Itinerários terapêuticos no cuidado em saúde em comunidades quilombolas / Therapeutic itineraries in health care in Quilombola communities

Resumo Este artigo teve como objetivo mapear os itinerários terapêuticos no cuidado em saúde em comunidades quilombolas rurais no norte de Minas Gerais, Brasil. Trata-se de um recorte de uma pesquisa qualitativa realizada em seis comunidades visitadas. Os dados foram produzidos por meio de 18 entrevistas individuais, analisados pelo referencial teórico-metodológico dos itinerários terapêuticos e organizados em três temas empíricos. As narrativas permitiram a compreensão dos percursos trilhados no cuidado em saúde pela população quilombola, a identificação dos componentes do subsistema popular (recursos naturais, o uso de chás e remédios caseiros), do subsistema familiar (transmissão de conhecimentos e herança cultural de cuidados), e do subsistema profissional (nível hospitalar, cuidados médicos, atenção primária e especializada). As dificuldades de acesso não decorrem apenas das distâncias geográficas, envolvem aspectos mais amplos da determinação social, como o racismo institucional, a baixa oferta de serviços, a necessidade de pagamento para deslocamentos e procedimentos médicos. Nesse sentido, fazem-se necessárias uma abordagem e intervenções das políticas públicas frente às desigualdades étnico-raciais, econômicas e de acesso aos serviços de cuidado em saúde.

Abstract This article aimed to map therapeutic itineraries in health care within rural Quilombola communities in the north of Minas Gerais, Brazil. This is a section of a qualitative research conducted in six visited communities. The data was collected through 18 individual interviews, analyzed using the theoretical-methodological framework of Therapeutic Itineraries, and organized into three empirical themes. The narratives allowed for understanding the paths taken in health care by the Quilombola population, identifying the components of the popular subsystem (natural resources, the use of teas and home remedies), the family subsystem (transmission of knowledge and cultural heritage of care), and the professional subsystem (hospital level, medical care, primary and specialized attention). The difficulties of access are not only due to geographical distances, but also broader aspects of social determination, such as institutional racism, low availability of services, the need for payment for transportation and medical procedures. In this sense, it is necessary to have an approach and interventions from public policies to address ethnic-racial, economic, and access inequalities in health care services.

Itinerarios terapéuticos de mujeres migrantes con hipertensión arterial: miradas desde el proceso salud-enfermedad-atención / Therapeutic itineraries of migrant women with arterial hypertension: views from the health-disease-care process

Introducción: La hipertensión arterial (HTA) es un factor de riesgo de morbilidad y mortalidad a nivel global y la principal causa de muerte prematura, afecta en buena parte a mujeres. El propósito del estudio fue comprender cómo las mujeres migrantes (MM) con HTA configuran sus itinerarios terapéuticos (IT) en la búsqueda de atención sanitaria en Colombia, desde el proceso salud-enfermedad-atención. Métodos: Estudio cualitativo con enfoque de teoría fundamentada. Se realizaron 16 entrevistas y 2 grupos focales a MM con HTA en Popayán Colombia. Se realizó muestreo teórico intencionado hasta alcanzar la saturación teórica y la abstracción de categorías emergentes a través de codificación abierta, axial y selectiva. Resultados: La codificación abierta generó 1.135 códigos. La categoría principal emergente fue que los IT en la atención de la HTA están determinados por dinámicas sociales, culturales, políticas y económicas. Como subcategorías relacionadas emergieron: riesgos de enfermar por HTA configuran IT; surge heterogeneidad de recursos terapéuticos formales e informales para atender la enfermedad; existen determinantes de acceso al sistema sanitario; y movilización de diversas prácticas para el seguimiento y control del padecimiento. Conclusión: Las mujeres en situación de migración con HTA configuran IT para lograr la atención en salud no solo desde el sistema sanitario estatal, sino a partir de diversos elementos del orden social, cultural, político y económico. En esta medida, la HTA supera nominaciones mórbidas exclusivas de la biomedicina y de la relación médico-paciente, para abocarse y trascender hacia un padecimiento que exige resolver contingencias del contexto. (AU)

Introduction: Arterial hypertension (AH) is a global risk factor for morbidity and mortality and the main cause of premature death, largely affecting women. The purpose of the study was to understand how migrant women (MW) with AH configure their therapeutic itineraries (TI) in the search for health care in Colombia, from the health-disease-care process. Methods: Qualitative study with a grounded theory approach. 16 interviews and two focus groups were conducted with MW with AH in Popayán Colombia. Intentional theoretical sampling was carried out until reaching theoretical saturation and the abstraction of emerging categories through open, axial and selective coding. Results: Open coding generated 1,135 codes. The main emerging category was that TI in AH care are determined by social, cultural, political, and economic dynamics. As related subcategories emerged: the risks of getting sick from AH configure TI; heterogeneity of formal and informal therapeutic resources arises to attend to the disease; there are determinants of access to the health system; and mobilization of various practices for monitoring and control of the disease. Conclusion: Women in a situation of migration with AH configure TI to achieve health care not only from the state health system, but from various elements of the social, cultural, political and economic order. To this extent, AH goes beyond morbid nominations exclusive to biomedicine and the doctor-patient relationship, to address and transcend towards a condition that requires resolving contingencies of the context. (AU)

Urban Itineraries with Smartphones to Promote an Improvement in Environmental Awareness among Secondary School Students.

Our world is undergoing a series of changes that are taking it to an unsustainable situation. In addition to alerting the population, we must seek education towards a more sustainable world. This research proposes the realization in Alcoy (Spain) of some urban itineraries with mobile devices and with secondary school students, in order to promote an improvement in awareness and action on environmental problems. This activity aims, among other objectives, through informal learning and outside the classroom, to raise awareness among secondary school students about the environmental problems that threaten us. With the completion of a questionnaire, after carrying out these urban itineraries, the results of 214 students confirm that, with this type of activity, there is a notable improvement in the level of awareness and concern for environmental problems. It is also detected that men prefer these types of environmental awareness tests, compared to women, who prefer tests that have a more creative and artistic theme. It is worth continuing to propose this type of activity among students and improve their approach by forecasting, planning, and improving the training of the teachers involved in it.

Cultural issues: Perspectives and experiences of patients with dissociative seizures in Argentina.

PURPOSE: To explore patients' subjective experience when receiving a diagnosis of Dissociative Seizures (DS) in Buenos Aires, Argentina, and their explanatory models about DS. METHOD: A qualitative approach using semi-structured interviews was used to gain an in-depth and contextual understanding of the perspectives of 19 patients with DS. Data collection and analysis were followed by an inductive and interpretive approach informed by the principles of thematic analysis. RESULTS: Four main themes emerged: 1) Reactions to the Diagnosis; 2) Ways of Naming the Disease; 3) Own Explanatory Models; 4) External Explanatory Models. CONCLUSIONS: This information might help achieve an adequate knowledge of the local characteristics of patients with DS. Most patients could not express any emotions or considerations about being diagnosed with DS, and they related their seizures to a personal or social-emotional conflict and environmental stress; however, family members related patients' seizures to a biological cause. It is important to analyze cultural differences in patients with DS in order to develop appropriate interventions for this specific population.

Bottle with a message: The role of story writing as an engagement tool to explore children's perceptions of marine plastic litter.

As human behaviors play a crucial role in addressing the global threat of plastic pollution, it is vital to understand perceptions about marine plastic litter (MPL) and to develop interventions encouraging pro-environmental behaviors (PEBs). This study evaluates story writing as a window to explore perceptions and as an engagement activity to boost PEBs. During the COVID-19 lockdowns, schoolchildren from the East Pacific coast participated in this activity, each creating a story and answering a pre-post survey. Qualitative and quantitative analysis of 81 stories and 79 surveys show awareness of sources and impacts. Participants identified land and local pollution as significant contributors to MPL and emphasized bio-ecological impacts, reflecting concern for landscape and wildlife. While the stories presented a diversity of solutions, recycling dominated the surveys. As participants reported an increase in self-assessed knowledge and improved PEBs after this activity, it can be seen as an engagement tool to encourage behavior change.

Itinerários terapêuticos de mulheres em situação de rua: as múltiplas faces do cuidado / Itinerarios terapéuticos de mujeres en situación de calle: las múltiples caras del cuidado / Therapeutic itineraries of homeless women: the multiple faces of care

Resumo O presente trabalho teve como objetivo refletir sobre a relação entre os itinerários terapêuticos de mulheres em situação de rua e os serviços de saúde e da assistência social. Utilizou-se como estratégia metodológica a etnografia multilocal, e como técnicas de construção dos dados, a observação participante e o diário de campo. Duas mulheres em situação de rua foram acompanhadas em suas trajetórias de busca por cuidados em saúde, e as observações foram feitas também na Casa de Passagem para mulheres, no Fórum da População em Situação de Rua, e junto ao Consultório na Rua. Os resultados apontam que os itinerários terapêuticos das mulheres se referem, principalmente, às possibilidades de produção de vida e apontam como os sentidos sobre o que é necessário precisam ser abarcados e compreendidos pelas redes de cuidado.

Resumen Este estudio tuvo como objetivo reflexionar sobre la relación entre los itinerarios terapéuticos de mujeres en situación de calle y los servicios de salud y de asistencia social. Fue utilizada como estrategia metodológica la etnografía multilocal, y como técnicas de recolección de datos, la observación participante y el diario de campo. Se acompaño a dos mujeres en situación de calle en sus trayectorias de búsqueda de atención en salud, y las observaciones fueron realizadas en la Casa de Passagem (Centro de Rehabilitación) para mujeres, en el Fórum da População em Situação de Rua (Foro de la Población en Situación de Calle), y en el Consultório na Rua (Oficina en la Calle). Los resultados apuntan que los itinerarios terapéuticos de las mujeres se refieren, principalmente, a las posibilidades de producción de vida y apuntan cómo los significados sobre lo necesario deben ser abarcados y comprendidos por las redes de atención en salud.

Abstract The aim of this study was to reflect on the relationship between the therapeutic itineraries of homeless women and health and social assistance services. Multilocal ethnography was used as a methodological strategy, and participant observation and field diary were used as data construction techniques. Two homeless women were accompanied in their search for health care, and observations were also made at the Casa de Passagem (Halfway House) for women, at the Fórum da População em Situação de Rua (Homeless Population Forum), and at the Consultório na Rua (Office on the street). The results point out that the women's therapeutic itineraries refer, mainly, to the possibilities of life production and point out how the meanings of what is necessary must be embraced and understood by the care networks.

Itinerarios de reconstrucción de cuerpos de mujeres atacadas con agentes químicos en Bogotá, Colombia / Itinerários de reconstrução de corpos de mulheres agredidas com agentes químicos em Bogotá, Colômbia / Itineraries of reconstruction of the bodies of women attacked with chemical agents in Bogotá, Colombia

Resumen El objetivo de este trabajo es analizar las experiencias de búsqueda y acceso a procedimientos para la reconstrucción física, social y psicológica de mujeres atacadas con agentes químicos en la ciudad de Bogotá. A partir un diseño etnográfico se recolectó información observacional y discursiva en escenarios de intervención formal y no formal sobre los cuerpos y se realizaron entrevistas en profundidad a sobrevivientes y a profesionales de la salud. Los datos fueron analizados a partir de un enfoque narrativo-crítico. Los hallazgos evidencian interpretaciones divergentes dentro de los sistemas cuidado de la salud sobre lo que constituye la reconstrucción de un cuerpo atacado con agentes químicos en un contexto marcado por grandes desigualdades en el acceso a la salud.

Abstract O objetivo deste trabalho é analisar as experiências de busca e acesso a procedimentos de reconstrução física, social e psicológica de mulheres agredidas com agentes químicos na cidade de Bogotá. Com base em um delineamento etnográfico, recolheu-se informação observacional e discursiva em cenários formais e não formais de intervenção sobre os corpos e realizaram-se entrevistas em profundidade a sobreviventes e profissionais de saúde. Os dados foram analisados a partir de uma abordagem narrativa-crítica. Os achados mostram interpretações divergentes nos sistemas de saúde sobre o que seria a reconstrução de um corpo agredido com agentes químicos em um contexto marcado por grandes desigualdades no acesso à saúde.

Abstract This article explores experiences of care-seeking for the physical, social and psychological reconstruction of women attacked with chemical agents in the city of Bogotá, Colombia. Based on an ethnographic design, observational and discursive information was collected in formal and nonformal therapeutic settings, and in-depth interviews were conducted with survivors and health professionals. The data was analyzed from a narrative-critical approach. The findings show divergent interpretations within health care systems on what constitutes the reconstruction of a body attacked with chemical agents in a context marked by profound inequalities in access to health.

El cuerpo cotidiano: itinerarios corporales de mujeres / The everyday body: women's body itineraries

Resumen El objetivo de este trabajo es estudiar los itinerarios corporales de mujeres de nivel socioeconómico (NSE) alto y bajo que viven en Santiago de Chile. A través de una investigación cualitativa se indaga en las prácticas de alimentación, ejercicio y cuidado estético. Se realizaron entrevistas reflexivas a cuatro mujeres y se hizo un análisis temático reflexivo. Los análisis muestran que las mujeres de nivel socioeconómico alto refieren a las prácticas corporales cotidianas desde una alta sensación/conciencia corporal, mientras que para las de nivel socioeconómico bajo el cuerpo se vive como un lugar de control sobre el que hay escaso registro. A la descripción de las prácticas se agrega el carácter moral y afectivo con que son descriptas. Como resultado emergente, el cuidado de hijos/as surge como una variable relevante dentro de los itinerarios corporales, específicamente respecto de las prácticas de alimentación y ejercicio. Se concluye que las diferencias en las prácticas de alimentación, ejercicio y cuidado estético entre mujeres de NSE alto y bajo son consistentes con disparidades presentadas en encuestas. Trabajar desde la noción de itinerarios corporales permitió mostrar el modo en que se articula una diversidad de asuntos cotidianos que tradicionalmente se han estudiado de manera desagregada. Se sugiere para futuras investigaciones trabajar con muestras que incluyan otro tipo de participantes (hombres y/o sujetos de NSE medio) e integrar el rol de cuidadora como una variable a considerar.

Abstract This work aims to study women's body itineraries, through the interviews of women from high and low socioeconomic status (SES) who live in Santiago de Chile. The project inquiries bodies' itineraries as a set of nutrition, exercise, and aesthetics care actions as everyday practices. This concept allowed reflecting on the body as a continuous becoming, a movement or action, and not a fixed entity. The project had a qualitative research design. Data was collected using reflexive interviews. Participants were asked to describe a typical day using magazine images. Every interview started with the question: "If your body could talk with images, how would it tell its day?". Four women were interviewed, two of high SES and two of low SES. The data analysis was conducted the reflexive thematic analysis guidelines. The results compared high and low SES bodies itineraries organized by type of practice. Women of high SES describe their nutrition practices in terms of body awareness; how food affects their bodies. Low SES women instead talk about their nutrition from a self-control perspective. These women describe their food intake as something that must be at all times regulated. For them, nutrition becomes a constant failure because they usually lack self-control. Women of high SES describe the exercise as a pleasant activity, it is related to wellbeing. The interviewed women from this group reported exercising regularly. Women of Low SES described their lack of exercising in terms of laziness. Women of low SES report makeup as a daily aesthetic care practice. Women describe that they start applying makeup at their house, continue in the subway or bus on the way to work, and finish at the workplace. Makeup doesn't have a delimited space or place. Women of high SES describe aesthetic care practices in terms of skincare. They emphasize that good-looking skin and body image reflect a healthy body. A significant difference between low and high SES women is that the first consider aesthetic care practices as superficial, while for the latter is an inner state that reflects exteriorly. In general terms, women of high SES refer to body itineraries in terms of awareness. Women regularly refer to how the practices of nutrition, exercise, and aesthetic care affect their bodies. Women of low SES instead describe their body itineraries as control practices that regularly fail. They don't report body sensations. The analysis shows that the description of nutrition, exercise, and aesthetic care have moral (good/bad) and affective dimensions (how a body shall be affected in these practices). Being a caregiver emerged as a relevant issue when accounting for body itineraries. Two of the four women we interviewed were mothers, one from each SES. Caregiving was significant in nutrition and exercise practices. Women with children tend to eat when and what their children are eating. Eating tends to be a practice distributed in the routine. For example, a woman had a sandwich with her son before school and then a coffee after dropping him at school. Likewise, exercise is in function to the children's routine. For example, a woman walks fast from the school to her house. Being a caregiver structures time and, as an effect, it is very significant in body itineraries. Finally, in the discussion the analysis was compared with other data. The different practices of women of high and low SES derive into different outcomes. Women of low SES are more obese and sedentary than women from high SES. The notion of body itineraries is an integrative concept to study nutrition, exercise, and aesthetic care.

Seasonal Variations in Voluntary Intake and ApparentDigestibility of Forages by Goats in the Chinese Altai Mountains.

Forage availability and quality directly impact animal performance, ultimately affecting productivity and health. This study aimed to understand the interaction between qualitative and quantitative vegetation availability and feed intake of goats on alpine pastures in the Chinese Altai Mountains. The daily grazing routes of three goats from a local herding family were monitored with GPS devices set at a logging rate of 64 s during spring and the early and late summer season in 2013 and 2014. The quantity and quality of vegetation along their grazing routes was determined, and the amount of feces excreted was measured in a total of five goats per season for the indirect determination of the animals' feed intake. The grazing routes were longer in spring than in summer, leading to larger grazing areas visited in spring. Vegetation on offer ranged from 980 to 2400 kg dry mass per hectare and was similar in the spring and summer seasons but higher in 2013 than in 2014. Feed consumption of forage and nutrients did not significantly differ between seasons and years, respectively, suggesting that the goats' nutrient intake was not restricted by interannual variability of forage on offer. Regular monitoring of animal numbers and of vegetation quantity and quality on the mountain rangelands can help responsible government agencies to estimate forage offtake of small ruminants in order to timely adjust grazing pressure in the study region.

(De)constructing 'therapeutic itineraries' of hypertension care: A qualitative study in the Philippines.

Hypertension, a major risk factor for non-communicable diseases, remains poorly controlled in many countries. In the Philippines, it is still one of the leading causes of preventable deaths despite the accessibility and availability of essential technologies and medicine to detect and treat hypertension. This paper characterizes the 'therapeutic itineraries' of people with hypertension from poor communities in rural and urban settings in the Philippines. We employ longitudinal qualitative methodology comprised of repeat interviews and digital diaries using mobile phones from 40 recruited participants in 12 months. Our findings demonstrate that therapeutic itineraries, rather than being organized according to categories that stem from the structure of the health system (i.e., diagnosis, treatment, follow-up, adherence), diverge from clinical pathways. Therapeutic itineraries begin at a stage we label as 'pre-diagnosis' (PD). Following this, itineraries diverge according to two possible entry points into the healthcare system: via incidental diagnosis (ID) whereby participants were diagnosed with hypertension without deliberately seeking care for hypertension-related symptoms and symptom-driven diagnosis (SD) whereby their diagnosis was obtained during a clinical encounter specifically prompted by hypertension-related symptoms. Participants whose itineraries follow the SD route typically oscillated between periods of regular and intermittent medical treatment, while participants who were diagnosed incidentally (ID) typically opted for self-care As we follow our participants' therapeutic itineraries, we explore the confluence of factors informing their care journey, namely, their conceptions of hypertension, their social relationships, as well the choices and trade-offs they make. We conclude with policy implications from our findings, chief of which is our proposition that models of care based on mere access and availability of clinical interventions fail to reflect the complexity of people's lay understanding and their lived experiences of hypertension and are thus ultimately unhelpful in improving its control.

Itinerários Terapêuticos Percorridos por Pessoas que Tentaram Suicídio / Therapeutic Itineraries Followed by People Who Attempted Suicide

Resumo Esta pesquisa analisou itinerários terapêuticos de usuários do Sistema Único de Saúde que tentaram suicídio. Foi realizada uma análise de conteúdo das entrevistas feitas com dez usuários que tentaram suicídio e seis referências técnicas da rede de saúde. Os resultados apontaram a presença de solidão e desamparo nos usuários; indicaram acolhimento adequado realizado pelos profissionais de saúde; ressaltaram a não identificação dos usuários com os serviços de saúde mental para os quais foram encaminhados; assinalaram o não seguimento dos casos na atenção primária e mostraram que os caminhos terapêuticos ultrapassaram as práticas biomédicas. Este estudo aponta a necessidade de políticas públicas específicas para esse público, que articulem a rede intersetorial de serviços e itinerários não técnicos de apoio à vida.

Abstract In this research, were analysed the therapeutic itineraries of patients from the Unified Health System who attempted suicide. An analysis of interviews produced with ten patients who attempted suicide and with six health network references were performed. The results indicated the presence of loneliness and helplessness in patients; indicated adequate reception by health professionals; emphasized about a non-identification of patients with mental health units to which they are sent; indicate the non-follow-up of cases in primary care; and showed that therapeutic pathways surpassed biomedical practices. This study demonstrates the need for specific public policies which articulate the multisectoral network of services and non-technical life support itineraries for those people.

Processo transexualizador no sus: questões para a psicologia a partir de itinerários terapêuticos e despatologização / Proceso transexualizador en el sus: cuestiones para la psicología desde itinerarios terapêuticos y despatologización / Transexualizing process in the sus: questions for psychology from therapeutic itinetaries and depathologization

RESUMO. Trata-se de uma pesquisa qualitativa, des critiva e exploratória, realizada no Tratamento Fora de Domicílio, na cidade de Cuiabá-MT, Brasil, que objetivou levantar reflexões sobre os itinerários terapêuticos de pessoas trans, na busca pelo Processo Transexualizador. Participaram três homens trans, duas mulheres trans e uma mulher travesti, com faixa etária de 21 a 32 anos. Os da dos foram coletados por entrevistas semiestruturadas e analisados mediante análise de conteúdo. Os resultados mostram que essas pessoas trans seguem trajetórias diver sas, procurando serviços institucionalizados ou informais (redes de socialidade trans), para a afirmação de suas identidades de gênero. Destacam-se entraves atinentes à patologização, ao acolhimento, à continuidade do cuidado, à resolutividade e à referência na rede de atenção do processo transexualizador. Observaram-se importantes pontos críticos na assistência social, endocrinológica e para a psicologia, sendo a peregrinação pelos serviços de saúde demarcada por constantes discriminações institucionais, permitindo a compreensão de como o sistema de saúde se organiza em relação ao atendimento dessas pessoas, elencando questões para o trabalho da psicologia, nesse campo, a partir de uma perspectiva da experiência e materialidade do gênero.

RESUMEN. Esta es una investigación cualitativa, descriptiva y exploratoria realizada en el tratamiento fuera del domicilio en la ciudad de Cuiabá, Brasil, que tuvo como objetivo plantear reflexiones sobre los itinerarios terapéuticos de las personas trans en la búsqueda del proceso transexual. Participaron tres hombres trans, 2 mujeres trans y 1 mujer travesti de 21 a 32 años. Los datos fueron recogidos a través de entrevistas semiestructuradas y fueron analizados mediante el Análisis de Contenido. Los resultados muestran que estas personas trans siguen caminos divergentes en busca de servicios institucionalizados o informales (redes sociales trans) para afirmar sus identidades de género. Se destacan los obstáculos relacionados con la patologización, acogida, la continuidad de la atención, la resolución y la referencia en la red de atención del Proceso Transexualizador. Se observaron puntos críticos importantes en la asistencia social, la endocrinología y la psicología, em que la peregrinación por los servicios de salud es delimitada por la constante discriminación institucional que permite comprender cómo se organiza el sistema de salud en relación con la atención de estas personas que señalan los problemas para el trabajo de la Psicología en este campo desde una perspectiva de experiencia y materialidad de género

ABSTRACT. This qualitative, descriptive and exploratory research conducted in the Away from Home Treatment (Tratamento Fora de Domicílio [TFD]), in Cuiabá, Brazil, aimed to raise reflections on the therapeutic process itineraries of trans people in the search for the Transsexualizer Process (Processo Transexual [PT]). Three transgender men, two transgender women and one transvestite woman participated. They were aged between 21 and 32 years. Data were collected through semi-structured interviews and analyzed using Content Analysis. The results show that trans people follow different itineraries, looking for institutionalized or informal services (trans sociality networks) to affirm their gender identities. Obstacles related to pathologization, reception, continuity of care, resolution and reference in the care network of the Transsexualizer Process stand out. Important critical points were observed in social, endocrinological and psychological care. The pilgrimage by health services was marked by constant institutional discrimination, allowing for the understanding of how the health system is organized concerning the care of these people, listing issues for the work of Psychology, in this field, from a perspective of the experience and materiality of gender.

Conhecimentos, percepções e itinerários terapêuticos de travestis e mulheres trans no cuidado a infecções sexualmente transmissíveis em Salvador, Brasil / Knowledge, perceptions and therapeutic itineraries of travestis and transgender woman in the care of sexually transmitted infections in Salvador, Brazil / Conocimientos, percepciones e rutas terapéuticas de travestis y mujeres trans en la atención de enfermedades de transmisión sexual en Salvador, Brasil

Resumo O artigo objetivou analisar conhecimentos, percepções, práticas de cuidado e Itinerrários Terapêuticos (IT) para o diagnóstico e tratamento das Infecções Sexualmente Transmissíveis (IST), com destaque para sífilis, entre Travestis e Mulheres Trans (TrMT) em Salvador, Brasil. Foram realizados 05 grupos focais e 06 entrevistas semiestruturadas com 30 TrMT. Os achados apontam amplo desconhecimento e percepções contraditórias sobre as IST, especialmente a sífilis; identificação de duas importantes trajetórias de cuidado às IST e o destaque para IT marcados por estigmas e discriminação nos serviços de saúde. Sugere-se a ampliação das ações de saúde para essa população reconhecendo suas necessidades e a construção de novas estratégias de prevenção e tratamento para IST, dialogadas com as TrMT, e garantia de autonomia, ética e sigilo na produção do cuidado.

Abstract The article aimed to analyze knowledge, perceptions, care practices and Therapeutic Itineraries (TI) for the diagnosis and treatment of Sexually Transmitted Diseases (STD), with emphasis on syphilis, among travesti and transgender women (TGW) in Salvador, Brazil. 05 focus groups and 06 semi-structured interviews with travesti/TGW were carried out with a total of 30 participants. The findings point to a wide lack of knowledge and contradictory perceptions about STD, especially syphilis; identification of two important trajectories of care for STD and the emphasis on TI marked by stigma and discrimination in health services. The expansion of health actions for this population is suggested, recognizing their needs and the construction of new prevention and treatment strategies for STD, in dialogue with the travesti/TGW, and guaranteeing autonomy, ethics and confidentiality in the production of care.

Resumen El artículo tuvo como objetivo analizar conocimientos, percepciones, prácticas de atención y Rutas Terapêuticas (RT) para el diagnóstico y tratamiento de las Enfermedades de Transmisión Sexual (ETS), con énfasis en la sífilis, entre las travestidas y mujeres trans (TrMT) en Salvador, Brasil. Se realizaron 05 grupos focales y 06 entrevistas semiestructuradas con 30 TrMT. Los hallazgos apuntan a una amplia falta de conocimiento y percepciones contradictorias sobre las ETS, especialmente la sífilis; identificación de dos importantes trayectorias de atención a las ETS y el énfasis en las RT marcadas por el estigma y la discriminación en los servicios de salud. Se sugiere ampliar las acciones de salud para esta población, reconociendo sus necesidades y la construcción de nuevas estrategias de prevención y tratamiento de las ETS, en diálogo con el TrMT, y garantizando la autonomía, ética y confidencialidad en la producción de cuidados.

Molecularización, genetización y centros de referencia: el Instituto de Bioquímica Clínica de Barcelona (1969-1980) / Molecularization, geneticization and reference centers: the Institute of Clinical Biochemistry of Barcelona (1969-1980)

En conjunto, la molecularización y la genetización de la biomedicina del siglo XX construyeron un enorme listado de enfermedades, la mayoría raras, con unas necesidades asistenciales muy específicas, una gran dependencia del laboratorio e importantes dificulta-des para la creación de expertos. Estos fenómenos indujeron grandes cambios en las redes asistenciales y en los itinerarios diagnósticos. Uno de los más significativos fue la aparición de centros de referencia en los que concentrar los recursos humanos y materiales para enferme-dades tan poco prevalentes. A partir del estudio del Instituto de Bioquímica Clínica “Fundación Juan March” de Barcelona, este artículo aborda la aparición de estos nuevos espacios en la España del Tardofranquismo. Farmacéuticos, pediatras, políticos y gestores sanitarios, con sus diferentes intereses, aparecen como actores involucrados en la forja de un instituto que en pocos años se erigió como centro de referencia nacional para enfermedades de depósito lisosomal. El trabajo revela la importancia que tuvo la sensibilidad social sobre la discapacidad intelectual como motor (y excusa) de la iniciativa, el papel de las fundaciones filantrópicas y la influencia de la ciencia norteamericana en todo el proceso, en circulación a través de los viajes de los científicos españoles al extranjero (AU)

Os itinerários terapêuticos de populações vulneráveis na Covid-19: uma revisão de escopo / Los itinerarios terapéuticos de poblaciones vulnerables en la Covid-19: una revisión de alcance / The therapeutic itineraries of vulnerable populations at Covid-19: a scoping review

Com o objetivo de investigar os Itinerários Terapêuticos percorridos pela população brasileira em situação de vulnerabilidade social na busca do cuidado em saúde durante a pandemia da Covid-19, foi realizada uma revisão de escopo de julho a novembro de 2021, conforme proposta de Joanna Briggs Institute, nas bases BVS, PubMed, Embase, Scielo, PsycInfo, Scopus e Web of Science, dentro do recorte de 2020 e 2021. Foram analisados 11 artigos subdivididos em três categorias: estratégias de cuidado das populações; ofertas em saúde; e dificuldades de acesso à saúde. O resultado explicitou lacunas e potencialidades existentes nos Itinerários Terapêuticos nessa busca do cuidado em saúde e como esses aspectos ficaram mais evidentes no período pandêmico. Percebeu-se um movimento por parte dessas populações vulneráveis para superar dificuldades cotidianas que determinam as condições desfavoráveis para os cuidados em saúde.(AU)

Con el objetivo de investigar los itinerarios terapéuticos recorridos a la búsqueda de cuidado de salud por parte de la población brasileña en situación de vulnerabilidad social durante la pandemia de Covid-19, se realizó, entre julio y noviembre de 2021, una revisión de alcance, conforme propuesta del Joanna Briggs Institute, en las bases BVS, PubMed, EMBASE, Scielo, PsycInfo, Scopus y Web of Science dentro del recorte de 2020 y 2021. Se analizaron 11 artículos subdivididos en tres categorías: estrategia de cuidado de las poblaciones; ofertas de salud; y dificultades de acceso a la salud. El resultado dejó claras las lagunas y potencialidades existentes en los itinerarios terapéuticos a la búsqueda del cuidado de salud de las poblaciones en situación de vulnerabilidad social y cómo esos aspectos quedaron más en evidencia en el período de la pandemia. Se percibió un movimiento por parte de esas poblaciones para superar dificultades cotidianas que determinan las condiciones desfavorables para los cuidados de salud.(AU)

With the objective of investigate the therapeutic itineraries followed for search the health care by the brazilian population in a situation of social vulnerability during the covid-19 pandemic, a scope review was carried out from July to September 2021, as proposed by the Joanna Briggs Institute, in the BVS, PubMed, EMBASE, Scielo, PsycInfo, Scopus and Web of Science databases within the 2020 and 2021 clippings. 11 articles were analyzed and divided into three categories: strategies care of population; health offerings; difficulties in accessing healthcare. Results explained gaps and potentialities existing on therapeutic itineraries in the search for health care for populations in a situation of social vulnerability and how these aspects became more evident in this pandemic period. There was a movement of this vulnerable populations to overcome the daily difficulties that determine the unfavorable conditions for health care.(AU)

Concepções e itinerários terapêuticos de pessoas em sofrimento psíquico em contextos quilombolas / Itinerarios terapéuticos y concepciones de personas en sufrimiento psíquico en contextos quilombolas / Conceptions and therapeutic itineraries of people in psychological distress in quilombola contexts

Resumo O estudo teve por objetivo analisar as concepções sobre o sofrimento psíquico e os cuidados em saúde mental na perspectiva de pessoas com diagnóstico de transtorno mental, residentes em comunidades quilombolas. Trata-se de uma pesquisa com abordagem qualitativa. Participaram nove pessoas de duas comunidades quilombolas do interior do Estado de Pernambuco. Os dados foram coletados através de questionário sociodemográfico e uma entrevista do tipo relato de vida e analisados a partir da Análise de Conteúdo Temática. As categorias temáticas versaram sobre o sofrimento psíquico e as estratégias de cuidado utilizadas pelos participantes no cuidado em saúde mental. Dentre os itinerários terapêuticos dos sujeitos, destacam-se estratégias pautadas no saber biomédico e o cuidado baseado no saber popular.

Resumen El estudio tuvo como objetivo analizar las concepciones sobre el distrés psicológico y el cuidado de la salud mental desde la perspectiva de personas diagnosticadas con trastornos mentales, residentes en comunidades quilombolas. Se trata de una investigación con enfoque cualitativo. Participaron nueve personas de dos comunidades quilombolas del interior del estado de Pernambuco. Los datos fueron recolectados a través de un cuestionario sociodemográfico y una entrevista de informe de vida y analizados usando el análisis de contenido temático. Las categorías temáticas se ocuparon de la angustia psicológica y las estrategias de atención utilizadas por los participantes en el cuidado de la salud mental. Entre los itinerarios terapéuticos de los sujetos destacan las estrategias basadas en el conocimiento biomédico y el cuidado basado en el conocimiento popular.

Abstract The study aimed to analyze the conceptions about psychological distress and mental health care from the perspective of people diagnosed with mental disorder living in quilombola communities. This is a research with qualitative approach, in which participated nine people from two quilombola communities in the interior of the state of Pernambuco. The data was collected through a socio-demographic questionnaire and a life report interview, and analyzed using thematic content analysis. The thematic categories regarded the psychological distress and the care strategies used by the participants in mental health care. Among the people's therapeutic itineraries, strategies based on biomedical knowledge and care based on popular knowledge are highlighted.

Itinerários terapêuticos de homens trans em transição de gênero / Itinerarios terapéuticos de hombres trans en transición de género / Therapeutic itineraries of trans men in gender transition

Resumo Este artigo busca compreender os itinerários terapêuticos de homens trans, analisando as relações com os sistemas formais e informais em saúde. Entende-se por itinerário as trajetórias, estratégias e recursos dessa população em busca de cuidados com a saúde e de possíveis mudanças corporais. Trata-se de pesquisa qualitativa, sob perspectiva analítico-institucional, realizada através de entrevistas semiestruturadas com quatro homens trans em processo de transição de gênero. Para análise dos resultados foram construídas três linhas de análise. Na primeira, foram abordadas as primeiras experiências vivenciadas pelos participantes, que vão desde o seu autorreconhecimento, até a busca por informações sobre a transexualidade através de redes sociais, a automedicação e uso de próteses. Na segunda linha, abordam-se os caminhos percorridos e suas relações com os sistemas de saúde. Por fim, o estigma é analisado como um atravessamento das ações dos serviços ofertados. A pesquisa busca dar subsídios para políticas nesta área.

Resumen Este artículo busca comprender los itinerarios terapéuticos de los hombres trans, analizando las relaciones con los sistemas de salud formales e informales. Se entiende por itinerario las trayectorias, estrategias y recursos de esta población en busca de atención médica y posibles cambios corporales. Se trata de una investigación cualitativa, desde una perspectiva analítico-institucional, realizada a través de entrevistas semiestructuradas con cuatro hombres trans en proceso de transición de género. Para analizar los resultados se construyeron tres líneas de análisis. En la primera, se abordaron las primeras experiencias de los participantes, que van desde el autorreconocimiento hasta la búsqueda de información sobre transexualidad a través de las redes sociales, la automedicación y el uso de prótesis. La segunda línea aborda los caminos tomados y sus relaciones con los sistemas de salud. Finalmente, se analiza el estigma como cruce de las acciones de los servicios ofrecidos. La investigación busca presentar subsidios para las políticas en esta área.

Abstract This article aims to understand the therapeutic itineraries of trans men, analyzing the relationship with formal and informal health systems. An itinerary is understood as the trajectories, strategies, and resources of this population in search of health care and possible bodily changes. This is qualitative research, from an analytical-institutional perspective, carried out through semi-structured interviews with four trans men in a process of gender transition. To analyze the results, three lines of analysis were constructed. In the first line, the first experiences lived by trans men were approached, ranging from self-recognition to the search for information about transsexuality through social networks, self-medication, and the use of prostheses. The second line addresses the paths taken and their relationship with health systems. Finally, stigma is analyzed as crossing the actions of the services offered. The research seeks to provide subsidies for policies in this area.

Therapeutic itineraries of Congolese refugees in the city of São Paulo.

São Paulo, the most populous Brazilian city, has been the main destination for refugees and it is home to the majority of Congolese, who are the second largest nationality to request refuge in Brazil. In the context of these migrations, previous experiences in displacement and in places of welcome can trigger illness and suffering. The purpose of this article was to analyse the therapeutic itineraries of refugees from the Democratic Republic of Congo who reside in the city of São Paulo. The research followed an ethnographic approach and included focus group, ethnographic observation and in-depth interviews with 15 Congolese men in refuge in São Paulo between 2015 and 2016. The difficulties faced in the dignified reconstruction of lives include housing, precarious work and racism. Different systems are actuated in healthcare, treatment in health centres and hospitals regarding acute and chronic physical problems, in addition to self-care, identified in the preparation of teas for gastrointestinal ailments. When confronted by suffering, religious social networks, and those of friends and family are activated, in addition to alcohol consumption. The family is sought when facing financial and, principally, emotional problems. The itineraries include multiple therapeutic systems and a dialectic relationship with free, universal services perceived as inequitable.

La experiencia de pacientes con crisis no epilépticas psicógenas: marcos interpretativos y de acción / A experiência de pacientes com crises não epiléticas psicogênicas: marcos interpretativos e de ação / The experience of patients with psychogenic non epileptic seizures: interpretative and action framework / L´expérience des patients atteints de crise psychogène non épileptique: cadres dinterprétation et daction

Resumen La perspectiva del paciente se presenta como algo importante a tener en cuenta para la comprensión del padecimiento y para lograr un tratamiento efectivo. El objetivo de la presente investigación es indagar las trayectorias terapéuticas y las experiencias durante el recorrido terapéutico de pacientes con Crisis No Epilépticas Psicógenas (CNEP) pertenecientes a un Hospital General de la Ciudad Autónoma de Buenos Aires. Se realizaron entrevistas semiestructuradas a diez pacientes diagnosticados con CNEP. Para el análisis de los datos se utilizó una metodología cualitativa basada en los principios del análisis temático. Se ha identificado una categoría central: Itinerarios terapéuticos dentro del sistema etnomédico y tres subcategorías: (1) Diagnósticos Recibidos; (2) Recursos del sistema etnomédico y (3) Evaluaciones de los recursos utilizados. La dificultad de arribar a un diagnóstico y un tratamiento que permitiera mejorar las CNEP, así como el uso de distintas medicinas, fue destacada por la totalidad de los pacientes.

Resumo A perspectiva do paciente se apresenta como algo importante a levar em conta para a compreensão do sofrimento e para se alcançar um tratamento eficaz. O objetivo desta pesquisa é investigar as trajetórias terapêuticas e as experiências durante a jornada terapêutica de pacientes com crise não epilética psicogênica (CNEP) de um Hospital Geral da Cidade Autônoma de Buenos Aires. Entrevistas semiestruturadas foram realizadas com dez pacientes com diagnóstico de CNEP. Para a análise dos dados, utilizou-se metodologia qualitativa baseada nos princípios da análise temática. Uma categoria central foi identificada: Itinerários terapêuticos dentro do sistema etnomédico; e três subcategorias: (1) Diagnósticos recebidos; (2) Recursos do sistema etnomédico; e (3) Avaliações dos recursos utilizados. A dificuldade de se chegar a um diagnóstico e a um tratamento que permitisse melhorar a CNEP, bem como o uso de diferentes medicamentos, foi destacada por todos os pacientes.

Abstract The patient's perspective is essential to understand their condition and to achieve an effective treatment. The objective of this paper is to investigate the therapeutic trajectories and experiences of patients with Psychogenic Non-Epileptic Crisis (PNES) under treatment in a General Hospital of the Autonomous City of Buenos Aires. Semi-structured interviews were conducted with ten patients diagnosed with PNES. For data analysis, a qualitative methodology based on thematic analysis was adopted. A central category has been identified: Therapeutic Itineraries within the Ethnomedical System, and three subcategories: (1) Diagnoses received; (2) Resources of the ethnomedical system; and (3) Evaluation of the resources used. The difficulty of finding a diagnosis, a treatment to improve PNES, and proper medicine were highlighted by all the patients.

Résumé Le point de vue du patient est présenté comme quelque chose d'important à prendre en compte afin de comprendre la maladie et d'obtenir un traitement efficace. L'objectif de cette recherche est d'analyser les trajectoires thérapeutiques et les expériences au cours du parcours thérapeutique des patients atteints de Crise Psychogénique Non Épileptique (CPNE) dans un hôpital général de la ville de Buenos Aires. Des entretiens semi-structurés ont été menés auprès de 10 patients diagnostiqués avec une CPNE. Pour l'analyse des données, une méthodologie qualitative basée sur les principes de l'analyse thématique a été utilisée. Une catégorie centrale a été identifiée : Les itinéraires thérapeutiques au sein du système ethno-médical et trois sous-catégories : (1) Diagnostics reçus ; (2) Ressources du système ethno-médical ; et (3) Évaluations des ressources utilisées. La difficulté d'arriver à un diagnostic et à un traitement permettant d'améliorer la CPNE, ainsi que l'utilisation de médicaments différents, a été soulignée par l'ensemble des patients.

Da busca pelo diagnóstico às incertezas do tratamento: desafios do cuidado para as doenças genéticas raras no Brasil / From the search for diagnosis to treatment uncertainties: challenges of care for rare genetic diseases in Brazil

Resumo As doenças genéticas raras constituem um importante problema de saúde pública, mas ainda são pouco estudadas na perspectiva da Saúde Coletiva. Este artigo tem por objetivo analisar os itinerários terapêuticos de pacientes com doenças genéticas raras nas cidades do Rio de Janeiro, Salvador e Porto Alegre, tendo por foco os desafios materiais, emocionais e estruturais enfrentados na busca por diagnóstico e tratamento. Foram realizadas entrevistas semiestruturadas com pacientes/cuidadores e profissionais de saúde em serviços públicos de genética médica. Observou-se que a experiência da doença genética rara, além de ser um desafio em si pelo caráter debilitante e incapacitante, é agravada por problemas de ordem prático-relacionais e burocrático-institucionais que não se resolvem com a chegada a um serviço especializado. A existência de longos itinerários terapêuticos até o diagnóstico, o desconhecimento dos médicos não geneticistas sobre as doenças raras, as dificuldades de transporte e de acesso a especialistas, a exames diagnósticos e complementares e o acesso a medicamentos e insumos alimentares de alto custo foram comuns às narrativas nas três cidades. A adesão aos cuidados oferecidos exigem estratégias de ação que dependem de arranjos envolvendo familiares, médicos, associações de pacientes e o Estado.

Abstract Rare genetic diseases are an important public health problem, but they are still little studied in Collective Health. This article aims to analyze the 'therapeutic itineraries' of patients in search of a diagnosis and treatment for rare genetic diseases in the cities of Rio de Janeiro, Salvador and Porto Alegre. It focuses on the material challenges, emotional and structural problems faced in these trajectories. Semi-structured interviews were conducted with patients/caregivers and health professionals in the context of public health medical genetics. Our findings suggest that the experience of the rare genetic disease is aggravated by practical, inter-relational and bureaucratic/institutional problems. The reality of long and circuitous journeys to obtain a diagnosis, non-geneticists' lack of knowledge about rare diseases, difficulties in transportation and access to specialists, diagnostic and complementary examinations, and access to high-cost medicines and food supplies were common challenges in all the narratives examined in the three Brazilian cities. In addition, adherence to care provided by medical genetics requires action and strategies that depend on arrangements involving family members, physicians, patient associations, and the state.