Escuta, afeto e amorosidade: etnografia sobre a construção de um cuidado na rua / Listening, affection and amorousness: ethnography on the construction of care on the street / Escucha, afecto y amorosidad: etnografía sobre la construcción del cuidado en la calle

O objetivo foi identificar elementos das práticas de cuidado de duas equipes de Consultório na Rua, localizadas no município do Rio de Janeiro, Brasil. Parte-se da ideia de que práticas de saúde devem ser construídas a partir de um habitus, defendido por Pierre Bourdieu. Esta pesquisa de cunho antropológico utilizou a etnografia como método para a apreensão dos dados e a sua análise seguiu a proposta da análise de domínio. A narrativa permeou espaços de cuidado com escuta qualificada e acolhimento, com identificação de afeto e amorosidade como elementos constituintes do cuidado à população de rua. Conclui-se que o cuidado se constrói na rua, na "horizontalidade", ao se colocar no lugar do outro, no estar junto, com acolhimento, escuta, afeto e amorosidade

The objective was to identify elements of the care practices of two Consultório na Rua teams, located in the city of Rio de Janeiro, Brazil. It starts from the idea that health practices must be built from a habitus, defended by Pierre Bourdieu. This anthropological research used ethnography as a method for capturing data and its analysis followed the proposal of domain analysis. The narrative permeated care spaces with qualified listening and user embracement, with identification of affection and amorousness as constituent elements of care for the homeless population. It is concluded that care is built on the street, in "horizontality", in putting oneself in the other's place, in being together, with user embracement, listening, affection and amorousness

El objetivo fue identificar elementos de las prácticas de cuidado de dos equipos de Consultório na Rua, ubicados en la ciudad de Río de Janeiro, Brasil. Se parte de la idea de que las prácticas de salud deben construirse a partir de un habitus, defendida por Pierre Bourdieu. Esta investigación antropológica utilizó la etnografía como método de captura de datos y su análisis siguió la propuesta del análisis de dominio. La narrativa permeó los espacios de atención con escucha y recepción cualificadas, con identificación del afecto y la amorosidad como elementos constitutivos de la atención a la población en situación de calle. Se concluye que el cuidado se construye en la calle, en la "horizontalidad", en ponerse en el lugar del otro, en el estar juntos, en la acogida, la escucha, el afecto y la amorosidad

Latent Tuberculosis Infection in Users of Drug Dependence Care and Follow-up Centers in Barcelona in 2017-2021: A Cross-sectional Descriptive Study.

Introduction: People who consume drugs have a higher risk of latent tuberculosis infection (LTBI). Our objective was to study the characteristics of people who use drugs and who attended the Centers for Drug Dependence Care and Follow-up of Barcelona during 2017-2021 and presented LTBI or did not perform the reading of the tuberculin skin test (TST) after the test had been done. Methods: A cross-sectional, descriptive study in Centers for Drug Dependence Care and Follow-up of Barcelona was performed during 2017-2021. The sociodemographic and epidemiological profile of people who use drugs that underwent a TST was analyzed and were examined the factors associated with LTBI. Additionally, the same sociodemographic and epidemiological analyses were made in PWUD that did not perform the reading of the TST after the test had been done. Adjusted odds ratios (ORa) and 95% confidence intervals (95% CI) were calculated. Results: Nine hundred forty-eight persons were profiled. The prevalence of LTBI was 22.9%, and the following factors were associated with it: be older than 41 years; be users of CAS Baluard, or CAS Horta-Guinardó; coming from a WHO region of high TB incidence; be homeless; and low territorial socioeconomic index. The following factors were associated with not performing the reading of the TST after the test had been done: be users from the CAS Baluard, Barceloneta, Nou Barris and Robadors; be homeless and low TSI. Conclusions: This study improves TB control and highlights the need for this LTBI control program in CASs.

Introducción: Las personas que consumen drogas tienen un mayor riesgo de infección tuberculosa latente (ITL). Nuestro objetivo fue medir las características de las personas que cosumen drogas y que acudieron a los centros de atención y seguimiento (CAS) a las drogodependencias de Barcelona entre 2017-2021 y que presentaron ITL, así como conocer el perfil de las que no acudieron a la lectura de la prueba de la tuberculina (PT). Métodos: Se realizó un estudio descriptivo transversal en los centros de atención y seguimiento a las drogodependencias de Barcelona durante el periodo 2017-2021. Se analizó el perfil sociodemográfico y epidemiológico de las personas que consumen drogas que se sometieron a una PT y se examinaron los factores asociados a la ITL. Además, los mismos análisis sociodemográficos y epidemiológicos se realizaron en las personas que consumen drogas que no realizaron la lectura de la PT después de realizarla. Se calcularon las odds ratio ajustadas (ORa) y los intervalos de confianza de 95% (IC 95%). Resultados: Se estudiaron 948 personas. La prevalencia de ITL fue de 22,9%, y los factores asociados fueron: ser mayor de 41 años, ser usuarios del CAS Baluard, o del CAS Horta-Guinardó, provenir de una región de la Organización Mundial de la Salud de alta incidencia de TB, ser una persona sin hogar y bajo índice socioeconómico territorial (IST). Los siguientes factores se asociaron con no acudir a la lectura de PT después de la realización de la prueba: ser personas usuarias del CAS Baluard, Barceloneta, Nou Barris y Robadors; personas sin hogar y bajo IST. Conclusiones: Este estudio mejora el control de la TB y destaca la necesidad de este programa de control de ITL en los CAS.

Treating head lice: a case study.

People who are homeless are greater risk of infections than the general public because they are often in poor health and have difficulty maintaining hygiene. This article discusses the treatment of head lice and uses a case history to outline specific issues that may arise in a person who is homeless and how these can be managed.

Multi-trajectory group profiles of well-being and associated predictors among adults experiencing homelessness and mental illness: findings from the At Home/Chez Soi study, Toronto site.

PURPOSE: To conduct a multi-dimensional and time-patterned analysis to identify distinct well-being trajectory profiles over a 6-year follow-up period among adults experiencing homelessness and mental illness. METHODS: Data from 543 participants of the At Home Chez Soi study's Toronto site were examined over a 6-year follow-up period, including measures of quality of life, community functioning, housing stability, and substance use. Well-being trajectories were identified using Group-Based Trajectory Modelling. Multinomial regression was used to identify predictor variables that were associated with each well-being trajectory profile. RESULTS: Four well-being profiles were identified: low well-being, moderate well-being, good well-being, and high well-being. Factors associated with a greater likelihood of following a better well-being profile included receiving Housing First, reporting female gender and non-white ethnicity, having post-secondary studies, and reporting a high resilience level. Concurrently, factors associated with a lower likelihood of better well-being profiles were having a history of chronic homelessness, experiences of discrimination in the healthcare setting, having comorbid mental disorders and a high level of symptom severity, and reporting a history of traumatic brain injury and childhood adversity. CONCLUSIONS: Individuals experiencing homelessness follow distinct well-being profiles associated with their socio-demographic characteristics, health status, trauma history, resilience capabilities, and access to housing and support services. This work can inform integrated housing and support services to enhance the well-being trajectories of individuals experiencing homelessness. TRIAL REGISTRATION: At Home/Chez Soi trial was registered with ISRCTN, ISRCTN42520374, http://www.isrctn.com/ISRCTN42520374 .

The Prevalence and Nature of Violence Against Women Experiencing Homelessness: A Quantitative Study.

Individuals experiencing homelessness-an extreme form of social exclusion-have considerably higher risk of being victims of violence than the general population. We analyze the episodes of violence suffered by 504 individuals experiencing homelessness in Spain, as well as the differences between men and women. The results indicate high levels of violence and suggest that gender (specifically, being a woman) is the primary factor driving exposure to violence among this group. Highlighting the reality of women experiencing homelessness can help social, mental health, and addiction services adjust responses to better address the needs of this group and offer comprehensive care.

Services for homeless people in Germany during the COVID-19-pandemic: A descriptive study.

DESIGN: A cross-sectional study was conducted in December 2020/January 2021 in the five significant cities of Germany. SAMPLE: 135 of 244 identified service institutions took part in the evaluation. MEASUREMENTS: This evaluation included changes in institutions' operating hours as well as capacity for homeless people. Service institutions described changes in guests' characteristics, moods, and mental burden. Finally, equipment including face masks, coveralls, and gloves was investigated. In addition, the study examined how the cooperation with the health authorities works. RESULTS: Institutions reduced their operating hours and capacity for guests (62.4%). Increased costs, which they had to cover themselves, were reported by 70.9% of institutions. Institutions reported, that guests showed more symptoms of aggression (15%), anxiety (25%), and desperation (32%) and fewer signs of being relaxed (75%). The institutions reported room for improvement in PPE supplies and collaboration with health authorities. CONCLUSIONS: Services are limited for a vulnerable population, which shows changes in moods and mental health. Health authorities are not sufficiently engaged to take over the role of institutions in caring for homeless people. In the future, in-depth investigation to improve this is necessary.

[Homelessness and mental health diagnose during the Great Recession (2008-2017): the effect of immigration.] / Sinhogarismo y salud mental durante la Gran Recesión (2008-2017): el efecto de la inmigración.

OBJECTIVE: Homelessness, which is a severe social problem across Europe and on the rise over the past decade, is closely linked to organic and mental health problems. In front of the lack of diagnostic analysis studies in the Spanish territory, this research aimed to determine the sociodemographic characteristics of a sample of individuals experiencing homelessness (IEH), to determine the prevalence of diagnoses of substance use disorders, dual pathology and other mental disorders and to analyze the existence of diagnostic differences between IEH born in the country and immigrant IEH. METHODS: A transversal and observational study was carried out, based on the analysis of mental health diagnostics of the medical histories of a sample of 1,072 IEH (453 locals and 619 immigrants) assisted between 2008 and 2017 in mental health services in Girona, northeastern Spain. For the statistical analysis, Student's t test was used to compare means and the chi-squared test was used for the analysis of qualitative variables. A binary logistic regression analysis was carried out to establish the predictor variables for the diagnosis of drug addiction and dual pathology. RESULTS: IEH showed high rates of mental disorders, especially psychoactive substances (82.6% of diagnosed people). 43.9% of IEH showed alcohol dependence as the reason for their diagnosis, followed by cocaine addiction and opiates. Foreign born IEH had more diagnoses for alcohol dependence and less for opiates or dual pathology than spanish born IEH. IEH born in Spain showed a higher vulnerability and received more mental health diagnoses than immigrant IEH. CONCLUSIONS: Even though immigrant PESS show more diagnoses for alcohol dependence, PESS born in Spain show a higher vulnerability and receive more mental health diagnoses than immigrant PESS. The process of migrating seems to establish a difference in the kind of mental disorders and addictions the PESS collective is prone to.

OBJETIVO: El sinhogarismo, grave problema social en toda Europa y en aumento durante la última década, está estrechamente vinculado a problemas orgánicos y de salud mental. Frente a la ausencia de estudios de análisis diagnóstico en territorio español, esta investigación pretendió conocer las características sociodemográficas de una muestra de personas en situación de sinhogarismo (PESS), determinar la prevalencia de diagnósticos de trastorno por uso de sustancias psicoactivas, patología dual y otros trastornos mentales y analizar la existencia de diferencias diagnósticas entre PESS nacidas en el país y PESS inmigrantes. METODOS: Se realizó un estudio transversal, observacional y analítico a partir del análisis de los diagnósticos de salud mental de las historias clínicas de una muestra de 1.072 PESS (453 autóctonas y 619 inmigrantes), atendidas durante 2008 y 2017 en los Servicios de Salud Mental de Girona (noreste de España). Para el análisis estadístico se utilizó t de Student para la comparación de medias y el ji-cuadrado para el análisis de variables categóricas. Se efectuó un análisis de regresión logística binaria para establecer las variables predictoras del diagnóstico de drogodependencias y patología dual. RESULTADOS: El 44% de la muestra estaba historiado en la Red de Salud Mental y Adicciones. Las PESS mostraron elevados índices de trastornos mentales, especialmente trastornos por uso de sustancias psicoactivas (82,6% de las personas diagnosticadas). El 43,9% de las PESS diagnosticadas lo fueron por dependencia al alcohol, seguidos de la dependencia a cocaína y a opiáceos. Las PESS inmigrantes tuvieron más diagnósticos por dependencia al alcohol y menos por dependencia a los opiáceos o patología dual que las PESS autóctonas. CONCLUSIONES: Aunque las PESS inmigrantes presentan más diagnósticos en dependencia al alcohol, las PESS nacidas en España muestran una mayor vulnerabilidad y reciben más diagnósticos de salud mental que las PESS inmigrantes. El proceso migratorio establece pues diferencias en el tipo de trastornos mentales y por uso de sustancias en la población de PESS.

'Money up in smoke': The financial benefits of smoking cessation may be more motivating to people who are homeless than potential health gains.

INTRODUCTION: High rates of tobacco smoking among people who are homeless or living in temporary accommodation exacerbate poor health outcomes and financial disadvantage. There is limited research on this population's perceptions of smoking cessation benefits or support strategies. METHODS: We conducted a cross-sectional survey of 68 male smokers living in a temporary accommodation hostel in Brisbane, Australia. The survey measured smoking and quit attempt history, perceptions of cessation aids and benefits of cessation, and awareness of the Intensive Quit Support program-a free Queensland government-funded program comprising 12 weeks of nicotine replacement therapy supplemented with weekly calls from Quitline. RESULTS: Participants (56% aged ≤40 years) spent a high proportion of their income on smoking (median $80/week). Although the most commonly reported perceived benefit of smoking cessation was improved health, more participants were interested in a campaign promoting the financial savings of quitting rather than the health benefits. Twice as many participants reported the high cost of smoking-provoked thoughts of quitting than graphic health warning labels on cigarette packs (70.6% vs. 30.9%). Participants reported a high level of interest in e-cigarettes as a cessation aid. There was a low level of awareness but moderate level of interest in the Intensive Quit Support program. DISCUSSION AND CONCLUSIONS: Smoking cessation campaigns promoting the financial savings of cessation may be more salient than health-focused campaigns among relatively young men who smoke and experience homelessness. There is a clear need for innovative, targeted strategies promoting smoking cessation among this population.

Longitudinal interrelationships of mental health discrimination and stigma with housing and well-being outcomes in adults with mental illness and recent experience of homelessness.

RATIONALE: Stigma and discrimination are negatively associated with social and health status. People who are homeless often experience systemic stigma and discrimination. OBJECTIVE: In this study, we analyze the longitudinal interrelationships between the trajectories of housing (housing stability) and well-being outcomes (i.e., recovery, quality of life, and community functioning) and the trajectories of discrimination and stigma in a sample of adults with mental illness and recent experiences of homelessness in Toronto, Canada. We also examined the effect of the Housing First (HF) intervention on these interrelationships. METHOD: The Group-Based Trajectory Model was used to estimate the interrelationship (or intersections) between discrimination and stigma with housing stability, recovery, quality of life, and community functioning in 274 participants of the At Home/Chez Soi, phase 2, Toronto site randomized trial over a two-year follow-up period. RESULTS: Three distinct trajectory groups were observed for discrimination (Low,Moderate decrease, and moderate increase), stigma (Low, Moderate, and High), recovery (Low, Moderate, and High), and the quality of life (Low, Moderate, and High). Two-trajectory groups (Low and High) were identified for housing stability and community functioning. The analyses showed that the trajectory groups for discrimination and stigma are strongly and contemporaneously interrelated with thetrajectory groups for housing stability, recovery, quality of life, and community functioning ability. The HF intervention had a mitigating effect on the changes across select trajectory groups, particularly for members of the Low and High discrimination and stigma trajectories group. CONCLUSION: Persistent mental health-related discrimination and stigma trajectories are longitudinally and contemporaneously interrelated with housing and well-being outcomes in persons experiencing mental illness and recent homelessness. These findings indicate the need for interventions and actions to reduce stigma toward thispopulation. Such interventions may improve housing stability, quality of life, mental health recovery, and community functioning.

Da gestação à laqueadura: cartografia de uma mãe órfã vivenciada em um Consultório na Rua / De la gestación a la ligadura de trompas: cartografía de una madre huérfana vivida en un consultorio en la calle / From pregnancy to sterilization: a cartography of an orphan mother experienced in a Clinic at the Street

Este artigo buscou mapear os afetos em cenas que ocorreram em uma vivência em um Consultório na Rua (CnaR) por meio da realização de uma cartografia. Os territórios mapeados, junto com a intercessão da obra "Sandman" de Neil Gaiman, que foi utilizada como dispositivo cognitivo de discussão da fantasia-realidade, evidenciaram modos de viver que desafiam os métodos tradicionais de produzir cuidado, enquanto tornaram visíveis capturas micropolíticas que levaram à produção de controle e enquadramento. Diante disso, foi perceptível no CnaR uma potência de produção de outros modos de cuidado ao mesmo tempo que as capturas micropolíticas para controle do vivente da rua agem agressivamente maquinando a produção da necessidade de esterilizações e desmaternizações com o sequestro de bebês pelo Estado. (AU)

El objetivo de este artículo fue mapear los afectos en escenas ocurridas en una experiencia en un consultorio en la calle (en portugués, Consultório na Rua - CnaR) por medio de la realización de una cartografía. Los territorios mapeados, juntamente con la intercesión de la obra Sandman de Neil Gaiman utilizada como dispositivo cognitivo de discusión de la fantasía-realidad, pusieron en evidencia modos de vivir que desafían los métodos tradicionales de producir cuidado, puesto que dieron visibilidad a capturas micropolíticas que llevaron a la producción de control y encuadre. Ante esto, fue perceptible en el CnaR una potencia de producción de otros modos de cuidado, al mismo tiempo que las capturas micropolíticas para control de la persona que vive en la calle actúan agresivamente maquinando la producción de la necesidad de esterilizaciones y desmaternizaciones juntamente con el secuestro de bebés por parte del Estado. (AU)

This article aimed to map the affections in scenes that occurred in an experience in a Clinic at the Street (CnaR) through the realization of a cartography. Mapped territories, with the intercession of Neil Gaiman's Sandman used as a cognitive device for the discussion of reality-fantasy, have highlighted ways of life that challenge traditional methods of care production, while making visible micropolitical captures that led to production of control and framing. Therefore, it was noticeable in the CnaR a potency of production of new ways of care, but at the same time, there are micropolitical captures for the control of street dwellers, conspiring aggressively to produce needs of sterilization and de-motherhood as well as the kidnapping of babies by the State. (AU)

Interpersonal relationships and drug use over time among homeless people: a qualitative study.

BACKGROUND: Homelessness is one of the most severe forms of social exclusion and is an important public health issue. It is characterized by processes of weakening of interpersonal bonds. The objective of this study was, therefore, to elucidate how interpersonal relationships change over the life cycle of homeless drug and alcohol users. METHOD: We used a qualitative methodology. The participants were adults who had a history of homelessness and use of alcohol and other drugs. The interviews were semi structured and used a timeline instrument. All interview were audio recorded, transcribed, and submitted to thematic analysis. RESULTS: Twenty individuals participated in the study. Reports on social exclusion over time stood out in respect of four main themes and their respective subthemes: Theme 1 - Childhood: instability upbringing, abuse, violence, and an absent or not very present father figure; Theme 2 - Adolescence: school dropout and failure; acceptance of gender and sexual orientation; birth of first child, living with a partner or getting married: Theme 3 - Adulthood: estrangement or conflicting relationship with family; health problems; drug trafficking and prostitution; Theme 4 - Cross-cutting factors: death of relatives and substance use. CONCLUSION: The results suggest that interpersonal relationships are permeated by successive breakups, conflicts and other events that start in childhood and can have a cumulative effect in later stages of life, and cross the subsequent phases. Substance abuse and dependence are mentioned as cross-cutting factors that intensify social exclusion in all stages of life.

Redes sociais significativas de homens em situação de rua no sul do Brasil / Significant social networks of homeless men in Southern Brazil / Redes sociais significativas de hombres sin hogar en el sur de Brasil

As redes sociais significativas representam os vínculos sociais que promovem apoio para o indivíduo nas diversas situações. Esta pesquisa objetivou identificar e analisar as redes sociais significativas de homens em situação de rua no sul do Brasil. Participaram 12 homens que preencheram o mapa de redes, o que permitiu analisar a estrutura, as funções e os atributos do vínculo. Verificou-se a concentração de pessoas nos seguintes quadrantes: comunidade, assistência social e equipe de saúde, pois as pessoas e instituições desenvolvem múltiplas funções de apoio emocional, ajuda material e regulação social buscando promover a cidadania. Por outro lado, identificou-se no quadrante da família fragilizações nos vínculos. Estes resultados indicam que os profissionais da assistência social e da saúde fornecem apoio de acordo com os objetivos e diretrizes das políticas públicas, mas os vínculos fragilizados nas relações familiares impossibilitam a retomada de projetos de vida.

Significant social networks represent the social bonds that promote support for the individual in different situations. This research aimed to identify and analyze the significant social networks of homeless person. Twelve men participated in the network map, which allowed us to analyze the structure, functions, and attributes of the link. There was a concentration of people in the following quarters: community, social assistance and health staff, since people and institutions develop multiple functions of emotional support, material help and social regulation that help in the sense of citizenship. On the other hand, the frailties in the links were identified in the quadrants of the family, friends, and study / work. These results indicate that social and health care workers provide support in accordance with the objectives and guidelines of public policies, but weak ties in other networks make it impossible to resume life projects.

Las redes sociales significativas representan los lazos sociales que promueven el apoyo al individuo en diferentes situaciones. Esta investigación buscou identificar y analizar las redes sociales significativas de los hombres sin hogar en el sur de Brasil. Participaron doce hombres que utilizaram el mapa de la red, lo que permitió analizar la estructura, las funciones y los atributos del vínculo. Se identifico una concentración de personas en los siguientes cuadrantes: comunidad, asistencia social y equipo de salud, ya que las personas e instituciones desarrollan múltiples funciones de apoyo emocional, ayuda material y regulación social buscando promover la cidadanía. Por otro lado, se identificaron debilidades en los vínculos en el cuadrante familiar. Estos resultados indican que los profesionales de las areas social y de salud utilizam apoyo de acuerdo con los objetivos y manuais de las políticas públicas, pero los lazos debilitados en las relaciones familiares imposibilitan retomar proyectos de vida.

Homeless persons with mental illness and COVID pandemic: Collective efforts from India.

COVID-19 pandemic had made an unprecedented impact worldwide. India has entered into a total lockdown by invoking the special provision of Epidemic Diseases Act of 1897 and Disaster Management Act, 2015. The complete lockdown policy has a direct and indirect impact on Homeless Persons with Mental Illness (HPMI) concerning shelter, basic needs and access to health care, besides the transmission of COVID infection. In this manuscript, we highlight the collective efforts undertaken by both the Government and Civil Society in providing care and protection to HPMI against COVID during the lockdown in India.

"Tudo é violência, viver é violência": representações sociais de mulheres em situação de rua na Regional Centro-Sul de Belo Horizonte/MG sobre violência / "Everything is violence, living is violence": social representations of homeless women in the Center-South Region of Belo Horizonte/MG on violence

As múltiplas faces da violência e seu impacto para a saúde das populações também são manifestas e se apresentam no cenário da pessoa em situação de rua. Inclusive nas grandes metrópoles. Tal fenômeno tem se tornado um problema de saúde pública e de urgência na promoção e proteção à cidadania de populações vulnerabilizadas. As políticas públicas somam esforços que são evidentes com a articulação intersetorial e outras agendas. Contudo, cada dia mais aumenta o contingente de pessoas em situação de rua em Belo Horizonte. As mulheres que se encontram nessa situação estão em condições muito peculiares de violação de direitos. O objetivo dessa pesquisa foi identificar a(s) representação(ões) social(ais) das mulheres em situação de rua da regional Centro-Sul de Belo Horizonte sobre a violência. Realizou-se uma pesquisa quanti-qualitativa com aplicação de questionário estruturado a 22 mulheres e 3 entrevistas narrativas semiestruturadas, para as análises das representações produzidas pelas falas e relatos de vivências de mulheres em situação de rua. Adotou-se o método da análise de conteúdo conjugada com a análise léxica. Tal análise de dados destacou a organização da mulher, sua força individual, suas representações sobre a vida em situação de rua e como isso compõe sua experiência sobre a violência. Através das entrevistas, percebe-se que pelo menos 75% das mulheres entrevistadas são migrantes que vieram para a capital visando a melhoria de suas condições de existência, com trajetória ainda de violência intrafamiliar ou doméstica. Considerou-se que as representações sociais das mulheres cisgêneras e transgêneras em situação de rua são muito similares, embora vivenciem estratégias diferentes para lidar com as vulnerabilidades postas diante de sua exposição às violências nas ruas. Esta dissertação buscou contribuir para a instrumentalização e delineamento de práticas interventivas, e alinhamentos metodológicos para os processos de trabalhos de equipes, de programas e serviços, que acessam usuárias em situação de rua a partir das construções identificadas pelas usuárias desses serviços socioassistenciais. Dessa forma, tornam-se imprescindíveis às políticas públicas a ampliação e compreensão sobre a acolhida e formas de intervenção mais assertivas, pautadas nas seguranças afiançadas e de direitos humanos e cidadania.

The multiple faces of violence and its impact on the health of populations are also evident and present themselves on the scene of homeless people, including in large cities. This phenomenon has become a public health problem and an urgent one in promoting and protecting citizenship of vulnerable populations. Public policies add up to efforts that are evident with intersectoral articulation and other agendas. However, the number of homeless people in Belo Horizonte is increasing every day. Women who are in this situation are in very peculiar conditions of violation of rights. The objective of this research was to identify the social representation (s) of homeless women in the central-south region of Belo Horizonte on violence, in view of their own condition of vulnerability, by the representation that they have of themselves and their condition of life on the streets. The methodology was guided by qualitative research with the application of a structured questionnaire to 22 women and by 3 semi-structured narrative interviews. The analysis of the representations produced by the speeches and reports of the experiences of women living on the street, these data through content analysis combined with the lexical analysis, in addition to the analysis of trajectories. Such data analysis proposed to answer the hypotheses of women's organization, individual strength, their representations about life on the street and how this composes their experience about violence. Through the interviews, it can be seen that at least 75% of the women interviewed are migrants, who came to the capital to improve their conditions of existence, with a trajectory of intrafamily or domestic violence. It was considered that the social representations of cisgender and transgender women living on the streets are very similar, although they experience different strategies to deal with the vulnerabilities posed by their exposure to street violence. Thus, this dissertation sought to contribute to the instrumentalization and delineation of interventional practices and methodological alignments for the work processes of teams, programs and services that access street users from the constructions identified by the users of these social assistance services, becoming essential to public policies, also expanding the understanding of the reception and more assertive forms of intervention, based on secured security and human rights and citizenship.

A dimensão do cuidado pelas equipes de Consultório na Rua: desafios da clínica em defesa da vida / The dimension of care by the 'Street Clinic' team: challenges of the clinic in defense of life

RESUMO O estudo objetivou analisar a produção de cuidados primários à saúde à população em situação de rua, prestados por equipes de Consultório na Rua (eCR) no contexto de uma metrópole brasileira, identificando potencialidades e dificuldades. Estudo de caso, de abordagem qualitativa, considerando o universo das sete equipes no ano 2016/2017, com observação direta do trabalho e realização de entrevistas semiestruturadas com profissionais de várias categorias (n=34), com análise temática de conteúdo. Observou-se que as eCR atuavam com escopo ampliado e integral de ações, cuidados clínicos e intersetoriais, nos espaços das ruas e nos serviços, em trabalho de equipe integrado. Organizavam-se com flexibilidade, baixa exigência, busca ativa nos territórios, de forma itinerante, no tempo oportuno, imediato, construção de planos terapêuticos compartilhados, que promoviam autonomia, baseados na redução de danos. Dificuldades eram inerentes às vulnerabilidades e complexidades dos casos, à fragmentação da rede de atenção, à qualidade dos instrumentos para registro em saúde e à carência de recursos estruturais (transporte, insumos para ações de promoção da saúde). Concluiu-se que o cuidado se sustentava na dimensão ético-política, usuário-centrado, na solidariedade e na defesa da vida.

ABSTRACT The study aimed to analyze the production of Primary Health Care to people living in the streets, provided by Street Office (eCR) teams in the context of a Brazilian metropolis, identifying potentialities and difficulties. This is a qualitative case study considering the universe of the seven teams in the 2016-2017 period, with direct observation of the work and conducting semi-structured interviews with professionals from various categories (n=34), with thematic content analysis. We observed that the eCR operated with an enlarged and comprehensive scope of actions, clinical and intersectoral care, in street spaces and services, through integrated teamwork. They were organized with flexibility, low demand, active search in the territories, in an itinerant way, timely, and immediately, with the construction of shared therapeutic plans, which promoted autonomy, based on harm reduction. Difficulties were inherent to the vulnerabilities and complexities of the cases, the fragmentation of the health care network, the quality of the instruments for health registration and the lack of structural resources (transportation and inputs for health promotion actions). We concluded that care was sustained in the ethical-political, user-centered dimension, in solidarity and in the defense of life.

Secondary care usage and characteristics of hospital inpatients referred to a UK homeless health team: a retrospective service evaluation.

BACKGROUND: UK "Pathway" teams offer specialist hospital care coordination for people experiencing homelessness. Emergency healthcare use is high among homeless people, yet "homelessness" is not routinely coded in National Health Service (NHS) data. Pathway team records provide an opportunity to assess patterns in admissions and outcomes for inpatients identified as homeless. METHODS: Retrospective analysis of patients referred to "Pathway" homelessness teams in seven UK hospitals to explore the patterns of hospital admission, morbidity, secondary healthcare utilisation and housing status. Each patient was individually identified as experiencing homelessness. Within a six-month period, demographic data, reason for admission, morbidity, mortality and secondary care hospital usage 120-days before and 120-days after the index admission was collected. RESULTS: A total of 1009 patients were referred, resulting in 1135 admissions. Most admissions had an acute physical health need (94.9%). Co-morbid mental illness and/or substance misuse was common (55.7%). Reasons for admission included mental and behavioral disorders (overdose, alcohol withdrawal or depression, 28.3%), external causes of morbidity and mortality (assault or trauma, 18.7%), and injury, poisoning and external causes (head injury, falls and fractures, 12.4%). Unplanned Emergency Department attendances reduced after index admission and unplanned hospital admissions increased slightly. Planned admissions doubled and total bed days increased. Housing status was maintained or improved for over 60% of inpatients upon discharge. Within 12 months of index admission, 50 patients (5%) died, 15 deaths (30%) occurred during the index admission. CONCLUSIONS: Disengagement with health services is common among homeless people. Many deaths are due to treatable medical conditions (heart disease, pneumonia, cancer). Observed increases in planned admissions suggests intervention from Pathway teams facilitates necessary investigations and treatment for homeless people. Equity, parity of care, and value should be inbuilt interventions for inclusion health groups and evaluations need to move beyond simply seeking cost reductions.

Is Facebook use healthy for individuals experiencing homelessness? A scoping review on social networking and living in the streets.

Background: Although they are faced with a situation of extreme social exclusion, individuals experiencing homelessness (IEH) have gradually begun to incorporate the use of social networking sites (SNS) into their everyday lives. Aims: To review the publications that have examined the use of SNS among IEH and to analyze the impact that this online activity has on the health of these individuals. Methods: This study employed a scoping review method, analyzing scientific literature published up to the end of 2016. Results: An analysis was performed on nineteen peer-reviewed articles and three grey literature publications. IEH, especially those who are younger, use SNS in a similar proportion to the overall population. When these individuals used the networks due to their own initiative, it was found to have a positive health effect in that it mitigated the consequences of living on the street. Interventions aimed at improving the participants' health achieved positive results, both in terms of preventing problems associated with drug abuse and high-risk sexual behavior and of promoting mental health. Conclusions: The use of SNS presents some health benefits for IEH. Virtual communication and information alternatives provide opportunities to improve the mental and general health of people in social exclusion situations.

The trajectory of crack users to the street situation in the perspective of family members

Abstract Objective. To understand the family experience regarding the trajectory of crack users for the street situation. Method. Qualitative study using the systemic approach as the theoretical referential and the narrative as methodological referential. We conducted interviews with eleven family members of crack users with street situation experience cared for at a community mental health service. We analyzed the interviews using the inductive content analysis technique. Results. The family members understood the trajectory of the crack users for the street situation from two perspectives. One before the street situation process, for which they described a problematic childhood, the presence of stressor traumas/ events, vulnerabilities in the family environment, and their family members' encounter with the drug world. Moreover, another posterior to the street situation, for which they narrated the perception of alterations in the users, the discovery of crack use, the deepening of the individuals' relationship with the streets, and the adoption of coping strategies. Conclusion. It was made evident that the family adopts an explicative model for the behavior of drug use and contact with the streets based on the life history of the crack user family member.

Resumen Objetivo. Comprender la trayectoria de usuarios de crack en situación de calle desde la perspectiva de los familiares. Métodos. Estudio cualitativo, realizado en un servicio público de salud mental, que utiliza el abordaje sistémico como referencial teórico y la narrativa como referencial metodológico. Se realizó una entrevista en profundidad con cuestión orientadora junto a 11 familiares, y la técnica de análisis de contenido para la exploración de las narrativas. Resultados. Los familiares comprendieron la trayectoria para la situación de calle a partir de dos perspectivas principales: el pasado, donde narraron eventos de la infancia / adolescencia de los usuarios, y el presente, donde contaron específicamente sobre la ocurrencia de la situación de calle. Discusión: Los eventos que justifican el uso de drogas son percibidos como momentos de fragilización, a partir del entendimiento de que el usuario era un "niño-problema". Conclusión. Se evidenció que la creencia familiar puede funcionar como los ajustes para cuidar y mantener la unión y la homeostasis familiar.

Resumo Objetivo. Compreender a experiência familiar sobre a trajetória de usuários de crack para a situação de rua. Método. Estudo qualitativo utilizando a abordagem sistêmica como referencial teórico e a narrativa como referencial metodológico. Foram realizadas entrevistas com 11 familiares de usuários de crack com vivência de situação de rua e atendidos em um serviço de saúde mental comunitário. As entrevistas foram analisadas por meio da técnica de análise de conteúdo indutivo. Resultados. Os familiares compreenderam a trajetória dos usuários de crack para a situação de rua a partir de duas perspectivas. Uma anterior ao processo da situação de rua, onde descreveram uma infância problemática, presença de traumas/eventos estressores, vulnerabilidades no ambiente familiar e o encontro dos seus familiares com o universo das drogas. E uma posterior, onde narraram sobre a percepção de alterações nos usuários, a descoberta do uso de crack, o aprofundamento da relação dos indivíduos com as ruas e a adoção de estratégias de enfrentamento. Conclusão. Evidenciou-se que a família adota um modelo explicativo para o comportamento de uso de droga e contato com a rua baseado na história de vida do familiar usuário de crack.

Vivências de pessoas LGBT em situação de rua e as relações com a atenção e o cuidado em saúde em Florianópolis, SC / Experiences of LGBT homeless people and its relations with health care in Florianopolis, SC

RESUMO As identidades de gênero e as orientações sexuais têm impacto sobre as vivências das pessoas em situação de rua, sendo importante motivo na quebra de vínculo familiar e ida para a rua, no caso, Lésbicas, Gays, Bissexuais, Travestis e Transexuais (LGBT). LGBT em situação de rua têm sua relação com o serviço de saúde comprometida e apresentam os piores indicadores de saúde quando comparados com os heterossexuais. O objetivo deste estudo foi compreender as implicações das identidades de gênero nas relações sociais e saúde de LGBT em situação de rua de Florianópolis (SC). Trata-se de uma pesquisa qualitativa realizada entre os meses de novembro de 2017 e fevereiro de 2018, com LGBT em situação de rua, no centro de Florianópolis (SC). Foram realizadas entrevistas individuais semiestruturadas para coleta de dados. Os principais motivos de ida para a rua foram os conflitos familiares e a opção pessoal. A rua foi apresentada como um espaço de intensa discriminação e violência contra LGBT, com aspectos interseccionais relacionados com a raça, amenizadas por estratégias de 'desvio de foco'. Devido às experiências discriminatórias com profissionais de saúde, o cuidado de saúde é feito pelas próprias pessoas em situação de rua.

ABSTRACT Gender identities and sexual orientation have an impact on the lives of homeless people, and are an important reason for breaking the family bond and ending up in the streets, in the case of Lesbians, Gays, Bisexuals, Transvestites and Transsexuals (LGBT). LGBT homeless people have their relationship with the health service compromised and have the worst health indicators when compared to heterosexuals. The aim of this study was to understand the implications of gender identities in social relations and health of the LGBT homeless population in Florianópolis (SC). It is a qualitative research carried out between November 2017 and February 2018, with LGBT homeless people in the city center of Florianópolis (SC). Individual semi-structured interviews were conducted for data collection. The main reasons for going to the street were family conflicts and personal choice. The street was presented as a space of intense violence and discrimination against LGBT population with intersectional aspects related to race, enlivened by some strategies of 'shifting of focus'. Due to discriminatory experiences with health professionals, health care is carried out by the very people in homeless situation.

[Physical activities adapted to homeless people]. / Les activités physiques adaptées aux personnes sans domicile fixe.

Around ten homeless people were invited to take part in a programme of physical activities to improve their health status. Only motricity and walking pathways were followed assiduously for eight weeks. The assessment of the physical condition and quality of life showed an improvement in these areas, in particular for one of the participants. However, the lack of motivation and assiduity remains an obstacle to regular activity.