Good Lives, Hidden Miseries : An Ethnography of Uncertainty in a Finnish Village

This is an ethnographic study, in the field of medical anthropology, of village life among farmers in southwest Finland. It is based on 12 months of field work conducted 2002-2003 in a coastal village. The study discusses how social and cultural change affects the life of farmers, how they experience it and how they act in order to deal with the it. Using social suffering as a methodological approach the study seeks to investigate how change is related to lived experiences, idioms of distress, and narratives. Its aim has been to draw a locally specific picture of what matters are at stake in the local moral world that these farmers inhabit, and how they emerge as creative actors within it. A central assumption made about change is that it is two-fold; both a constructive force which gives birth to something new, and also a process that brings about uncertainty regarding the future. Uncertainty is understood as an existential condition of human life that demands a response, both causing suffering and transforming it. The possibility for positive outcomes in the future enables one to understand this small suffering of everyday life both as a consequence of social change, which fragments and destroys, and as an answer to it - as something that is positively meaningful. Suffering is seen to engage individuals to ensure continuity, in spite of the odds, and to sustain hope regarding the future. When the fieldwork was initiated Finland had been a member of the European Union for seven years and farmers felt it had substantially impacted on their working conditions. They complained about the restrictions placed on their autonomy and that their knowledge was neither recognised, nor respected by the bureaucrats of the EU system. New regulations require them to work in a manner that is morally unacceptable to them and financial insecurity has become more prominent. All these changes indicate the potential loss of the home and of the ability to ensure continuity of the family farm. Although the study initially focused on getting a general picture of working conditions and the nature of farming life, during the course of the fieldwork there was repeated mention of a perceived high prevalence of cancer in the area. This cancer talk is replete with metaphors that reveal cultural meanings tied to the farming life and the core values of autonomy, endurance and permanence. It also forms the basis of a shared identity and a means of delivering a moral message about the fragmentation of the good life; the loss of control; and the invasion of the foreign. This thesis formed part of the research project Expressions of Suffering. Ethnographies of Illness Experiences in Contemporary Finnish Contexts funded by the Academy of Finland. It opens up a vital perspective on the multiplicity and variety of the experience of suffering and that it is particularly through the use of the ethnographic method that these experiences can be brought to light. Keywords: suffering, uncertainty, phenomenology, habitus, agency, cancer, farming

Depression in / by / for women : agency, feminism and self-help in groups

Depression in / by / for Women: Agency, Feminism and Self-Help in Groups on ensimmäinen väitöstasoinen tutkimus feministisestä terapiasta Suomessa sijoittuen psykologian, sosiaalitieteellisen mielenterveystutkimuksen sekä feministisen tutkimuksen alueille. Perinteisen näkemyksen mukaan feministisen tutkimuksen tulee olla ”naisista, naisten tekemää ja naisille kohdistettua”. Naiset ja masennus -projektitutkimus keskittyy naisten kokemaan masennukseen sisältäen mahdollisen miesten sekä patriarkaalisen hyvinvointivaltion osuuden masennukseen. Masennusta kokevat naiset ovat tutkimuksessa sekä tutkimuksen kohteena että aktiivisia osanottajia, mikä tuo heidän äänensä kuuluville. Tutkimus perustuu vuosien 1994-2000 välisenä aikana kerättyyn 11 ryhmän osallistujia koskevaan kvalitatiivisiin ja kvantitatiivisiin aineistoon. Irmeli Laitinen on ollut suunnittelemassa, keräämässä ja analysoimassa sitä yhdessä projektin muiden jäsenten kanssa. Tutkimuksessa mitattiin kuinka ryhmiin osallistuvien seka masennuksen tunteet että toiminnat muuttuivat yhden vuoden aikana. Tutkimuksen tavoitteena oli sekä masennuksesta kärsivien naisten osallistuminen feministiseen toimintatutkimukseen että ammatillisesti ohjatun oma-apuryhmämenetelmän kehittäminen suomalaiseen mielenterveyspalveluun. Projektin tutkimustulosten mukaan siihen osallistuneet naiset voimaantuivat ymmärtämään itseään sekä saivat luottamusta sosiaaliisiin taitoihinsa. Pidemmällä aikavälillä naisten tunteet muuttuivat myönteisiksi, heidän suhteensa itseensä positiivisemmaksi ja he aktivoituivat fyysisesti. Lisäksi tutkimustulokset viittaavat siihen, että masennus voi johtua näkymättömästä, sukupuolisesti virittyneestä jännitteestä naisystävällisessä hyvinvointivaltiossa paljastaen ”hyvinvointimasennusoireilun”. Suomalaisen sosiologi Erik Allardtin hyvinvointitypologian - having, loving, being – mukaisesti nämä ryhmään osallistuvat naiset eivät koe puutteita niinkään materiaalisessa hyvinvoinnissa (having) vaan pikeminkin suhteiden, sosiaalisen ja emotionaalisen hyvinvoinnin ulottuvuuksilla (loving ja being). Se, että masentuneet naiset pystyvät tuomaan esille pitkään vaiennettuja kokemuksiaan, voi merkitä paljon heidän paranemisessaan ja voimaantumisessaan. Ammatillisesti ohjatut oma-apuryhmät ja naisystävälliset hoitokäytännöt mahdollistivat tämänkaltaisen paranemisprosessin alkamisen tutkimukseen osallistuneissa ryhmissä.

The sources of moral motivation : studies on empathy, guilt, shame and values

The goals of this study were to analyze the forms of emotional tendencies that are likely to motivate moral behaviors, and to find correlates for these tendencies. In study 1, students narratives of their own guilt or shame experiences were analyzed. The results showed that pure shame was more likely to motivate avoidance than reparation, whereas guilt and combination of guilt and shame were likely to motivate reparation. However, all types of emotion could lead to chronic rumination if the person was not clearly responsible for the situation. In study 2, the relations of empathy with two measures of guilt were examined in a sample of 13- to 16-year-olds (N=113). Empathy was measured using Davis s IRI and guilt by Tangney s TOSCA and Hoffman s semi-projective story completion method that includes two different scenarios, guilt over cheating and guilt over inaction. Empathy correlated more strongly with both measures of guilt than the two measures correlated with each other. Hoffman s guilt over inaction was more strongly associated with empathy measures in girls than in boys, whereas for guilt over cheating the pattern was the opposite. Girls and boys who describe themselves as empathetic may emphasize different aspect of morality and feel guilty in different contexts. In study 3, cultural and gender differences in guilt and shame (TOSCA) and value priorities (the Schwartz Value Survey) were studied in samples of Finnish (N=156) and Peruvian (N=159) adolescents. Gender differences were found to be larger and more stereotypical among the Finns than among the Peruvians. Finnish girls were more prone to guilt and shame than boys were, whereas among the Peruvians there was no gender difference in guilt, and boys were more shame-prone than girls. The results support the view that psychological gender differences are largest individualistic societies. In study 4, the relations of value priorities to guilt, shame and empathy were examined in two samples, one of 15 19-year-old high school students (N = 207), and the other of military conscripts (N = 503). Guilt was, in both samples, positively related to valuing universalism, benevolence, tradition, and conformity, and negatively related to valuing power, hedonism, stimulation, and self-direction. The results for empathy were similar, but the relation to the openness conservation value dimension was weaker. Shame and personal distress were weakly related to values. In sum, shame without guilt and the TOSCA shame scale are tendencies that are unlikely to motivate moral behavior in Finnish cultural context. Guilt is likely to be connected to positive social behaviors, but excessive guilt can cause psychological problems. Moral emotional tendencies are related to culture, cultural conceptions of gender and to individual value priorities.

Pathways to health : Determinants of health, health behaviour and health inequalities in early adulthood

There is increasing evidence that the origins of poor adult health and health inequalities can be traced back to circumstances preceding current socioeconomic position and living conditions. The life-course approach to examining the determinants of health has emphasised that exposure to adverse social and economic circumstances in earlier life or concurrent adverse circumstances due to unfavourable living conditions in earlier life may lead to poor health, health-damaging behaviour, disease or even premature death in adulthood. There is, however, still a lack of knowledge about the contribution of social and economic circumstances in childhood and youth to adult health and health inequalities, and even less is known about how environmental and behavioural factors in adulthood mediate the effects of earlier adverse experiences. The main purpose of this study was to deepen our understanding of the development of poor health, health-damaging behaviours and health inequalities during the life-course. Its aim was to find out which factors in earlier and current circumstances determine health, the most detrimental indicators of health behaviour (smoking, heavy drinking and obesity as a proxy for the balance between nutrition and exercise), and educational health differences in young adults in Finland. Following the ideas of the social pathway theory, it was assumed that childhood environment affects adult health and its proximal determinants via different pathways, including educational, work and family careers. Early adulthood was studied as a significant phase of life when many behavioural patterns and living conditions relevant to health are established. In addition, socioeconomic health inequalities seem to emerge rapidly when moving into adulthood; they are very small or non-existent in childhood and adolescence, but very marked by early middle age. The data of this study were collected in 2000 2001 as part of the Health 2000 Survey (N = 9,922), a cross-sectional and nationally representative health interview and examination survey. The main subset of data used in this thesis was the one comprising the age group 18 29 years (N = 1,894), which included information collected by standardised structured computer-aided interviews and self-administered questionnaires. The survey had a very high participation rate at almost 90% for the core questions. According to the results of this study, childhood circumstances predict the health of young adults. Almost all the childhood adversities studied were found to be associated with poor self-rated health and psychological distress in early adulthood, although fewer associations were found with the somatic morbidity typical of young adults. These effects seemed to be more or less independent of the young adult s own education. Childhood circumstances also had a strong effect on smoking and heavy drinking, although current circumstances and education in particular, played a role in mediating this effect. Parental smoking and alcohol abuse had an influence on the corresponding behaviours of offspring. Childhood circumstances had a role in the development of obesity and, to a lesser extent, overweight, particularly in women. The findings support the notion that parental education has a strong effect on early adult obesity, even independently of the young adult s own educational level. There were marked educational differences in self-rated health in early adulthood: those in the lowest educational category were most likely to have average or poorer health. Childhood social circumstances seemed to explain a substantial part of these educational differences. In addition, daily smoking and heavy drinking contributed substantially to educational health differences. However, the contribution of childhood circumstances was largely shared with health behaviours adopted by early adulthood. Employment also shared the effects of childhood circumstances on educational health differences. The results indicate that childhood circumstances are important in determining health, health behaviour and health inequalities in early adulthood. Early recognition of childhood adversities followed by relevant support measures may play an important role in preventing the unfortunate pathways leading to the development of poor health, health-damaging behaviour and health inequalities. It is crucially important to recognise the needs of children living in adverse circumstances as well as children of substance abusing parents. In addition, single-parent families would benefit from support. Differences in health and health behaviours between different sub-groups of the population mean that we can expect to see ever greater health differences when today s generation of young adults grows older. This presents a formidable challenge to national health and social policy as well as health promotion. Young adults with no more than primary level education are at greatest risk of poor health. Preventive policies should emphasise the role of low educational level as a key determinant of health-damaging behaviours and poor health. Keywords: health, health behaviour, health inequalities, life-course, socioeconomic position, education, childhood circumstances, self-rated health, psychological distress, somatic morbidity, smoking, heavy drinking, BMI, early adulthood

Depression and Cognition in Type 2 Diabetes from a Life Course Perspective

Background: Type 2 diabetes is linked to several complications which add to both physical and mental distress. Depression is a common co-morbidity of diabetes which can occur both as a cause and a consequence of type 2 diabetes. Depression has been shown to correlate with glucose regulation and treating depression might prove beneficial for glucose regulation as well as for mental well being. Another complication which might affect diabetes management is cognitive decline. Several risk factors and complications of diabetes might modify the risk for developing cognitive impairment, which is increased 1.5 times among subjects with type 2 diabetes. Type 2 diabetes, depression and impaired cognitive performance have all been linked to low birth weight. This thesis aimed to explore the effects and interactions of birth weight, depression and cognitive ability in relation to type 2 diabetes from a life course perspective. Subjects and methods: Studies I, II and V were part of the Helsinki Birth Cohort Study. 2003 subjects participated in an extensive clinical examination at an average age of 61 years. A standard glucose tolerance test (OGTT) was performed and depressive symptoms were assessed using the Beck Depression Inventory (BDI). In addition data was obtained from child welfare clinics and national registers. A subset of the cohort (n=1247) also performed a test on cognitive performance (CogState ®) at the average age of 64. Studies III and IV were randomised clinical trials where mildly depressed diabetic subjects were treated with paroxetine or placebo and the effect on metabolic parameters and quality of life was assessed. The first trial included 14 women and lasted 10 weeks, while the second trial included 43 subjects, both men and women, and lasted 6 months. Results: Type 2 diabetes was positively associated with the occurrence of depressive symptoms. Among diabetic subjects 23.6% had depressive symptoms, compared to 16.7% of subjects with normal glucose tolerance (OR = 1.77, p<0.001). Formal mediation analysis revealed that cardiovascular disease (CVD) is likely to act as a mediator in the association. Furthermore, low birth weight was found to modify the association between type 2 diabetes, CVD and depression. The association between BDI score and having type 2 diabetes or CVD was twice as strong in the subgroup with low birth weight (≤ 2500g) compared with the group with birth weight > 2500g (p for interaction 0.058). In the six months long randomised clinical trial (study IV) paroxetine had a transient beneficial effect on glycosylated haemoglobin A1c (GHbA1c) and quality of life when compared to placebo after three months of treatment. In study V we found that subjects with known diabetes had a consistently poorer level of cognitive performance than subjects with normal glucose tolerance in most of the tested cognitive domains. This effect was further amplified among those born with a small birth weight (p for interaction 0.002). Conclusions: Type 2 diabetes is associated with a higher occurrence of depressive symptoms compared to subjects with normal glucose tolerance. This association is especially strong among subjects with CVD and those born with a low birth weight. Treating depressed diabetic subjects with paroxetine has no long term effect on glucose regulation. Physicians should be aware of depression as an important co-morbidity of type 2 diabetes. Both depression and the cognitive decline often seen among diabetic subjects are increased if the subject is born with a low birth weight. Physicians should recognise low birth weight as an additional risk factor and modifier of diabetic complications.

Vain hätapua? : Taloudellinen avustaminen diakoniatyön professionaalisen itseymmärryksen ilmentäjänä

Financial Help Alone? Financial help as an exponent of professional diaconal work One essential form of helping people in the Evangelical Lutheran Church s diaconal work is providing economic aid. It can be seen as work which is in accordance with the spirit of the Church Order (4:3). One of the tasks of diaconal work, determined by the Church Order, is to help those whose distress is the greatest and who have no other source of help. This financial support has become a permanent and essential working method, which has also created tension of various kinds. Financial support has been criticized, especially when the support has been used to fill a gap in the social services provided by the government. It has been argued that diaconal work has been forced to take on responsibility for tasks that belong to the welfare state. The tensions involved in the financial support of diaconal work do not only concern the patching up and supplementing of the deficiencies in the welfare state s services but also the question of diaconal workers self-understanding of financial support and how it relates to their professionalism. In this thesis, I examine the experiences and visions diaconal workers have concerning financial support in their work with clients. The viewpoint of my work is the diaconal workers own experiences and interpretations of the meaning of financial support in customer service. In the articles of my thesis, I examined the meanings that diaconal workers gave to financial support in the aspects of work motivation, empowerment, expertise and tensions. The research material of my articles consists of three different data, which are theme interviews from diaconal workers, a survey from diaconal workers of Espoo and a diaconal barometer of 2009. I have analysed the theme interviews and the survey using qualitative content analysis. The results of my articles showed that diaconal workers motivation in tasks concerning economic aid was sustained by the nature and spiritual aspects of support activities. Work that supported empowerment through financial assistance meant influencing the client s personal life, community and local ties and structural circumstances of the surrounding society. Diaconal workers expertise in financial support work can be characterised as horizontal, which means that the expertise was built on acknowledging the client s dignity, the uniqueness of the client s life situation and listening to the client s own voice. Diaconal workers were also experts in community and area-based work. The tensions in financial support work are linked to its unofficial and undefined role in the field of social welfare and the inability of other aiding parties to respond to their duties. The results of my thesis on the experiences and visions of financial support reveal that it is multilateral and multidimensional. Diaconal workers used financial support to help the clients, taking into account their individual, communal, social and spiritual context. The professionalism of this financial support is reflectively related to the client s need of help and the spontaneity and unexpectedness of the situation. Support work was deeply bound to diaconal workers experiences of spirituality as the basic value in their work, the foundation of their idea of humanity and their method of helping others. In different tasks of financial support diaconal workers balanced between traditional, individual client work based on caritas and working methods which are based on supporting the individual s empowerment and active citizenship, as in postmodern social work. Diaconal workers experiences of financial support illustrated the transition or turning point in the professionalism of diaconal work, which involves finding one s own, stronger and clearer professional identity than earlier with respect to other helpers in society. Creating a unique identity is part of the empowerment process of diaconal work, in which it must define its professional role by itself. In postmodern pluralism and the fragmented context of diaconal activities, the question arose as to whether the spiritual traditions and traditional values of diaconal work support the modifications and adaptations needed in new, unpredictable situations. Diaconal work is said to be fast to react, able to predict changes and adapt to those changes. To preserve its sensitive reactive ability, also in the complex postmodern world, it must retain its own views and orientations. Otherwise, the distinctive values and traditions of diaconal work might sustain static diaconal work, employee-centeredness and a smug attitude when defining beneficiaries and needs, which highlights the paternalism of diaconal work. Such paternalism may complicate the progress of working methods which are based on empowerment and citizenship.

Biomarkers in acute respiratory failure

Acute respiratory failure (ARF) is the most common type of organ failure leading to the need for intensive care. It is often secondary to acute lung injury (ALI) and its more severe form, acute respiratory distress syndrome (ARDS). ARF, and especially ALI and ARDS, cause increased morbidity, and mortality rates remain high (up to 40%). These disorders are characterised by inflammatory reaction and tissue damage. In some cases, inflammation continues and leads to an overwhelming repair process with ongoing fibrosis, accompanied by organ dysfunction and eventually a loss of function. Measuring the magnitude of the inflammation, and the repair process, would theoretically offer information concerning outcome. Early identification of patients whose disease process is likely to proceed unfavourably, would help clinicians to optimise their treatment. The aim of this study was to evaluate the epidemiology of ARF, its treatment, and outcome in Finland, with special interest in biomarkers, and their value in the prediction of mortality. Altogether, 958 adult patients treated with ventilatory support were prospectively included in this study during an eight week period in 2007 in 25 intensive care units. Plasma aminoterminal pro-brain natriuretic peptide (NT-pro-BNP) was assessed in 602 patients, and plasma cell-free DNA in 580 patients, to evaluate their prognostic value in ARF. Markers of collagen metabolism were studied in longitudinal serum samples in 68 patients in order to evaluate their evolution in ARF and the association to multiple organ dysfunction (MOD). Ventilatory support was used in 39% of all ICU patients. The estimated incidence of ARF was 149.5/100 000 per year. Median tidal volumes used were higher than recommended. Overall mortality at 90 days was 31%. Plasma NT-pro-BNP and cell-free DNA were highly increased in the majority of patients. Both markers were independent predictors of 90-day mortality, but their discriminative power was at most moderate when used separately. The mortality was highest in those patients, in whom both biomarkers were over their separate cut-off values. Thus, combined use of these biomarkers may increase their clinical value in the mortality prediction. The markers of collagen metabolism changed significantly over time in surviving patients. None of these markers did associate with MOD in these patients.

Laboratory studies on the volume change characteristics of kaolinite contaminated with sodium phosphate/sulfate

Reported distress to an industrial structure from phosphate/sulfate contamination of kaolinitic foundation soil at an industrial location in Southern India prompted this laboratory study. The study examines the short-term effect of sodium sulfate/phosphate contamination on the swell/compression characteristics of a commercial kaolinite. Experimental results showed that the unsaturated contaminated kaolinite specimens exhibited slightly higher swell potentials and lower compressions than the unsaturated uncontaminated kaolinite specimens. It is suggested that the larger double layer promoted by the increased exchangeable sodium ion concentration is responsible for the slightly higher swell potentials and lower compressions of the unsaturated contaminated kaolinite specimens.

Efficient syntheses of benzothiazepines as antagonists for the mitochondrial sodium-calcium exchanger: Potential therapeutics for type II diabetes

Type II diabetes mellitus is a chronic metabolic disorder that can lead to serious cardiovascular, renal, neurologic, and retinal complications. While several drugs are currently prescribed to treat type II diabetes, their efficacy is limited by mechanism-related side effects (weight gain, hypoglycemia, gastrointestinal distress), inadequate efficacy for use as monotherapy, and the development of tolerance to the agents. Consequently, combination therapies are frequently employed to effectively regulate blood glucose levels. We have focused on the mitochondrial sodium-calcium exchanger (mNCE) as a novel target for diabetes drug discovery. We have proposed that inhibition of the mNCE can be used to regulate calcium flux across the mitochondrial membrane, thereby enhancing mitochondrial oxidative metabolism, which in turn enhances glucose-stimulated insulin secretion (GSIS) in the pancreatic beta-cell. In this paper, we report the facile synthesis of benzothiazepines and derivatives by S-alkylation using 2-aminobenzhydrols. The syntheses of other bicyclic analogues based on benzothiazepine, benzothiazecine, benzodiazecine, and benzodiazepine templates are also described. These compounds have been evaluated for their inhibition of mNCE activity, and the results from the structure-activity relationship (SAR) studies are discussed.

Effect of lipopolysaccharide on alteration of phospholipids and their fatty acid composition in spleen and thymus by in vitro metabolic labeling

Lipopolysaccharide (LPS) is an endotoxin, a potent stimulator of immune response and induction of LPS leads to acute lung injury (ALI)/acute respiratory distress syndrome (ARDS). ARDS is a life-threatening disease worldwide with a high mortality rate. The immunological effect of LPS with spleen and thymus is well documented; however the impact on membrane phospholipid during endotoxemia has not yet been studied. Hence we aimed to investigate the influence of LPS on spleen and thymus phospholipid and fatty acid composition by 32P]orthophosphate labeling in rats. The in vitro labeling was carried out with phosphate-free medium (saline). Time course, LPS concentration-dependent, pre- and post-labeling with LPS and fatty acid analysis of phospholipid were performed. Labeling studies showed that 50 mu g LPS specifically altered the major phospholipids, phosphatidylcholine and phosphatidylglycerol in spleen and phosphatidylcholine in thymus. Fatty acid analysis showed a marked alteration of unsaturated fatty acids/saturated fatty acids in spleen and thymus leading to immune impairment via the fatty acid remodeling pathway. Our present in vitro lipid metabolic labeling study could open up new vistas for exploring LPS-induced immune impairment in spleen and thymus, as well as the underlying mechanism.

Acute toxicity of Gammalin 20 to Chrysichthys nigrodigitatus (Lacepede)

The impact of acute exposure of Gammalin 20 (an organochlorine pesticide) was investigated in a static bioassay test over a 96-(4-day) period on the fingerlings of Chrysichthys nigrodigitatus (lacepede). The 96-hLC sub(50) of Gammalin 20 was determined as 2.31 Ug/l with lower and upper limits of toxicities as 2.10 and 4.44 Ug/l respectively. At higher concentrations, the colour of the exposed fish became darker, opercular movement slowed down while pigmentation pattern increased and respiratory distress was observed, erratic swimming, tonic convulsion and no response to gentle prodding, and finally death. The implications of these results were discussed with a suggestion of the total ban on the use of Gammalin 20 in capture fisheries due to its harmful and persistence nature in the aquatic environment

Evaluation of toxicity effect of Datura innoxia root extract to Clarias gariepinus fingerlings

Clarias gariepinus fingerlings were exposed 96 hours under laboratory conditions using static bioassays with continuous aeration to determine acute toxicity of Datura innoxia root extract. The LC sub(50) of the exposed fingerlings was 128.83 mg/L. The fish exhibited loss of balance, respiratory distress and swam erratically just prior to death

Toxicity of linear alkylbenene sulphonate (LAS) detergent, to Clarias gariepinus fingerlings

The acute toxicity of Linear Alkylbenzene Sulphonate (LAS) detergent to Clarias gariepinus fingerlings was investigated using static bioassays and continous aeration over a period of 96h. The 96h LC sub(50) was determined as 24.00mgL super(-1). During the exposure period, the test fish exhibited several behavioural changes before death such as restlessness, rapid swimming, loss of balance, respiratory distress and haemorrhaging of gill filaments amongst others. Opercula ventilation rate as well as visual examination of dead fish indicates lethal effects of the detergent on the fish. Water quality examination showed increase in pH from 6.55 to the alkaline, death point of 10.55. There was also a remarkabel rise of alkalinity from 20.00mgL super(-1) to 52.50mgL super(-1)

Da deficiência à diferença: um percurso necessário à subjetivação da criança cega

As reflexões acerca desta pesquisa iniciaram-se tendo como ponto de partida o interesse pelas questões relacionadas às experiências mais primitivas que estão na base da constituição da subjetividade. Pensa-se, tal como alguns autores, que as vivências iniciais de um bebê são bastante importantes para a formação de seu aparato psíquico, sobretudo, as que dizem respeito ao conjunto de sensações nas quais o mesmo está imerso. Mas, então, o que se passa quando o bebê nasce com alguma deficiência em seu aparato sensório-motor, como no caso de bebês cegos de nascença? Sabe-se que as pessoas cegas precisam utilizar outros meios para estabelecer relações com o mundo dos objetos, pessoas e coisas que as cercam, implicando um processo de profunda reorganização perceptiva no qual os estímulos proporcionados pelo ambiente desempenharão um papel fundamental. No entanto, vários estudos apontam que muitas destas crianças cegas desde o nascimento não conseguem se desenvolver de modo harmônico manifestando distúrbios freqüentemente semelhantes ao autismo em crianças videntes, entre outros. Parece que, nestes casos, a incapacidade visual do bebê afetou profundamente as capacidades de vínculo com as figuras de apego e este fato originou seqüelas importantes na evolução da criança. No outro extremo, bebês que conseguiram um nível de desenvolvimento adequado, mostraram vínculos saudáveis com a família, em especial com a mãe. Assim, a finalidade da presente pesquisa prende-se, por um lado, à compreensão do caminho percorrido por crianças que não contam com o auxílio do sentido da visão e, por outro, ao entendimento do papel dos primeiros vínculos tanto para os casos de saúde quanto para os casos em que a patologia e o sofrimento psíquico surgem.

Queimadura autoinfligida em mulheres: a violência de gênero inscrita no corpo

O objeto deste estudo consiste na violência autoinfligida em mulheres por queimadura. As lesões por queimadura são consideradas causas externas (acidentes e violências) e tem contribuído para o aumento geral dos índices de morbimortalidade acarretando perda de anos de vida produtiva. São resultantes de múltiplos fatores como condições socioeconômicas, violências e desigualdade de gênero. Esta pesquisa teve como objetivos: analisar o perfil sociodemográfico das mulheres que vivenciaram queimadura autoinfligida; descrever as circunstâncias e o contexto social relacionados à queimadura autoinfligida em mulheres; analisar os fatores motivadores da queimadura autoinfligida em mulheres; e, discutir a queimadura autoinfligida em mulheres na perspectiva de gênero. Trata-se de uma pesquisa de abordagem qualitativa e exploratória. Os cenários da pesquisa foram dois Centros de Tratamento de Queimados (Municipal e Federal) localizados no Estado do Rio de Janeiro. Os sujeitos do estudo foram 10 mulheres com história de queimadura autoinfligida e que não tivessem história de tentativa de suicídio anterior e diagnóstico de sofrimento psíquico, uma vez que estas situações poderiam comprometer a análise das vivências de violência. A coleta de dados foi realizada através de entrevista semi-estruturada, com roteiro previamente elaborado, no período de novembro de 2009 a março de 2010. Os dados foram analisados através da técnica de Análise de Conteúdo de Bardin, tendo emergido duas categorias: a) A vida da depoente antes da queimadura: percepção da sua condição pessoal; relações familiares envolvendo mãe, pai, avós, irmãos e filhos; relações sociais e relação com o companheiro; b) Queimadura autoinfligida em mulheres: uma questão de violência de gênero: fatores motivadores da queimadura autoinfligida na perspectiva da mulher e queimadura autoinfligida como desfecho da vivência de violência conjugal. As participantes do estudo caracterizavam-se por ter uma vida, anterior ao evento da queimadura, marcada pela violência na relação familiar e, principalmente, com o parceiro. A constante vivência de violência presente na relação com o parceiro, manifestadas por diferentes expressões (físicas, sexuais e psicológicas) resultou em intenso sofrimento que culminou na queimadura autoinfligida. Ficou evidenciado que a queimadura autoinfligida, no grupo estudado foi uma tentativa de interromper com a violência de gênero vivenciada. A escolha pelo fogo foi justificada pelas mulheres como um elemento capaz de produzir maior letalidade e ser de fácil acesso no ambiente doméstico. As mulheres afirmam que o evento da queimadura autoinfligida promoveu transformações em suas vidas. Nos agravos à saúde da mulher, em especial na violência autoinfligida por queimaduras, é relevante considerar as questões de gênero como estratégia de ação e ampliação das práticas de cuidado.