Latin American Forensic Odontology: A Scoping Review of its Current Research and the Objective/Subjective Nature of its Studies

SUMMARY: The new paradigm in Forensic Sciences initiated by the entry of genetics (the current standard of legal evidence) and accentuated by recognized wrongful convictions derived from experts today in the eye of criticism, has highlighted the potential for bias and error in forensic disciplines when they depend on human interpretation and subjectivity, which has not been avoided by Forensic Odontology (FO). However, a subjective judgment is not necessarily wrong, so the refinement of processes, the development of standards, and robust research can contribute to the validity of interpretation to increase objectivity. Latin America (LATAM) has its own realities and needs, which have conditioned the priorities and objectives of FO research. A scoping review is presented to systematically map the investigation of LATAM researchers and identify the objective or subjective nature of their assessments. LATAM shows interesting productivity and intentions to adhere to international standards, with Brazil leading this research significantly, followed by Chile and Colombia, among others. However, there is a disproportionate approach in certain lines of research (dental age estimation), and needs to address other quantitative studies, and to improve the visibility of the LATAM FO research.

El nuevo paradigma en ciencias forenses iniciado por la entrada de la genética (el actual estándar de la evidencia jurídica), y acentuado por reconocidas condenas injustas derivadas de pericias hoy en el ojo de la crítica, ha destacado el potencial de sesgo y error que poseen algunas disciplinas forenses cuando dependen de la interpretación humana y la subjetividad, lo cual no ha sido ajeno a la odontología forense (OF). Sin embargo, un juicio subjetivo no necesariamente es erróneo, con lo que el refinamiento de procesos, el desarrollo de estándares y la investigación robusta pueden contribuir a validar esa interpretación para aumentar su objetividad. Latinoamérica (LATAM) posee realidades y necesidades propias que han condicionado las prioridades y objetivos de la investigación en OF. Se presenta una revisión con búsqueda sistemática para mapear sistemáticamente la investigación en OF realizada por investigadores latinoamericanos, así como identificar la naturaleza objetiva o subjetiva de sus evaluaciones. LATAM demuestra una productividad interesante e intenciones de adherirse a estándares internacionales, con Brasil liderando significativamente esta investigación, seguido por Chile y Colombia entre otros. Sin embargo, se observa un enfoque desproporcionado en ciertas líneas de investigación (estimación de edad dental particularmente), y necesidad tanto de abordar otros estudios cuantitativos como de mejorar la visibilidad de la investigación latinoamericana en OF.

La educación basada en la comunidad desde las percepciones de estudiantes: un estudio cualitativo / Community-Based Education from the students' perceptions: a qualitative study

Introducción. La Universidad del Norte Santo Tomás de Aquino (UNSTA) presenta como nueva oferta de grado la carrera de medicina, que enfatiza un enfoque orientado a la familia y la comunidad. El programa de estudio incorpora la educación basada en la comunidad (EBC), desde el primer al último ciclo de la carrera. Objetivos. Indagar acerca de las percepciones que los estudiantes que cursaron el primer año de medicina en la UNSTA tienen acerca de sus experiencias en EBC y caracterizar la valoración que le otorgan al contacto precoz con la comunidad. Material y métodos. Estudio cualitativo, paradigma hermenéutico. Modo de generación conceptual, método de análisis de la teoría fundamentada a partir de entrevistas en profundidad. Resultados. Según la percepción de estudiantes, la EBC permite abrir la cabeza (descubrir otras realidades, chocarse con otros contextos, construir otra idea de médico); significa nutrirse de la práctica temprana (tener una marca para toda la carrera, salirse del libro, aprender de la salud pública local, conocer a un esencial invisible, valorar los diagnósticos de situación locales, sentirse parte y ponerse el delantal); posibilita aprender más allá de la medicina (generar un estudio más reflexivo, vivir el trabajo en equipo, mejorar las habilidades comunicacionales, entender a la persona como un todo e iniciar un compromiso social). Conclusiones. Los hallazgos subrayan los numerosos beneficios de un plan de estudio que integre la EBC desde el principio. No solo fomenta el aprendizaje reflexivo, sino que también facilita un proceso clínico centrado en la persona y su contexto, iniciando así un compromiso social. (AU)

Background. Universidad del Norte Santo Tomás de Aquino (UNSTA) introduces a new medicine degree program. The graduate profile will be that of a general practitioner with family and community orientation. The study program incorporates community-based education (CBE) from the first to the last cycle of the program. Objectives. To investigate the perceptions that students who completed the first year of medicine at UNSTA have about their experiences at CBE and to characterize the value they give to early contact with the community. Material and methods. Qualitative study, hermeneutic paradigm, conceptual generation mode, grounded theory analysis based on in-depth interviews. Results. According to the perception of students, CBE allows us to open our minds (to discover other realities, encounter other contexts, and build another idea of a medical doctor); it means being nourished by early practice (having a mark for the entire career, going outside the book, learning from local public health, getting to know an invisible essential, valuing local situation diagnoses, feeling a part and putting on the apron); it makes it possible to learn beyond medicine (to generate a more reflective study, to experience teamwork, to improve communication skills, to understand the person as a who leand to initiate a social commitment). Conclusions. Our findings underscore the numerous benefits of a study plan that integrates CBE from the outset. It not only fosters reflective learning but also facilitates a clinical process that is centered on the individual and their environment, thereby initiating a social commitment. (AU)

Importância dos estudos qualitativos na compreensão do significado da prática de atividade física entre idosos / The importance of qualitative studies in understanding the meaning of physical activity practice among the elderly / Importancia de los estudios cualitativos en la comprensión del significado de la práctica de actividad física en ancianos

O envelhecimento da população demanda um olhar mais atento para os desejos e necessidades dos idosos. Embora a promoção de um envelhecimento ativo e saudável seja assunto prioritário para a saúde pública, boa parte dos trabalhos desta área são quantitativos, de metodologia epidemiológica, focados nos fatores de risco e proteção para a saúde desta população. Esse viés metodológico não capta a experiência vivida do envelhecimento, não explica as ações de cada um em relação à sua saúde. O objetivo deste ensaio é refletir sobre a importância dos estudos qualitativos na compreensão das necessidades, forças e fraquezas dos idosos que irão refletir na motivação e na maneira de atuar e dar significado à prática de atividade física e ao cuidado com a sua saúde.(AU)

The aging of the population demands a closer look at the desires and needs of older adults. Although promoting active and healthy aging is a priority for public health, much of the work in this area is quantitative, using an epidemiological methodology focused on risk and protective factors for the health of this population. This methodological bias does not capture the experience of aging or explain the behavior of each individual in relation to their health. The objective of this essay is to reflect on the importance of qualitative studies in understanding the needs, strengths, and weaknesses of older adults, which will shed light on motivation, behavior, and the meaning of physical activity and health care practices.(AU)

El envejecimiento de la población exige una mirada más cercana a los deseos y necesidades de las personas mayores. Si bien la promoción del envejecimiento activo y saludable es un tema prioritario para la salud pública, gran parte del trabajo en esta área es cuantitativo, con metodología epidemiológica, enfocado en los factores de riesgo y protección para la salud de esta población. Este sesgo metodológico no capta la experiencia vivida del envejecimiento ni explica las acciones de cada uno en relación a su salud. El objetivo de este ensayo es reflexionar sobre la importancia de los estudios cualitativos en la comprensión de las necesidades, fortalezas y debilidades de las personas mayores, lo que permitirá reflexionar sobre la motivación y forma de actuar y dar sentido a la práctica de actividad física y el cuidado de su salud.(AU)

Healthcare Practitioners’ Views of Postnatal Depression: A Qualitative Synthesis / Jurnal Sains Kesihatan Malaysia

@#The World Health Organisation recommends healthcare practitioners to equip themselves with appropriate skills to assess the psychological distress in women attending the antenatal and postnatal healthcare. Nevertheless, little is known about the healthcare practitioners’ perceptions of postnatal depression and its management. The aims of this review were: (i) to explore the experiences of healthcare practitioners in caring for women with postnatal depression in different countries and (ii) to identify any qualitative study conducted in Malaysia regarding the healthcare practitioners’ perceptions of postnatal depression. To achieve these objectives, a qualitative synthesis of studies reporting the healthcare practitioners’ experience of managing women with postnatal depression was conducted. A search in CINAHL, PubMed, MEDLINE, PsycINFO, and ASSIA databases was performed using specific keywords and published peer-reviewed articles from 2006 to 2016 were screened for inclusion criteria. A total of 15 relevant studies were identified and reviewed. The studies included were conducted in eight different countries: America, Australia, United Kingdom, Brazil, Canada, Greek, Mexico, and Slovenia. No study conducted in Malaysia was found. This review suggested that the experiences of managing women with postnatal depression were relatively similar among the healthcare professionals in different countries. The main limitations reported by the healthcare practitioners were the lack of resources on maternal mental health and the absence of policy regarding the management of postnatal depression. Further research should investigate how Malaysian healthcare practitioners perceive postnatal depression and their roles in its management to provide more insights into the current clinical practice in Malaysia for postnatal depression.

Blinding Retinopathy of Prematurity in Western India: Characteristics of Children, Reasons for Late Presentation and Impact on Families

Objective: To ascertain why children with end-stage retinopathyof prematurity (ROP) become blind, and to explore the impact ofblindness on families.Design: Mixed quantitative and qualitative methods.Setting: Tertiary-care eye hospital in India.Participants: Children with end-stage ROP and their carers.Intervention: Cases presenting between June 2009 and July2016 were identified from medical records and data extracted.Carers were contacted for missing information, if required. Datawere analyzed to explore where failure had occurred in theprocess of screening and treatment. A subset of carers wereselected for in-depth interviews to explore the impact of having ablind child. Interviews were recorded, transcribed and analyzedusing a thematic framework.Main outcome measures: Parental perceptions.Results: 66 children were included: median age 4.3 y (range 3mo– 6 y), 58% boys. 74% were blind due to ‘screening failure’,which was associated with lower maternal education (P=0.03). Ofthe 17 case of treatment failure (24.6%), majority (12, 70%) hadaggressive posterior ROP. A subset of carers of 18 children (50%boys) were interviewed, mostly mothers. Most reportedimpoverishment as a result of having a blind child, and manyreported lack of access to special education, negative attitudes ofothers and concerns about the future.Conclusions: Screening for retinopathy of prematurity needs tobe expanded and counselling improved. Access to specialeducation and rehabilitation need to be improved.

Semelhanças e contrastes nos padrões de uso de crack em Santa Catarina, Brasil: capital vs Meio Oeste / Similarities and differences in crack cocaine use patterns in Santa Catarina, Brazil: Capital vs. Midwest

Resumo O crack é um problema relevante de saúde pública no Brasil, em função dos danos e riscos individuais e sociais secundários ao seu uso/abuso. O objetivo deste artigo é descrever características das cenas de uso de crack na Capital e no Meio-Oeste de Santa Catarina. O projeto se valeu da metodologia Time-Location Sampling. Em janeiro-junho de 2011, foram mapeadas 41 cenas de uso de crack na Capital e 33 no Meio-Oeste catarinense. Após seleção aleatória das cenas a serem observadas, foram sorteados os dias e os turnos em que estas seriam observadas em detalhe, totalizando 98 cenas/turno na Capital e 62 no Meio-O-este. As observações foram registradas em caderno de campo, analisadas via análise de conteúdo de Bardin e discutidas à luz da literatura nacional e internacional. Os usuários de crack entrevistados eram majoritariamente adultos do sexo masculino, com uma maior associação entre estar em situação de rua e consumir a droga na Capital. Enquanto no Meio-Oeste a maioria das cenas estavam ativas no período noturno, na Capital, apresentaram-se ativas em todos os períodos. Foram identificadas práticas de risco associadas ao uso do crack, como associação de múltiplas drogas, prostituição, compartilhamento de cachimbo e favores sexuais em troca da substância.

Abstract Crack cocaine has been a major public health problem in Brazil due to the individual and social harms and risks deriving from its use. This article aims to assess the characteristics of drug scenes in the capital and Midwest of Santa Catarina state. The project used the Time-Location Sampling. Between January and June 2011, 41 crack cocaine scenes were mapped in capital of Santa Catarina, whereas 33 were mapped in the Midwest of that state. Such scenes were randomly selected to be observed, as well as their days and shifts (time periods/day) for in-depth observation. Overall, 98 scenes/shifts were observed in the capital and 62 in the Midwest. First-hand reports were logged as field notes into notebooks. Analyses of the empirical material were based on Bardin's content analysis, and findings were compared and contrasted with Brazilian and international literature. Most crack cocaine users were adult males. In the capital, a substantial fraction of the users lived in the streets, but in both settings most interviewees have used multiple substances. In the Midwest, most scenes occurred at night, whereas in the capital scenes occurred in all shifts. Risk practices associated with the use of crack cocaine were: association of multiple drugs, prostitution, pipe sharing and sexual favors in exchange for the substance.

Psychosocial impact of early onset dementia among caregivers / Impacto psicossocial da demência de início precoce em cuidadores

Introduction: There is growing recognition of early onset dementia (EOD) as a significant clinical and social problem because of its effects on physical and mental health of people with dementia (PWD) and their caregivers. Objective: To analyze the psychosocial impact of EOD in family caregivers. Methods: The study design was qualitative. Nine EOD caregivers (7 women) were recruited at a service for Alzheimer's disease and assessed using semi-structured interviews. Interpretative phenomenological analysis was used to analyze caregivers' reports. Results: Five themes emerged from the narratives: psychological and emotional impact; physical impact; financial and professional impact; social impact and need for support services. The majority of the caregivers of people with EOD perceived their emotional wellbeing as poor or extremely poor. Carers reported poor physical health, which tends to be longer-lasting than mental health problems. Two caregivers had to retire after the disclosure of the dementia diagnosis, and seven reduced their work loads because they had to look after PWD. Preserving the abilities of PWD is essential to maintain their self-esteem, dignity and sense of utility. For the caregivers, interventions and stimulating activities make PWD feel worthwhile and contribute to improving life. Conclusion: The caregivers of people with EOD assume the role of caregiver prematurely and need to balance this activity with other responsibilities. There is a need for more studies of EOD in order to improve understanding of the impact of this disease and to enable development of adequate services for PWD and their caregivers.

Introdução: A demência de início precoce ( early onset dementia , EOD) vem sendo reconhecida como um importante problema clínico e social devido aos efeitos sobre a saúde física e mental das pessoas com demência e seus cuidadores. Objetivo: Analisar o impacto psicossocial da EOD em cuidadores familiares. Métodos: O estudo baseia-se na metodologia qualitativa. Foram realizadas entrevistas semiestruturadas com nove cuidadores EOD (sete mulheres) recrutados em um serviço para doença de Alzheimer. Utilizou-se análise fenomenológica interpretativa para analisar as narrativas dos cuidadores. Resultados: Cinco temas emergiram das narrativas: impacto psicológico e emocional; impacto físico; impacto financeiro e profissional; impacto social e necessidade de serviços de apoio. A maioria dos cuidadores percebe seu bem-estar emocional como ruim ou extremamente ruim. Os cuidadores reconhecem prejuízos na saúde física, que tendem a ser mais duradouros do que os problemas de saúde mental. Dois cuidadores tiveram que se aposentar após o diagnóstico de demência, e sete diminuíram sua carga de trabalho porque tinham que cuidar dos pacientes. Preservar as habilidades das pessoas com demência é essencial para manter a sua autoestima, dignidade e sentimento de utilidade. Para os cuidadores, intervenções e atividades de estimulação fazem com que as pessoas com demência se sintam mais úteis e contribuam para uma vida melhor. Conclusão: Os cuidadores de pessoas com EOD assumem prematuramente o papel de cuidador e precisam equilibrar esta atividade com outras responsabilidades. Há necessidade de mais estudos sobre EOD, a fim de se obter uma melhor compreensão do impacto da doença e para o desenvolvimento de serviços adequados para pacientes e seus cuidadores.

El acoso psicológico laboral desde la mirada de un perpetrador: un estudio de caso / Assédio moral no trabalho a partir da perspectiva de um autor: um estudo de caso / The mobbing at workplace from perpetrator's point of view: a case study / Harcèlement au travail du point de vue d'un auteur: une étude de cas

Se realizó una investigación de corte cualitativo y orientación fenomenológica, con el propósito de conocer las autopercepciones de una presunta perpetradora de acoso psicológico en el trabajo. El tipo de estudio fue el análisis de un caso y la selección de la participante se logró por muestreo de oportunidad. La información fue obtenida a través de la técnica de la entrevista en profundidad y los datos fueron registrados y analizados bajo el método fenomenológico para conocer cómo la participante se percibía a sí misma en su rol de perpetradora de acoso psicológico en el trabajo. Se construyó una explicación de las categorías emergentes de las experiencias y vivencias de la entrevistada, con base en la interpretación fenomenológica para el establecimiento de sentido y significado a la información proporcionada. Los hallazgos obtenidos muestran la preparación, escenificación, deliberación, intencionalidad de dañar y abuso de la perpetradora en la comisión de comportamientos típicos de acoso psicológico. Asimismo, los datos sugirieron la presencia de un trastorno de la personalidad del tipo paranoide y antisocial en la perpetradora. También se identificó el uso de un puesto de representación sindical para bloquear el desarrollo profesional de su víctima dentro de la institución. Se recomienda la realización de estudios cualitativos en los que participen todos los actores involucrados en el proceso del acoso psicológico en el trabajo (perpetradores, víctimas y testigos).

Nousavons mené une recherchequalitative et de l'orientationphénoménologique, afin de connaître les auto-perceptions des d'unauteurprésumé de harcèlementautravail.Le typed'étudeétaitl'analysed'un cas et en sélectionnantl'échantillon des participants a étéobtenu par opportunité.L'information a étéobtenue par la technique de la entrevues en profondeur et les donnéesontétéenregistrées et analyséesdans la méthodephénoménologique de la façondont le participant se perçoitdans son rôle en tantqu'auteur de harcèlementautravail.Il a étéconstruit une explication des catégoriesémergentes de sens à partir des expériencesbasées sur l'interprétationphénoménologique de la mise en place de la signification et l'importance de l'informationfournie.Les résultatsmontrent la préparation, la mise en scène, la délibération, l'intention de nuire et l'abus de l'auteurdans la commission de comportementstypiquesde harcèlement. En outre, les donnéessuggèrent la présenced'untrouble de la personnalitéantisociale et de typeparanoïdedans le harceleuse.Nousavonsaussiidentifiél'utilisation de la représentationsyndicale à bloquer le développementprofessionnel de la victime ausein de l'institution. Ilestrecommandé que les étudesqualitativesimpliquanttoutes les partiesprenantesdans le processus de harcèlementpsychologiqueautravail [auteurs, victimes et des témoins].

Realizou-se uma pesquisa qualitativa e de orientação fenomenológica a fim de conhecer as autopercepções de uma autora de assédio moral no trabalho. O tipo de estudo foi análise de caso e a seleção da amostra participante se deu por oportunidade. As informações foram obtidas através da técnica de entrevistas em profundidade e os dados foram registrados e analisados a partir do método fenomenológico, para se conhecer como o participante se percebe em seu papel de autor do assédio moral no trabalho. Construiu-se uma explicação das categorias emergentes a partir das experiências e vivências do entrevistado, com base na interpretação fenomenológica para a criação de sentido e significado às informações fornecidas. Os achados mostram a preparação, o estadiamento, a deliberação, a intenção de prejudicar e o abuso do autor na prática de comportamentos típicos de assédio moral no trabalho. Além disso, os dados sugerem a presença de um transtorno de personalidade antissocial e do tipo paranoico no agressor. Também foi identificado o uso de representação sindical para bloquear o desenvolvimento profissional da vítima dentro da instituição. Recomenda-se a realização de estudos qualitativos envolvendo todos os intervenientes no processo de assédio moral no trabalho (agressores, vítimas e testemunhas).

We conducted a qualitative research with phenomenological orientation.The purpose was to know the self-perceptions of an alleged perpetrator of mobbingat work. The type of study was the analysis of a case and the participant was selected by opportunity sampling. The information was obtained through the technique of in-depth interviews and data were analyzed by the phenomenological method for know how the participant perceived herself in her role as perpetrator of mobbing at work. It was built a categories scheme from the interviewed experiences based on phenomenological interpretation. The aim was the establishment of sense and significance of information provided. The findings show the preparation, staging, deliberation, intent to harm and abuse of the perpetrator in the commission of typical mobbing behaviors. Furthermore, the data suggest the presence of a personality disorder and antisocial paranoid type in the mobbing perpetrator. We also identified the use of union representation power to obstruct the victim's professional development within the institution. It is recommended qualitative studies with involving all actors in the process of mobbing at work [perpetrators, victims and witnesses].

A configuração da rede social de mulheres em situação de violência doméstica / The configuration of the social network of women living in domestic violence situations

Este artigo apresenta a configuração da rede social das mulheres que vivem em situação de violência doméstica num município da região metropolitana de São Paulo. Foram realizadas entrevistas com nove mulheres e oito profissionais e observação em três serviços que compõem a rede de proteção à mulher. Para a análise utilizou-se os pressupostos teóricos de redes sociais. Verificou-se que a violência impingida às mulheres pelos seus parceiros impossibilita a manutenção dos vínculos sociais, colocando-as em situação de isolamento e fragilidade. As instituições e os profissionais podem exercer um papel fundamental para que as mulheres saiam do ciclo de violência, desde que a rede de atenção e os fluxos entre os serviços sejam organizados. O estudo das redes sociais com o enfoque nos vínculos e trocas entre os atores pode contribuir para ampliar o conhecimento sobre a dinâmica relacional na situação de violência.

This article presents the configuration of the social network of women living in domestic violence situations in a city in the metropolitan region of São Paulo, Brazil. Interviews were conducted with 9 women and 8 professionals, in addition to observation in three institutions which constitute the network for protection of women. The analysis was underpinned by the theoretical assumptions of social networks. Results show that violence inflicted upon women by their partners make them unable to establish and maintain social bonds, and thus face isolation and ostracism. Professionals and institutions can play a vital role for getting women out of the cycle of violence provided that care networks and services are well organized. Further studies of social networks, focusing on the nature of the links and exchanges among actors may contribute to acquiring knowledge about the relationship dynamics in situation of violence.

Motivos e circunstâncias para o aborto induzido entre mulheres vivendo com HIV no Brasil / Motives and circumstances surrounding induced abortion among women living with HIV in Brazil

O impacto da infecção pelo HIV/Aids na decisão de interromper uma gravidez entre mulheres vivendo com HIV/Aids é ainda um tema pouco estudado. Visando entender como a infecção pelo HIV/Aids interfere na prática do aborto foi realizado estudo qualitativo em sete municípios brasileiros com mulheres portadoras desse vírus que haviam induzido um aborto em algum momento da vida. Este trabalho apresenta a análise das entrevistas de 30 mulheres que engravidaram após o diagnóstico. Os resultados mostram que para algumas a infecção foi o principal motivo de interrupção da gravidez, enquanto que para outras estiveram referidos a outras circunstâncias da vida. A decisão de abortar após o diagnóstico da infecção pelo HIV não é igual para todas as mulheres, e é influenciada pelo momento do diagnóstico e os demais aspectos da vida, como a relação com o parceiro, a inserção de trabalho e o suporte familiar. Os resultados sugerem a necessidade de atenção dos serviços de saúde quanto às decisões reprodutivas das mulheres vivendo com HIV/Aids; de incorporação dos homens nas ações preventivas de saúde sexual e reprodutiva e do aprofundamento da discussão sobre a ilegalidade do aborto no país e suas danosas consequências para mulheres, homens e crianças.

The impact of HIV/AIDS infection on the decision of women living with HIV/AIDS to interrupt a pregnancy remains an understudied topic. In an effort to understand the influence of HIV/AIDS diagnosis on abortion practices, a qualitative study was carried out in seven Brazilian municipalities with women living with HIV/AIDS who reported inducing an abortion at some point in their lives. This study presents the analysis of interviews with thirty women who became pregnant after diagnosis. The results show that for some women, infection was the primary motive for terminating their pregnancy, while for others, the motives for abortion were predominantly related to life circumstances. The decision to abort due to HIV infection is not the same for all women. It is related to the timing of the diagnosis and other aspects of the woman's life during her pregnancy, such as the relationship with her partner, her job and family support. The results suggest the need for more attention from health services to the reproductive decisions of women living with HIV/Aids; the incorporation of men into sexual and reproductive health prevention actions; and a deeper discussion of the illegality of abortion in Brazil and its harmful consequences for women, men, and children.

Autopercepción de presuntos perpetradores de acoso psicológico en el trabajo. Un acercamiento fenomenológico: A phenomenological approach / Workplace mobbing from alleged perpetrators' point of view

Objetivos: Conocer las autopercepciones de los supuestos perpetradores en el proceso de acoso psicológico en el trabajo. Materiales y métodos: Se realizó un estudio cualitativo a presuntos perpetradores de acoso psicológico en el trabajo con base en el método fenomenológico a partir de entrevistas en profundidad. El análisis e interpretación se efectuó con el programa Atlas.ti. Resultados: Participaron nueve sujetos que realizan funciones directivas. Las autodescripciones se constituyeron de las percepciones de los entrevistados. Se conformaron tres categorías centrales: las capacidades personales y habilidades para la dirección, los principios en el ejercicio del cargo y las conductas precursoras de acoso psicológico. Los presuntos perpetradores hacen una especie de recomposición perceptual y cognitiva que les distancia del reconocerse como causantes de acoso psicológico.A pesar de que solo dos entrevistados reconocieron su condición de perpetrador, los siete restantes bien pueden ser denominados como tales, ya que en algún momento su comportamiento fue violento, ya sea verbal o conductualmente, y provocó menoscabo en el estado psicológico y emocional de sus víctimas. Conclusiones: Las limitaciones que tienen los hallazgos de un estudio como el que se presenta son evidentes. Sin embargo, consideramos que el alcance futuro de estudios de corte cualitativo que analicen el fenómeno del acoso psicológico en el trabajo está aún intacto y, por ende, representa un área de oportunidad para la generación de conocimiento en el tema.

Objective: To know the self-perceptions of alleged perpetrators in the process of mobbing at workplace. Materials and methods: A qualitative study was realized to alleged perpetrators of mobbing at workplace. We used the phenomenological method from interviews in depth. The analysis and interpretation was carried out by the software Atlas.ti. 6.2 Results: They informed nine subjects that realize managerial functions. The self-descriptions were constituted of the perceptions of the interviewed ones. Three central categories conformed; personal capacities and management skills, personal principles in the exercise of the job post and mobbing at workplace behaviors. The alleged perpetrators do a species of perceptual and cognitive alteration that distances them from being recognizing as mobbers. In spite of the fact that only two interviewed ones recognized their condition of perpetrators, although the other seven can be well named as such, since in some moment his behavior was violent, already be verbal or behaviorally and it provoked a damage in the psychological and emotional condition of his victims. Conclusions: The limitations that take the findings of this study appears are evident. Nevertheless, we think that the future scope of studies of qualitative cut that should analyze the phenomenon of mobbing at workplace is still intact, and it represents an area of opportunity for the generation of knowledge in the topic.

An Examination of Women Experiencing Obstetric Complications Requiring Emergency Care: Perceptions and Sociocultural Consequences of Caesarean Sections in Bangladesh.

Little is known about the physical and socioeconomic postpartum consequences of women who experience obstetric complications and require emergency obstetric care (EmOC), particularly in resource-poor countries such as Bangladesh where historically there has been a strong cultural preference for births at home. Recent increases in the use of skilled birth attendants show socioeconomic disparities in access to emergency obstetric services, highlighting the need to examine birthing preparation and perceptions of EmOC, including caesarean sections. Twenty women who delivered at a hospital and were identified by physicians as having severe obstetric complications during delivery or immediately thereafter were selected to participate in this qualitative study. Purposive sampling was used for selecting the women. The study was carried out in Matlab, Bangladesh, during March 2008–August 2009. Data-collection methods included in-depth interviews with women and, whenever possible, their family members. The results showed that the women were poorly informed before delivery about pregnancy-related complications and medical indications for emergency care. Barriers to care-seeking at emergency obstetric facilities and acceptance of lifesaving care were related to apprehensions about the physical consequences and social stigma, resulting from hospital procedures and financial concerns. The respondents held many misconceptions about caesarean sections and distrust regarding the reason for recommending the procedure by the healthcare providers. Women who had caesarean sections incurred high costs that led to economic burdens on family members, and the blame was attributed to the woman. The postpartum health consequences reported by the women were generally left untreated. The data underscore the importance of educating women and their families about pregnancy-related complications and preparing families for the possibility of caesarean section. At the same time, the health systems need to be strengthened to ensure that all women in clinical need of lifesaving obstetric surgery access quality EmOC services rapidly and, once in a facility, can obtain a caesarean section promptly, if needed. While greater access to surgical interventions may be lifesaving, policy-makers need to institute mechanisms to discourage the over-medicalization of childbirth in a context where the use of caesarean section is rapidly rising.

Perceptions about Probiotic Yogurt for Health and Nutrition in the Context of HIV/AIDS in Mwanza, Tanzania.

Recently, the food and malnutrition issues have taken centre stage within the arena of HIV/AIDS epidemic, with several calls being made for context-specific health and nutrition interventions to deal with the emerging food insecurity and malnutrition issues in settings with high burdens of HIV/AIDS. The use of probiotics as nutritional supplements in HIV/AIDS-affected and resource-poor settings has also been advocated. This paper presents the results of a qualitative study on community knowledge and perceptions about probiotics and their potential impact on people’s everyday life in the context of the HIV/AIDS epidemic. In-depth interviews (n=26) were conducted with residents in Mwanza, Tanzania. The results showed that people living with HIV/AIDS, who were using probiotic yogurt produced through a joint partnership of Western Heads East, Tanzania Medical Research Institute and the Tukwamune Women’s Group, reported perceived beneficial effects, such as gain in weight and improved health and well-being. Yet, these beneficial effects might be resulting in growing misconceptions about probiotic yogurt being ‘medicine’ for the treatment of HIV/AIDS; this is leading some people living with HIV/AIDS to abandon taking their antiretroviral medications based on the view that the probiotic yogurt is making them feel much better. The findings illustrate the potential challenges with regard to the introduction of nutritional food supplements into new contexts plagued by malnutrition and infectious diseases. Public-health education and awareness programmes are needed when introducing novel foods into such contexts.

Significados da dieta e mudanças de hábitos para portadores de doenças metabólicas crônicas: uma revisão / The significance of dietary and behavioral changes in patients with chronic metabolic disorders: a review

Eating behavior and the psycho-cultural significance of food for patients with chronic metabolic disorders have been a focus of interest due to the difficulty in ensuring the compliance of these patients in terms of changing their habits and in fostering self-care. A review of the literature was condusted using the LILACS and MEDLINE databases and the PUBMED search engine to identify qualitative studies in which the opinion of patients with respect to diet and lifestyle was analyzed. Key words used were: metabolic syndrome; eating behavior; diet; obesity; psychological factors; qualitative study; and dietary habits. Inclusion criteria consisted of: articles in English, Spanish or Portuguese, published between 2000 and 2008; studies carried out in adult populations; containing one or more of the key words in the title. Based on the 15 papers analyzed, it was concluded that compliance with a change of habit is a dynamic process that depends on various individual factors and requires greater interaction between professionals and patients in clinical practice. Promoting self-care depends on respecting the decisions and feelings resulting from personal experience.

Comportamento alimentar e significados psicoculturais da alimentação para portadores de distúrbios metabólicos crônicos têm sido foco de interesse em virtude da dificuldade de adesão às mudanças de hábitos e à promoção do autocuidado. Revisão bibliográfica foi realizada a partir das bases de dados Lilacs e Medline® e no sistema de busca Pubmed, visando estudos qualitativos que analisam a visão dos pacientes sobre dieta e estilo de vida. Palavras chaves: metabolic syndrome, eating behavior, diet, obesity, psychological factors, qualitative study e dietary habits. Critérios de inclusão: idioma inglês, espanhol ou português; período 2000 a 2008; população adulta; contendo um ou mais descritores no título. A partir de 15 artigos analisados foi concluído que a adesão às mudanças de hábitos é um processo dinâmico, dependente de vários fatores individuais para seu estabelecimento e requer maior interação entre profissionais e pacientes na prática clínica. A promoção do autocuidado depende do respeito às decisões e aos sentimentos decorrentes da vivência pessoal.

Type, Content, and Source of Social Support Perceived by Women during Pregnancy: Evidence from Matlab, Bangladesh.

Specific and contextualized data on social support during distinct health events are needed to improve social support interventions. This study identified the type, content, and source of social support perceived by women during pregnancy. In-depth interviews with 25 women, aged 18-49 years, living in Matlab, Bangladesh, were conducted. The findings demonstrated that women perceived, the receipt of eight distinct types of support. The four most frequently-mentioned types included: practical help with routine activities, information/advice, emotional support and assurance, as well as the provision of resources and material goods. Sources varied by type of support and most frequently included-—mothers, mothers-in-law, sistersin- law, and husbands. Examples depicting the content of each type of support revealed culturally-specific issues that can inform community-based social support interventions.

Barriers to Sexual Health Services for Young People in Nepal.

Although sexual and reproductive health education and services are provided to young people, current rates of HIV infection and pregnancy are increasing in Nepal, indicating that young people do not always use sexual health services. Health facilities have apparently failed to provide young people with specialized sexual health education and services. This study explored the barriers to using sexual health services, including condom-use among young people in Nepal. Participants from 10 focus groups and 31 in-depth interviews, carried out by a same-sex researcher, reported many socioeconomic, cultural and physical norms that impose barriers to accessing information on sexual health and relevant services. It is concluded that the establishment of youth-friendly service centres in convenient places might help encourage young people to use sexual health services.

Understanding Tuberculosis: Perspectives and Experiences of the People of Sabah, East Malaysia.

Malaysia is a country with the intermediate burden of tuberculosis (TB). TB is still a public-health problem in Sabah, one of the two states in East Malaysia. In 2007, the state of Sabah contributed slightly more than 3,000 of 16,129 new and relapse cases reported in the country. It has a notification rate of two and a half times that of the country’s. Very few studies on TB have been conducted in Sabah, and there is little documentation on the perceptions of TB patients and the community about TB, healthcare-seeking behaviour, and impact of TB on the people of Sabah. A qualitative study was conducted in 2006 in seven districts in Sabah to assess the knowledge and perceptions of TB patients and the community about TB, also to know the experiences of healthcare services, and to examine the impact of TB on patients and families. Purposive sampling identified 27 TB patients and 20 relatives and community members who were interviewed using a set of questions on knowledge, perceptions about TB, healthcare-seeking behaviour, and impact of TB. A further 11 health staff attended informal discussions and feedback sessions. Most interviews were taped and later translated. Data were analyzed using thematic content analysis. Ninety-six percent of the respondents did not know the cause of TB. Some thought that TB occurred due to a ‘tear’ in the body or due to hard work or inflammation while others thought that it occurred due to eating contaminated food or due to sharing utensils or breathing space with TB patients. Although the germ theory was not well-known, 98% of the respondents believed that TB was infectious. Some patients did not perceive the symptoms they had as those of TB. The prevailing practice among the respondents was to seek modern medicine for cure. Other forms of treatment, such as traditional medicine, were sought if modern medicine failed to cure the disease. TB was still a stigmatizing disease, and the expression of this was in both perceived and enacted ways. TB also affected the patients in various aspects of their lives, such as psychosocial, physical, financial and life practices. Patients who were farmers complained that they did not recover fully from their disease and were not, thus, able to continue with their previous work. Patients changed their life practices, such as not sharing their utensils, had a separate sleeping area, and practised social distancing. On the other hand, most health workers were unaware of the effects of TB on their patients and that knowledge of their patients on TB was inadequate. There is a need to understand the reasons for the misconceptions about TB and to address the lack of knowledge on TB through health education. Patients need to recognize the symptoms of TB early so that prompt treatment can be initiated, and patients need to be convinced of its curability.

Cultural Dimensions of Depression in Bangladesh: A Qualitative Study in Two Villages of Matlab.

This article reports the results of a qualitative study conducted in two villages of Matlab to explore the cultural dimensions of depression. Participants included adult men and women with and without a history of depressive episode (n=42), formal and informal healthcare providers (n=6), and caregivers (n=2). Adults (n=10) with a history of depressive episode were selected from a 2005 survey conducted by ICDDR,B. A case vignette was used for eliciting local terms for depression, perceived causes, impact, and treatments. Hardly anyone recognized the term bishonnota (literal translation of depression) used in the past survey. The participants thought that the vignette was about chinta rog (worry illness), and they spoke of somatic symptoms in relation to this condition. When explored further, they mentioned sadness and psychological complaints. Men felt that it affected them more while women felt the opposite. They associated chinta rog with poverty and social issues with impacts on marriage, work, and education. From their responses, it seemed that they preferred a psychosocial framework attributing the cause to thoughts and emotions, resulting from social causes. Commonly-suggested treatments were more income, better relationships, and tablets. Former health providers were often the first choice for help-seeking. The study hopes to ‘culturally inform’ the formal healthcare providers and programme planners.