Perinatal mortality and maternal health in rural China

Background and context Since the economic reforms of 1978, China has been acclaimed as a remarkable economy, achieving 9% annual growth per head for more than 25 years. However, China's health sector has not fared well. The population health gains slowed down and health disparities increased. In the field of health and health care, significant progress in maternal care has been achieved. However, there still remain important disparities between the urban and rural areas and among the rural areas in terms of economic development. The excess female infant deaths and the rapidly increasing sex ratio at birth in the last decade aroused serious concerns among policy makers and scholars. Decentralization of the government administration and health sector reform impacts maternal care. Many studies using census data have been conducted to explore the determinants of a high sex ratio at birth, but no agreement has been so far reached on the possible contributing factors. No study using family planning system data has been conducted to explore perinatal mortality and sex ratio at birth and only few studies have examined the impact of the decentralization of government and health sector reforms on the provision and organization of maternal care in rural China. Objectives The general objective of this study was to investigate the state of perinatal health and maternal care and their determinants in rural China under the historic context of major socioeconomic reforms and the one child family planning policy. The specific objectives of the study included: 1) to study pregnancy outcomes and perinatal health and their correlates in a rural Chinese county; 2) to examine the issue of sex ratio at birth and its determinants in a rural Chinese county; 3) to explore the patterns of provision, utilization, and content of maternal care in a rural Chinese county; 4) to investigate the changes in the use of maternal care in China from 1991 to 2003. Materials and Methods This study is based on a project for evaluating the prenatal care programme in Dingyuan county in 1999-2003, Anhui province, China and a nationwide household health survey to describe the changes in maternal care utilization. The approaches used included a retrospective cohort study, cross sectional interview surveys, informant interviews, observations and the use of statistical data. The data sources included the following: 1) A cohort of pregnant women followed from pregnancy up to 7 days after birth in 20 townships in the study county, collecting information on pregnancy outcomes using family planning records; 2) A questionnaire interview survey given to women who gave birth between 2001 and 2003; 3) Various statistical and informant surveys data collected from the study county; 4) Three national household health interview survey data sets (1993-2003) were utilized, and reanalyzed to described the changes in maternity care utilization. Relative risks (RR) and their confidence intervals (CI) were calculated for comparison between parity, approval status, infant sex and township groups. The chi-square test was used to analyse the disparity of use of maternal care between and within urban and rural areas and its trend across the years in China. Logistic regression was used to analyse the factors associated with hospital delivery in rural areas. Results There were 3697 pregnancies in the study cohort, resulting in 3092 live births in a total population of 299463 in the 20 study townships during 1999-2000. The average age at pregnancy in the cohort was 25.9 years. Of the women, 61% were childless, 38% already had one child and 0.3% had two children before the current pregnancy. About 90% of approved pregnancies ended in a live birth while 73% of the unapproved ones were aborted. The perinatal mortality rate was 69 per thousand births. If the 30 induced abortions in which the gestational age was more than 28 weeks had been counted as perinatal deaths, the perinatal mortality rate would have been as high as 78 per thousand. The perinatal mortality rate was negatively associated with the wealth of the township. Approximately two thirds of the perinatal deaths occurred in the early neonatal period. Both the still birth rate and the early neonatal death rate increased with parity. The risk of a stillbirth in a second pregnancy was almost four times that for a first pregnancy, while the risk of early neonatal deaths doubled. The early neonatal mortality rate was twice as high for female as for male infants. The sex difference in the early neonatal mortality rate was mainly attributable to mortality in second births. The male early neonatal mortality rate was not affected by parity, while the female early neonatal mortality rate increased dramatically with parity: it was about six times higher for second births than for first births. About 82% early neonatal deaths happened within 24 hours after birth, and during that time, girls were almost three times more likely to die than boys. The death rate of females on the day of birth increased much more sharply with parity than that of males. The total sex ratio at birth of 3697 registered pregnancies was 152 males to 100 females, with 118 and 287 in first and second pregnancies, respectively. Among unapproved pregnancies, there were almost 5 live-born boys for each girl. Most prenatal and delivery care was to be taken care of in township hospitals. At the village level, there were small private clinics. There was no limitation period for the provision of prenatal and postnatal care by private practitioners. They were not permitted to provide delivery care by the county health bureau, but as some 12% of all births occurred either at home or at private clinics; some village health workers might have been involved. The county level hospitals served as the referral centers for the township hospitals in the county. However, there was no formal regulation or guideline on how the referral system should work. Whether or not a woman was referred to a higher level hospital depended on the individual midwife's professional judgment and on the clients' compliance. The county health bureau had little power over township hospitals, because township hospitals had in the decentralization process become directly accountable to the township government. In the township and county hospitals only 10-20% of the recurrent costs were funded by local government (the township hospital was funded by the township government and the county hospital was funded by the county government) and the hospitals collected user fees to balance their budgets. Also the staff salaries depended on fee incomes by the hospital. The hospitals could define the user charges themselves. Prenatal care consultations were however free in most township hospitals. None of the midwives made postnatal home visits, because of low profit of these services. The three national household health survey data showed that the proportion of women receiving their first prenatal visit within 12 weeks increased greatly from the early to middle 1990s in all areas except for large cities. The increase was much larger in the rural areas, reducing the urban-rural difference from more than 4 times to about 1.4 times. The proportion of women that received antenatal care visits meeting the Ministry of Health s standard (at least 5 times) in the rural areas increased sharply from 12% in 1991-1993 to 36% in 2001-2003. In rural areas, the proportion increase was much faster in less developed areas than in developed areas. The hospital delivery rate increased slightly from 90% to 94% in urban areas while the proportion increased from 27% to 69% in rural areas. The fastest change was found to be in type 4 rural areas, where the utilization even quadrupled. The overall difference between rural and urban areas was substantially narrowed over the period. Multiple logistic regression analysis shows that time periods, residency in rural or urban areas, income levels, age group, education levels, delivery history, occupation, health insurance and distance from the nearest health care facilities were significantly associated with hospital delivery rates. Conclusions 1. Perinatal mortality in this study was much higher than that for urban areas as well as any reported rate from specific studies in rural areas of China. Previous studies in which calculations of infant mortality were not based on epidemiological surveys have been shown to underestimate the rates by more than 50%. 2. Routine statistics collected by the Chinese family planning system proved to be a reliable data source for studying perinatal health, including still births, neonatal deaths, sex ratio at birth and among newborns. National Household Health Survey data proved to be a useful and reliable data source for studying population health and health services. Prior to this research there were few studies in these areas available to international audiences. 3.Though perinatal mortality rate was negatively associated with the level of township economic development, the excess female early neonatal mortality rate contributed much more to high perinatal mortality rate than economic factors. This was likely a result of the role of the family planning policy and the traditional preferences for sons, which leads to lethal neglect of female newborns and high perinatal mortality. 4. The selective abortions of female foetuses were likely to contribute most to the high sex ratio at birth. The underreporting of female births seemed to have played a secondary role. The higher early neonatal mortality rate in second-born as compared to first-born children, particularly in females, may indicate that neglect or poorer care of female newborn infants also contributes to the high sex ratio at birth or among newborns. Existing family planning policy proved not to effectively control the steadily increased birth sex ratio. 5. The rural-urban gap in service utilization was on average significantly narrowed in terms of maternal healthcare in China from 1991 to 2003. This demonstrates that significant achievements in reducing inequities can be made through a combination of socio-economic development and targeted investments in improving health services, including infrastructure, staff capacities, and subsidies to reduce the costs of service utilization for the poorest. However, the huge gap which persisted among cities of different size and within different types of rural areas indicated the need for further efforts to support the poorest areas. 6. Hospital delivery care in the study county was better accepted by women because most of women think delivery care was very important while prenatal and postnatal care were not. Hospital delivery care was more systematically provided and promoted than prenatal and postnatal care by township hospital in the study area. The reliance of hospital staff income on user fees gave the hospitals an incentive to put more emphasis on revenue generating activities such as delivery care instead of prenatal and postnatal care, since delivery care generated much profits than prenatal and postnatal care . Recommendations 1. It is essential for the central government to re-assess and modify existing family planning policies. In order to keep national sex balance, the existing practice of one couple one child in urban areas and at-least-one-son a couple in rural areas should be gradually changed to a two-children-a-couple policy throughout the country. The government should establish a favourable social security policy for couples, especially for rural couples who have only daughters, with particular emphasis on their pension and medical care insurance, combined with an educational campaign for equal rights for boys and girls in society. 2. There is currently no routine vital-statistics registration system in rural China. Using the findings of this study, the central government could set up a routine vital-statistics registration system using family planning routine work records, which could be used by policy makers and researchers. 3. It is possible for the central and provincial government to invest more in the less developed and poor rural areas to increase the access of pregnant women in these areas to maternal care services. Central government together with local government should gradually provide free maternal care including prenatal and postnatal as well as delivery care to the women in poor and less developed rural areas. 4. Future research could be done to explore if county and the township level health care sector and the family planning system could be merged to increase the effectiveness and efficiency of maternal and child care. 5. Future research could be done to explore the relative contribution of maternal care, economic development and family planning policy on perinatal and child health using prospective cohort studies and community based randomized trials. Key words: perinatal health, perinatal mortality, stillbirth, neonatal death, sex selective abortion, sex ratio at birth, family planning, son preference, maternal care, prenatal care, postnatal care, equity, China

A Shared European History? Perceptions of Imperialism and Islam in Matriculation Examination Essays and History Textbooks

The European Union (EU) is faced with a continuous decrease in public support. There is a tension between the growing Euroscepticism and the concurrent academic discourse of a shared European identity. Informed and inspired by the current debates, this Master’s Thesis investigates the potential of a shared past to create shared identity. It also addresses the logic of cultural exclusion that is often connected to collective cultural identities. The source material is a combination of exam essays, written as answers to the history tests in the Finnish matriculation examinations of 2005-2008, and upper secondary school history textbooks. From the sources, current perceptions of Islam (as Europe’s Other) and the age of imperialism (as a debated period from Europe’s past) among the youth are studied. Through the analysis the thesis aims to indicate the level of consensus within the pupils’ identification with the past and with Europe. This objective is pursued through examining the pupils’ perceptions of Europe’s past and its relationship to non-European cultures and countries as they are manifested in the essays, and reflecting upon the level of influence that history textbooks as representatives of national hegemonic historical narratives might have on the contents, framings and emphases with and through which the pupils approach, imagine, and reproduce Europe’s past. The approach is based on previous research on the presence of history and the field of textbook research. The theoretical categories with which the sources are analyzed are derived primarily from literature on identity, European integration, history and memory, postcolonial criticism, and theorizations of European identity. Results of the research project suggest that the rhetoric of European superiority, despite its apparent demise, still resonates in contemporary understandings of Europeanness. Dominant perceptions of imperialism comprise of European agency and colonial submission, dominant perceptions of the Islamic world of fundamental difference. Identification with European history among the Finnish youth is rather shallow when examined through perceptions of imperialism; the Islamic world is perceived as Other and its representations are dominated by recent and contemporary international relations.

Bridging East and West : The Establishment of the International Institute for Applied Systems Analysis (IIASA) in the United States Foreign Policy of Bridge Building, 1964-1972.

The dissertation examines the foreign policies of the United States through the prism of science and technology. In the focal point of scrutiny is the policy establishing the International Institute for Applied Systems Analysis (IIASA) and the development of the multilateral part of bridge building in American foreign policy during the 1960s and early 1970s. After a long and arduous negotiation process, the institute was finally established by twelve national member organizations from the following countries: Bulgaria, Canada, Czechoslovakia, Federal Republic of Germany (FRG), France, German Democratic Republic (GDR), Great Britain, Italy, Japan, Poland, Soviet Union and United States; a few years later Sweden, Finland and the Netherlands also joined. It is said that the goal of the institute was to bring together researchers from East and West to solve pertinent problems caused by the modernization process experienced in industrialized world. It originates from President Lyndon B. Johnson s bridge building policies that were launched in 1964, and was set in a well-contested and crowded domain of other international organizations of environmental and social planning. Since the distinct need for yet another organization was not evident, the process of negotiations in this multinational environment enlightens the foreign policy ambitions of the United States on the road to the Cold War détente. The study places this project within its political era, and juxtaposes it with other international organizations, especially that of the OECD, ECE and NATO. Conventionally, Lyndon Johnson s bridge building policies have been seen as a means to normalize its international relations bilaterally with different East European countries, and the multilateral dimension of the policy has been ignored. This is why IIASA s establishment process in this multilateral environment brings forth new information on US foreign policy goals, the means to achieve these goals, as well as its relations to other advanced industrialized societies before the time of détente, during the 1960s and early 1970s. Furthermore, the substance of the institute applied systems analysis illuminates the differences between European and American methodological thinking in social planning. Systems analysis is closely associated with (American) science and technology policies of the 1960s, especially in its military administrative applications, thus analysis within the foreign policy environment of the United States proved particularly fruitful. In the 1960s the institutional structures of European continent with faltering, and the growing tendencies of integration were in flux. One example of this was the long, drawn-out process of British membership in the EEC, another is de Gaulle s withdrawal from NATO s military-political cooperation. On the other hand, however, economic cooperation in Europe between East and West, and especially with the Soviet Union was expanding rapidly. This American initiative to form a new institutional actor has to be seen in that structural context, showing that bridge building was needed not only to the East, but also to the West. The narrative amounts to an analysis of how the United States managed both cooperation and conflict in its hegemonic aspirations in the emerging modern world, and how it used its special relationship with the United Kingdom to achieve its goals. The research is based on the archives of the United States, Great Britain, Sweden, Finland, and IIASA. The primary sources have been complemented with both contemporary and present day research literature, periodicals, and interviews.

The Reception of the Maccabean Martyrs : Their Historiographical and Paradigmatic Functions in Antique and Late-antique Jewish and Christian Sources

The study attempts a reception-historical analysis of the Maccabean martyrs. The concept of reception has fundamentally to do with the re-use and interpretation of a text within new texts. In a religious tradition, certain elements become re-circulated and thus their reception may reflect the development of that particular tradition. The Maccabean martyrs first appear in 2 Maccabees. In my study, it is the Maccabean martyr figures who count as the received text; the focus is shifted from the interrelations between texts onto how the figures have been exploited in early Christian and Rabbinic sources. I have divided my sources into two categories and my analysis is in two parts. First, I analyze the reception of the Maccabean martyrs within Jewish and Christian historiographical sources, focusing on the role given to them in the depictions of the Maccabean Revolt (Chapter 3). I conclude that, within Jewish historiography, the martyrs are given roles, which vary between ultimate efficacy and marginal position with regard to making a historical difference. In Christian historiographical sources, the martyrs role grows in importance by time: however, it is not before a Christian cult of the Maccabean martyrs has been established, that the Christian historiographies consider them historically effective. After the first part, I move on to analyze the reception in sources, which make use of the Maccabean martyrs as paradigmatic figures (Chapter 4). I have suggested that the martyrs are paradigmatic in the context of martyrdom, persecution and destruction, on one hand, and in a homiletic context, inspiring religious celebration, on the other. I conclude that, as the figures are considered pre-Christian and biblical martyrs, they function well in terms of Christian martyrdom and have contributed to the development of its ideals. Furthermore, the presentation of the martyr figures in Rabbinic sources demonstrates how the notion of Jewish martyrdom arises from experiences of destruction and despair, not so much from heroic confession of faith in the face of persecution. Before the emergence of a Christian cult of the Maccabean martyrs, their identity is derived namely from their biblical position. Later on, in the homiletic context, their Jewish identity is debated and sometimes reconstructed as fundamentally Christian , despite of their Jewish origins. Similar debate about their identity is not found in the Rabbinic versions of their martyrdom and nothing there indicates a mutual debate between early Christians and Jews. A thematic comparison shows that the Rabbinic and Christian cases of reception are non-reliant on each other but also that they link to one another. Especially the scriptural connections, often made to the Maccabean mother, reveal the similarities. The results of the analyses confirm that the early history of Christianity and Rabbinic Judaism share, at least partly, the same religious environment and intertwining traditions, not only during the first century or two but until Late Antiquity and beyond. More likely, the reception of the Maccabean martyrs demonstrates that these religious traditions never ceased to influence one another.

Chromium isotope variations (delta Cr-53/52) in mantle-derived sources and their weathering products: Implications for environmental studies and the evolution of delta Cr-53/52 in the Earth's mantle over geologic time

Here we report chromium isotope compositions, expressed as delta Cr-53/ 52 in per mil (&) relative to NIST 979, measured in selected Cr-rich minerals and rocks formed by the primary magmatic as well as the secondary metamorphic and weathering processes. The main objectives of this study were: (i) to further constrain the isotope composition of the Earth's mantle Cr inventory and its possible variation during geological history, based on the analysis of globally distributed and stratigraphically constrained mantle-derived chromites; and (ii) to investigate the magnitude and systematics of Cr isotope fractionation during oxidative weathering and secondary alteration (i. e., hydration, serpentinization) of the magmatic Cr sources. Specifically, we analyzed delta Cr-53/ 52 in a set of globally distributed mantle-derived chromites (FeMgCr2O4, n = 30) collected from various locations in Europe, Asia, Africa and South America, and our results confirm that a chromite-hosted Earth's mantle Cr inventory is uniform at - 0.079 +/- 0.129& (2SD), which we named here as a ` canonical' mantle d 53/ 52 Cr signature. Furthermore our dataset of stratigraphically constrained chromites, whose crystallization ages cover most of the Earth's geological history, indicate that the bulk Cr isotope composition of the chromite-hosted mantle inventory has remained uniform, within about +/- 0.100&, since at least the Early Archean times (similar to 3500 million years ago, Ma). To investigate the systematics of Cr isotope fractionation associated with alteration processes we analyzed a number of secondary Cr-rich minerals and variably altered ultramafic rocks (i. e., serpentinized harzburgites, lherzolites) that revealed large positive delta Cr-53/ 52 anomalies that are systematically shifted to higher values with an increasing degree of alteration and serpentinization. The degree of aqueous alteration and serpentinization was quantified by the abundances of fluid-mobile (Rb, K) elements, and by the Loss On Ignition (LOI) parameter, which determines the amount of structurally bound water (OH/ H2O) present in secondary hydrated minerals like serpentine. Overall, we observed that altered ultramafic rocks that yielded the highest LOI values, and the lowest amounts of fluid mobile elements, also yielded the heaviest delta Cr-53/ 52 signatures. Therefore, we conclude that secondary alteration (i.e., hydration, serpentinization) of ultramafic rocks in near-surface oxidative environments tend to shift the bulk Cr isotope composition of the weathered products to isotopically heavier values, pointing to a dynamic redox cycling of Cr in the Earth's crustal and near-surface environments. Hence, if validated by future

Peces continentales de la Argentina: Iconografía. Gymnocharacinus bergii.

Espanol: Este trabajo tiene como objetivo la recopilación de dibujos y diferentes figuras de las especies presentes en nuestro territorio. Para ello, hemos utilizado como principales fuentes de información la obra de Ringuelet et al. (1967), Reis et al. (2003), López et al. (2003; 2006) y las bases de datos on-line de W. N. Eschmeyer y Fish Base. El tratamiento incluye una ficha individual con imágenes seleccionadas de la especie tratada y las que eventualmente hayan surgido por trabajos de índole anatómica. Se adjuntan las referencias de los trabajos utilizados en la confección de cada ficha. Esta es una publicación abierta, por lo que requerirá de actualización permanente, para lo cual sería necesario se sume a nuestra tarea la buena voluntad y colaboración de la comunidad ictiológica. Los compiladores entendemos que esta contribución, además de aportar valiosa información, rescata el trabajo de mujeres y hombres que son parte de la rica historia de la ictiología nacional y regional. (Texto en Espanol y PDF tiene viente dos paginas) English: The goal of this work is to present a collection of drawings and figures depicting the species present in our country. To achieve this, our main sources of information have been the works of Ringuelet et al. (1967), Reis et al. (2003), and López et al. (2003; 2006), as well as the online databases of W. N. Eschmeyer and Fish Base. Each species has an individual factsheet with selected images, including some from anatomical research works. All the works referenced are mentioned in each factsheet. This is an open-ended publication. As such, it will require permanent updating, which will depend on the good will and collaboration of the ichthyological community. As compilers, we understand that this contribution not only provides valuable information, but also highlights the work of men and women who are part of the rich history of our national and regional ichthyology. (Text is in Spanish. PDF contains 22 pages.)

Peces continentales de la Argentina: Iconografía. Lepidosiren paradoza.

Spanish: Este trabajo tiene como objetivo la recopilación de dibujos y diferentes figuras de las especies presentes en nuestro territorio. Para ello, hemos utilizado como principales fuentes de información la obra de Ringuelet et al. (1967), Reis et al. (2003), López et al. (2003; 2006) y las bases de datos on-line de W. N. Eschmeyer y Fish Base. El tratamiento incluye una ficha individual con imágenes seleccionadas de la especie tratada y las que eventualmente hayan surgido por trabajos de índole anatómica. Se adjuntan las referencias de los trabajos utilizados en la confección de cada ficha. Esta es una publicación abierta, por lo que requerirá de actualización permanente, para lo cual sería necesario se sume a nuestra tarea la buena voluntad y colaboración de la comunidad ictiológica. Los compiladores entendemos que esta contribución, además de aportar valiosa información, rescata el trabajo de mujeres y hombres que son parte de la rica historia de la ictiología nacional y regional. English: The goal of this work is to present a collection of drawings and figures depicting the species present in our country. To achieve this, our main sources of information have been the works of Ringuelet et al. (1967), Reis et al. (2003), and López et al. (2003; 2006), as well as the online databases of W. N. Eschmeyer and Fish Base. Each species has an individual factsheet with selected images, including some from anatomical research works. All the works referenced are mentioned in each factsheet. This is an open-ended publication. As such, it will require permanent updating, which will depend on the good will and collaboration of the ichthyological community. As compilers, we understand that this contribution not only provides valuable information, but also highlights the work of men and women who are part of the rich history of our national and regional ichthyology. (Texto en espanol y PDF tiene cuatorce paginas.)

Peces continentales de la Argentina: Iconografía. Brycon orbignyanus.

The goal of this work is to present a collection of drawings and figures depicting the species present in our country. To achieve this, our main sources of information have been the works of Ringuelet et al. (1967), Reis et al. (2003), and López et al. (2003; 2006), as well as the online databases of W. N. Eschmeyer and Fish Base. Each species has an individual factsheet with selected images, including some from anatomical research works. All the works referenced are mentioned in each factsheet. This is an open-ended publication. As such, it will require permanent updating, which will depend on the good will and collaboration of the ichthyological community. As compilers, we understand that this contribution not only provides valuable information, but also highlights the work of men and women who are part of the rich history of our national and regional ichthyology.

An assessment of the implementation of alternative income sources for fishermen's wives as a strategy for poverty alleviation under the Kainji Lake Fisheries Promotion Project

Kainji Lake Basin is the first man-made Lake in Nigeria with a surface area of 1270km super(2). Since its creation in 1968 research activities were carried out on biological, socio-economic, hydrological and limnological characteristics of the water body. Extension activities concentrated on the dissemination of proven technologies developed by the Research scientists. Most of the socio-economic and extension activities focused on fishermen as women were regarded as homemakers and their activities concentrated in the home. The situation is even compounded by the Islamic injunction of seclusion. The intervention of NGKLFPP in 1993 has introduced many changes into the research and extension activities directed at the beneficiaries of the project because women were considered as a major stakeholder around the Lake area. The intervention of the project in Kainji Lake in the introduction of alternative income generating activities to women is enumerated in this paper. The intervention has improved the living standard of women and to a certain level reduced poverty among women in the area

Lessons from History for Transitions to a Low Carbon Economy

4 p.

The Demand for Environmental Quality in Driving Transitions to Low Polluting Energy Sources

38 p.

Sexualidade e gênero na Amazônia urbana do Peru

O tema da sexualidade na região amazônica do Peru tem sido objeto de diversas elaborações discursivas desde os tempos coloniais, destacando-se certas ideias, como intensidade e desordem. Tais concepções sedimentaram-se em representações de ampla difusão e permanência no país, sendo a charapa ardiente, representação hipersexualizada da mulher amazônica, a mais paradigmática. A existência desses discursos e a escassez de literatura acadêmica sobre o tema da sexualidade nesta região motivaram esta pesquisa, que objetivou explorar o lugar da sexualidade na construção de si, entre mulheres da Amazônia urbana do Peru. Para tal foi efetuada uma revisão de fontes secundárias, dirigida a rastrear a origem desta representação e sua recriação, na história do país. A seguir, a partir de informações obtidas em entrevistas em profundidade com mulheres da região investigada, foram exploradas suas opiniões acerca desta representação e a maneira como lidam com ela, em circunstâncias concretas da vida cotidiana. Os relatos evidenciaram tanto processos de negação como de reprodução e resignificação, em um jogo complexo e flexível, que varia de acordo com o contexto em que as mulheres se encontram. Por outro lado, foram apreendidas as trajetórias afetivo-sexuais das informantes, por intermédio de entrevistas em profundidade, a partir de indagações sobre diversos temas, como iniciação sexual, infidelidade feminina, valoração da atividade sexual e trocas econômico-sexuais, entre outros. Foram identificados eixos estruturantes da vida sexual destas mulheres. Destaca-se um discurso relacional, que enaltece a reciprocidade como marco da vida sexual e, em segundo plano, comparece também uma retórica fisicalista, que considera a atividade sexual como necessidade corporal. Por fim, o estudo evidenciou um importante papel da sexualidade como recurso feminino, no plano econômico, em estreita articulação com dimensões afetivas e considerações familiares. Trata-se de trocas econômico-sexuais que integram a dinâmica cotidiana de reciprocidade nos vínculos afetivo-sexuais.

A Percepção do usuário de drogas sobre o mundo do trabalho: uma contribuição para a prática do enfermeiro

Estudo qualitativo, com base na Análise de Conteúdo, a partir da interrogação sobre como o usuário de drogas em situação de tratamento para a dependência química percebe-se como trabalhador, e qual sua relação com o mundo do trabalho. O referencial teórico apoiou-se nas definições de drogas psicotrópicas, dependência química e trabalho, das seguintes fontes, respectivamente, Organização das Nações Unidas (ONU), Classificação Internacional das Doenças (CID-10) e Ministério do Trabalho (MT) e a teoria da Psicodinâmica do trabalho. A metodologia baseou-se na Análise de Conteúdo Temática. A coleta de dados desenvolveu-se por meio de entrevistas em profundidade, e pela obtenção de dados sociodemográficos e de trabalho a partir dos registros. Foram realizadas trinta e oitos entrevistas semi estruturadas com dez mulheres, quatorze homens usuários de múltiplas drogas e quatorze homens usuários somente de bebidas alcoólicas. Todos os sujeitos eram trabalhadores em tratamento no Centro de Atenção Psicossocial-álcool e drogas Centro Estadual de Tratamento e Reabilitação de Adictos (Caps-ad CENTRA-RIO). Foram organizadas e analisadas seis categorias: conciliação ente o trabalho e o consumo de drogas; trabalho e angústia; o mundo do trabalho favorecendo/estimulando o consumo; beneficio e UD; trabalho pleno; perspectivas de vida do UD. Discutiu-se a intensa relação de sofrimento que permeia o tempo todo o trabalhador usuário de drogas, as diversas alternativas experimentadas para conseguir conciliar o binômio trabalho e drogas, a submissão aos valores construídos no ambiente de trabalho, a função de integradora intragrupo dos trabalhadores e terapêutica das drogas para conseguir cumprir o trabalho real, sua função relaxante e domadora da angústia e do medo. Nas conclusões, discutem-se os limites do mundo do trabalho em acompanhar a evolução do campo da saúde mental e a Reforma Psiquiátrica, e a importância para a enfermagem do trabalho. O enfermeiro deve ser o articulador para que este trabalhador usuário de drogas atue como protagonista ativo da sua própria história, contribuindo com sua experiência, para que os profissionais de saúde, o trabalho e a sociedade em geral aperfeiçoem formas de cuidar integral.

Frances E. W. Harper and Pauline E. Hopkins: the uplifting of black women through literature

A presente dissertação tem como objetivo apresentar duas influentes autoras afro-americanas do século XIX, Frances E. W. Harper e Pauline E. Hopkins. Ambas as autoras, através de seus romances Iola Leroy, or, Shadows Uplifted (1892) e Contending Forces: a Romance Illustrative of Negro Life North and South (1900) respectivamente, entrelaçam ficção e história com o propósito de criar novas alternativas de discurso, afastando-se, portanto, do oficial. Ademais, o presente trabalho propõe demonstrar como Frances Harper e Pauline Hopkins fazem uso do espaço literário com a finalidade de escrever a história do oprimido, permitindo, principalmente, que as mulheres afro-americanas dessem voz as suas experiências e as suas próprias histórias. Assim sendo, a literatura produzida por Frances e Harper e Pauline Hopkins será analisada como forma de empoderamento da comunidade afro-americana, principalmente como forma de aquisição de poder para as Mulheres Afro-Americanas.