La enseñanza de las metodologías cualitativas en carreras de las ciencias de la salud: desafíos y reflexiones a partir de experiencias de docencia en fonoaudiología / Training students of health sciences in qualitative method: challenges and reflections from the teaching experience in speech and language therapy

Explicar los alcances del enfoque cualitativo de investigación social en salud a estudiantes de carreras de Ciencias de la Salud resulta un desafío en la entrega de la perspectiva antropológica y social en la formación profesional. Lo anterior debido a que estos estudiantes están acostumbrados a operar en las dicotomías naturaleza/cultura y ciencia/creencia. Como docentes,implica enseñarles a observar más allá de dichas dicotomías. También exige superar la limitada comprensión que puede haber sobre lo que es la aproximación cualitativa en investigación y lo que les puede ofrecer. Por ello, el propósito del estudio es reflexionar sobre los alcances que tienen estos desafíos en el aula, recurriendo a casos de ejercicios de diseños de investigación cualitativa en la carrera de Fonoaudiología de la Facultad de Medicina de la Universidad de Chile. Concluimos que un acercamiento temprano a metodologías cualitativas permite a estudiantes de pregrado desarrollar una visión crítica hacia las dicotomías reduccionistas respecto de la producción y validación de conocimientos. Además, promueve entender la dimensión social de la salud como un fenómeno individual y colectivo. También favorece concebir a la Medicina como un campo de trabajo transdisciplinar.

To explain the scope of the qualitative approach to undergraduate students of healthcare sciences is a challenge for those of us who must translate the anthropological and social perspectives to students used to operate within nature/culture and science/belief dichotomies. This challenge involves teaching to look beyond these dichotomies and forces us, as lecturers, to overcome the barriers or limited understanding that often characterize health professionals' relation to what qualitative approach can offer to them. Based upon the teaching experience of the authors, this article aims to reflect about the emergence of these challenges, turning, therefore, to examples of qualitative research design in the speech and hearing program at the faculty of medicine of the University of Chile. We believe that an early approach to qualitative methodologies would allow undergraduate students to develop a critical vision in relation to reductive dichotomies, in addition to promoting an understanding of health as an individual and collective phenomenon, and of medicine as a trans disciplinary field of work.

Estrategia de entornos de trabajo saludables en el sector informal: perspectiva de los actores / Strategy for Healthy Workplaces in the Informal Sector: Stakeholders' Perspective / Estratégia de ambientes de trabalho saudáveis no setor informal: perspectiva dos atores envolvidos

Objetivo: esta investigación buscó examinar la perspectiva de trabajadores informales y tecnólogos de salud ocupacional sobre la implementación de la estrategia de entornos de trabajo saludables en las unidades de trabajo informal (UTI) de la localidad de Usaquén (Bogotá, Colombia). Método: e s t u d i o descriptivo en 16 UTI utilizando herramientas cualitativas. Se hizo observación directa en 16 UTI y encuestas de conocimientos, actitudes y prácticas a 17 trabajadores (hombres y mujeres). Se hicieron entrevistas semiestructuradas a dos tecnólogos en salud ocupacional. Resultados: los trabajadores que han sido parte de la estrategia tienen un conocimiento satisfactorio de los riesgos ocupacionales. Esto ha llevado a algunas medidas positivas de prevención en las UTI (p. ej. orden, señalización). Sin embargo, la mayoría de conocimientos sobre los riesgos y su prevención no se manifiestan en prácticas de los trabajadores. Los participantes identificaron como principales barreras para la implementación de la estrategia el tiempo disponible por parte de los trabajadores y la corta duración del programa. Discusión y Conclusiones: desde la perspectiva de los participantes, la estrategia de entornos de trabajo saludables ha presentado algunos beneficios. Sin embargo, es importante que las barreras identificadas sean superadas. Este tipo de estrategias requieren de continuidad para que la capacitación se manifieste en beneficios de salud para los trabajadores. Las actividades que fueron percibidas como las más efectivas son aquellas que están articuladas con requerimientos legales de las UTI. Esta investigación aporta a la literatura científica sobre la salud ocupacional en trabajadores informales y a los pocos estudios cualitativos en salud ocupacional

Objective: This research examines the perspective of informal workers and occupational health and safety technicians on implementing the strategy for healthy workplaces in informal work units (UTI, for its abbreviation in Spanish) of the Usaquen district (Bogota, Colombia). Method: A descriptive study in 16 UTIs using qualitative tools. Direct observation was conducted in 16 UTIs, and 17 workers (men and women) were surveyed on knowledge, attitudes, and practices. Semistructured interviews were conducted with two occupational health and safety technicians. Results: The workers who have been part of the strategy demonstrate adequate knowledge of the occupational hazards. This fact has led to take some positive preventive measures in the UTIs (e.g., order, signposting). However, most knowledge about risks and their prevention is not shown during workers' practices. The participants identified workers' time availability and the program's short duration as the main barriers to implementing the strategy. Discussion and Conclusions: From the participants' perspective, the strategy for healthy workplaces has had some benefits. However, it is important to overcome the identified barriers. These types of strategies require continuity so that the training is translated into health benefits for workers. The activities perceived as the most effective are those articulated with the legal regulations of UTIs. This research contributes to the scientific literature on informal workers' occupational health and the few qualitative studies on occupational health and safety

Objetivo: Buscou-se examinar a perspectiva de trabalhadores informais e tecnólogos em saúde ocupacional sobre a implementação da estratégia de ambientes de trabalho saudáveis nas unidades informais de trabalho (UIT) do município de Usaquén (Bogotá, Colômbia). Método: estudo descritivo em 16 UITs por meio de ferramentas qualitativas. Foi realizada observação direta em 16 UITs e enquetes de conhecimentos, atitudes e práticas a 17 trabalhadores (homens e mulheres). Além disso, realizaram-se entrevistas semiestruturadas com dois tecnólogos em saúde do trabalhador. Resultados: os trabalhadores que têm sido parte da estratégia possuem um conhecimento satisfatório dos riscos ocupacionais. Isso tem levado a algumas medidas preventivas positivas nas UITs (por exemplo, ordem, sinalização). Porém, grande parte do conhecimento sobre os riscos e sua prevenção não se manifesta nas práticas dos trabalhadores. Os participantes identificaram como principais entraves à implementação da estratégia o tempo disponível por parte dos trabalhadores e a curta duração do programa. Discussão e conclusões: na perspectiva dos participantes, a estratégia de ambiente de trabalho saudável apresentou alguns benefícios. No entanto, é importante que as barreiras identificadas sejam superadas. Esses tipos de estratégias requerem continuidade para que a formação se manifesteem benefícios à saúde dos trabalhadores. As atividades que foram percebidas como mais eficazes são aquelas que são articuladas com as exigências legais das UITs. Esta pesquisa contribui para a produção científica sobre saúde ocupacional em trabalhadores informais e aos poucos estudos qualitativos na área de saúde ocupacional.

Comprensión del cambio psicoterapéutico en adolescentes: voces de pacientes y terapeutas / Understanding the psychotherapeutic change in adolescents: Voices of patients and therapists

Resumen Este estudio tuvo como objetivo comprender el proceso de cambio psicoterapéutico desde las perspectivas subjetivas de adolescentes y terapeutas que participaron en una terapia. Método: se utilizó un enfoque cualitativo; la recolección de información se realizó a través de entrevistas semiestructuradas audiograbadas, luego de finalizar la terapia. Participaron 17 díadas terapéuticas (adolescentes: edad promedio 15,8 años; 64,7% género femenino; terapeutas: edad promedio 30,3 años; 55,5 % género femenino), que realizaron sus terapias en contextos naturales y con diferentes enfoques teóricos. Codificadores entrenados analizaron los datos a través de los procedimientos propuestos por la Teoría Fundamentada, codificación abierta y axial, y procesos de reorganizaciones y triangulaciones permanentes. Resultados: se identificaron dos fenómenos comprensivos relacionados con los procesos de cambio psicoterapéutico: (a) El encuentro con "otro" como plataforma segura y sustrato relacional generador del cambio y, (b) El cambio como empoderamiento y desarrollo. Discusión: se examina el rol central que ocupan la relación terapéutica y el logro de las tareas del desarrollo (identidad, autonomía y autodeterminación) en el cambio psicoterapéutico. Además, se reflexiona acerca de las habilidades y acciones de los terapeutas.

Abstract This study aimed to understand the process of psychotherapeutic change from the subjective perspectives of adolescents and therapists who participated in therapy. Method: A qualitative approach was used; information was collected through a semi-structured audio-recorded interview, which occurred at the end of therapy. The participants were 17 therapeutic dyads (adolescents: average age 15.8 years; 64.7% female gender; therapists: average age 30.3 years; 55.5% female gender), who performed their therapies in natural contexts and with different theoretical approaches. Trained coders analyzed the data through the procedures proposed by the Grounded Theory, with open and axial coding, performing processes of permanent reorganizations and triangulations. Results: The results show two major phenomena related to the processes of change: (a) The encounter with "the other" as a safe platform and relational substrate to generate change and (b) Change as empowerment and development. Discussion: The central role of the therapeutic relationship and the achievement of developmental tasks (identity, autonomy and self-determination) in psychotherapeutic change is discussed. In addition, it also reflects on the skills and actions of the therapists.

Proceso de tratamiento a víctimas del crimen organizado: Un estudio cualitativo centrado en la experiencia de psicólogos clínicos / Process of treatment to victims of organized crime: A qualitative study focused on the experience of clinical psychologists

Resumen El crimen organizado representa una de las más graves problemáticas a nivel mundial. No solo por el gran número de muertes violentas y lesiones entre los grupos rivales y en la población general, sino por las afectaciones en la salud mental de las personas que viven en ciudades con alta incidencia delictiva. Las víctimas directas o indirectas del crimen organizado suelen desarrollar diversos síntomas, dependiendo del tipo de delito y el grado de violencia (intensidad y duración) a la que fueron sometidas, así como del tipo de atención recibida después del ataque. Se presentan los hallazgos de un estudio cualitativo sobre el proceso de atención a víctimas del crimen organizado, desde la perspectiva de los psicólogos clínicos. El estudio fue realizado en el estado de Tamaulipas, al norte de México. Su propósito fue conocer las fases del proceso de atención y las estrategias clínicas utilizadas, las reacciones cognitivas, emocionales y sociales generadas en los terapeutas, las estrategias de autocuidado y las limitaciones contextuales. Participaron ocho psicólogos clínicos de diferentes enfoques terapéuticos. Se realizaron entrevistas individuales semiestructuradas y fueron analizadas con el software Atlas.ti 7, en base a la Teoría Fundamentada. Los resultados indican un proceso de atención con cuatro fases: previa, inicial, tratamiento y cierre. El terapeuta emplea estrategias clínicas específicas para cada fase del tratamiento y además desarrolla estrategias para su autocuidado emocional y protección, debido a las condiciones de violencia en el contexto local.

Abstract Organized crime represents one of the most serious problems worldwide. Not only because of the large number of violent deaths and injuries among rival groups and in the general population, but also because of the mental health effects of people living in cities with a high incidence of crime. The direct or indirect victims of crimes such as homicide, kidnapping, extortion, human trafficking, robbery with violence, rape, among others, often develop various symptoms depending on the type of offense, the degree (intensity and duration) of violence to which they were subjected, and the care (medical, psychological, legal) received after the attack. This paper presents the findings of a qualitative study on the process of care for victims of organized crime from the perspective of clinical psychologists. It was conducted in the state of Tamaulipas, in northern Mexico. The purpose of the study was to know the phases of the psychological care process and the clinical strategies used; the cognitive, emotional and social reactions generated in the therapists; the self-care strategies used by psychologists, and the contextual limitations for care. Eight clinical psychologists from different therapeutic approaches participated. Semi-structured interviews were conducted and analyzed with the Atlas.ti 7 software, based on Grounded Theory. The results indicate a process of attention with four phases: previous, initial, treatment and closure. In the previous phase, participants identify adult men and women as the main victims of organized crime who attend therapy. Direct victims come for crimes such as kidnapping and extortion. Indirect victims are usually close relatives of the direct victims and come for crimes such as homicide, forced disappearance and kidnapping. In the initial phase, psychologists use the therapeutic alliance, rapport, empathy and the promotion of attachment to treatment. Psychologists with private practice can perform specific actions such as attending the patient's home when the patient is afraid to leave. The most frequent diagnoses found in this phase are post-traumatic stress disorder, depressive disorders, and anxiety disorders. The treatment phase is characterized by the diversity of techniques used according to the therapeutic model adopted by each psychologist. The closing phase occurs when the patient has emotionally stabilized and therapists seek relapse prevention, so they follow up on cases. During the process of care for victims, therapists have different cognitive, emotional and social reactions; and develop strategies for their personal care, due to the conditions of violence that are experienced in the local context. The most used self-care strategies are to attend a personal therapeutic process, supervise the cases, exercise, eat well, express their emotions, go to natural environments to distract themselves and reduce the number of cases they attend. Among the limitations identified in the process of care for victims of organized crime, therapists mention the need for specialized training, including not only their professional training, but have a procedure or a specific protocol to deal with such cases.

Desejo por filhos entre mulheres de alta escolaridade: conflitos, mudanças e permanências / Desire for motherhood among women with higher education: conflict, change and permanence / Deseo de hijos entre mujeres con educación superior: conflictos, cambios y permanencias

Este trabalho analisa as percepções e os significados da maternidade para um grupo de mulheres de alta escolaridade, casadas ou em união consensual, com no máximo um filho, residentes em um município mineiro de porte médio. Os dados provêm de 16 entrevistas semiestruturadas, realizadas em 2018 no município de Governador Valadares, MG. Os resultados indicam que, embora a maternidade seja um acontecimento desejado e valorizado, a decisão dessas mulheres não é isenta de dúvidas em relação às dificuldades para conciliar um filho com o desejo de liberdade e crescimento profissional. Essas dúvidas decorrem do fato de a maternidade ainda ter um lugar de destaque na vida das mulheres, mesmo entre um grupo de vanguarda, e se tornar mãe permanece tendo um efeito expressivo em suas vidas. Os conflitos gerados pela concomitância entre a permanência do desejo relacionado à maternidade e a emergência de novos projetos individuais apresentados às mulheres desafiam a lógica tradicional que relaciona escolaridade e projetos reprodutivos.

This paper analyzes the perceptions and meanings of motherhood for a group of women with high education, married or in consensual union, with no more than one child, residents of a mid-size city. Data come from sixteen semi-structured interviews conducted in 2018 in the municipality of Governador Valadares, MG. Results show that although motherhood is a desired and valued event, the decision is loaded with doubts regarding the difficulties to reconcile raising a child with the desire for freedom and professional growth. Doubts emerge as motherhood continues to have a prominent place in women's lives, even within a rather avant-garde group. Becoming a mother remains a significant event in their lives. Conflicts generated by the simultaneous existence of the desire to be a mother and the new individual projects unveiled to women defies the common perception that links schooling to reproductive intentions.

Este artículo analiza las percepciones y los significados de la maternidad para un grupo de mujeres con educación superior, casadas o en unión consensual sin hijos o, como máximo, un hijo, residentes de una ciudad de tamaño mediano. Los datos provienen de 16 entrevistas semiestructuradas hechas en Governador Valadares, Minas Gerais, en 2018. Los resultados indican que, aunque la maternidad es un evento deseado y valorado, la decisión de estas mujeres educadas no es indudable en relación con las dificultades para conciliar a un niño con el deseo de libertad y crecimiento profesional porque la maternidad todavía tiene un lugar destacado en la vida de las mujeres y convertirse en madre sigue teniendo un efecto significativo en sus vidas. Los conflictos generados por la concomitancia entre la persistencia del deseo relacionado con la maternidad y la aparición de nuevos proyectos individuales para las mujeres desafían la lógica tradicional que relaciona los proyectos escolares y reproductivos.

Indicadores asociados al desarrollo de competencias clínicas para el ejercicio de la psicoterapia en Argentina / Indicators Associated with the development of clinical competencies for the practice of psychotherapy in Argentina

En las últimas décadas, han aumentado los estudios sobre las competencias para el ejercicio de profesiones de la salud. En psicología y en particular, en la psicoterapia, se han elaborado diferentes escritos que detallan las competencias que deben adquirir los y las psicoterapeutas durante su formación. Sin embargo, no se encuentran estudios sistemáticos que detallen las actividades y experiencias asociadas a su desarrollo, denominadas en este trabajo como indicadores asociados. Con el objetivo de conocer cuáles son las actividades y experiencias asociadas al desarrollo de competencias clínicas, se realizaron 20 entrevistas semi-dirigidas que fueron sometidas a un análisis temático en el que complementariamente participaron expertos, quienes actuaron como jueces en diferentes etapas del proceso. Como resultado, se identificaron cinco indicadores asociados: i. Formación de base y actualización, ii. Desarrollo personal y trabajo sobre sí mismo, iii. Pertenencia a instituciones y red de profesionales, iv. Supervisión y v. Experiencia personal y profesional.

In recent decades, studies on the competencies for the exercise of health professions have increased. In psychology, particularly for psychotherapy, various writings have been produced detailing the competencies that psychotherapists must acquire during their training. However, no systematic studies are detailing the activities and experiences associated with their development, in this work called Associated Indicators. In order to know the activities and experiences associated with the development of clinical competencies, 20 semi-structured interviews were carried out subjected to a thematic analysis in which experts participated as judges in different stages of the process. As a result, five associated indicators were identified: Basic training and refresher training, personal development and work on oneself, membership of institutions and networks of professionals, supervision and personal and professional experience.

Prototipo móvil para fomentar el uso de condón en jóvenes mexicanos: un estudio de caso / Mobile Prototype for the Promotion of Condom Use in Mexican Youth: a Case Study

Se han utilizado aplicaciones móviles para promover el uso del condón que carecen de fundamento teórico y no consideran la opinión de los usuarios en su desarrollo por lo que han sido evaluadas negativamente. El objetivo fue desarrollar y evaluar una aplicación móvil para promover el uso correcto y consistente del condón en jóvenes mexicanos con riesgo de VIH, basado en enfoque de pensamiento de diseño centrado en el usuario. Utilizando metodología cualitativa se realizaron tres fases. En la primera fase, inspiración, se identificaron las necesidades de 9 jóvenes con respecto al uso del prototipo. En la segunda fase, ideación, se transformaron estas necesidades en soluciones y se validaron en 15 jóvenes. En la tercera fase, implementación, se realizó una prueba de usabilidad en otros 15 jóvenes. En conclusión, este enfoque ofreció una solución práctica para el desarrollo de un prototipo móvil para fomentar el uso de condón en jóvenes(AU)

Mobile applications have been used to promote the use of condoms, but those have no theoretical basis and do not consider the opinion of users in their development, which is why they have been evaluated negatively. The objective was to develop and evaluate a mobile application to promote the correct and consistent use of the condom in youth at risk of HIV, based on a user-centered design thinking approach. Using qualitative methodology, three phases were carried out. In the first phase, inspiration, the needs of 9 young people were identified with respect to the use of the prototype. In the second phase, ideation, these needs were transformed into solutions and validated in 15 youths. In the third phase, implementation, a usability test was conducted on other 15 youths. In conclusion, this approach offered a practical solution for the development of a mobile prototype to encourage the use of condoms in young people(AU)

The perceptions of physical therapists about facilitators and challenges in the use of different tools for resistance training in COPD patients: a mixed-method study / Percepção de fisioterapeutas sobre facilitadores e barreiras no uso de diferentes ferramentas para treinamento resistido em pacientes com DPOC: estudo de método mistos / Percepción de fisioterapeutas sobre facilitadores y barreras en el uso de diferentes herramientas de entrenamiento de resistencia en pacientes con EPOC: estudio de método mixto

ABSTRACT This study sought to quantify and qualitatively analyze the perception of physical therapists about facilitators and the challenges in the use of different types of tools for resistance training in chronic obstructive pulmonary disease (COPD) patients. This was a mixed-model study with qualitative analysis developed in a rehabilitation center. Six physical therapists who performed a randomized clinical trial were interviewed. The protocol consisted of the evaluation of three types of resistance training: elastic tubes, elastic bands, and training with conventional weight machines. After completion of the randomized trial, therapists were invited to participate in a focus group to collect qualitative data. Physical therapists also answered a quantitative questionnaire containing closed questions. The main outcome measures were the opinion of physical therapists about the advantages and disadvantages in clinical practice of each of the analyzed tools. The focus group analysis resulted in eight themes: Insecurities regarding load and handling tools, implementation of home-based treatment, improvements of tools, advantages and disadvantages of tools, incidence of injuries with elastic tools, patient's preferences, and particularities of the tools. Physical therapists pointed out different challenges and facilitators for resistance training. Characteristics of the tools such as costs, portability, handling and practicality were cited as factors that influence clinical practice. In the quantitative analysis, no differences were observed when comparing the scores of each instrument. The three tools analyzed are applicable and feasible in the clinical practice of physical therapists; moreover, they present different characteristics and particularities that should be considered, such as cost, clinical applicability, portability and perception of the patient and therapists.

RESUMO O objetivo do estudo foi quantificar e analisar qualitativamente a percepção de fisioterapeutas sobre facilitadores e barreiras no uso de diferentes ferramentas para treinamento resistido em pacientes com doença pulmonar obstrutiva crônica (DPOC). O método utilizado foi desenvolvido em um centro de reabilitação. Seis fisioterapeutas que participaram como terapeutas de um ensaio clínico randomizado foram entrevistados. O protocolo consistiu na avaliação de três ferramentas para treinamento resistido: tubos elásticos, bandas elásticas e treinamento convencional com equipamentos de musculação. Depois da finalização do ensaio clínico randomizado, os fisioterapeutas foram convidados a participar de um grupo focal para análise qualitativa e responder questionário fechado para análise quantitativa. Os profissionais opinaram sobre vantagens e desvantagens de cada uma das três ferramentas na prática clínica. A análise do grupo focal resultou em oito temas: insegurança em relação à carga e manuseio das ferramentas; implementação de tratamento domiciliar; melhorias para ferramentas; vantagens e desvantagens das ferramentas; incidência de lesões com ferramentas elásticas; preferência dos pacientes; e particularidades de cada ferramenta. Fisioterapeutas apontaram diferentes barreiras e facilitadores para o treinamento resistido. Características das ferramentas - como custo, portabilidade, manuseio, praticidade e percepção do paciente e fisioterapeuta - foram citadas como fatores que influenciam a prática clínica. Na análise quantitativa, nenhuma diferença foi observada quando comparados os escores para cada instrumento. As três ferramentas são aplicáveis na prática clínica do fisioterapeuta. Adicionalmente, as características e particularidades de cada uma delas devem ser consideradas.

RESUMEN El objetivo del estudio fue cuantificar y analizar cualitativamente la percepción de fisioterapeutas sobre facilitadores y barreras en el uso de diferentes herramientas de entrenamiento de resistencia en pacientes con enfermedad pulmonar obstructiva crónica (EPOC). El método utilizado fue desarrollado en un centro de rehabilitación. Seis profesionales que participaron como terapeutas en un ensayo clínico aleatorizado fueron entrevistados. El protocolo consistió en la evaluación de tres herramientas de entrenamiento de resistencia: tubos elásticos, bandas elásticas y entrenamiento convencional con equipo de entrenamiento con pesas. Después del ensayo clínico aleatorizado, se invitó a los fisioterapeutas a participar en un grupo focal para análisis cualitativo y a responder un cuestionario cerrado para análisis cuantitativo. Los profesionales opinaron sobre las ventajas y desventajas de cada una de las tres herramientas en la práctica clínica. El análisis del grupo resultó en ocho temas: falta de fiabilidad en lo referente a la carga y al manejo de las herramientas; puesta en práctica del tratamiento domiciliario; mejoras en las herramientas; ventajas y desventajas de las herramientas; incidencia de lesiones con las herramientas elásticas; preferencia de los pacientes; particularidades de cada herramienta. Los fisioterapeutas señalaron diferentes barreras y facilitadores para el entrenamiento de resistencia. Características de la herramienta - como costo, portabilidad, manejo, practicidad y percepción del paciente y del fisioterapeuta - fueron mencionadas como factores que influyen en la práctica clínica. En el análisis cuantitativo no se observaron diferencias de puntaje entre los instrumentos. Las tres herramientas son aplicables en la práctica clínica del fisioterapeuta. Además, se deben considerar las características y particularidades de cada una de ellas.

Cirugía bariátrica en pacientes jóvenes: ¿Cómo evalúan el proceso? / Bariatric surgery in young patients: How do they appraise the process?

RESUMEN La tasa de cirugía bariátrica en personas cada vez más jóvenes ha ido aumentando, sin embargo, son escasos los datos sobre la evolución del funcionamiento psicosocial de población joven sometida a esta intervención. Surge la necesidad de conocer diferencias y similitudes con población adulta. Objetivo: Explorar las experiencias y necesidades pre y postoperatorias de jóvenes sometidos a cirugía bariátrica en centros de salud de Chile. Método: Estudio cualitativo de alcance exploratorio/descriptivo y de corte transversal. Se aplicaron entrevistas semi-estructuradas a 27 jóvenes de entre 18 y 27 años sometidos a cirugía bariátrica. Los datos fueron analizados mediante la técnica de codificación abierta de la teoría fundamentada. Resultados: Se identifican cuatro categorías respecto a la evolución del proceso operatorio, incluyendo: historial de obesidad, motivos de consulta, vivencias postoperatorias, y factores ambientales y personales facilitadores del proceso. Discusión: Los participantes exhiben, en general, experiencias similares a las reportadas por adultos. No obstante, se evidencian elementos específicos al contexto y etapa evolutiva de la juventud, que son necesarios de considerar en el acompañamiento profesional y familiar pre y postoperatorio a corto y largo plazo.

ABSTRACT The rate of bariatric surgery has increased in younger populations, nonetheless data about the psychosocial evolution of young adults who undergo this intervention is scarce. Thus, there is a need to understand the differences and similarities of experiences compared with older adults. Aim: To explore pre- and post-operative experiences and needs of young adults who underwent bariatric surgery in health care centers in Chile. Method: Cross-sectional qualitative study with an exploratory/descriptive scope. We interviewed 27 young adults between 18 and 27 years old, who underwent bariatric surgery. Data were analyzed using open coding technique from grounded theory. Results: Four categories regarding the evolution of the operative process were identified. These included: obesity history, surgery motives, postoperative experiences, as well as environmental and personal facilitators of the process. Discussion: Participants, in general, showed similar experiences compared to the ones reported by adults. Nonetheless, we found specific elements of the developmental period and age-specific context, which are necessary to consider for the short- and long-term pre- and post-operative professional and family support.

Narratives of mothers of children with autism spectrum disorders: focus on eating behavior / Narrativa de mães de crianças com transtorno do espectro do autismo: foco no comportamento alimentar

Abstract Objective To investigate the eating behavior of individuals with autism through their mothers' narratives. Methods The study of narratives was used to report on the narrators' experiences. Data on the eating habits of individuals with autism were collected using semi-structured interviews held individually with the mothers. The interviews were recorded, transcribed and codified using the NVivo software program. Results Eighteen mothers of boys/young men with autism participated in the study. Analysis yielded three major categories: eating patterns, the family's attitudes to the child's eating habits, and food-related behavior. Conclusion Results show that autism-related factors may affect the child's food choices. Environmental factors, particularly the parents' behavior, may also play a decisive role, both in reinforcing the child's food choices and in encouraging a healthier and more diversified diet. Professionals should instruct parents regarding their decisive role in reinforcing or discouraging inappropriate mealtime behavior in children with autism.

Resumo Objetivo Investigar o comportamento alimentar de indivíduos com transtorno do espectro do autismo (TEA) através das narrativas de suas mães. Métodos Os dados sobre os hábitos alimentares dos indivíduos com TEA foram coletados utilizando entrevistas semiestruturadas realizadas individualmente com as mães. As entrevistas foram gravadas, transcritas e codificadas usando o programa NVivo. Resultados Dezoito mães de meninos/jovens homens com autismo participaram do estudo. A análise produziu três categorias principais: padrões alimentares, a atitude da família em relação aos hábitos alimentares da criança e comportamentos relacionados à alimentação. Conclusão Os resultados mostram que os fatores relacionados ao autismo podem afetar as escolhas alimentares da criança. Os fatores ambientais, particularmente o comportamento dos pais, também podem desempenhar um papel decisivo, tanto no reforço das escolhas alimentares da criança quanto no incentivo a uma dieta mais saudável e diversificada. Os profissionais devem instruir os pais sobre o seu papel decisivo no reforço ou desencorajamento do comportamento inapropriado nas refeições em crianças com TEA.

Barriers to Infant and Child-feeding Practices: A Qualitative Study of Primary Caregivers in Rural Uganda.

The purpose of this study was to explore the barriers to the use of appropriate infant and young childfeeding practices by primary caregivers living in a rural Ugandan district. A community-based qualitative design and focus group discussions were used for collecting data from primary caregivers of children aged 0 to 24 month(s). On an average, each of the four focus group discussions had 11 participants. The focus group discussions were conducted using a structured interview guide and were tape-recorded. The recorded data were later transcribed and analyzed using qualitative thematic analysis techniques. All the participants were females, and the majority had low levels of education and at least one child in the age-group of 0-24 month(s) in their household. The findings show that the main barriers to the use of appropriate infant and young child-feeding practices fall under four themes: caregiver’s knowledge about breastfeeding, caregiver’s knowledge about complimentary feeding, influence of culture custodians on the caregivers, and patterns and burden of other responsibilities the caregivers have in the household. The four categories of barriers imply that there are various missed opportunities to implement hospital and community-based interventions to improve infant and young child-feeding practices, which is one way of preventing malnutrition. Therefore, in rural areas of Uganda, the major factors responsible for the high prevalence of malnutrition among infants and children are still those related to knowledge, culture, and social status of the primary caregivers.

O estudo de caso como metodologia de investigação psicanalítica / Case study as a methodology for psychoanalytic research

Registram-se divergências epistemológicas relativas ao estudo de caso como método adequado à validação da teoria psicanalítica entre uma posição que compreende a investigação psicanalítica como o estudo dos significados e método apropriado à investigação das teorias psicanalíticas e uma abordagem que privilegia a adoção de um caráter científico, baseando-se na integração de metodologias de investigação apoiada em lógicas de relações probabilísticas de causalidade. A investigação psicanalítica, de acordo com modelos de causalidade, parece não considerar a especificidade do seu campo de estudo, o inconsciente, requerendo uma abordagem específica de investigação. Neste trabalho os autores propõem a utilização do estudo de caso como metodologia de investigação psicanalítica científica, através da realização de supervisão clínica e da análise da contratransferência como metodologias geradoras de evidência científica para a teoria psicanalítica(AU)

Epistemological differences regarding case study as an appropriate validation method of psychoanalytic theory have been observed, from a position that understands psychoanalytic research as the study of meanings, and the appropriate method to research psychoanalytic theories; and an approach that favors the adoption of a scientific character, based on the integration of research methodologies supported on logics of probabilistic causal relations. The psychoanalytic investigation, according to causal models, does not seem to consider the specificity of its study field, the unconscious, requiring a specific approach to research. In this work the authors propose the use of case study as a methodology for psychoanalytic scientific research, by means of clinical supervision and the analyses of countertransference as methodologies that generate scientific evidence for the psychoanalytic theory(AU)

Existen diferencias epistemológicas en relación con el estudio de caso como método apropiado para validar la teoría psicoanalítica, entre una posición que comprende la investigación psicoanalítica como el estudio de los significados y el método adecuado para la investigación de las teorías psicoanalíticas y un enfoque a favor de la adopción de un carácter científico, basado en la integración de metodologías de investigación basándose en relaciones de causalidad lógica probabilística. La investigación psicoanalítica de acuerdo con modelos de causalidad no parece tener en cuenta la especificidad de su campo de estudio, el inconsciente, que requiere un método específico para su investigación. En este trabajo los autores proponen el uso del estudio de caso como metodología de la investigación psicoanalítica científica, mediante la realización de la supervisión clínica y el análisis de la contratransferencia como metodologías que generan evidencia científica para la teoría psicoanalítica(AU)

Discursos sobre sexología en Chile: ambivalencias del discurso profesional sobre la sexología en Chile / The ambivalence of professional discourse on sexology in Chile

En este artículo se explora el campo de la sexología en Chile, se analiza cómo lo ven y cómo lo definen los profesionales que se desempeñan en dicho campo. Se hizo un estudio cualitativo basado en entrevistas a 11 profesionales. Entre los principales hallazgos encontramos que los profesionales estudiados no se reconocen en la definición de sexólogo/a. Esta definición es imprecisa como campo disciplinario y no tiene especialización científica. La sexología sin referencia institucional disciplinaria o gremial, carecería de estándares de calidad. La sexología desregulada institucionalmente queda expuesta a déficits de control y fines no legítimos. El/la profesional queda sin designación, ni reconocimiento profesional (no es especialidad o subespecialidad de alguna disciplina), ni tampoco sujeto a control o autoridad científica o gremial especializada. El profesional queda con una definición social construida principalmente a partir de su exposición pública y carente de una autodefinición afirmativa.

This paper explores the professional field of sexology in Chile and also shows how sexologists see and define themselves. A qualitative study was conducted and 11 professionals were interviewed. Main findings indicate that sexology can be defined as a clinical field disciplinarily associated with medicine (urology, gynecology, and to a lesser extent, psychiatry) and psychology (clinical psychology). Sexology appears as private professional practice, though not in public health, and as a professional field, rather than a research area. In addition, there is a two-fold development concerning its conceptual, methodological, and technological approach: sexual medicine and sexual therapy. Finally, interviewees do not recognize themselves as sexologists and there is no evidence of the use of this term in the past.

Estudio cualitativo sobre la atención médica a los enfermos crónicos en el Seguro Popular / A qualitative study on health care to chronically ill people in Popular Health Insurance program

OBJETIVO: Examinar la atención médica que brinda el Seguro Popular a los enfermos crónicos en México, desde la perspectiva de quienes padecen las enfermedades y también de los profesionales de la salud. MATERIAL Y MÉTODOS: Se llevó a cabo un estudio cualitativo en la ciudad de Guadalajara, Jalisco, México, donde se entrevistó a 40 enfermos crónicos y a 14 profesionales sanitarios de primer nivel; posteriormente, se realizó un análisis crítico del discurso. RESULTADOS: El Seguro Popular ha significado ganancias y pérdidas para los participantes. Los enfermos lo valoran positivamente al considerarlo un regalo, mas no un derecho social. Sus carencias económicas y de recursos les impiden acceder a la atención médica, obtener medicamentos y realizarse estudios de laboratorio, también generándose relaciones conflictivas con los profesionales. CONCLUSIÓN: Los propósitos del Seguro Popular distan de lograrse en la atención a los enfermos crónicos. El Seguro tendría que ser objeto de análisis, y otorgar prioridad a la perspectiva de los enfermos y del personal de salud operativo.

OBJECTIVE: To examine health care provided to chronically ill people in the Popular Health Insurance (Seguro Popular) from the perspective of patients and health professionals. MATERIALS AND METHODS: A qualitative study was carried out in Guadalajara, Mexico. 40 chronically ill people, and 14 health professionals of primary health centers participated in the study. Information was gathered using semi-structured interviews; critical discourse analysis was carried out. RESULTS: Seguro Popular has meant gains and losses to participants. Cronically ill people value it positively since it is perceived as a gift, not a social right. Some obstacles impede participants accessing health care, obtaining medications and analysis. Conflictive relations also cause tensions between patients and health professionals. CONCLUSION: The initial goals of Seguro Popular are not achieved regarding health care to chronically ill people. The perspectives of sick people should be prioritized.

Validación de métodos alternativos para análisis microbiológico de alimentos y aguas / Validation of alternative methods for the microbiological analysis of food products and water

El empleo de métodos microbiológicos alternativos para la detección de microorganismos es una herramienta importante para garantizar la inocuidad de alimentos y aguas. Numerosos y diversos métodos alternativos para microbiología se comercializan actualmente gracias a avances recientes, sobre todo en el campo de la biotecnología. Para que un nuevo método microbiológico sea aceptado, su fabricante debe demostrar su adecuación. En una primera revisión, se realizó el análisis de los principales parámetros determinados en la validación de los métodos microbiológicos cualitativos. El objetivo de esta segunda parte consiste en abordar los indicadores más importantes a considerar para los métodos microbiológicos cuantitativos

The use of alternative microbiological methods for the detection of microorganisms is an important tool to ensure the safety of food products and water. A large number of alternative microbiological methods are currently available on the market, thanks to recent advances mainly in the field of biotechnology. In order for a new microbiological method to be accepted, its manufacturer must prove its adequacy. In a first review, an analysis was made of the main parameters determined for the validation of qualitative microbiological methods. The purpose of this second part is to approach the most important indicators to be considered for quantitative microbiological methods

Social psychology: research methods and techniques / Psicologia social: métodos e técnicas de pesquisa

The objective of this paper is to identify the research methods adopted by researchers in the field of Social Psychology, differentiating them by considerations derived from the four epistemic dimensions. Our starting point was a study conducted to identify the theoretical references and research methods used by educators and researchers in the field of social psychology. The results presented here refer to data, obtained in the years 2011 and 2012, relating to 545 social psychologists and professors of social psychology, of which 157 responded in Portuguese and 388 in Spanish. The average age of participants was 41.5 years (standard deviation = 11.4; minimum = 21 years; maximum = 78), being 54% female and 43% male. The participants originated from 19 countries, with Spain (158), Brazil (149), Mexico (64), and Argentina (45) the most frequent. Based on the results, we sought to classify and subsequently to estimate the frequency of use of the methods, considering them based on the distribution of the researchers from two geographic regions, Latin America and the Iberian Peninsula. Since geographical distribution did not provide a consistent criterion for differentiating between methods, we tried to understand the differences by considering ultimately the theoretical approach embraced by the researcher.

O presente artigo tem por objetivo identificar os métodos de pesquisa adotados por pesquisadores da área da Psicologia Social, diferenciando-os a partir de considerações oriundas de quatro dimensões epistêmicas. O nosso ponto de partida foi um estudo conduzido com a finalidade de identificar os referenciais teóricos e os métodos de pesquisa utilizados por professores e pesquisadores da área da psicologia social. Os resultados aqui apresentados se referem aos dados, obtidos nos anos de 2011 e 2012, concernentes a 545 psicólogos sociais e professores de psicologia social, dos quais 157 responderam na língua portuguesa e 388 em espanhol. A média de idade dos participantes foi de 41,5 anos (desvio-padrão = 11.4; mínimo = 21 anos; máximo = 78), sendo 54% do sexo feminino e 43% do sexo masculino. Os participantes se declaram originários de 19 países, sendo Espanha (158), Brasil (149), México (64) e Argentina (45) os mais frequentes. Com base nos resultados, procuramos classificar e posteriormente fazer uma estimativa da frequência de utilização dos métodos, considerando-os a partir da distribuição dos pesquisadores de duas regiões geográficas, América Latina e Península Ibérica. Dado que a distribuição geográfica não proporcionou um critério consistente para a diferenciação entre os métodos, procuramos entender as diferenças levando em consideração fundamentalmente a abordagem teórica acolhida pelo pesquisador.

Los métodos y procesos multicriterio para la evaluación / Multicrieria metthods and processes for assessment

El presente artículo tiene por objeto evidenciar las bondades que el método multicriterio otorga en las evaluaciones científicas que sean consistentes con un marco de racionalidad. Inicia haciendo referencia al método científico a través del cual el hombre trata de entender el mundo, construyendo uno artificial desde la ciencia. A continuación se reflexiona sobre el valor agregado que pueden proporcionar los métodos cualitativos al entregar una visión diferente del mundo, al tomar en consideración variables que no pueden ser expresadas cuantitativamente. Para finalizar se expone el método multicriterio como una herramienta útil para determinar el impacto de acciones a desarrollo sobre la sostenibilidad al incorporar los conflictos que existen entre objetivos económicos, ambientales y sociales, y entre distintos niveles de decisión en las evaluaciones científicas.

This article aims to make clear the benefits the multicriteria-method gives to scientific assessment which are consistent with a rationality framework. It begins by referring to the scientific method, through which humankind tries to understand the world building an artificial world from science. Afterwards a reflection on the added value qualitative methods as a methodology can give, is presented since they allow a broader worldview by taking into account variables that cannot be expressed quantitatively. Finally, a multicriteria-method is presented as a useful tool to determine the impact of actions on sustainability, while incorporating the existing conflicts between economic, environmental and social objectives, and between different levels of decision making in scientific assessment.

Validity of Workers’ Self-Reports. Evaluation of a Question Assessing Lifetime Exposure to Occupational Physical Activity.

Aims: In epidemiological studies exposure assessment based on questionnaires is the most cost-effective method. A question about lifetime exposure to occupational physical activity (OPA) was used in a population-based survey (part of the Copenhagen Aging and Midlife Biobank, CAMB). The aim of the study was to validate this question through a three-step process. Methodology: Firstly, the response process was studied by cognitive interviewing of 7 persons. Secondly, 64 persons participated in semi-structured interviews about their work-life, and expert judgments of exposure to OPA were compared with questionnaire-data. Exposure was 20 years of work in one of four categories of OPA: sedentary, standing and walking, moderate or high OPA. Kappa values were calculated for agreement and interpreted according to Landis and Koch’s criteria. Agreement was visualized in Bland-Altman plots. Thirdly, intra- and inter-rater reliability of expert judgments was tested. Results: Response process: The question had a complicated instruction, and the respondents found it hard to remember, categorize, and summate exposures. Semi-structured interviews: Kappa value for exposure to sedentary work was ‘substantial’ (0.71) but ‘fair’ for the other categories of OPA (0.27-0.29). Agreement between questionnaire and interview was higher in sedentary jobs and jobs with high OPA. Intra-rater reliability of expert judgments was ‘substantial’ or ‘moderate’ (0.60-0.71). Inter-rater reliability was high in sedentary jobs but lower in the more active jobs. Conclusion: Self-reports of lifetime exposure to sedentary work are valid in the CAMB cohort, whereas the validity of self-reports of exposure to high levels of occupational physical activity (OPA) are questionable. Thorough pre-testing of questions about lifetime OPA is recommended.

Qualitative environmental health research: an analysis of the literature, 1991-2008 / Pesquisa qualitativa de saúde ambiental: uma análise da literatura, 1991-2008

Qualitative research uses nonnumeric data to understand people's opinions, motives, understanding, and beliefs about events or phenomena. In this analysis, I report the use of qualitative methods and data in the study of the relationship between environmental exposures and human health. A primary search for peer-reviewed journal articles dated from 1991 through 2008 included the following three terms: qualitative, environ*, and health. Searches resulted in 3,155 records. Data were extracted and findings of articles analyzed to determine where and by whom qualitative environmental health research is conducted and published, the types of methods and analyses used in qualitative studies of environmental health, and the types of information qualitative data contribute to environmental health. The results highlight a diversity of disciplines and techniques among researchers who used qualitative methods to study environmental health. Nearly all of the studies identified increased scientific understanding of lay perceptions of environmental health exposures. This analysis demonstrates the potential of qualitative data to improve understanding of complex exposure pathways, including the influence of social factors on environmental health, and health outcomes.

Pesquisa qualitativa usa dados não numéricos para entender opiniões, motivos e crenças sobre eventos e fenômenos. Nesta análise, o uso de métodos e de dados qualitativos é reportado no estudo da relação entre exposição ambiental e saúde humana. Uma pesquisa preliminar por artigos de 1991 a 2008 incluiu os três seguintes termos: qualitativo, ambiente e saúde. A pesquisa resultou em 3.155 registros. Dados foram extraídos e artigos analisados para determinar onde e por quem a pesquisa de saúde ambiental foi conduzida e publicada, os tipos de métodos e análises usados em estudos qualitativos de saúde ambiental e os tipos de dados de informação qualitativa que contribuem para a saúde ambiental. Os resultados ressaltam uma diversidade de disciplinas e técnicas entre pesquisadores que usaram métodos qualitativos para estudar saúde ambiental. Quase todos os estudos identificaram um aumento da compreensão científica de percepções de exposições de saúde ambiental. A análise demonstra o potencial de dados qualitativos para melhorar a compreensão de caminhos de exposição complexos, incluindo a influência de fatores sociais em saúde ambiental e resultados.

Reflexividad dialógica en el estudio de jóvenes y prácticas políticas / Dialogic reflexivity in the study of youth and political practices / Dialógica reflexividade no estudo de jóvenes y práticas políticas

Tradicionalmente los métodos cualitativos se han ocupado de las prácticas de los sujetos, describiendo sus acciones, expresiones y discursos. Sin embargo, es necesario innovar metodologías que aborden los sentidos y significados que los sujetos otorgan a sus prácticas, generando en el proceso investigativo reflexiones que permitan potenciarlas. La reflexividad dialógica, comprendida como la capacidad de los sujetos para interrogar lo dicho, lo hecho y lo pensado, la asumimos como una opción metodológica que permite abordar memorias, prácticas y discursos en sus múltiples formas expresivas. El conocimiento logrado por medio de dispositivos metodológicos dialógicos como la observación participante, el taller, la entrevista y las tertulias, permite al sujeto conocido su develamiento y autorreconocimiento en el proceso de investigación.

Os métodos qualitativos tradicionalmente se centram sobre as práticas dos sujeitos por meio das descrições de suas ações, expressões e discursos. No entanto, é necessário inovar as metodologias que abordam os significados que os sujeitos atribuem às suas práticas. Neste sentido, o propósito desta metodologia é evidenciar um novo processo de investigação crítica que permita uma reflexão coletiva entre os sujeitos analisados. Dialógica reflexividade, entendida como a capacidade dos indivíduos para questionar o que foi dito, feito e pensado, entendê-la como uma abordagem metodológica que permite refletir nas memórias, práticas e discursos em suas múltiplas formas de expressão. O conhecimento adquirido pelos dispositivos metodológicos dialógicos como a observação participante, entrevistas e grupos de discussões, permite ao sujeito conhecer e se autoreconhecer- se no processo de investigação.

Qualitative methods have focused, traditionally, on the practices of subjects, describing their experiences, expressions and discourses. However, it is necessary to innovate methodologies that address the senses and meanings that subjects give to their own experiences, to achieve reflection in the investigative process and enhance those practices. Dialogic reflexivity, understood as the ability of individuals to question what was said, done and thought, represents a methodological approach that allows to tackle memories, practices and discourses in their multiple forms of expression. The knowledge gained through dialogic methodological tools such as participant observation, workshops, interviews and focus groups, enables the subject to know its unveiling and self-recognition in the research process.