Influence of Positive Thinking Ideology on Physician Representations of Cancer.

To understand the influence of positive thinking ideology on cancer representations among physicians in the city of Medellín. METHODS: This qualitative study was conducted on the basis of the theoretical and methodological elements of Corbin and Strauss's grounded theory. Fourteen physicians were included and selected according to the criteria of maximum variation for education, years of study, and personal and family history of cancer. The information was collected through semi-structured interviews and analyzed with open, axial, and selective coding. RESULTS: the ideology of positive thinking has managed to permeate the medical discourse and the representations that they form about the etiology and treatment of cancer. Physicians place the mind, emotions, attitude, and positive thinking as determinants of the origin of the disease and the response to therapy. To argue this link, they use two strategies: (i) a sophisticated and specialized discourse that involves relationships among thoughts, genetics, the neurological, immune and endocrine system and (ii) a mystical and less rational discourse that emphasizes the omnipotence of the mind and thoughts. In no case was the idea of positive thinking rejected or in disagreement with this style of thinking expressed. CONCLUSION: The fact of linking the disease with mental factors refers to the mind-body dualism and generates a responsibility of the patients on the etiology and therapeutics of the disease, as well as an erasure of the social and political determinants of cancer. The technical discourse and the symbolic capital of physicians offer scientific legitimacy to these ideas and can become performative for patients.

Explanatory Model of Psychogenic, Behavioral and Environmental Causal Attributions of Cancer, and Their Psychogenic, Biomedical and Alternative Treatment in the General Population of Medellín, Colombia.

BACKGROUND: Understanding the causal attributions for cancer, the elements affecting therapeutic adherence, and behaviors that may compromise people's health or even put them at risk of dying from this disease has garnered a considerable degree of attention. METHODS: This study was designed in the city of Medellín with the aim to develop and validate a model for the study of (i) the categories that can be attributable to cancer etiology, (ii) the categories that can be attributed to the efficacy of treatment, and (iii) the relationship between the categories that can be attributed to the etiology and to the efficacy of the treatment. Structural equations were performed on 611 participants. RESULTS: The analysis revealed that attributing the disease to psychogenic factors distances people from biomedical treatments (ß coefficient, -0.12), and brings them closer to psychogenic (ß coefficient, 0.22) and alternative treatments (ß coefficient, 0.24). Attributing cancer to behavioral factors brings people closer to psychogenic treatments (ß coefficient, 0.40) over biomedical treatments (ß coefficient, 0.24). CONCLUSIONS: Symbolic, cultural, and social factors were evidenced, thereby leading to the underestimation of biomedical treatments and imparting a greater degree of importance to psychogenic or alternative therapies. These therapies will subsequently affect the achievement of therapeutic objectives such as increased survival.

Perfil de investigaciones en malaria asociada al embarazo: revisión sistemática 1925-2018 / Research profile in pregnancy-associated malaria: systematic review 1925-2018 / Perfil das pesquisas sobre malária associada à gravidez: Revisão sistemática 1925-2018

Resumen Objetivo: Describir el perfil de publicaciones en malaria asociada al embarazo en el ámbito mundial, con base en los países, tipos y años de estudio, 1925-2018. Metodología: Revisión sistemática de la literatura, mediante el seguimiento de la guía prisma y garantizando la reproducibilidad del protocolo de selección y extracción de variables. Se aplicaron doce estrategias de búsqueda en PubMed, Science Direct, SciELO y Google Scholar. Se realizó síntesis cualitativa mediante frecuencias para el país, año de estudio y tipología de investigación. Resultados: Se tamizaron 3362 publicaciones, de las cuales 617 cumplieron el protocolo. El 81,5 % fueron de África, 9,9 % de Asia y 5,3 % de América. La mayor proporción de publicaciones fue posterior al 2009. El 65,8 % fueron estudios observacionales; el 22,0 %, ensayos clínicos, y los estudios cualitativos, de evaluación económica o evaluación de programas y políticas, fueron menores al 5 %. No se hallaron estudios de pruebas diagnósticas, evaluación de programas o investigaciones cualitativas en América. Conclusión: El perfil de publicaciones evidencia el predominio de la investigación epidemiológica tradicional-positivista y su concentración en África, lo que implica retos para las agendas sanitarias y de investigación en salud pública, pero con mayor necesidad en América.

Abstract Objective: To describe the profile of publications on pregnancy-associated malaria worldwide, based on countries, types and years of study, 1925-2018. Methodology: Systematic review of the literature, by monitoring the PRISMA guide and guaranteeing the reproducibility of the variable selection and extraction protocol. Twelve search strategies were applied in PubMed, Science Direct, SciELO and Google Scholar. Qualitative synthesis was performed using frequencies for the country, year of study and type of research. Results: 3362 publications were screened, of which 617 complied with the protocol. 81.5% were from Africa, 9.9% from Asia and 5.3% from America. The highest proportion of publications was after 2009. 65.8% were observational studies; 22.0%, clinical trials, while qualitative studies, economic evaluation studies or evaluation studies of programs and policies accounted for less than 5%. No studies of diagnostic tests, evaluation of programs or qualitative research were found in America. Conclusion: The profile of publications shows the predominance of traditional-positivist epidemiological research and its concentration in Africa, which implies challenges for health and research agendas in public health, but with greater need in America.

Resumo Objetivo: Descrever o perfil das publicações sobre malária associada à gravidez no âmbito mundial, com base nos países, tipos e anos de estudo, 1925-2018. Metodologia: Revisão sistemática da literatura através do seguimento da recomendação PRISMA e garantindo a reprodutibilidade do protocolo de seleção e extração de variáveis. Foram aplicadas doce estratégias de busca em PubMed, Science Direct, SciELO e Google Scholar. Foi realizada síntese qualitativa através de frequências para o país, ano do estudo e tipologia de pesquisa. Resultados: Foram escolhidas 3362 publicações, das quais 617 cumpriram o protocolo. Um total de 81,5% foi da África, 9,9% da Ásia e 5,3% da América. O maior número proporcional de publicações foi posterior a 2009. Os estudos observacionais registraram 65,8%; os ensaios clínicos 22,0% e os estudos qualitativos, de avaliação econômica ou avaliação de programas e políticas registrados foram menores a 5%. Não foram encontrados estudos de testes diagnósticos, avaliação de programas ou pesquisas qualitativas na América. Conclusão: O perfil das publicações evidencia a predominância da pesquisa epidemiológica positivista tradicional e sua concentração na África, o que representa desafios para as agendas de saúde e de pesquisa em saúde pública, mas com uma necessidade maior na América.

Conocimientos, actitudes y prácticas (CAP) sobre sostenibilidad en estudiantes de una universidad pública colombiana / Knowledge, attitudes, and practices (KAP) in sustainability among students of a colombian university

RESUMEN La educación para el desarrollo sostenible tiene el propósito de generar cambios en los conocimientos, las actitudes y las prácticas de las personas, para promover transiciones hacia la sostenibilidad. Los estudios de Conocimientos Actitudes y Prácticas (CAP) pueden ser una herramienta útil, oportuna y pertinente, para valorar los logros de la educación con orientación ambiental. Este estudio analizó el perfil de CAP sobre Sostenibilidad y sus factores asociados en estudiantes de una universidad pública colombiana, mediante un estudio descriptivo transversal, de 356 estudiantes universitarios. Se encontró que la dimensión con los puntajes más altos fue la de Actitudes, seguida por los Conocimientos y el más bajo para las Prácticas, y asociaciones con el sexo, la edad y el programa de formación al que pertenecen los estudiantes.

ABSTRACT The education for sustainable development aims at generating changes in people's knowledge, attitudes, and practices in order to promote transitions towards sustainability. Studies on Knowledge, Attitudes, and Practices (KAP) may become useful, timely and pertinent tools to assess the accomplishments of environmentally-oriented education. This study analyzed the profile of KAP in Sustainability, together with its associated factors, among students at a public Colombian university by means of a cross-sectional descriptive study which included 356 subjects. It found that attitudes dimension showed the highest scores, followed in decreasing order by knowledge and practices, as well as associations with gender, age, and the undergraduate program the students belong to.

[Social determination and determinants of malaria: a systematic review, 1980-2018Determinação social e determinantes sociais da malária: revisão sistemática, 1980-2018]. / Determinación y determinantes sociales de la malaria: revisión sistemática, 1980-2018.

OBJECTIVE: Describe how the 'social determination of health' approach has been applied in malaria studies around the world. METHODS: Systematic review of original studies published from 1980 to 2018. Six search strategies were used in ten multidisciplinary databases, and in libraries and repositories of seven universities in Brazil, Colombia, Ecuador, and Peru. PRISMA guidelines were followed, methodological quality was evaluated according to STROBE criteria, and a qualitative summary of the results was conducted. RESULTS: Ten studies published from 1984 to 2017 met pre-established inclusion and exclusion criteria; 33 social determinants of malaria were identified. Of individual determinants, greater malaria risk was found in adults, people who are often outdoors at night, and people who do not take preventive measures; intermediate determinants were dwellings with poor physical and sanitary infrastructure, overcrowded, located in forested areas, and containing animals. Regarding socioeconomic determinants, the people at greatest risk were involved in agro-forestry activities, migrants, and those with low income and a low educational level. Malaria caused high economic losses and led to poverty and educational delay. CONCLUSION: No studies were found that used Latin American social medicine approaches or that applied the World Health Organization's hierarchical and multilevel analysis for individual, intermediate, and structural determinants. No progress has been made in the analysis of social categories-territory, social class, gender, ethnic group, macroeconomic policies-or other socioeconomic characteristics that determine risk of illness or death from malaria.

OBJETIVO: Descrever como foi aplicado o enfoque da determinação social da saúde nos estudos de malária no mundo. MÉTODOS: Uma revisão sistemática de estudos originais publicados entre 1980 e 2018 foi conduzida com o uso de seis estratégias de busca em 10 bases de dados multidisciplinares e em bibliotecas e repositórios de sete universidades do Brasil, Colômbia, Equador e Peru. O estudo se baseou nos critérios da recomendação PRISMA e a qualidade metodológica foi avaliada segundo os critérios da iniciativa STROBE. Foi realizada uma síntese qualitativa dos resultados. RESULTADOS: Dez estudos publicados entre 1984 e 2017 preencheram os critérios de inclusão e exclusão predefinidos. Foram identificados 33 determinantes sociais da malária. Com relação aos determinantes individuais, foi observado maior risco da malária em adultos, pessoas com hábitos noturnos e que não aderem a práticas preventivas. Os determinantes intermediários foram moradias com infraestruturas física e sanitária precárias, com aglomeração de pessoas, localizadas em áreas de mata e com a presença de animais. E, quanto aos determinantes socioeconômicos, houve maior risco da doença entre os indivíduos que se dedicam a atividades agroflorestais, migrantes e pessoas com baixa escolaridade e baixa renda. A malária causou grande prejuízo econômico, gerando pobreza e atraso educacional. CONCLUSÃO: Não foram encontrados estudos com enfoques da medicina social latino-americana nem estudos contendo análises com modelo hierárquico e multinível para os determinantes individuais, intermediários e estruturais de acordo com a definição da Organização Mundial da Saúde. Não foi possível aprofundar a análise das categorias sociais (território, classe social, gênero, etnia e políticas macroeconômicas) ou outras características socioeconômicas que determinam o risco de ter a doença ou morrer de malária.

Determinación y determinantes sociales de la malaria: revisión sistemática, 1980-2018

[RESUMEN]. Objetivo. Describir cómo se ha aplicado el enfoque de la determinación social de la salud en los estudios sobre malaria en el mundo. Métodos. Revisión sistemática de los estudios originales publicados entre 1980 y 2018. Se emplearon seis estrategias de búsqueda en diez bases de datos multidisciplinarias, y en las bibliotecas y los repositorios de siete universidades de Brasil, Colombia, Ecuador y Perú. Se siguió la guía PRISMA; la calidad metodológica se evaluó según los criterios de STROBE y se realizó la síntesis cualitativa de los resultados. Resultados. Diez estudios publicados entre 1984 y 2017 cumplieron con los criterios de inclusión y exclusión preestablecidos; se identificaron 33 determinantes sociales de la malaria. De los determinantes individuales se halló mayor riesgo de malaria en adultos, personas con hábitos nocturnos y sin prácticas preventivas; de los intermedios, fueron las viviendas con mala infraestructura física y sanitaria, hacinamiento, ubicadas en áreas boscosas y con animales. De los socioeconómicos, el mayor riesgo correspondió a personas con actividades agroforestales, migrantes, y con bajos ingresos y escolaridad. La malaria ocasionó elevadas pérdidas económicas y generó pobreza y retardo educativo. Conclusión. No se hallaron estudios con los enfoques de la Medicina Social Latinoamericana ni que aplicaran el análisis jerárquico y multinivel para los determinantes individuales, intermedios y estructurales, de la Organización Mundial de la Salud. No se ha logrado avanzar en el análisis de categorías sociales —territorio, clase social, género, etnia, políticas macroeconómicas— u otras características socioeconómicas que determinan el riesgo de enfermar o morir de malaria.

[ABSTRACT]. Objective. Describe how the ‘social determination of health’ approach has been applied in malaria studies around the world. Methods. Systematic review of original studies published from 1980 to 2018. Six search strategies were used in ten multidisciplinary databases, and in libraries and repositories of seven universities in Brazil, Colombia, Ecuador, and Peru. PRISMA guidelines were followed, methodological quality was evaluated according to STROBE criteria, and a qualitative summary of the results was conducted. Results. Ten studies published from 1984 to 2017 met pre-established inclusion and exclusion criteria; 33 social determinants of malaria were identified. Of individual determinants, greater malaria risk was found in adults, people who are often outdoors at night, and people who do not take preventive measures; intermediate determinants were dwellings with poor physical and sanitary infrastructure, overcrowded, located in forested areas, and containing animals. Regarding socioeconomic determinants, the people at greatest risk were involved in agro-forestry activities, migrants, and those with low income and a low educational level. Malaria caused high economic losses and led to poverty and educational delay. Conclusion. No studies were found that used Latin American social medicine approaches or that applied the World Health Organization’s hierarchical and multilevel analysis for individual, intermediate, and structural determinants. No progress has been made in the analysis of social categories—territory, social class, gender, ethnic group, macroeconomic policies—or other socioeconomic characteristics that determine risk of illness or death from malaria.

[RESUMO]. Objetivo. Descrever como foi aplicado o enfoque da determinação social da saúde nos estudos de malária no mundo. Métodos. Uma revisão sistemática de estudos originais publicados entre 1980 e 2018 foi conduzida com o uso de seis estratégias de busca em 10 bases de dados multidisciplinares e em bibliotecas e repositórios de sete universidades do Brasil, Colômbia, Equador e Peru. O estudo se baseou nos critérios da recomendação PRISMA e a qualidade metodológica foi avaliada segundo os critérios da iniciativa STROBE. Foi realizada uma síntese qualitativa dos resultados. Resultados. Dez estudos publicados entre 1984 e 2017 preencheram os critérios de inclusão e exclusão predefinidos. Foram identificados 33 determinantes sociais da malária. Com relação aos determinantes individuais, foi observado maior risco da malária em adultos, pessoas com hábitos noturnos e que não aderem a práticas preventivas. Os determinantes intermediários foram moradias com infraestruturas física e sanitária precárias, com aglomeração de pessoas, localizadas em áreas de mata e com a presença de animais. E, quanto aos determinantes socioeconômicos, houve maior risco da doença entre os indivíduos que se dedicam a atividades agroflorestais, migrantes e pessoas com baixa escolaridade e baixa renda. A malária causou grande prejuízo econômico, gerando pobreza e atraso educacional. Conclusão. Não foram encontrados estudos com enfoques da medicina social latino-americana nem estudos contendo análises com modelo hierárquico e multinível para os determinantes individuais, intermediários e estruturais de acordo com a definição da Organização Mundial da Saúde. Não foi possível aprofundar a análise das categorias sociais (território, classe social, gênero, etnia e políticas macroeconômicas) ou outras características socioeconômicas que determinam o risco de ter a doença ou morrer de malária.

Análisis de sostenibilidad de la política de control de malaria del municipio de El Bagre, Colombia / Sustainability Analysis of the Malaria Control Policy in the Municipality of El Bagre, Colombia / Análise de sustentabilidade da política de controle de malária do município de El Bagre, Colombia

El objetivo de esta investigación fue analizar la sostenibilidad de la política de control de malaria en el municipio de El Bagre durante el año 2011. Se llevó a cabo un estudio de diseño mixto de modelo dominante CUAL-cuan, de carácter exploratorio. Se hicieron catorce entrevistas y una revisión documental, para identificar procesos sociales y ecológicos involucrados con la malaria, y también para describir y analizar la política de control de esta enfermedad. Se encontró que la minería, las migraciones, las prácticas y creencias culturales, el conflicto armado y las variaciones climáticas se relacionaban con la dinámica de la enfermedad y, asimismo, que la estructura de la política de control da cuenta de escasa capacidad de los actores para adaptar las acciones de control a estos procesos socioecológicos de la región. La política de control mostró ser efectiva aunque, bajo los supuestos del modelo, es escasamente sostenible.

The objective of this research was to analyze the sustainability of the malaria control policy in the municipality of El Bagre, during 2011. We performed a mixed-design study with a dominant model QUAL^quan, of exploratory character. We carried out fourteen interviews and a review of the documentation to identify social and ecological processes involved with malaria, and also to describe and analyze the control policy for this illness. We found that mining, migrations, cultural practices and beliefs, the armed conflict and climate variations are related with the dynamic of the illness. Likewise, we found that the structure of the control policy accounts for the limited capacity of the actors to adapt the control actions to the socio-ecological processes of the region. The control policy showed to be effective, although, under the assumptions of the model, it is barely sustainable.

O objetivo desta pesquisa foi analisar a sustentabilidade da política de controle de malária no município de El Bagre durante o ano 2011. Efetuou-se estudo de desenho misto de modelo dominante QUAL-quan, de caráter exploratorio. Foram feitas quatorze entrevistas e uma revisao documental, para identificar processos sociais e ecológicos envolvidos na malária, mesmo para descrever e analisar a política de controle desta doenca. Encontrou-se que a mineracao, migra-coes, práticas e crencas culturais, o conflito armado e as variacoes climáticas relacionavam-se com a dinámica da doenca e, do mesmo modo, que a estrutura da política de controle mostra escassa capacidade dos atores para adaptar as acoes de controle a esses processos socioecológicos da regiao. A política de controle mostrou ser efetiva embora, sob os supostos do modelo, escassamente sustentável.

Concepts associated with health from the perspective of sustainable development / Conceptos asociados a la salud desde la perspectiva del desarrollo sostenible

The concept of health is a social construction defined by the historical-cultural contexts of societies. At the moment, this context is characterized by global challenges such as climate change, energy crisis, the north-south divide, and poverty, among others. In view of these challenges, sustainable development has emerged as a proposal to cope with these drawbacks of the Western development model. In this sense, it is plausible to suppose, in accordance with a new global scenario of sustainable development, that a new conception of health is also emerging. For that reason, this paper aims at identifying this renewed concept of health, together with related concepts which are mentioned in the official documents on sustainable development originated in the world summits. Despite the fact that the concepts of health and sustainable development have been understood as being equivalent, none of the aforementioned official documents has provided societies with an explicit concept of health. It was verified that the concept of health has been associated with that of need satisfaction and preservation of ecosystems, whereas the construct of illness is associated with the concepts of poverty and high consumption levels. Finally, it is concluded that health is an intermediate goal of sustainable development and not an end in itself.(AU)

Sentidos de la práctica en el Proyecto Interinstitucional por una Infancia Saludable (PRISA) / Meaning of the academic practices implemented in PRISA (Proyecto Interinstitucional por una Infancia Saludable)

La presente sistematización se realizó en el marco del Proyecto Interinstitucional por una Infancia Saludable (PRISA), proyecto interinstitucional de prácticas académicas en el que participaron seis facultades del área de la salud de la Universidad de Antioquia. La sistematización partió de un proceso reflexivo y continúo con un riguroso transcurso metodológico a través del cual se encontró el sentido a las voces de los actores participantes en PRISA y en la sistematización. El proceso de reflexión e indagación conllevó al establecimiento de los objetivos de la sistematización y a la definición de las técnicas de investigación más propicias para interactuar con los actores de PRISA y encontrar el sentido a sus vivencias. Se establecieron los siguientes objetivos; entre otros: a) indagar por el concepto de Práctica Social y académica de las unidades académicas que participaron en PRISA. b) indagar por el sentido de las prácticas académicas para los actores participantes en PRISA. Entre los hallazgos de la sistematización se evidencia que PRISA constituyó un escenario de vivencias y de aprendizajes, de esta manera el concepto instrumental e instructivo de la práctica se transformó, porque profesores, estudiantes y comunidad le dieron otros sentidos a la misma, generando acciones pedagógicas y sociales que, en la búsqueda de otros significados, configuraron nuevos propósitos y motivaciones que trascendieron lo propuesto institucionalmente; instaurándose nuevas relaciones e intersubjetividades y, por lo tanto, generando aprendizajes desde la práctica.

It was systematization method applied to the project for a healthy childhood-PRISA-academic practices that involved six health programs from the University of Antioquia. The systematization begun with a reflexive process involving a systematic and continue accurate methodological processes that allowed us to find the meaning of actor’s experiences working in PRISA and participating in the systematization method. The process led us to establish the objectives of the systematization and the definition of investigative techniques more appropriate for the actors of PRISA in order to find the meaning of their experiences. The following objectives were proposed: a) to investigate the concept of academic practice and social academic units that are applied by people working in PRISA. b) To investigate actor’s academic practice outcomes working in PRISA. We found with the systematization method that PRISA was a place for learning experiences. The concept of instrumental and instructive practice was essential, for teachers, students and community who found meaning for this practice, this experience made they to take pedagogical and social actions, to search for other meanings, creating new purposes and motivations that may go beyond the institutional proposals, establishing new relationships and therefore generating knowledge for themselves.