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Bias: Call it the "October Suppress" as the so-called "mainstream" media provided less coverage to the current president's bungling of and lying about Benghazi than they did to another president's decades-old DUI arrest.
Last Friday, Pulitzer Prize-winning former New York Times reporter Judith Miller and Kirsten Powers, a Daily Beast columnist, appeared on Fox News' "Happening Now" program to justifiably bash the mainstream media and its orchestrated suppression of coverage of the terrorist attack in Benghazi.
Neither is a charter member of the "vast right-wing conspiracy," but both roundly condemned the shameful and politically motivated actions of their colleagues. Miller called them "co-conspirators" in a Benghazi cover-up, and Powers said the "mainstream media is pathetic" and "carrying water for the administration."
They are right and just one example is what happened on all the Sunday talk shows on Oct. 28. When the Benghazi attack was brought up by a guest, the moderator quickly changed the subject.
When Newt Gingrich raised Benghazi on ABC's "This Week," host George Stephanopoulos quickly moved on to another topic. Also running interference for Team Obama was NBC's David Gregory who cut off GOP panelist Carly Fiorina while promising to "get to that a little later," which he never did.
On CNN's "State of the Union," Candy Crowley, who aided President Obama in the second presidential debate by wrongly telling Mitt Romney that Obama called Benghazi a terrorist attack from day one, sloughed off attempts by two GOP officials to bring up Benghazi.
Folks like ABC's Rick Klein explain away the Benghazi non-coverage by saying it's because GOP nominee Mitt Romney did not make much of an issue of it, particularly during the presidential debates. If he had spoken out about it, he would have covered it.
Yet witness what happened in the town hall debate when Romney did bring it up. Crowley took Obama's side and argued with Romney as the president looked on approvingly. When Romney condemned our Egyptian embassy's apology for the video the administration used as an excuse for weeks after the attack, he was condemned for politicizing the issue, the media spending more time on his comments than the terrorist attack.
NBC's Brian Williams opened his Sept. 12 Nightly News with: "Romney is taking fire tonight for the way he went on the attack" over Benghazi. CBS Evening News anchor Scott Pelley noted "Democrats said the governor had injected politics into a tragedy."


text:
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Located in one of New Jersey s most desirable areas, SDK Prospect Towers offers our residents spacious floor plans, beautiful hardwood floors, on-site parking and a fully equipped fitness center. Just outside New York City, it is in a superb location with easy access to transportation, the finest medical facilities, employment hubs, shopping, and entertainment. Our team of professionals strives to meet each and every one of your requests, ensuring that you live in comfort.
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January 22, 2015
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text:
NCL British Isles - Hit or Miss: Norwegian Jade Cruise Review by mindySUE
Overall Member Rating
NCL British Isles - Hit or Miss
Destination: Europe - British Isles & Western
Embarkation: Southampton
This ship asked guests not to go their room until 2 pm, so we ate at the formal dining room - Grand Pacific to kill time. Muster drill like no other we experienced, long and complex and held in the Stardust theatre which is very tight and cramped. They had us put on our life jackets while sitting in the very narrow seats... not exactly the best place to have a drill.The muster process lasted a very long time.
The ship accommodated the cruise critic group "meet and greet" that night, by offering some reserved tables in the Grand Pacific. We met with several people we had communicated with on-line and it was good to reconfirm some of the shared private excursions we committed to prior to sailing.
Food: With alternative and anytime dining, it is hard to get bored given all the options. The two main dining rooms - Grand Pacific (aft - formal dining room) and Alizar (mid-ship, supper club type of atmosphere) serve the usual fare which was sometimes good and many times not. Starters ok; soups very good; salads poor. Entrees mostly mediocre and desserts really mediocre. Breads were always good and the capuccino ( no charge) is good as well). The infamous lobster night was not held until the seventh night and instead of offering it as a full tail, they gave one-half tail and served it with grouper ... ugh. The second half of the tail was offered three nights later in a concoction of cream sauce over pasta with shrimp and scallops. Not good either.
We dined in two of the alternative dining rooms for an additional fee: Le Bistro ( ate between 6 pm and 7 pm so it is half the $15 p.p. additional fee). Had a great lobster bisque and perhaps the best Rack of Lamb ever. Towards the end of the trip we ate at Cagney's and had a dismal meal - prime rib ordered rare came well done the first time and medium the second time. The server just couldn't be upfront about not having rare cut of beef available. At $25 per head, this dinner was a major disappointment.
The food in the Garden Cafe on deck 12, which serves breakfast, lunch and dinner, buffet-style , was the worst we have had on any ship in terms of taste, quality and variety.While the layout and availability of the food is good, avoiding long lines, there is truly not enough seating and it was a struggle in the mornings to get two seats to be able to eat breakfast. Worse yet, no trays are used so guests have to juggle carrying a plate and beverage to tables. Not good for seniors. To the ship's credit, the crew does a great job of picking up the dirty plates, cleaning the tables to help compensate for the dire lack of seating.
There was a chocolate buffet towards the end of the cruise, late in the evening. While everything looked great, wonderful decorations, the confectionaries lacked that good old choco taste. We nibbled a little, but left soon after arriving.
One of low key, bright spots of dining is the small Blue Lagoon restaurant on the 8th floor which is open 24 hours a day and serves North American "comfort "foods from noon on. Buffalo Wings, Nachos, Artichoke Dip, Potato Skins, Mac N' Cheese, Fish and Chips, Cheeseburgers, Panini Sandwiches and warm brownie with ice cream and chocolate sauce were appreciated, As the trip went on, more and more people used this little gem, perhaps because the food at the Garden Cafe was so disappointing.
Entertainment was mixed. A ventriloquist and tenor on the first night out were repeated the next two nights. It was six nights before we had a major show. We had three major shows in all and each were very good, though not as lavish as on other ships. Stardust Theatre has a very small stage and not accommodating of big sets. There was a great Russian Violinist, who we saw on the Jewel, several comedians, a magician and a few other acts. Altogether, it was not the same show experience we have had on other lines. Worse yet, the theatre is so small and tight ( seats very uncomfortable ), and you have to get up every time someone wants to get to the center of rows. This theatre design is a major goof on both the Jewel and the Jade, making it almost impossible to serve drinks.
This ship has two nice-sized salt water pools on deck 12, which didn't get much use because the large amount of ports visited and the lack of cooperation of weather on the two sea days.
10 of the 13 days were absolutley beautiful - with only three days of rain, and unfortunately two of them were the only sea days we had. Everywhere we went, people commented on how lucky we were with the weather as it was supposed to be rainy and cold. We figured that is why no other ships offer this route, and why NCL only does this route only once in the spring. It is a shame because it was a great collection of ports. The North Sea and the Atlantic were very smooth and we had no vibration in the assigned balcony room (10030) in the front of the ship.
We did not buy any of the ships tours as we found them way over-priced and not offering as much as we could get on our own with private tours. For five of the ports we pre-bought from Viator online tix to the HopOn/HopOff buses ( in US dollars which ended up being several dollars cheaper than what was charged at each city. The vouchers I printed were easily traded for bus tickets right before boarding each bus.
LeHavre Nomandy - We joined another couple we met on cruisecritic.com and rented a car right at the port ( with a gps ) for 105 euros and drove an hour and one-half to Arromances ( Allied troops landing ); Bayeaux ( saw remainging 4 German bunkers); and the absolutely beautiful American Cemetary on Omaha Beach. We ate lunch at what lloked like a charming little hotel and restaurant at the entrance to the American Cemetary. Unfortunatley the food was terrible and vey expensive. Avoid it. As it turns out the 65th D-Day Celebration with attendees such as Barack Obama was just a few days later. This experience was the highlight of the whole cruise for us. Something we will never forget. On the way back we stopped in the delightful French seaside town of Honfleur, with its cafes, and shops, but it was so busy since it was a holiday, we could not find a parking place so we drove back to the ship, a little disappointed we could not savour the town.
Falmouth UK: This is a tender port and tendering was not well done. We waited 65 minutes to get on a tender after we picked up the required tickets. Falmouth is a charming little seaport town with many, many shops. We just walked the streets and tried the famous Cornish Pasties which were very good and very reasonably priced.
Ireland: Cork, Dublin, Belfast ( we did the Hop On/Hop Off buses). We bought tix for these and other cities online from Viator which worked out well, as we saved quite a bit over the rate charged on site. For us, Belfast was the most impressive and had the most interesting blend of architecture.
Scotland: In Glasgow and Edinburgh we did the Ho/Ho's and used the bus supplied by the city to get into Glasgow and another tender to the port area to pick up a cab we would share with another couple to get to Edinburgh ( whose train at the port is in a very poor location; many uphill steps, walking in between a lot of bushes on a narrow path). Edinburgh is a fantastic city. Much construction in Glasgow made the city a little harder to traverse. For Inverness we chose a private tour with Ocean Links Golf and Tours. There were 6 of us on the large mini bus and we had a full eight hour tour which included Dunrobin Castle ( with a wonderful Falconry display); Dornoch cathedral ( where Madonna's son was baptized), views of many other Casles; Shins Falls where salmon try to swim upstream and many other inland drives. Our tour guide, Mrs. Pat Murray, a retired school teacher, did a fabulous job giving many details about the area. This tour was 55 euros p.p, and cheaper than the ship's tours.
Holland: For Amsterdam, our favorite city of the whole tour, we took the trolley #25 just outside of the major port terminal into the Central Train station and walked across the street to the water to pickup the HopOn/HopOff canal boat. We rode two of the three lines ( red and blue ) and were dazzled by the buildings, architecture and beauty of this city. We also walked around a lot and even took a quick tour of the Red LIght district. After viewing a few windows with "not so pretty maidens", we did some local shopping and had some delicious fries which everyone seemed be eating. What we didn't realize until the end of the day is that the Blue Line Canal boat drops you right back at the port's passenger terminal, which saved us from having to buy trolley tix.
Belgium: Our final port was Zeebrugge. We opted to go Bruges and shared a 45 euro minibus with four other couples. This saved us from having to get a bus to the Strand train station and then a train to Bruge. Our bus dropped us off at the Central Market Square, where most touring of this brillant gem of a city emanates from. We got picked up several hours later by the same taxi for the return 25 minute drive to our ship. Walking is the best way to view this medieval city which has lovely well kept buildings, many of which date back to the 1500 and 1600's. Two blocks from the market square we caught a canal boat and took the 30 minute boat ride through many of the city's back canals. Canal ride costs 6.7 euros.There were many horse and carriages available for hire right at the Market Square. There was also a local fish market around the corner from the square which looked interesting. Many nice shops offering lace and embroidered items. Unfortunately since we were disembarking the next day and had to sail back to Southampton, the ship cuts the Zeebrugges stop short, asking guests to be back for 4 pm sailing. This was one of those charming ports that you definitely want to come back and stay in.
While the food, entertainment and some other serivices were lacking, we still had a great time, because NCL created a port ine-up like no other cruise line. Everyone we came in contact with on the ship echoed the same comment ... "what a great set of ports". Less
Published 06/20/09
Cabin review: B210030 Family Balcony
Balcony @ 162 sq. ft. is smaller than most other lines, yet functional enough. Still manage to have enough storage and mercifully, the bathroom is better designed than most ,,,, glass shower door and glass door segregating toilet from sink and shower. Although this is a 2006, ship TV's are not flat-panel display. Balcony very small. Bed/linens very comfy, up-to- date.Read All Family Balcony (B2) Reviews >>
Read Cruise Critic's Norwegian Jade Review >>
Lovely Cruise
Great Value
Great Itinerary, Average Ship
Lovely Cruise
Beautiful Shp, Great Itinerary
Love NCL JADE
Not the best, but definitely n...
Disappointing cruise line with...
Nice Ship
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text:
Vera Bradley Bags
Vera Bradley handbags, shoulder bags, satchels, duffles, and totes are known for their quilted cotton, riotous colors, and patterns that range from paisleys to florals. Founded in 1982 by Patricia R. Miller and Barbara Bradley Baekgaard, the Fort Wayne, Indiana company, takes its name from Baekgaard's mother, who was a model in the 1930s for Elizabeth Arden.
While the company's duffle-shaped shoulder bags are its signature, in recent years its squared-off Hipster bags and practical Backpack styles have struck a nerve. Some Vera Bradley fans go for the latest patterns and designs (new ones are released each spring and fall), while others try to find bags in retired colors. Examples of these classics designs include Ivory Floral Blue and Spring Violet (1980s), Tavern on the Green and Dellft (1990s), and Hens-n-Holly and Pink Elephants (2000s).
Best of the Web ("Hall of Fame")
Bag Lady University
Bag Lady University is the place to learn about handbag makers from Adrian's, which made Bakelite bags, to Whiting … [read review or visit site]


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Justin Bieber was arrested in Miami on Thursday morning after failing a field sobriety test.
Justin Bieber was pulled over at 4 a.m. on Thursday after a drag racing incident. He was driving a yellow Lamborghini when police pulled him over. After failing the field sobriety test, Bieber was taken to Miami Beach Police headquarters for a breathalyzer, reports The Orlando Sentinel.
Justin Bieber was still at the Miami Beach Police headquarters as of 8:15 a.m. this morning. He is expected to be taken from the police headquarters to Miami-Dade County's Main Jail. Bieber's mugshot will be taken when he reaches the prison, The Orlando Sentinel notes.
This isn't Justin Bieber's first run in with the law. The singer has faced accusations from his neighbors in his Calabasas, Calif., community of throwing large parties and reckless driving. He also faced a felony search warrant for allegedly trowing eggs at a neighbor's house, which caused $20,000 worth of damage, reports The Los Angeles Times.


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Aleksandra (ID: 72170)
Date of birth:January 27, 1994
Height:5' 6" (168 cm)
Weight:116 lb (53 kg)
Hair color:brown
Eyes color:aqua
Marital status:single
Education:incomplete higher education
English language:Using dictionary
Others foreign languages:No
Seeks partner:25 - 70 years old
Total photos:6
Bikini photos:0
Hobbies and interests:
The most pleasant thing for me is reading books. I can not tell that I appreciate some definite style in literature. Each book for me it is a drew-well of knowledge. Also I adore cooking and creating new dishes. I adore being outside a lot, adore going to the sea side.
About me:
I have a very merry and even tempered character. Also I am an open-hearted lady, my heart and soul are very tender. I love romantic walks under the moonlight. I respect family traditions and want to have a good family with a loving husband and children. I think I will be a good and exampling mother, because I have a good example, it is my parents who live together for a long time and they are still happy and love each other.
Looking For Men Type:
I would like to meet a man with a kind heart and a strong spirit. I value such features of character as honesty, tenderness, reliability, self-dependence. I like men who know how to treat a woman, men who have beautiful soul but not only appearance, men who want to create good family, based on love, belief and understanding.
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text:
Elinda wrote:
Aripyanfar wrote:
In Iran, where Sharia law applies, a guy threw acid in a woman's face. He asked her to marry him, she refused, and later he tossed the acid in her face. Anyway, this time the law was on the woman's side. Her face was melted and she was blinded for life. In a direct "eye for an eye" sentence, the judge sentenced the man to be strapped down in hospital, sedated unconscious, and enough drops of acid be carefully dropped in each eye to blind him for life. By the woman he blinded. The judge also ordered the man pay her compensation money. The woman refused to take compensation money from him, but agreed to be guided to drop the acid in his eyes with her own hand, as she wanted him to directly experience what she had to live with so he understood what he had done to her, and in hopes that the increasing number of acid attacks on women would stop. Human rights organisations world wide protested the sentence and asked that it be commuted.
An article.
Edited, Jun 28th 2012 4:29am by Aripyanfar
An article.
Edited, Jun 28th 2012 4:29am by Aripyanfar
I remember reading about this.
How tragic to ever have to have that kind of desire; To want or need to cause someone so much pain.
Did you not see the picture of the woman in the article linked? Were that me, I too would wish to dispense justice in an "eye for an eye" manner. I'm not saying it's the right thing to do, but I do understand it, and I'm not at all sure there's an adequately fair alternative.
Edited, Jun 28th 2012 1:32pm by BrownDuck


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A guest post by Ron G
A Get Home Bag is a smaller bag designed to get you from where ever you are to home (or other predestinated location, according to the nature, location, other specifics of the Schummer HTF situation, and your family's plans). A GHB will be useful if you drive, take public transportation, or have to walk all, or part of, the way home.
The contents of our GHB's are based upon an ongoing Threat Level Analysis. Everyday I wake up, check the current events, evaluate what it all means to us, and decide if we need to change our Threat Level. I repeat the process every night before going to bed.
Threat Level I:
Normal conditions. At this moment our GHB's, setting by our back door, consists of the following items:
- Flash Light (AAA)
- Extra Bic Lighter
- Leatherman or Gerber type multi tool. (I always wear mine).
- Knife, 3 inch, folding
- Water, 1 bottle, 16 oz.
- Energy Bar
- 2 Packages Chicken or Tuna Salad Cracker Snacks
- 1 Can Vienna Sausage
- 2 4 oz Containers of Peanut Butter
- Two Way Radio (AAA)
- 3 Extra AAA batteries
- Small Pkg. of dry dog food (Wife only, in case the dog is with her).
Threat Level II:
At Threat Level II we carry the GHB in our vehicles. We also put CB Radios in the vehicles, keep vehicle gas level above ¾, avoid trips to the other side of town, and keep our cell phones fully charged. We add another 16 oz bottle of water and several pieces of Zocai Chocolate.
Threat Level III:
We carry the GHB's everywhere we go. At work I will carry it to and from my truck and the office, at lunch, into stores, whatever. We want friends and coworkers to get used to seeing them. If they ask I will answer honestly (not giving to much info because of COMSEC) however, I will not tell them about…
Threat Level IV:
We add a handgun and extra ammo (50 rounds minimum) to the GHB's and we carry the GHB's everywhere we have to go. (At this time we do not have CC Permits but if we see the need we will carry anyway).
There are many other things we will do as our Threat Level assessment dictates but this is just our about GHB's.
A few other things, your geographical location and situation, changing seasons, the nature and location of the SHTF, your families plans, and the distances you may have to travel, should cause you to adjust the contents of your GHB If you cant wear good walking shoes at work you will need to keep a pair in your bag.
Keep an eye on any "Best Buy Dates" on the food and water and keep your GHB as light as possible.
BTW: We use Maxpedition Versipacks. (Not associated with them in any manner). Quality is good but they do not lend themselves into maintaining a "greyman" appearance very well. One of the Messenger bags may have been wiser.
Please share your thoughts in the comments below…


text:
Yes parents I am alive and kicking!!!
Not only did I arrive, but I have been having the most amazing time. We are only on our fourth day and it feels like home. I also don't even know where to begin…
The first two days as you can glance over from previous blogs, has been quite the physical challenge. I am very aware of my leg muscles at the moment, but it felt great. We built and worked on two different houses for two different families that we met and it was one of the most memorizing moments of my life. Seeing the joy on their faces brought such peace to my heart. We also arrived at Baylor yesterday (also can see the specifics from previous blogs) and it was a day filled with emotions and feelings I didn't know that i could be capable of. I wish I could describe the day for you in detail, but I couldn't if I tried. It has been the first time in my life that I have been speechless. You better believe it family…I was speechless. We have plenty more to do and I cannot wait to see what happens next. It's amazing because it's always an adventure and always something new to see and something interesting to learn. Cannot wait to show you all my pictures and amazing memories. I'll email or call soon!!
Love you all—Merry xmas Bobby, Dominique, Mommy, Mike, Teddy, Big Al and Bailey xoxoxx
To my family and friends,
I wanted to message you all to let you know that I have made it here safe and sound. It is crazy to think that today marks only the fourth day of working here in Lesotho. For myself and many others I have talked to it seems that we have been here much much longer. I think its the combination of the new beautiful scenery that we come across everyday. The Basotho have opened there arms to us and have taught me something new everyday. So far, my favorite activities that I have been able to experience have been being able to go to Baylor where we were able to host a carnival for HIV/AIDS children. The amount of smiles that I saw on these children and the fun we had, helped me forget that these children are faced with a much tougher challenge. We have also had the ability to build houses for a girl who is taking care of two orphans who have lost parents to AIDS. After learning the story, the motivation to work my hardest to get these houses done has been pouring through me. Days are full with no down time, as we are working hard on projects from sun up til sun down. Mom, Meg, Meaghan, and anyone else that is able to read this: I miss you all and hope that you are all enjoying Chicago. I cannot wait to share all the great memories, pictures, and stories that I have been building everyday.
Talk to you soon,
P.S. Merry Christmas to the Bordine and Galloway family and to the many other love ones of mine out there!


text:
> -----Original Message-----
> From: Andy Lee [mailto:m0n0wall at trigger dot net]
> Sent: dinsdag 27 april 2004 8:29
> To: m0n0wall at lists dot m0n0 dot ch
> Subject: [m0n0wall] PPPoE and IPSEC not possible in practice?
> I'm guessing that noone else has gotten IPSEC working when
> using a PPPoE connection.
> I can bring up the SA's between two m0n0wall routers simply
> by sending a few pings from one private subnet to the other.
> However, it seems that practical network traffic, like
> Windows Networking for non-small directories, Windows
> Terminal Services, or even web-browsing to an Intranet
> web server will not work. I am guessing that they are using
> large packets.
> Since m0n0wall uses the FAST_IPSEC, I can't try to reduce
> the MTU on the ipsec interface (or I don't know how). I
> have tried reducing the MTU of the LAN interfaces (by
> running "ifconfig sis0 mtu 1300" from /exec.php) but that
> didn't solve the problem. I'm not even sure if this would
> have fixed it since I'm don't understand this MTU/MSS
> behaviour well. Perhaps the BSD TCP/IP stack reassembled
> the fragments before putting it through IPSEC.
> As a workaround, will forcing all the end-user PC's to use
> a lower MTU work? There is apparently a Windows 2000 registry
> entry that can force maximum MTU sizes. If anyone has any
> insight, it would be much appreciated!
Well, this last thing I have done with w2003 servers (DC's) to overcome this
Not exactly the same problem, but when using the Safenet softremote client,
the MTU is set in Windows to 1372. On a pc with some realtek network-cards,
this gives problems (I guess the ICMP reply to fragment is not sent
correctly, when bigger packets are received), and DC-authentication (on
plain ethernet) suffered from this. Setting the MTU on the DC's to 1372
solved the problem.
I guess setting the MTU on both sides will solve your problem... maybe... :)
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text: NetScout® Systems, Inc., today announced the company joined the Open Networking Foundation (ONF) in calendar Q3 of 2012, bringing 28 years of network-based performance management experience to help address the expected opportunities and challenges of managing the delivery of services that may arise from software-defined networking (SDN) architecture. The ONF is a non-profit organization, recognized throughout the networking industry for its dedication to improving SDN standards and solutions worldwide. As a member of ONF, NetScout will collaborate on approaches to address the new performance management challenges associated with implementing and running SDN-based service delivery environments for both its enterprise and service provider customers. NetScout believes SDN will help drive the transformation of modern enterprise, service provider and cloud operator data center and service delivery networks, and will bring substantial infrastructure efficiencies as well as enable new services. However, the resulting virtualized network will create an even greater level of interdependency between network traffic, control traffic, applications and enabling technology. Consequently, assuring service levels and providing a superior user experience require complete visibility and understanding of multiple, dynamically changing traffic flows. This can be best accomplished using packet flow technology, NetScout's core competency. "ONF's mission is to promote the commercialization and use of SDN and its underlying technologies," said Dan Pitt, executive director, Open Networking Foundation. "SDN represents the future of the network for the delivery of services. With this market evolution comes the need to assure that services delivered over an SDN-based infrastructure are delivered without negative impact to performance or the user experience. We are encouraged when member companies step forward to drive the advancement of market segments, such as performance management, that are crucial to the overall success of SDN. Such efforts by members will serve to accelerate SDN adoption by enterprises and service providers."


text:
Hey there, time traveller!
This article was published 26/7/2014 (1096 days ago), so information in it may no longer be current.
A man is reported dead following a susipicous fire in a downtown apartment tower.
Police are said to be investigating the death as a homicide.
Police maintained a visible presence Sunday at Holiday Towers at 160 Hargrave St. It marked the second day police were outside the building.
Emergency crews were called Saturday around 5:30 a.m. to a fire in a suite in the south tower of the twin residential towers. They reported they found a man who was badly injured and later called the incident suspicious. He was taken to hospital.
The fire, which started on the stove, caused $10,000 in damage.
At the tower Sunday, some residents said they feared the worst even before the reports of the man's death.
"I heard somebody might have died," said one woman Sunday morning.
Laura said she watched the police at the location all day Saturday, she added.
She said the south tower was also the location of a suspicious death barely a month ago.
On June 2, police said homicide investigators had been called in after a report of a death. The body of a male was found inside a suite.
A local security guard who was keeping an eye on the address Sunday said there had been a heavy police presence Saturday but there was no word from the authorities on the investigation.


text:
America's election challenge
For the first time in decades, how America votes
is under scrutiny by Congress, state legislatures and voters themselves. Florida's
mistake-riddled experience in the 2000 presidential election revealed flaws that
for years had been known only by insiders in the voting process. In a series of
articles, USA TODAY takes an in-depth look at the problems, from antiquated voting
equipment to the training and procedures of election administrators, poll workers
and citizens. Also included: a look at possible solutions and the pitfalls faced
by lawmakers as they thread their way through changes in the most basic
and politically sensitive of the nation's democratic processes.


text:
Monster truck
From Wikipedia, the free encyclopedia
A monster truck is a vehicle usually styled after a pickup truck. It is changed or purposely built with very big wheels and suspension. Monster trucks are used for competition and popular entertainment.
Usually, a monster truck show involves the truck crushing smaller cars under its huge tires.


text:
Expand Messages
- http://www.wrel.com/modelmap.htm
Looking at current traditional models and then at the strike
activity, along with the idea that there was a bloom over the western
shores of Central America . . . I am having difficulty picking this
one. I will speculate at this point that it indeed heads between the
Mississippi and Texas and landfalls as a Cat 1-3 and most likely is a
threat to the Mississippi delta, where there already has been a very
strong rain pattern there that enough time has occurred for it to
impact the microbial biosphere out to the GOM and hence impact
conductivities there. Already there has been a number of strikes that
would appear to be associated with the storm just south of
The shifting later tropical storm season is starting to make its run,
and I will bring it to fair readers given the new technologies to
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Revista da Escola de Enfermagem da USP
Print version ISSN 0080-6234
Rev. esc. enferm. USP vol.46 no.4 São Paulo Aug. 2012
The family planning of women with mental disorders: what CAPS professionals have to say
Escolástica Rejane Ferreira MouraI; Tatiane Gomes GuedesII; Suellen Alves FreireIII; Adriana Teofilo BessaIV; Violante Augusta BragaV; Raimunda Magalhães da SilvaVI
Professor, Federal University of Ceará, Nursing Department. CNPq Research
Fellow. Fortaleza, CE, Brazil. email@example.com
IIRN. Nursing Professor, Faculdade Nordeste. Fortaleza, CE, Brazil. firstname.lastname@example.com
IIIRN, Federal University of Ceará. Fortaleza, CE, Brazil. email@example.com
IVRN, Federal University of Ceará. Fortaleza, CE, Brazil. firstname.lastname@example.com
VRN. Professor, Federal University of Ceará, Nursing Department. Fortaleza, CE, Brazil. email@example.com
VIRN. Professor, Federal University of Ceará, Nursing Department. Coordinator of the Master's Program in Collective Health. Fortaleza, CE, Brazil. firstname.lastname@example.com
The objective of this study was to explore the family planning demands that occur at the Psychosocial Care Center (Centro de Atendimento Psicossocial - CAPS) and investigate the contributions of this service to women with mental disorders. This qualitative study was performed with eight workers from a CAPS located in Fortaleza-CE. Data collection was performed through interviews, and the data were submitted to content analysis. The following demands were identified: relatives' request for information on how to cope with a sexually active patient; patients susceptible to sexual violence and pregnancy; and women with depression taking lithium carbonate. Contributions identified were: the need for an integrated network (primary healthcare/CAPS) with professionals who understand the complexities regarding these women's family planning; supportive care should be provided in the primary healthcare setting, emphasizing matrix organization as a strategy to make both centers co-responsible, thus avoiding unnecessary patient referrals to the CAPS by strengthening the ability to deal with these cases in the primary healthcare setting
Descriptors: Women; Mental disorders; Family planning; Mental Health Services
Current mental health policy is designed to encourage the re-socialization of patients by progressively replacing the hospital-centered and asylum-based model, which has an exclusionary, oppressive and reductive nature, with a care model guided by the principles of the Brazilian Unified Health System (SUS): universality, equity and integrality added to a proposal to deinstitutionalize the mental health care system(1). Therefore, it is expected to change the paradigm of disease to the individual's suffering in existence in his/her social body with the construction of new knowledge and practice concerning madness.
Psychosocial Care Centers (CAPS(a)) were created to respond to this proposition. CAPS are devices designed to care for patients with mental disorders, encourage social and family integration, support patients in their efforts toward autonomy, and integrate them in a concrete social and cultural environment, designated as their territory. CAPS are the main strategy in the process of psychiatric reform(2). Additionally, these services have to offer specialized technical support concerning mental health care to the Primary Health Care (PHC) service through a matrix system. Within this system, we highlight family planning care directed to women with mental disorders as the object of this study.
The matrix system or matrix support is a tool used in the field of mental health care to change the organizational structure of the health care system network, in order to avoid unnecessary referrals to CAPS, by strengthening the solution of cases within the primary health care service. Matrix support is designed to provide both care support and technical-pedagogical support to the team of the Family Health Strategy (ESF). The referral team or professionals, in this case, CAPS, is the one responsible to provide care for an individual, family or community case, increasing the possibility of establishing bonds between professionals and users(3). The link between mental health practices and EFS practices is based on bonding, shared responsibility, and the involvement and knowledge of the family, in which a community- and territory-based model is imperative at this level of care(4).
The current Brazilian Policy on Women's Integral Health Care corroborates the relevance of this study because it proposes to include actions directed to social actors excluded from the health care system in the public health care network, especially women with mental disorders. This is the reason these women were chosen to be the subjects of this study. According to this policy's guidelines, women's integral health care should be guided by respect for differences, without discrimination of any kind and without the imposition of one's personal values or beliefs. It includes the qualification of mental health care to women of 26 capitals, in the Federal District and cities where there are CAPS, therapeutic residence services, and other modalities of mental health care services aimed to replace the previous model. The proposed health actions emphasize: improved obstetric care; family planning; care in the event of abortion; combat against domestic and sexual violence; and care provided to adolescents and women during menopause. This policy also includes prevention and treatment of women with HIV/AIDS and those with non-transmissible chronic diseases, such as mental disorders(5).
Based on the previous discussion, we observe that women with mental disorders have the right to access family planning care services, which is provided by ESF teams, responsible for providing primary health care service in Brazil. Reinforcing this statement, a study conducted by the Health Care System in Fortaleza, CE, Brazil of 255 women with mental disorders and cared for in one unit of CAPS, verified that these women require care in terms of family planning, as well as a gynecological-obstetrical profile similar to that of most women in fertile age but without a diagnosis of having a mental disorder. Such findings indicate the need for actions focused on this population(6).
Even though family planning is a responsibility of the ESF teams (PHC), such care is not very effective and does not cover all women with mental disorders. The reason is that the healthcare system is fragmented, that is, PHC workers seem to be poorly informed about the specificities of family planning provided to women with mental disorders and workers at CAPS seem to be poorly informed about the actions that should be accessed by this population(6). Consequently, these women become vulnerable to unplanned pregnancies and to issues involving the pregnancy-maternity relationship and mental disorders such as the teratogenicity of some psychotropic drugs, which when not used may cause psychiatric breakdowns in addition to harming autonomy and leading to potential psychiatric hospitalizations, that may harm care provided to children.
Therefore, the following questions emerged: do the professionals working at CAPS receive demand for family planning? How do they provide such care? How can they contribute to promoting family planning to these patients? To answer these questions, the following objectives were established: to verify the needs concerning family planning for women with mental disorders cared for at CAPS units and to identify the contributions of this service's workers to this field of care.
This field study with a qualitative approach was conducted in a CAPS II, which belongs to the Regional Executive Secretary II in the city of Fortaleza, CE, Brazil. A total of eight professionals participated in the study, including a nurse, a nursing auxiliary, a nursing technician, a psychiatrist, a social worker, an occupational therapist, a psychologist, and an educator. These professionals were chosen because they are in direct contact with patients and for this reason can perceive their needs concerning the object of this study, making the gathering of ideas from an interdisciplinary perspective more likely. Workers with less than one year in the field of mental health were not included, considering the need for a minimum time to adapt and establish rapport in the field. Four professionals did not participate due to lack of time and two refused to participate.
Data were collected in December 2009 through semi-structured interviews addressing subjective and objective questions. The subjective questions were tape-recorded and the objective questions were completed on the form by the researcher herself, which enabled a greater interaction between the interviewer and the participants.
Transcribed data were organized according to content analysis. Such an analysis is a technique of investigation that consists of discovering core meanings that compose communication, the presence of which, or frequency with which they appear, may mean something for the chosen analytical object(7). The forms were coded by the letter P and numbered according to the order of interview.
Guidelines from Resolution 196/1996, Brazilian National Council of Health, concerning research involving human subjects were complied with. The study was submitted to and approved by the Ethics Research Committee at the Federal University of Ceará (COMEPE-protocol nº 227/09). After being informed of the study's objectives, the participants provided written and informed consent. Participation was voluntary and confidentiality was ensured.
Characterization of the participants
The age of the participants ranged from 29 to 55 years old; six were women. Four professionals worked in the mental health field for two years and the remaining for one year, four, five, and 15 years. All reported some kind of specialization in the mental health field.
Six professionals reported having cared for patients with mental disorders who required family planning. The remaining did not report such demand, though all reported that no action focused on family planning had been developed within CAPS. This result is coherent with the organization of the SUS, since family planning is a responsibility of the ESF staff, who should send patients to more complex levels only when these require surgical contraceptive methods or present complex infertility conditions. However, the ESF teams should receive technical support from specialized teams in the event of chronic diseases, or patients with complications and special conditions, or in the case of women with mental disorders, such support should be provided by CAPS teams(8). Despite the negative answer of all the respondents concerning the development of actions in the sphere of family planning within CAPS, these professionals reported some demand, which are presented and discussed in the following item.
CAPS is responsible for providing mental health care to patients in this facility and one of the challenges faced by the service is to go beyond and become not only a place that provides technical care to mental suffering per se, but also a place that promotes social and inter-sector cooperation, especially in relation to the ESF, providing support concerning mental health care, including mental disorder versus family planning as a field of matrix support(9).
Needs concerning family planning presented to the CAPS staff from women with mental disorders
The needs of these women were synthesized in the following categories: family members ask for information to deal with sexually active patients, patients that are vulnerable to sexual violence and pregnancy (no fixed partner, the partner does not participate in family planning), and patients with depression using a teratogenic drug (lithium carbonate).
The real need to understand these women's sexuality and their need for family planning care is evident. Specific situations are reported, situations for which the EFS teams could provide care, with the technical support of experts in the mental field - CAPS.
The sexuality of women with mental disorders is a controversial subject because on the one hand, there is this belief that individuals with mental disorders are exhibitionists and exacerbate their sexuality. On the other hand, there is a belief that these are asexual individuals. It is important to acknowledge that the sexuality of individuals with mental disorders is similar to that of individuals considered to be "normal". These individuals feel and love as anyone else and have the need to express themselves sexually.
A bibliographic review was conducted in the BIREME database and the production from 1990 to 2003 addressing the sexuality of adolescents with mental disorders was analyzed. It revealed that parents are faced with new challenges when their children with mental disorders reach adolescence and need to be re-integrated into society. This is especially true when these adolescents awaken to genital sexuality, since there is still a lot of prejudice in this field. The difficulty of parents in dealing with the sexual manifestations of these adolescents, such as masturbation, became apparent, which led to the conclusion that discussions with parents and adolescents with mental disorders need to be expanded with a view to enable them to experience sexuality with less stigma and be less exposed to risks(10).
The primary health care services and CAPS need to form an integrated network with professionals qualified to deal with the sexuality of this population, to include family members and turn them into caregivers. A study conducted with 17 nurses of psychiatric hospitals in Ribeirão Preto, SP, Brazil aimed to identify the social representations of these professionals concerning the sexuality of patients with mental disorders and verified that nurses denied the sexuality of mental patients, defining the manifestations of sexuality witnessed in the psychiatric units as deviation, transgression or disease(11).
When family members ask for information on how to deal with a sexually active patient, as reported by P2, it is important to inform the general particularities of family planning concerning this group, but each situation needs to be analyzed individually. Among these particularities, the ones considered to be the most relevant include: heritability of mental disorders such as bipolar disorder, which has a genetic factor and inheritance is characterized by complex mechanisms of transmission, involving multiple genes that are under the influence of environmental factors; psychiatric hospitalizations and/or episodes of psychological suffering, which can interfere in contraceptive practice, care provided to children, or in prenatal care; the use of contraceptives that require a woman's self-control, which may be compromised by a patient's altered behavior, loss of autonomy or lack of discernment; the need of a partner and/or family members to be involved in the reproductive and contraceptive choices of certain patients and in certain times of their lives (periods of crises); the use of psychotropics since some (anticonvulsants) present drug-interaction with oral hormonal contraceptives and others may cause teratogenic effects when used during pregnancy (lithium carbonate) (6).
(...) family members become concerned that an unwanted pregnancy might occur; so they seek information, also because a pregnancy with a disorder would be unfeasible(...). Family members are the first to report that the patient has a partner (P2).
When P2 states that because a pregnancy with a disorder would be unfeasible, he sets a counterpoint because the message seems judgmental and generalizing, hurting the sexual and reproductive rights of people with mental disorders. In this context, it is important to make a differentiated clinical judgment between episodic disorders with better prognosis and the possibility to be controlled therapeutically and chronic disorders, with a more complex prognosis and therapeutic control; the experience of maternity may improve certain psychological disorders.
A study conducted in Ribeirão Preto, SP, Brazil with ten women with mental disorders, all with at least one child aged from 7 to 12 years old, spoke about being affected by a mental disorder and stated it may negatively affect the quality of affective and family relationships. Nonetheless, despite all the difficulties they face to perform the role of being a mother, these women stated that maternity was a normalizing event in their adult lives. The interviewees had in common the fact of having experienced at least one unplanned pregnancy, as an experience associated with the urgent need to face maternity. The study also revealed that these women had the need to recognize themselves in the maternal function so they managed to keep fighting the limitations imposed by their mental disorders(12).
A demand highlighted by P3 and P4 was the vulnerability of these patients in relation to sexual violence and pregnancy due to a relationship with a casual partner and the non-involvement of this individual in family planning. For P3,
(...) contrary to what it is believed, patients with more severe mental disorders also have active sexual lives (...) while women are more vulnerable to sexual violence (...) We see a lot of people with severe mental retardation who were raped and became pregnant, this is relatively frequent.
P4 mentioned a user with five children who suffered from sexual violence and faced hardships.
Violence against these women is an important social and public health problem. In addition to the pressure imposed on them due to their responsibilities as women and mothers, they are also victims of sexual discrimination, concomitantly with experiencing poverty, hunger, malnutrition, excess of work, and domestic and sexual violence(13).
The factors that contribute to greater sexual violence against mental patients include: increased dependency on others for long-term care; denial of human rights, which results in a perception of a lack of power, both from the view of the victim and the aggressor; the perception of the aggressor that there is a lower risk of being caught; difficulties the victim has making others believe her story; the victim's poor knowledge concerning what is appropriate and not appropriate in terms of sexuality; social isolation, increased risk of being manipulated by others; potential of being abandoned or being vulnerability in public places; a lack of economic independence on the part of most individuals with mental disorders(14).
Hence, it is important to warn women with mental disorders and their family members about the risks of sexual violence, instructing them concerning the importance of being vigilant and the prevention of being exposed to suspicious or risk situations, and informing them that sexual violence is a crime and should be reported so the aggressor is punished.
Given the vulnerability of this population to sexual violence, which is often associated with impaired autonomy, and consequently, with unplanned pregnancies, contraceptive methods that are independent of personal control such as IUDs, injectable contraceptives, and tubal ligation, would be the first indication of actions to take. Although, the risk of sexually transmitted diseases remains(6).
This is not about awakening or encouraging women with mental disorders to practice sex, because contrary to what is believed, most of these patients are already sexually active, but to provide them with information about what happens to their bodies that causes them to feel desire, inform them as to what masturbation is, and the possibilities of becoming pregnant and acquiring sexually transmitted diseases, thus, ensuring them their rights and dignity(15).
In addition to being exposed to a pregnancy due to sexual violence, some of these women do not have a fixed partner, and when there is a fixed partner, he does not share responsibility for family planning. Such a behavior is common among the male population in general, and should be addressed as a priority when there is a mental disorder, in which one of the spouses should become more substantially responsible for family planning(5). P5 highlighted the following in relation to this aspect:
There is this case of a patient who already had an unplanned child and then became pregnant again when she began receiving care in CAPS and has an unstable relationship (...)
P8 reinforces:
We've worked with many women who already had children, with no fixed partners or a partner who does not participate [in the family planning].
Women with depression arising from bipolar disorder or postpartum depression refer to another demand reported by the CAPS team. P4 noted that
most patients already have grown children and don't want to get pregnant anymore, and many are sterilized (...) the users who are of a fertile age and cannot get pregnant because of the heavy medication they take [referring to bipolar disorder], would have to stop taking lithium if they became pregnant, and if they stop taking the mood stabilizer, their condition will definitely be compromised.
In this report are included demands for contraception for women who are satisfied with their offspring and no longer want to conceive; women who are already sterilized, but paying attention to safe sex it is still relevant; and the particular aspect related to patients taking lithium carbonate, a teratogenic medication, which, when used during pregnancy or if suspended, may lead to psychiatric breakdowns. Hence the risks and benefits need to be evaluated and in this case, a joint evolution between the physician and/or nurse from the primary health care service with the specialist at CAPS is required.
Contributions of CAPS workers to the family planning care of patients with mental disorders
As previously mentioned, none of the interviewed professionals reported actions focused on family planning for women with mental disorders. However, P1 reported:
Here, the one who addresses this subject is the doctor or the nurse;
P4 and P6 reinforced this report:
the nursing staff provides guidance;
and P4 proceeds:
(...) but there's some effort involved for the EFS staff to provide such care. The CAPS is specialized and family planning is the responsibility of the ESF staff [...] we provide the appropriate guidance when we are faced with such a demand and refer the patient to the primary health care service.
The statements of P1, P4 and P6 were confirmed by the report of P3, who stated:
(...) when we see it is simple family planning, and the person feels anxious or depressed, then we just need to prescribe a pill, or something like that, and we provide guidance. When it's the case of people vulnerable to suffer sexual violence or women with understanding problems, we refer to the nursing staff (...) to get guidance here at CAPS, because unfortunately sending patients to the PHC service is not a two-way road, we always receive people who should be cared for in the PHC service but they don't cooperate.
Concerning this aspect, P8 also mentioned:
(...) what we do is to provide guidance within the groups concerning the importance of family planning, but it's not a specific family planning intervention. We work for them to bring their husbands and send them to the unit.
We observe in these testimonies that the team's actions are unsystematic and sporadic, and they recognize these are actions to be implemented in the PHC service, and it is probably the reason they all reported not providing family planning care within CAPS or not becoming committed to another field of care, which is not the main focus of mental health care. The professionals mentioned contributions appropriate to these demands but the need to define responsibilities, flows, and the roles of the health teams in both ends of care delivery became apparent.
Therefore, the production of health care undergoes structural reforms to achieve greater problem-solving capacity. Within the matrix system, the teams from the referral units (is this case, CAPS) provide specialized support to the primary care teams. In this respect, the referral teams are responsible for extending clinical care, performing therapeutic projects in the medium and long terms, promoting bonding and responsibility, reducing unnecessary referrals. The professionals in Fortaleza, CE, Brazil, are internalizing this strategy and the services are still occasional, but the first initiatives are in the process of being implemented. The idea is innovating and should be enlarged as interaction among professionals is established(16).
In the context of contributions, the CAPS team listed difficulties and facilities dealing with the needs of patients concerning family planning, characterized as support to the organization and management of health services.
The list of difficulties included the patients' deficit of attention and cognition, which hinders the professionals' approach; the lack of a partner or family members during consultations; the need to provide technical qualification to both the team at CAPS and at the PHC service; insufficient time to provide care; lack of family planning directed to this population within the PHC service; and the lack of contraceptive methods within CAPS. We observe that this set of responses shows a lack of definition concerning who is responsible to provide care to this population. The reports show family planning is a responsibility of the PHC service, but there is also a concern as to whether the CAPS team is qualified (which is essential for them to provide technical support within matrix support) and has contraceptive methods available.
This context is shown in the following testimonies:
(...) The greatest difficulty is the disorder itself, because sometimes the patient comes without a companion and doesn't know what to report about her sexual life, doesn't talk about the subject, doesn't maintain such a dialog. I come from the medical clinic, so I already have an advantage with patients in this field, but I believe that it's not the same for other professionals who just arrived and don't have experience with the medical clinic, they miss it more than I do.(P2).
(...) I have 15 minutes to care for a patient. I have to see the medication, the symptoms, which are our main responsibility, only that care is not restricted to symptoms, there are family issues, social and family planning issues. So, given the time available, it is not feasible to do this and we know that family planning is a responsibility of the PHC service (...) it requires qualifications, but we always receive people who should receive care there. Not having the right methods in the CAPS is a problem, we should have condoms in the CAPS (P3).
(...) The PHC's professionals are not prepared, because they send everyone here [CAPS]. Professionals should be prepared but most have no interest (P6).
(...) I cared for a patient who was in her third pregnancy and she has severe postpartum depression and the doctor didn't want to give her medication [referring to technical insecurity], even though she was in the seventh month of pregnancy (P8).
Depending on the type of mental disorder, women may have some attention and cognition deficit; consequently, they have difficulty learning information necessary for decision-making and/or the autonomy to use a contraceptive method appropriately. Therefore, establishing a relationship of trust with the patient is crucial to promoting family planning care. Considering that these women have disorders that may compromise their autonomy, individualized care is essential, along with the involvement of the partner and other significant family members in decision-making, treating the relationship between pregnancy and mental disorder, even though it is a delicate subject, as a sexual and reproductive right of this population(6). Three interviewees reported the importance of the family context in this approach, noting the participation of the family and partner during consultations, which is an opportunity for them to prepare to support the patient.
The need for qualification is apparent in both services. In this context, the participants themselves noted matrix support as a significant instrument to minimize this gap, identifying specific situations that can be considered in the purview of PHC service and, in other cases, in the specialized mental health care services (CAPS). This strategy is widely accepted by the interviewed professionals and they highlight the importance of integrating CAPS and the PHC service in order to share cases and gather knowledge to better care for this population. P7 emphasizes this condition when he states:
I guess qualification should be provided to professionals, because care within the units is very fragmented. Within matrix support, it's a team having various perspectives (P7).
And P2 complements this view:
(...) matrix support is working to open discussion of this type of care. Investing in professional qualification is the most appropriate path to being recognized by the other units composing the network.
With regard to insufficient time to provide care, it is known that CAPS should provide clinical follow-up and promote the patients' social reinsertion, encourage family reconstruction, aid reinsertion in the job market, and promote leisure, as a social sphere that promotes quality of life, access to civil rights and strengthens family and community ties, in addition to supporting mental health care in the PHC unit. There are many actions to be developed and for that it is necessary to organize human resources, define roles and the quantity of patients cared for within CAPS(9).
The PHC service should be the entrance door for patients with mental disorders, however, it is apparent these patients are underserved. This is a difficulty experienced by the CAPS workers, which, as a secondary service, should receive only the most severe cases of mental disorders. There is a certain disbelief in the referral of patients to the PHC service because there is no counter-referral. Patients end up lost within the healthcare network, when the network should ensure the implementation of integral actions(6). Reinserting mental health patients into the community is a significant challenge for health workers in the ESF. Professional qualification during the undergraduate program and a lack of qualification programs available during professional practice are obstacles that hinder the implementation of care for these users(4).
The facilities listed by the CAPS professionals include: acknowledgement concerning the importance of patient interest in sexuality-related information, which is facilitated by group activities. The presence of a family member during consultations is mentioned as both a difficulty and a facilitator.
The reports exemplify these contributions:
(...) when there's a family member present during consultation, and a lot of the patients do have one present, you can intermediately clarify doubts, you have a better access to the patient (P2).
The facilitating factor is that the patient has an open dialog with us (P3).
Testimonies within the groups become more common, because they open up and talk with other professionals (P5).
Therapeutic groups are important in the treatment of mental health patients because they are a privileged opportunity for patients to exchange experiences in which they help each other to overcome problems, that is, the socialization established within the groups enables personal transformation. When the participants establish solidarity ties with the professionals, the group becomes a community that relates through the lens of culture through which people see the world. Hence, patients feel comfortable to discuss about subjects of interest and interact, which facilitate the care provided by the workers and the workers' better understand the patients' dimensions of life(17).
Other reports from the CAPS professionals directly referred to the family planning care provided to this population. They emphasized guidance concerning: the use of combined oral contraceptives for patients with milder disorders and the referral of patients with more severe disorders and a high risk of becoming pregnant to obtain tubal ligation; ongoing medication treatment for their disorder, and in the case of lithium carbonate, to pay attention to the teratogenic risks because patients become more vulnerable to crises when this medication is suspended; the importance of the family role; encouraging the partner and family during family groups and home visits.
P3, P4, P6 and P7 added the role of the nursing team to provide guidance concerning family planning. For that, the nursing team needs to know and understand this context to offer appropriate support and the information required by each patient and to help the patient to become an active participant in their therapeutic process, including her nuclear family. Hence, it is necessary to encourage the patient and her family members to understand the disease and the remaining aspects of her life, including the sexual and reproductive aspects and family planning(16). We should note that each health worker has specific functions and these should be performed the best possible way, however, each professional is also responsible for the integrality of health actions. Therefore, each health worker should support other workers and follow-up on cases, contributing with knowledge and actions.
Depending on each case, we refer to and talk with other professionals. I particularly refer to the nursing staff. The difficulty is that the team has a high rate of turnover and there is no way to follow a case with a specific professional (P6).
The opinions of the CAPS team concerning family planning care provided to women with mental health disorders are polarized. Part of the professionals argue that these patients should be cared for in the PHC service, but such a service is not provided and the professionals are not prepared to care for this specific population. Part of the group argues these patients should remain within CAPS, but CAPS does not provide contraceptive methods and when there are male condoms available, people question whether these should be distributed considering the work overload of these professionals.
Amidst these different points, we perceive these women are not supported in terms of family planning and the various spheres of their health, as manifested by P4:
(...) A person is not only mental disorder, is not like a stone in the gallbladder, not only a headache, she is a whole (...) if you look from the biomedical model perspective, you look for a disease, and unfortunately it happens a lot, you don't see someone with happiness, with a life history, who dates, kisses, goes shopping, goes out, goes to the beach. We have matrix support, otherwise we'll try to take care for a lot of things and won't be able to cover everything (...).
This discussion only reinforces the relevance of this study. It encourages responsibility concerning care provided to people with mental disorders and the needs to be shared by the PHC service and CAPS in the field of family planning. P4 and P5 also highlighted that they prefer to refer the cases to matrix support to obtain a better resolution, while P1, P2 and P3 stated they prefer to refer cases to the PHC units. A consensus was not reached among the interviewees. However, we highlight matrix support as a strategy to share responsibility between the CAPS and PHC units, joining forces and opinions toward multidisciplinary care, sharing cases, and increasing the EFS problem-solving capacity as recommended by matrix support.
Family planning can be included in the therapeutic plan. Sometimes, we refer patients to the PHC unit and they send them back. The patient goes back and forth so many times that we end up caring for patients who should actually be cared for in the unit. After all, here they are listened to, establish bonds and participate in groups." (P5).
When we perceive there is a need for family planning, we provide appropriate guidance but then refer patients to the PHC unit (P4).
Six of the eight professionals reported they cared for women with mental disorders who require family planning care and agree that such needs should be considered in addition to those in the psychiatric field. Hence, this study provides evidence that women with mental disorders show demand for family planning care, which reinforces the need for a care network to care for this public.
The contributions provided by the Psychosocial Care Center to deal with the family planning needs of patients with mental disorders motivated a discussion concerning the appropriate place to care for this population within this field. On the one hand, current law stipulates that PHC provide such care and, consequently, it should be technically prepared to provide it. On the other hand, CAPS provides specialized mental health care and should be technically prepared to deal with the psychiatric needs of these women. However, the law also provides that the PHC unit is the health service's entrance door for women with mental disorders and special cases should be referred to CAPS, though both services should be responsible for and give continuity to basic actions implemented for the patients.
This discussion reinforces the relevance of this study because it reinforces the need for the PHC service and CAPS to establish a technical partnership to provide care to people with mental disorders and meet their needs concerning family planning.
Based on the Psychiatric Reform principles, which view the connection between primary health care and mental health care as essential and urgent, we suggest matrix support, mentioned by various of the interviewed professionals, to be used in order to provide better quality care to women with mental disorders with family planning needs.
Additionally, considering that the study was conducted in a unit of a Psychosocial Care Center, which has peculiarities in its organizational structure, we suggest further studies to be conducted in different regions of the country to investigate other Brazilian contexts.
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2. Brasil. Ministério da Saúde; Secretaria de Atenção à Saúde. Reforma Psiquiátrica e Política de Saúde Mental no Brasil [Documento apresentado à Conferência Regional de Reforma dos Serviços de Saúde Mental: 15 anos depois de Caracas]. Brasília; 2005. [ Links ]
3. Campos GWS, Domitti AC. Apoio matricial e equipe de referência: uma metodologia para gestão do trabalho interdisciplinar em saúde. Cad Saúde Pública. 2007;23(2):399-407. [ Links ]
4. Ribeiro LM, Medeiros SM, Albuquerque JS, Fernandes SMBA. Mental health nursing and the family health strategy: how the nurse is working? Rev Esc Enferm USP [Internet]. 2010 [cited 2010 Aug 15];44(2):376-82. Available from: http://www.scielo.br/pdf/reeusp/v44n2/en_19.pdf [ Links ]
5. Brasil. Ministério da Saúde; Secretaria de Atenção à Saúde, Departamento de Ações Programáticas Estratégicas. Saúde mental e atenção Integral à Saúde da Mulher: princípios e diretrizes. Brasília: Ministério da Saúde; 2004. [ Links ]
6. Guedes TG, Moura ERF, Almeida PC. Particularidades do planejamento familiar de mulheres portadoras de transtorno mental. Rev Latino Am Enferm. 2009;17(5):639-44. [ Links ]
7. Bardin L. Análise de conteúdo. Lisboa: Edições 70; 2008. [ Links ]
8. Brasil. Ministério da Saúde. Portaria n. 336, de 19 de fevereiro de 2002. Define e estabelece diretrizes para o funcionamento dos Centros de Atenção Psicossocial [Internet]. Brasília; 2002 [citado 2010 jul. 22]. Disponível em: http://portal.saude.gov.br/portal/arquivos/pdf/Portaria%20GM%20336-2002.pdf [ Links ]
9. Delfini PSS, Sato MT, Antoneli PP, Guimarães POS. Parceria entre CAPS e PSF: o desafio da construção de um novo saber. Ciênc Saúde Coletiva; 2009;14 Supl 1:1483-92. [ Links ]
10. Olga MB, Suely FD. Sexualidade e o adolescente com deficiência mental: uma revisão bibliográfica Ciênc Saúde Coletiva 2005;10(2):389-397. [ Links ]
11. Miranda FAN, Furegato ARF. Percepções da sexualidade do doente mental pelo enfermeiro. Rev Latino Am Enferm. 2002;10(2):207-13. [ Links ]
12. Soares MVB, Carvalho AMP. Mulheres portadoras de transtornos mentais e a maternidade. Rev Latino Am Enferm. 2009;17(5):632-8. [ Links ]
13. Santos AMCC. Articular saúde mental e relações de gênero: dar voz aos sujeitos silenciados. Ciênc Saúde Coletiva. 2009;14(4):1177-82. [ Links ]
14. Strickler HL. Interaction between family violence and mental retardation. Ment Retard. 2001;39(6):461-71. [ Links ]
15. Barros RD, Williams LCA, Brino RF. Habilidades de auto-proteção acerca do abuso sexual em mulheres com deficiência mental. Rev Bras Educ Espec. 2008;14(1):93-110. [ Links ]
16. Figueiredo AD. Saúde mental na atenção básica: um estudo hermenêutico-narrativo sobre o apoio matricial na Rede SUS-Campinas (SP) [dissertação]. São Paulo: Universidade Estadual de Campinas; 2006. [ Links ]
17. Lemos PM, Cavalcante Junior FS. Psicologia de orientação positiva: uma proposta de intervenção no trabalho com grupos em saúde mental. Ciênc Saúde Coletiva. 2009; 14(1):233-42. [ Links ]
18. Mota TD, Barros S. Saúde mental, direitos, cidadania: o escritório de advocacia como agência para inclusão social. Rev Esc Enferm USP. 2008;42(2):220-6. [ Links ]
Correspondence: Received: 08/29/2010
Escolástica Rejane Ferreira Moura
Rua Alexandre Baraúna, 949 - Rodolfo Teófilo
CEP 60430-160 - Fortaleza, CE, Brazil
Approved: 12/26/2011
Study financially supported by CNPq - Edital MCT/CNPq/CT-Saúde/MS/SCTIE/DECIT, nº. 33/2008 - Mental Health. Process: 575129/20085.
Received: 08/29/2010


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Washington Redskins
Washington Redskins news, rumors and injuries
Redskins | Joey Mbu in line to start at NT
Fri, 28 Jul 2017 09:22:12 -0700
Washington Redskins NT Joey Mbu appears to be the frontrunner to start at nose tackle, according to CSN Mid-Atlantic's JP Finlay.
Comment () | Share: | Source: CSN Mid-Atlantic - JP Finlay
Redskins | Josh Doctson has strong first day of camp
Thu, 27 Jul 2017 16:48:59 -0700
Washington Redskins WR Josh Doctson "showed signs" of why he was highly regarded coming out of college during the first day of training camp Thursday, July 27. With no restrictions, unlike during spring practices, Doctson went all out, displaying great footwork at the line and crisp route-running, as well as good hands. The second-year receiver is "encouraged" by how good he feels and believes he will have a big season.
Fantasy Tip: Doctson is a solid sleeper candidate who could emerge with a breakout campaign in 2017, especially with DeSean Jackson and Pierre Garcon no longer in town. He was the club's first-round draft choice a year ago, and now that he's fully healthy, it looks like the 24-year-old is primed to provide a return on Washington's investment. Look at him as a value pick at the end of drafts.
Comment () | Share: | Source: The Washington Post - Mike Jones
Redskins | Twisted ankle for Jordan Reed?
Thu, 27 Jul 2017 13:39:23 -0700
Washington Redskins TE Jordan Reed (toe, ankle) may have twisted his ankle overcompensating for his toe ailment, according to head coach Jay Gruden.
Fantasy Tip: Reed isn't expected to miss much time, but Washington doesn't want to risk any setbacks with Reed either. He has a substantial injury history and needs to be ready when the games count. If there aren't any setbacks, Reed remains a top three- to-five fantasy consideration at tight end.
Comment () | Share: | Source: The Washington Times - Nora Princiotti
Redskins | Jordan Reed's toe not a big issue
Thu, 27 Jul 2017 09:05:21 -0700
Updating previous reports, Washington Redskins TE Jordan Reed's (toe) injury isn't a big concern to the team, and he's expected to return during the preseason.
Fantasy Tip: Reed is a legit TE1 when he's healthy, but that is like catching lightning in a bottle in recent years.
Comment () | Share: | Source: ESPN.com - Dianna Marie Russini
Redskins | Jordan Reed has toe injury
Wed, 26 Jul 2017 16:12:22 -0700
Updating a previous report, Washington Redskins TE Jordan Reed (toe) was placed on the Physically Unable to Perform list because of significant toe soreness, according to a team spokesperson. He will be evaluated further before he is cleared to practice because the team wants to avoid any possible long-term injury.
Fantasy Tip: Owners will need to monitor the situation to see how long Reed will be sidelined because of this toe injury. Reed is a bit of a risky option for owners because of his injury history but is a No. 1 fantasy tight end when he is healthy.
Comment () | Share: | Source: The Associated Press - Stephen Whyno
Redskins | Kendal Thompson not ready to practice
Wed, 26 Jul 2017 14:45:48 -0700
Washington Redskins WR Kendal Thompson (undisclosed) was placed on the Active/Physically Unable to Perform list Wednesday, July 26.
Comment () | Share: | Source: Redskins.com - Stephen Czarda
Redskins | Jordan Reed placed on PUP list
Wed, 26 Jul 2017 14:44:14 -0700
Washington Redskins TE Jordan Reed (undisclosed) was placed on the Active/Physically Unable to Perform list Wednesday, July 26.
Fantasy Tip: Reed can return to practice at any point during training camp, so owners should monitor the situation. He has dealt with injuries during his career but has been a very successful play when he is healthy. He has recorded 17 touchdowns in the last two seasons and should be considered a solid No. 1 tight end in fantasy leagues.
Comment () | Share: | Source: Redskins.com - Stephen Czarda
Redskins | Montae Nicholson ready for camp
Wed, 26 Jul 2017 13:47:04 -0700
Washington Redskins S Montae Nicholson (shoulder) will not be placed on the Physically Unable to Perform list and will be ready for practice, according to head coach Jay Gruden.
Comment () | Share: | Source: ESPN.com - John Keim
Redskins | Fabian Moreau to avoid NFI list
Wed, 26 Jul 2017 12:39:38 -0700
Washington Redskins CB Fabian Moreau (pectoral) will not be placed on the Non-Football Injury list at the start of training camp even though he has been recovering from a torn pectoral muscle.
Comment () | Share: | Source: NFL Network - Ian Rapoport
Redskins | Ryan Grant still receiving kudos
Tue, 25 Jul 2017 10:47:54 -0700
Washington Redskins WR Ryan Grant has yet to lose the confidence of his coaching staff despite making only 39 catches in three seasons in large part because he is the best route-runner on the team this year or last year, including Pierre Garcon and DeSean Jackson. "I'm easily Ryan Grant's biggest fan. He's always been our best pure route-runner out of everyone. … He's been a consummate pro. He says nothing and he works all the time. He's gotten a bad rap for situations that weren't completely his fault. The world will never know that," receivers coach Mike Hilliard said.
Fantasy Tip: Head coach Jay Gruden said last month Grant needed more opportunities, but it will be hard for him to get those with Terrelle Pryor, Jamison Crowder and Josh Doctson almost certain to occupy the first three spots on the depth chart. In short, he'll need an injury to one of those three to be fantasy-viable and, even then, he would probably a fringe option at best.
Comment () | Share: | Source: ESPN.com - John Keim
Redskins | Two Redskins beginning on PUP
Mon, 24 Jul 2017 06:16:09 -0700
Washington Redskins FS DeAngelo Hall (knee) and LB Houston Bates (knee) will begin camp on the Physically Unable to Perform list.
Comment () | Share: | Source: ESPN.com - John Keim
Redskins | Rob Kelley to hold to starting job 'for now'
Sun, 23 Jul 2017 10:11:15 -0700
Washington Redskins RB Rob Kelley will likely begin the season as the starter "for now" if he shows he has improved over last season, according to ESPN.com's John Keim.
Fantasy Tip: At the very least, rookie Samaje Perine was drafted to help Washington with its red zone woes. More likely, however, the Redskins saw a potential upgrade. Kelley will be lucky if he can keep this from becoming a split backfield and could easily be Perine's backup no later than midseason. He is almost certainly being overdrafted as a RB3/4 this summer.
Comment () | Share: | Source: ESPN.com - John Keim
Redskins | Terrelle Pryor destined for Pro Bowl?
Sat, 22 Jul 2017 08:08:47 -0700
Washington Redskins WR Terrelle Pryor may be new to the receiver position, but former position coach Al Saunders would be "shocked if he isn't in the Pro Bowl," according to ESPN.com's John Keim.
Fantasy Tip: The Redskins need to replace a pair of 1,000-yard receivers in Pierre Garcon and DeSean Jackson, and there is a strong belief Pryor and Jamison Crowder will be able to do the job. At 6-4 and nearly 230 pounds with incredible athleticism, Pryor should be able to dominate in the red zone as well in a way Garcon and Jackson could not. He should be a solid WR2 in fantasy, capable of being a WR1.
Comment () | Share: | Source: ESPN.com - John Keim
Redskins | Josh Doctson key for Kirk Cousins?
Thu, 20 Jul 2017 20:26:23 -0700
Washington Redskins WR Josh Doctson's progression this season could help determine if QB Kirk Cousins decides to sign a long-term extension, according to JP Finlay of CSNMidAtlantic.com.
Fantasy Tip: Doctson should be the fourth option in a pass-happy attack, and he can be considered an upside WR5 coming off an injury-plagued rookie year.
Comment () | Share: | Source: CSNMidAtlantic.com - JP Finlay
Redskins | Kirk Cousins wants to stay in Washington
Tue, 18 Jul 2017 16:54:56 -0700
Washington Redskins QB Kirk Cousins' first choice is to stay with the Redskins despite both sides not agreeing on a long-term deal. Cousins said he would love to stay in Washington long term and has hope for getting a deal done next offseason.
Fantasy Tip: The bottom line is that Cousins will still play for the Redskins in 2017. He's set to make a lot of money next year, though, whether that's from the Redskins or someone else. As for fantasy, Cousins has QB1 appeal after averaging 4,541.5 yards and 27 touchdowns the last two seasons, not to mention he's scored nine times on the ground in that span.
Comment () | Share: | Source: NFL.com - Kevin Patra
KFFL: Sports Link of the Day
Washington Redskins Player News


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At the yearly gathering of booklovers held in Chicago's McCormick Place convention center June 22 – 27, Wordsworth the Better World Bookmobile is...
Anthony Bourdain
Joel Rose
Langdon Foss
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On one side, the Internationalists, who blend foods from all over the world into exotic delights. On the other, the "Vertical Farm," who prepare nothing but organic, vegetarian, macrobiotic dishes. Into this maelstrom steps Jiro, a renegade and ruthless sushi chef, known to decapitate patrons who dare request a California Roll, or who stir wasabi into their soy sauce. Both sides want Jiro to join their factions. Jiro, however has bigger ideas, and in the end, no chef may be left alive
Anthony Bourdain, top chef, acclaimed writer (Kitchen Confidential, Medium Raw) and star of the hit travel show, No Reservations, co-writes with Joel Rose (Kill Kill Faster Faster, The Blackest Bird) this stylized send-up of food culture and society, with detailed and dynamic art by Langdon Foss.
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Handmade Rakhis: Single #46 (Set of 2 Rakhis with Homemade Chocolates)
Handmade Rakhis are personal, beautiful and classy in a subtle, elegant way.
Store bought Rakhis seem so tired somehow. The designs are typical and OLD. You seem to have seen the same designs year after year. They are garish and in-your-face tacky. Or they are oh-my-goodness expensive. Why can't they find a middle ground somewhere?
Well, now they do.
Handmade Rakhis at Tissayra are not choking at the seams (please forgive the mixed metaphors) with decorations, tinsel and garish beads. They are tastefully assembled and aren't crammed with conflicting design elements. Yes, they are simply stylish, if we do say so ourselves.
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Air Conditioning
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'The Process Is the Punishment': Are Scott Walker's Allies Being Targeted?
'The Process Is the Punishment': Are Scott Walker's Allies Being Targeted?
Several conservative organizations that supported Republican Gov. Scott Walker's union reforms have reportedly been targeted recently by a special prosecutor in Wisconsin, calling to mind the scandal involving the Internal Revenue Service's intimidation of Tea Party groups.
Special prosecutor Francis Schmitz has served dozens of pro-Walker groups with subpoenas demanding any and all documentation pertaining to the failed 2011 and 2012 campaigns to have the governor recalled.
The subpoenas call for "all memoranda, email … correspondence, and communications" between the subpoena target and at least 29 conservative groups, including Wisconsin and national nonprofits, political vendors and party committee, according to The Wall Street Journal, which reviewed copies of two subpoenas.
Groups that have so far been involved in Schmitz's probe include the League of American Voters, Wisconsin Family Action, Wisconsin Manufacturers & Commerce, Americans for Prosperity—Wisconsin, American Crossroads, the Republican Governors Association, Friends of Scott Walker and the Republican Party of Wisconsin.
One subpoena specifically called for "all records of income received, including fundraising information and the identity of persons contributing to the corporation," the Journal reported. In short, we want to know who your donors are.
The targeted groups were unable to comment on Schmitz's investigation because it's being conducted under the state's John Doe law, which prohibits the target of a subpoena from discussing its details with anyone but the state or an attorney. Basically, the state can review and investigate a target and that target is left with few options to publicly defend himself.
But Eric O'Keefe, a target of Schmitz's far-reaching probe, was willing to go on the record about his subpoena. O'Keefe, director of the Wisconsin Club for Growth, a pro-tax reduction conservative group, told the Journal he received his subpoena in October, saying at least three other people involved in Schmitz's investigation had their homes raided and files seized by law enforcement officials.
O'Keefe said he doesn't know what prompted the investigation. Other groups declined to comment on the specifics of the investigation.
The investigation calls for several of the pro-Walker groups that are not legally required to disclose the names of donors to disclose the names of donors. Remember what happened when the IRS did that to numerous Tea Party groups? Private donor information ended up in the hands of investigative journalism outfit ProPublica, much to the shock of those donors.
The subpoenas don't allege specific wrongdoing, according to the Journal. It may be that officials are merely looking into whether independent conservative groups illegally coordinated during the recall elections.
If this is indeed what prosecutors are investigating, then "their goal may be to transform the independent expenditures into candidate committees after the fact, requiring revision of campaign-finance disclosures and possible criminal charges," the Journal explained.
Unsurprisingly, the timing of the probe has raised a few eyebrows considering Walker is gearing up for his 2014 re-election campaign.
Now it may very well be that some of these groups illegally coordinated during the recall elections. It is entirely likely that the "subpoena monsoon," as the Journal referred to it, and the home raids are entirely justified.
"But in the meantime the effect is to limit political speech by intimidating these groups from participating in the 2014 campaign," the Journal noted. "Stifling allies of Mr. Walker would be an enormous in-kind contribution to Democrats. Even if no charges are filed, the subpoenas will have served as a form of speech suppression. "
The subpoenas "froze my communications and frightened many allies and vendors of the pro-taxpayer political movement in Wisconsin and across the country," O'Keefe told the Journal.
And even if the investigation doesn't turn up any nefarious doings, he says, "the process is the punishment."
Click here to read the full story in The Wall Street Journal.
Right...you keep telling yourself that.
Quoting -Celestial-:
Many of those groups are shady
Quoting -Celestial-:
Many of those groups are shady
Everyone is shady in your opinion that fails to follow your extreme far left political views.