise limits. The ACS narratives show their viewpoint about users, the weaknesses in their formation, still based on actions that make them the sanitary police. There is professional hierarchy in the health team, the interviewees' statements showed the idea they have about the bond with users, which shows the feeling of solidarity and compassion, corroborating with the proposal of the ethics of caring based on responsibility for the human connection. Being from the community interferes with one’s privacy and excessive intervention in people's lives, reproducing biopower attitudes in the control of bodies.

Resumo Este artigo discute o trabalho do agente comunitário de saúde (ACS) com foco nos problemas éticos enfrentados no cotidiano do trabalho e cuidado, espaço de cuidado e as diretrizes disciplinares sobre sua atividade. A metodologia é de origem qualitativa com utilização da cartografia associada a instrumentos da etnografia (observação participante, caderno de campo e entrevista semiestruturada). O ACS tem sido considerado um trabalhador diferenciado por pertencer à comunidade e à instituição de saúde. Tal característica pode trazer um potencial para a produção de projetos terapêuticos singulares e apontam também para a existência de conflitos na relação trabalhador-usuário e para o exercício de poder e de novas formas de controle. Trabalho e espaços de convivência comunitária não encontram limites precisos. As narrativas dos ACS mostram sua visão a respeito dos usuários, o sentido de vínculo, demonstrando sentimento de solidariedade e compaixão, o que corrobora a proposta da ética do cuidar baseada na responsabilidade pela conexão humana. Há fragilidades na formação do ACS para lidar com as questões de cuidado em saúde. Ser da comunidade interfere na sua própria privacidade e na intervenção excessiva na vida das pessoas, reproduzindo atitude de controle dos corpos.

Abstract This article discusses the work of community health agents (ACS) focusing on the ethical problems in their daily work and care, the space of care and the disciplinary guidelines in their activities. In the scenario of changing care model, ACS have increasingly been considered differentiated workers as they belong to the community and to the health institution. These characteristics can bring a differential and potential for the production of unique therapeutic projects at the same time, which point to the existence of conflicts in the worker-user relationship and to the exercise of power and new forms of control in the primary care setting. Work and community spaces do not find precise limits. The ACS narratives show their viewpoint about users, the weaknesses in their formation, still based on actions that make them the sanitary police. There is professional hierarchy in the health team, the interviewees' statements showed the idea they have about the bond with users, which shows the feeling of solidarity and compassion, corroborating with the proposal of the ethics of caring based on responsibility for the human connection. Being from the community interferes with one’s privacy and excessive intervention in people's lives, reproducing biopower attitudes in the control of bodies.

Resumo Nas quase quatro décadas da epidemia de HIV/aids, sua administração clínica sofreu mudanças consideráveis. O atual alargamento temporal impõe aos sujeitos HIV+ (re)posicionamentos no agenciamento da vida e da enfermidade a partir da perspectiva de uma doença de longa duração que sugere adequação dos hábitos e comportamentos, frequente interação com serviços e profissionais da saúde e uso contínuo de medicamentos - além da convivência com os impactos sociais, subjetivos e físicos da enfermidade. A pesquisa discute, a partir de dados de uma pesquisa com jovens soropositivos, os processos de revelação do diagnóstico. Foram seis entrevistas abertas, a partir de uma questão norteadora, com jovens entre 18 e 22 anos, de camadas populares, de ambos os sexos e transmissão materno-infantil. A perspectiva teórica que ancorou nossas digressões foi a socioantropológica. Entre esses jovens a normalidade figura como eixo estruturante do diagnóstico, o que contrastou, entre outras coisas, com o fato de que a maioria dos entrevistados preferia manter segredo sobre sua sorologia. Família e serviço alternaram-se como responsáveis pela revelação. Além disso, o ativismo aparece como forma de encontrar lugar para a sorologia no curso da vida e como estratégia acionada para lidar com o cotidiano após o diagnóstico.

Abstract During the almost four decades of the HIV/AIDS epidemic, its clinical administration has undergone considerable changes. The current temporal extension imposes on HIV+ subjects (re)positions in the agency of life and illness from the perspective of a long-term illness that suggests the adaptation of habits and behaviors, frequent interaction with health services and professionals and the continuous use of medicines - in addition to coexistence with the social, subjective and even physical impacts of the disease. The objective of this work is to discuss, based on data from a research carried out with young seropositive patients, the processes of disclosure of the diagnosis. Six interviews were opened in depth, from a triggering question, with youngsters between 18 and 22 years of age, from the popular strata and of both sexes and of mother-to-child transmission. The theoretical perspective that anchored our digressions was socio-anthropological. The results indicate that among these young people, normality appears as the structural axis of the diagnosis, which contrasts, among other things, with the fact that most interviewees prefer to keep their serology a secret. Family and service alternated as responsible for the revelation. In addition, activism appears as a way to find a place for serology in the course of life and as a strategy to deal with the routine after the diagnosis.

Resumo Nas quase quatro décadas da epidemia de HIV/aids, sua administração clínica sofreu mudanças consideráveis. O atual alargamento temporal impõe aos sujeitos HIV+ (re)posicionamentos no agenciamento da vida e da enfermidade a partir da perspectiva de uma doença de longa duração que sugere adequação dos hábitos e comportamentos, frequente interação com serviços e profissionais da saúde e uso contínuo de medicamentos - além da convivência com os impactos sociais, subjetivos e físicos da enfermidade. A pesquisa discute, a partir de dados de uma pesquisa com jovens soropositivos, os processos de revelação do diagnóstico. Foram seis entrevistas abertas, a partir de uma questão norteadora, com jovens entre 18 e 22 anos, de camadas populares, de ambos os sexos e transmissão materno-infantil. A perspectiva teórica que ancorou nossas digressões foi a socioantropológica. Entre esses jovens a normalidade figura como eixo estruturante do diagnóstico, o que contrastou, entre outras coisas, com o fato de que a maioria dos entrevistados preferia manter segredo sobre sua sorologia. Família e serviço alternaram-se como responsáveis pela revelação. Além disso, o ativismo aparece como forma de encontrar lugar para a sorologia no curso da vida e como estratégia acionada para lidar com o cotidiano após o diagnóstico.

Abstract During the almost four decades of the HIV/AIDS epidemic, its clinical administration has undergone considerable changes. The current temporal extension imposes on HIV+ subjects (re)positions in the agency of life and illness from the perspective of a long-term illness that suggests the adaptation of habits and behaviors, frequent interaction with health services and professionals and the continuous use of medicines - in addition to coexistence with the social, subjective and even physical impacts of the disease. The objective of this work is to discuss, based on data from a research carried out with young seropositive patients, the processes of disclosure of the diagnosis. Six interviews were opened in depth, from a triggering question, with youngsters between 18 and 22 years of age, from the popular strata and of both sexes and of mother-to-child transmission. The theoretical perspective that anchored our digressions was socio-anthropological. The results indicate that among these young people, normality appears as the structural axis of the diagnosis, which contrasts, among other things, with the fact that most interviewees prefer to keep their serology a secret. Family and service alternated as responsible for the revelation. In addition, activism appears as a way to find a place for serology in the course of life and as a strategy to deal with the routine after the diagnosis.

Resumo Com base na cartografia proposta neste estudo, procurou-se analisar a rede de cuidados à saúde mental, tomando um usuário como analisador dessa própria rede. A produção de dados se deu com observação do cenário de trabalho e cuidado, anotações em caderno de campo, acompanhamento do usuário e entrevistas com este e com seu principal cuidador. O achado do estudo que mais chama atenção é o fato de que o usuário é um grande protagonista na construção da sua rede, do seu cuidado, criando, a partir disso, novas possibilidades de existência e produzindo sua própria desinstitucionalização, levando a crer ser possível a construção de outras cidades no mundo da loucura.

Abstract Based on the mapping proposed in this study, we tried to analyze the mental health care network, taking a user as analyzer of his own network. The production data was observing the work and care setting, notes in a diary, user's monitoring and interviews with him and with his primary caregiver. The finding of the study that draws more attention is the fact that the user is a major player in building his network, his care, creating from it, new possibilities of existence and producing its own institutionalization, leading us to believe the construction of other cities in the world of madness is possible.

Resumo Com base na cartografia proposta neste estudo, procurou-se analisar a rede de cuidados à saúde mental, tomando um usuário como analisador dessa própria rede. A produção de dados se deu com observação do cenário de trabalho e cuidado, anotações em caderno de campo, acompanhamento do usuário e entrevistas com este e com seu principal cuidador. O achado do estudo que mais chama atenção é o fato de que o usuário é um grande protagonista na construção da sua rede, do seu cuidado, criando, a partir disso, novas possibilidades de existência e produzindo sua própria desinstitucionalização, levando a crer ser possível a construção de outras cidades no mundo da loucura.

Abstract Based on the mapping proposed in this study, we tried to analyze the mental health care network, taking a user as analyzer of his own network. The production data was observing the work and care setting, notes in a diary, user's monitoring and interviews with him and with his primary caregiver. The finding of the study that draws more attention is the fact that the user is a major player in building his network, his care, creating from it, new possibilities of existence and producing its own institutionalization, leading us to believe the construction of other cities in the world of madness is possible.

A coexistência do setor público e privado de saúde no Brasil é antiga e os arranjos percorridos têm contribuído para a construção de um sistema fragmentado e complexo. Na busca por estabelecer políticas setoriais em harmonia com o Sistema Único de Saúde, a Agência Nacional de Saúde Suplementar tem estimulado o desenvolvimento de programas de promoção da saúde e prevenção de doenças no setor. Essas ações são consideradas como um conjunto heterogêneo de estratégias na consolidação de políticas que visem à saúde da população. Este é um estudo de caráter qualitativo que objetiva analisar esses programas em uma operadora de autogestão, com o intuito de compreender se eles produzem dispositivos biopolíticos. Foram coletados os discursos dos usuários dos programas por meio de um roteiro semiestruturado e utilizou-se a técnica de análise de conteúdo. Os resultados mostram que se encontram em curso alguns processos de reestruturação da produção do cuidado, e os aspectos relacionais têm sido priorizados nesses programas. Essas ações configuram-se em dispositivos biopolíticos conduzindo formas de viver. É importante a existência de equilíbrio entre as práticas desses poderes e a produção de liberdade, atentando para que não haja intervenções biopolíticas arbitrárias e autoritárias na produção das ações de saúde.

The coexistence of public and private health care systems in Brazil is old and their arrangements have contributed to the construction of a fragmented system. In seeking to establish policies in agreement with the Brazilian Unifed Health System, the National Agency of Supplemental Health insurance has encouraged the development of programs for health promotion and disease prevention on the private sector. These actions are a heterogeneous set of strategies to consolidate policies aiming at the population's health. This is a qualitative study that analyzes these preventive programs in a private health insurance agency, to understand whether they produce bio-political devices. Speeches were collected from users of the programs through a semi-structured script using the technique of content analysis. The results show that some restructuring processes of care production are ongoing, and relational aspects have been targeted in these programs. These actions are configured in devices leading biopolitical forms of life. It is important to have balance between these powers and the production practices of freedom, noting that there is no arbitrary and authoritarian biopolitical interventions in the production of health actions.