Doença como experiência: as relações entre vulnerabilidade social e corpo doente enquanto fenômeno biocultural no estado do Pará

O estudo ora apresentado analisa a representação biossocial de pessoas com Anemia Falciforme (AF) no Estado do Pará, agravo entendido como um fenômeno biocultural por envolver aspectos evolutivos, genéticos, ambientais, socioeconômicos e culturais da vivência cotidiana dos indivíduos acometidos pela síndrome. A investigação aborda as sociabilidades de quarenta (40) interlocutores com AF, representando cerca de 10% dos pacientes em tratamento na Fundação Hemopa (Belém), centro de referência em doenças hematológicas do Estado, englobando a sua situação de vulnerabilidade social, suas percepções de Saúde e Doença, os tratamentos complementares (folk medicine), diagnóstico, estigmas, preconceitos, tabus e dificuldades de acesso e acessibilidade aos serviços do SUS com os quais eles convivem rotineiramente. A metodologia compreensiva e a análise de conteúdo revelam as experiências próximas dos sujeitos que diariamente convivem com as instabilidades da enfermidade. A vivência da doença, elaborada através das relações sociais, conversas, percepções e enredamentos familiares e extrafamiliares do grupo em questão, que em seu conjunto organiza sua vida social de modo sui gêneris, foram os principais dados revelados, considerando a dor física e psicológica representada pelo corpo adoecido. O habitus em relação ao estilo de vida dos sujeitos é um recorte que engloba a natureza étnico-racial da AF, ainda entendida como “doença que vem do negro” e que necessita ser desmistificada pelos profissionais de saúde que os assistem no dia-a-dia em ambulatórios de todo o Estado. Concluo sugerindo que a AF é uma doença que está atrelada aos Determinantes Sociais em Saúde, incorporando as diversas suscetibilidades dos interlocutores, que necessitam de maior sensibilidade política e dos setores de atenção básica à saúde para que as pessoas que compartilham as vicissitudes da AF possam ser incluídas socialmente.

Parâmetros para justiciabilidade do direito social à saúde: o caso do estado do Pará

A partir do debate da chamada judicialização da saúde e seus impactos orçamentários e de planejamento das políticas públicas da área, a pesquisa trabalha com a hipótese de que o poder Judiciário deve buscar maior racionalização na tarefa de decidir este tipo de demanda, com a proposição de parâmetros/critérios racionais para tanto; buscando-se restabelecer o equilíbrio entre a faceta individual e coletiva do direito à saúde. Para tanto, uma abordagem constitucional e do direito sanitário é apresentada, sob o paradigma da medicina baseada em evidências. A jurisprudência do Suprermo Tribunal Federal sobre o direito social à saúde é exposta e sistematizada, enfatizando-se a Audiência Pública ocorrida em 2009 neste Tribunal. Procurando compreender de que forma e se este debate mais recente encontrou ecos na realidade regional e local, foi realizada pesquisa a acórdãos do Tribunal de Justiça do Estado do Pará, julgados entre 2008 e 2011, comparando-se com a jurisprudência do Egrégio Tribunal e visando, igualmente, conhecer as características de tais demandas a partir dos seguintes critérios: espécie de autor, representação em juízo, doença de que padecem, objeto da demanda, espécie de ação interposta, perfil dos recorrentes e resultado da demanda, bem como os principais argumentos apresentados pelos atores presentes na dinâmica – autores, réus e magistrados. A partir da pesquisa empreendida, propõem-se parâmetros específicos para a justiciabilidade do direito objeto de estudo, a partir do referencial teórico do direito como integridade de Ronald Dworkin, restabelecendo-se a integração entre direito subjetivo público e direito coletivo, como complementares à natureza do direito à saúde.

Qualidade de vida e vulnerabilidade social na percepção do idoso

According to data from the World Health Organization, the older population will grow sixteenfold from 1950 to 2025 in comparison to a fivefold population growth in the same period, which is referred to by UNO as the “Ageing Era”. This places Brazil in the sixth position in the contingent of older individuals worldwide, with a number that is higher than 32 million. Considering how topics such as quality of life and social vulnerability are important in face of the growing older population, these topics must be furthered studied so that they can be understood as important variables for both better clinical practice and scientific research. To describe the social vulnerability and evaluate the quality of life of older individuals in a population hospitalized in the internal medicine ward of Bauru State Hospital. This is a descriptive qualitative study that was conducted by means of interviews and using Bardin’s discourse analysis. The inclusion criteria used in this study were: individuals at 60 years of age who were mentally capable of answering the proposed questions. Two categories concerning Quality of Life and Social Vulnerability emerged from the interviews. The following emerged from the theme Quality of Life: “Life as something important” and subcategories that involved feeling useful in society, having a supportive family, independence, optimism and joy and survival. Also, the following emerged from the theme Social Vulnerability: “Negative recognition of older individuals in society” and subcategories that involved lack of respect, functional disability, family indifference, housing-related insecurity, an inefficient health care system and loneliness. Quality of Life and Social Vulnerability are largely discussed themes in the present scenario. In this study, it was possible to perceive that the older population needs social support, effective public... (Complete abstract click electronic access below)

Syntax of social life in postpartum depression: Mother-child interaction

Purpose: Understand the difficulties and experienced of individuals suffering from postpartum depression, related to mood disturbances, the mother-child bond and its repercussions in the meanings established for the experience of being a mother. Methods: Forty-one patients were interviewed, with ages ranging from 20 to 49 years, from a total of 106 attended at the Primary Care Unit, in the interior of the state of Parahiba, Brazil. A sample of 21 women was selected, presenting an inclusion profile, propitious to mapping postpartum depression. The eligible patients were referred by two PSF (Health Family) teams (one each from the urban and rural zones), aimed at diagnosing the psychic disturbance of the perperium. They were accompanied by a psychologist and all signed an informed consent form. A field diary supported the information recorded. Beck's Depression Inventory complemented the inclusion and follow-up of the patients. The data were analyzed statistically. Results: We confirmed the findings of the most recent studies that infant abandonment in the postpartum period occurs in situations where multiple and serious factors add up, such as misery (86.7%), little schooling (67%), lack of a support network (36.5%), estrangement of the mother's family relations (12%) and lack of paternal involvement (91.5%). Conclusion: The feeling of psyching pain and suffering, resulting from postpartum depression, is the most emphasized by women (87%) because it triggers the greatest discomfort, due to the difficulty in overcoming it.

Evaluation of the prevalence and nutritional and social determinants of overweight in a population of schoolchildren: a cross-sectional analysis of 5,037 children

Objective: To evaluate the prevalence and nutritional and social determinants of overweight in a population of schoolchildren in Southern Brazil. Methods: Cross-sectional descriptive study of 5,037 children of both genders, between 6 and 10.9 years of age, from public and private schools of Maringa, Parana, Brazil. Evaluation of factors associated with excess weight (overweight and obesity) included gender, age, school type, socioeconomic level, education of the head of the family, eating habits, and means of commuting to school. After univariate analysis (Fisher's exact test), we adjusted a logistic regression model and used Wald's test for decision-making (p < 0.05). Results: The mean age was 8.7 +/- 1.3 years, with 52.8% females; 79.1% of the students attended public school and 54.6% had families of socioeconomic class A or B. Regarding nutritional status, 24% of children were overweight (7% obesity, 17% overweight). Being male, attending a private school, and having a head of the family with over four years of education were significantly associated with excess weight. In relation to food, inadequate intake of,carbohydrates was associated with a 48% greater chance of overweight/obesity (p < 0.001; OR: 1.48; 95% CI: 1.25-1.76), Conclusion: The prevalence of overweight found in this study is approximate to that reported in national studies. Its association with gender and inadequate food intake indicates that these factors should be considered in initiatives aimed at preventive measures in childhood.

Spatio-temporal patterns of tuberculosis incidence in Ribeirao Preto, State of Sao Paulo, southeast Brazil, and their relationship with social vulnerability: a Bayesian analysis

Introduction: The purpose of this ecological study was to evaluate the urban spatial and temporal distribution of tuberculosis (TB) in Ribeirao Preto, State of Sao Paulo, southeast Brazil, between 2006 and 2009 and to evaluate its relationship with factors of social vulnerability such as income and education level. Methods: We evaluated data from TBWeb, an electronic notification system for TB cases. Measures of social vulnerability were obtained from the SEADE Foundation, and information about the number of inhabitants, education and income of the households were obtained from Brazilian Institute of Geography and Statistics. Statistical analyses were conducted by a Bayesian regression model assuming a Poisson distribution for the observed new cases of TB in each area. A conditional autoregressive structure was used for the spatial covariance structure. Results: The Bayesian model confirmed the spatial heterogeneity of TB distribution in Ribeirao Preto, identifying areas with elevated risk and the effects of social vulnerability on the disease. We demonstrated that the rate of TB was correlated with the measures of income, education and social vulnerability. However, we observed areas with low vulnerability and high education and income, but with high estimated TB rates. Conclusions: The study identified areas with different risks for TB, given that the public health system deals with the characteristics of each region individually and prioritizes those that present a higher propensity to risk of TB. Complex relationships may exist between TB incidence and a wide range of environmental and intrinsic factors, which need to be studied in future research.

Genetic characterization, population history and evolutionary medicine perspective in two native south american populations: Yanesha and Wichi

Two Amerindian populations from the Peruvian Amazon (Yanesha) and from rural lowlands of the Argentinean Gran Chaco (Wichi) were analyzed. They represent two case study of the South American genetic variability. The Yanesha represent a model of population isolated for long-time in the Amazon rainforest, characterized by environmental and altitudinal stratifications. The Wichi represent a model of population living in an area recently colonized by European populations (the Criollos are the population of the admixed descendents), whose aim is to depict the native ancestral gene pool and the degree of admixture, in relation to the very high prevalence of Chagas disease. The methods used for the genotyping are common, concerning the Y chromosome markers (male lineage) and the mitochondrial markers (maternal lineage). The determination of the phylogeographic diagnostic polymorphisms was carried out by the classical techniques of PCR, restriction enzymes, sequencing and specific mini-sequencing. New method for the detection of the protozoa Trypanosoma cruzi was developed by means of the nested PCR. The main results show patterns of genetic stratification in Yanesha forest communities, referable to different migrations at different times, estimated by Bayesian analyses. In particular Yanesha were considered as a population of transition between the Amazon basin and the Andean Cordillera, evaluating the potential migration routes and the separation of clusters of community in relation to different genetic bio-ancestry. As the Wichi, the gene pool analyzed appears clearly differentiated by the admixed sympatric Criollos, due to strict social practices (deeply analyzed with the support of cultural anthropological tools) that have preserved the native identity at a diachronic level. A pattern of distribution of the seropositivity in relation to the different phylogenetic lineages (the adaptation in evolutionary terms) does not appear, neither Amerindian nor European, but in relation to environmental and living conditions of the two distinct subpopulations.

Identity formation at the beginning of the twenty-first century: Intersubjectivity, art, and medicine in Siri Hustvedt’s works

„Ich bin, weil du bist“ – so lautet eines der Schlüsselzitate in What I Loved, dem 2003 erschienenen dritten Roman der zeitgenössischen amerikanischen Autorin Siri Hustvedt. Die Bedeutung von Beziehung und Interaktion für die Identitätsbildung spielt eine zentrale Rolle nicht nur in diesem Roman, sondern auch in ihrem Gesamtwerk, das vier Romane, ein memoir, drei Essay-Sammlungen und einen Lyrikband umfasst. Hustvedt erforscht die Identität als ein vielschichtiges Produkt bewusster und unbewusster Verknüpfungen innerhalb der sozialen und biologischen Umwelt. Das Bewusstsein wird als eine dialogisch geprägte Entität gezeigt, dessen Identität erst durch die Beziehung auf ein Anderes geformt werden kann. Um dem Mysterium der menschlichen Identitätsfindung nachzuspüren, bedient sich Hustvedt sowohl philosophischer, psychoanalytischer, biologischer als auch kunsttheoretischer Diskurse. In ihren Romanen stellt sich die Frage nach der Erklärung von Identität als komplexe Problematik dar: Ist die Beziehung zu anderen Menschen vor allem durch unsere Entwicklung als Kind und die Nähe zu Bezugspersonen geprägt? In welchem Ausmaß ist das Empfinden von Subjektivität beeinflusst von körperlichen und unbewussten Mechanismen? Inwiefern ist die Wahrnehmung visueller Kunst eine Kooperation zwischen Betrachter und Künstler? rnDiesen und anderen Fragen geht diese Dissertation nach, indem sie Hustvedts Werk als Anlass für eine Analyse intersubjektiver Strukturen der Identität nimmt. Die Intersubjektivitätsphiloso¬phien von Hegel, Buber, Bakhtin, Husserl, und Merleau-Ponty dienen hierbei als Ausgangspunkt für die Interpretation von relationaler Identität in Hustvedts Werken. Die Dissertation konzentriert sich auf Hustvedts Darstellung der Beziehung zwischen Selbst und Anderem in der Photographie und in der Malerei, der Überschreitung von Körpergrenzen in Hysterie und Anorexie sowie der Auswirkung des Verlustes von Bezugspersonen auf die persönliche Identität. Entscheidend für den Hustvedtschen Kunstbegriff ist das Zusammenspiel von Kunstobjekt, Künstler und Betrachter. Die Grenzen zwischen Innerem und Äußeren werden aufgelöst: mal wird der Rezipient Teil des Kunstwerks, mal verschmilzt der Künstler förmlich mit seinem Objekt. Auch hier wird wiederum deutlich, dass Identität nur in Wechselbeziehung und als zwischenmenschliche Kooperation entsteht. Hustvedt betritt durch ihre einzigartige Auseinandersetzung mit den Wechselbeziehungen und fragilen Grenzen zwischen Ich und Umwelt Neuland auf dem Gebiet der literarischen Identitätsforschung, da sie ihr Prinzip des „mixing,“ des unausweichlichen Eindringens fremder Substanz in die eigene Identität, aus dem Blickwinkel dieser verschiedenen Erklärungsansätze beleuchtet. rn

Lack of social support in the etiology and the prognosis of coronary heart disease: a systematic review and meta-analysis

To conduct a systematic review and meta-analysis on the relevance of low social support for the development and course of coronary heart disease (CHD).

Money is not enough: exploring the impact of social and cultural resources on youth health

Findings on socioeconomic health differentials in youth remain fragmented with the role of cumulative and interaction effects of different forms of health resources not well understood.

[Psychosomatic medicine and arterial hypertension - love it or leave it?]

Over the last two decades modern psychosomatic research has found multiple evidence for an impact of psychosocial factors on the control of arterial blood pressure as well as the development of arterial hypertension. This narrative review focuses first on the current stress concept and factors that influence the degree of blood pressure change following a psychosocial stressor. Second, relevant psychosocial factors associated with blood pressure are presented such as marital status, social support, socioeconomic status and work conditions. In addition, the influence of personality and cognition on blood pressure will be discussed. The second part focuses on the outcome of cognitive-behavioral therapies and relaxation techniques as a means to effectively control blood pressure. In conclusion, there is now good evidence showing that psychosocial factors and stressors may increase blood pressure. The working environment, the socioeconomic status as well as aspects of personality and cognitive factors like rumination may also impact blood pressure with to an extent that is clinically relevant. With respect to therapeutic options, cognitive-behavioral interventions, combined with relaxation techniques all fitting the needs of the individual patient best can offer a clinically meaningful contribution of an effective blood pressure control.

The eight-item modified Medical Outcomes Study Social Support Survey: psychometric evaluation showed excellent performance

Evaluation and validation of the psychometric properties of the eight-item modified Medical Outcomes Study Social Support Survey (mMOS-SS).

Xenomelia: a social neuroscience view of altered bodily self-consciousness

Xenomelia, the "foreign limb syndrome," is characterized by the non-acceptance of one or more of one's own extremities and the resulting desire for elective limb amputation or paralysis. Formerly labeled "body integrity identity disorder" (BIID), the condition was originally considered a psychological or psychiatric disorder, but a brain-centered Zeitgeist and a rapidly growing interest in the neural underpinnings of bodily self-consciousness has shifted the focus toward dysfunctional central nervous system circuits. The present article outlays both mind-based and brain-based views highlighting their shortcomings. We propose that full insight into what should be conceived a "xenomelia spectrum disorder" will require interpretation of individual symptomatology in a social context. A proper social neuroscience of xenomelia respects the functional neuroanatomy of corporeal awareness, but also acknowledges the brain's plasticity in response to an individual's history, which is lived against a cultural background. This integrated view of xenomelia will promote the subfield of consciousness research concerned with the unity of body and self.