Exploring spiritual/religious coping strategies among mothers of children with severe or profound intellectual disability during genetic counseling in Brazil.

Parents use several coping strategies to deal with the challenges of caring for children with disabilities. This qualitative study explored the spiritual/religious coping strategies adopted by Brazilian mothers of children with severe or profound intellectual disabilities who were attending the medical genetics clinic for genetic counseling. Individual semi-structured interviews were conducted with 15 participants, selected by convenience. Thematic content analysis was used to investigate the data. Five major themes were recognized: (1) spirituality/religion as a source of resilience; (2) surrender to God's plan; (3) a feeling of predestination; (4) children with a disability perceived/conceived as a blessing; and (5) pleading for divine intervention. Participants highlighted the ability to recover and adapt to bad circumstances and stressful events with God's support using spiritual/religious resources and practices. They attributed the cause and control of events in their lives to an external and transcendental source, showing themselves to be resigned to the condition of their child with a disability and his/her demands. The feeling of predestination appeared as a form of divine intervention as well as a way of attributing meaning to the situation. Their child with a disability was compared constantly to an "angel," a celestial being created by God to be a messenger and fulfill divine purposes. From the participants' perspective, these coping mechanisms appeared to have helped them adjust to the situation. Spirituality and religiousness have become crucial in cultures such as Brazil, where religious practices, often highly syncretic, are common. A more detailed and comprehensive understanding of how spiritual/religious coping strategies are mobilized during the genetic counseling process can improve the cultural competence of genetic counselors and help guide proposals for more effective clinical interventions.

Alcohol Consumption During Pregnancy in Brazil: Elements of an Interpretive Approach.

With this research, we aimed to raise elements to enhance the understanding of alcohol consumption among pregnant women in Brazil. Fourteen women identified as alcohol consumers during pregnancy were interviewed. Alcohol consumption during pregnancy seemed to be associated with three groups of interconnected issues: subjective and individual issues (such as expectations, motivations, and women's difficulty in identifying their own consumption as risky); sociocultural and environmental issues (such as alcohol cultural value, easy access, and influence from relatives, friends, and partners); misinformation, inconsistent opinions publicized through media and lack of technically addressing the subject during prenatal care. Collective and individual health educative actions seem necessary to decrease alcohol consumption among Brazilian women with similar sociocultural characteristics. Media campaigns and explicit information about negative alcohol effects, articulated with individualized actions, such as a systematic approach of this theme during prenatal care, could allow earlier and more appropriate identification and intervention of women at risk.

Motivation for alcohol consumption or abstinence during pregnancy: A clinical-qualitative study in Brazil.

BACKGROUND: In Brazil, alcohol consumption is estimated to range from 7 to 40% in pregnant women. This research investigated the motivation for alcohol consumption or abstinence during pregnancy in a purposive sample of Brazilian women. METHODS: Clinical-qualitative research was conducted, in which 14 women participated, identified as risk-drinkers during pregnancy by the T-ACE screening tool. Data were collected through semi-structured individual interviews. Reports were recorded, transcribed and investigated by a thematic content analysis approach. The results were discussed based on a comprehensive and interpretive framework. RESULTS: Sixteen themes were extracted and these were then classified into three thematic categories: (a) general motives for alcohol use, (b) specific motives for drinking during pregnancy, and (c) reasons for partly or fully abstaining from drinking during pregnancy. Social motives were the most relevant, particularly due to deeply rooted cultural values. Enhancement motives were widely mentioned and associated with a hedonic posture. Consumption also aimed to deal with negative emotions, characterizing two types of coping specifically to pregnancy: first, perceiving pregnancy as a period of less opportunity for social interaction and, therefore, drinking alcohol at home to compensate; secondly, perceiving pregnancy as a period of greater irritability, and hence experiencing difficulties to abstain. On the other hand, concern about fetal health, disapproval of consumption by relatives and health professionals, as well as the social construction of mothering were reported as reasons to abstain. CONCLUSIONS: Some specificities influence the decision to continue or discontinue alcohol consumption during pregnancy. To reduce consumption, we suggest educational actions based on a collective health perspective, articulated with individualized measures that allow identification and proper intervention for women at risk.

[Saturation sampling in qualitative health research: theoretical contributions]. / Amostragem por saturação em pesquisas qualitativas em saúde: contribuições teóricas.

The transparency and clarity of research reports, emphasizing the data collection stage, are considered important parameters for evaluating the scientific rigor of qualitative studies. The current paper aims to analyze the use of saturation sampling as a methodological concept, frequently employed in descriptions of qualitative studies in various areas of knowledge, particularly in the field of health care. We discuss and confront the following topics: definition of sampling closure by theoretical saturation; difficulties in the acceptance and operationalization of intentional samples (with examples), adequate size of the intentional sample, the significance of valuing what is repeated or the differences contained in the sample reports, inadequate uses of expressions containing the term saturation, and finally possible metaphors for understanding the concept.

Deficiência intelectual grave ou profunda: investigação qualitativa de estratégias maternas de enfrentamento / Discapacidad intelectual grave o profunda: investigación cualitativa de estrategias de afrontamiento materno / Severe or profound intellectual disability: a qualitative investigation of maternal coping strategies

RESUMO Objetivou-se investigar estratégias de enfrentamento relatadas por uma amostra de mães brasileiras de filhos com deficiência intelectual grave ou profunda. Os poucos estudos brasileiros sobre este objeto justificaram a exploração qualitativa do tema. Participaram quinze mães recrutadas por conveniência em serviços de saúde de um município do Estado de São Paulo, Brasil. Foram feitas entrevistas semiestruturadas individuais e uma análise temática de conteúdo. Os resultados compreendem quinze temas, induzidos diretamente do corpus e alocados em três pré-categorias baseadas em estudos teóricos sobre coping. Houve um predomínio de menções a estratégias de enfrentamento centradas no problema e nas relações interpessoais, mescladas com estratégias centradas na emoção. Nossas entrevistadas não pareceram considerar-se alvos das políticas indutoras da atenção integral às pessoas com deficiência do Sistema Único de Saúde brasileiro, vigentes há cerca de duas décadas, e cuja efetiva implementação poderia ajudar a extrapolar o cuidado baseado preponderantemente na responsabilidade parental, em suas visões. Em suas falas, há demandas de maior efetividade também dos setores de serviço social, educação e transporte. Apontaram necessidades de maior interação e apoio sociocomunitário, expressando expectativas de um progressivo redesenho cultural da ética do cuidado que fomente ações no âmbito extrafamiliar, diminuindo suas sobrecargas. Esses aspectos das falas das entrevistadas podem ser abordados no manejo clínico dos filhos. Um enfrentamento progressivamente mais saudável da condição por que passam traria benefícios diretos também aos indivíduos com deficiência.

RESUMEN El objetivo fue investigar las estrategias de afrontamiento reportadas por una muestra de madres brasileñas de niños con discapacidades intelectuales severas o profundas. Los pocos estudios brasileños sobre este objeto justificaron la exploración cualitativa del tema. Quince madres participaron, reclutadas por conveniencia en los servicios de salud de un municipio del estado de São Paulo, Brasil. Se realizaron entrevistas semiestructuradas individuales y un análisis de contenido temático. Los resultados comprenden quince temas, inducidos directamente del corpus; fueron asignados en tres categorías previas teóricamente basadas. Las menciones predominantes de estrategias de afrontamiento se referían a aquellos centrados en problemas y relaciones interpersonales, que se mezclaron con estrategias centradas en la emoción. Nuestras entrevistadas no parecían considerarse objetivos de políticas inductoras de una atención integral para las personas con deficiencia en el Sistema Único de Salud de Brasil, en vigor durante aproximadamente dos décadas, y cuya implementación efectiva podría ayudar a extrapolar la atención basada principalmente sobre responsabilidad parental, en sus opiniones. Expresaron demandas de una mayor efectividad de los sectores de servicio social, educación y transporte. Señalaron la necesidad de una mayor interacción social y apoyo sociocomunitario, y parecían expresar las expectativas de un rediseño cultural progresivo de una ética de la atención que fomente acciones en el ámbito extrafamiliar, reduciendo sus sobrecargas. Estos aspectos de las declaraciones de los entrevistados pueden abordarse en el manejo clínico de sus hijos. Un afrontamiento más saludable de la condición que están experimentando también beneficiaría a las personas con discapacidades.

ABSTRACT. The objective was to investigate coping strategies reported by a sample of Brazilian mothers of children with severe or profound intellectual disabilities. The few Brazilian studies on this object justified the present qualitative exploration of the theme. Fifteen mothers participated, recruited by convenience in health services from a municipality in the interior of the state of São Paulo, Brazil. Individual semi-structured interviews and a thematic content analysis were carried out. The results comprise fifteen themes, induced directly from the corpus; they were allocated into three pre-categories based on theoretical studies on coping. Predominant mentions of coping strategies concerned those centered on problem and interpersonal relationships, which were mixed with strategies focused on emotion. Our interviewees did not seem to consider themselves targets of policies that induce a comprehensive care for people with disability in the Brazilian Unified Health System, in force for about two decades, and whose effective implementation could help extrapolate care based predominantly, on parental responsibility in the views of the participants. They expressed demands for a greater effectiveness also from the sectors of social service, education and transport. They pointed out the need for greater social interaction and socio-community support, seeming to express expectations of a progressive cultural redesign of an ethics of care that fosters actions in the extra-family sphere, reducing their overloads. These aspects of the interviewees' statements can be addressed in the clinical management of their children. A progressively healthier coping with the condition they are experiencing would also benefit individuals with disabilities.

Data collection in clinical-qualitative research: use of non-directed interviews with open-ended questions by health professionals.

Non-directed interviews constitute the main data collection instrument in qualitative health research. Studies in which this is evident are well documented in international literature. For health professionals, knowing what people feel and imagine makes it possible to develop a more adequate clinician-patient relationship. It is indispensable to know what the life phenomena mean for individuals, because the meanings have a structuring function. People organize their lives around the meaning they attribute to situations or object. This is also relevant to their health care. From research conducted at the Laboratory of Clinical-Qualitative Research, State University of Campinas, Campinas (São Paulo), Brazil, the authors address, in this article, the following matters: characterization of non-directed interviews, directiveness of interviews, approach techniques, observation of non-verbal and paraverbal manifestations, registry techniques / speech transcription, and validity/reliability of non-directed interviews. This is useful for people interested in research at graduate and undergraduate level.

[New possible determinants of the quality of life of patients with treated thyroid cancer: a qualitative study]. / Possíveis novos determinantes da qualidade de vida de pacientes com câncer de tireoide tratado: um estudo qualitativo.

The aim of this study was to develop a qualitative approach of determinant factors of the quality of life of treated patients with papillary thyroid carcinoma. Sixteen in-depth interviews were conducted with individuals 18 to 45 years old regarding their disease representations and experiences, followed by statements content analysis. The results show issues already provided in structured questionnaires about quality of life, although others were only partially assumed in these surveys (management of the concept of disease etiology; the "forced" patient introduction into the medical conceptual universe; the fear of the prognosis and positive changes in lifestyle). The results interpretation were benefited from recently developed theoretical elaborations: the anxieties related to illness experience seem to be configured as a "modern risk", in the context of a "risk society". The development of structured questionnaires on quality of life requires frequent qualitative studies to capture changes in subjective aspects of the construct, given the dynamic changes of historical, cultural and psychological meanings of the health disease process, constantly influenced by technological innovations and continuing epidemiological interpretations.

Spontaneous harm reduction: a barrier for substance-dependent individuals seeking treatment?

OBJECTIVE: Greater information regarding motivations and treatment barriers faced by substance-dependent individuals has clinical and public health implications. This study aimed to formulate hypotheses regarding psychological, social and family variables that can be constructed as motivations or subjective barriers for the early seeking of formal treatment. METHODS: A qualitative study was conducted in an intentional sample (selected through saturation and variety of types) of 13 substance-dependent individuals who sought treatment. In-depth, semi-structured interviews were conducted using open questions, and the transcribed data were subjected to qualitative analysis. RESULTS: Four types of spontaneous harm reduction measures were identified, according to the subjective logic of each participant: having some periods at rest (not using and recovering from adverse effects); caretaking by close acquaintances (relatives, partners, drug dealers and alcoholic beverage sellers); selectivity regarding substance source, type and means of administration; establishing "healthy" limits of ingestion. CONCLUSIONS: The measures identified might represent barriers to the early seeking of treatment but might also represent spontaneous learning of abilities beneficial to future treatment. Health care professionals should take into consideration their existence and should address them in clinical settings. Issues representative of the formulated categories should be presented in structured questionnaires used in future quantitative studies of barriers to treatment in this population.

Sexual health care of two generations of men: continuities and volatilities of scripts and habitus.

To acquire in-depth understanding of meanings attributed by young men to sexual health care, the similarities and asymmetries present in a corpus of 60 reports of men from two different generations were analyzed regarding this type of care. A process of in-depth hermeneutics was undertaken under the theoretical sociological perspectives of sexual scripts, male habitus and generation. Fifteen analytical categories were grouped together into the three dimensions of sexual scripts (intra-psychic, interpersonal and cultural). Some findings indicate the presence of provisions which were not enduring and have not been transposed to the next generation. However, striking cultural similarities or habitus around male sexuality were also found in the two different socio-historical contexts, allowing for an interpretation on the as yet inconstant use of condoms among the young.

[Doctor-patient relationship barriers to substance dependents seeking treatment]. / Barreiras na relação clínico-paciente em dependentes de substâncias psicoativas procurando tratamento.

INTRODUCTION: Knowing the barriers substance dependents come across when seeking treatment has medical and public health implications. The study's aim was to formulate hypothesis on psychological and social and familiar variables forming subjective barriers to early treatment. METHODS: A qualitative exploratory study was conducted in an intentional sample (selected through saturation and variety of types) of 13 substance dependents who sought treatment. In-depth open-question semi-structured interviews were conducted and the transcribed data underwent qualitative analysis. RESULTS: The main barriers in doctor-patient relationship were fear of doctors and facilities which are regarded as "sadistic," and the perception of doctor-patient "distancing." CONCLUSIONS: Health care professionals should take into consideration the existence of barriers to treatment and should bear this in mind when promoting their services. Issues such as "fear of being abused" and "doctors wouldn't know how to treat me" should be covered in structured questionnaires of further quantitative studies.

[Social anxiety and propranolol abuse: a case study]. / Ansiedade social e abuso de propranolol: relato de caso.

A patient with severe social anxiety disorder has taken unprescribed propranolol for six years (up to 320 mg/day). In addition to the psychoanalytic treatment that had been instituted and after the diagnosis and prescription of tranilcipromine, both the social anxiety symptoms and propranolol abuse have improved; after the prescription of paroxetine she underwent a better controlled use of the betablocker. Despite the informal self-prescription for several years, the generalized social anxiety symptoms persisted. This case exemplifies the special difficulty of social phobic patients to seek for treatment. The author formulates a hypothesis that there may be an increasing informal prescription of betablockers among persons with social anxiety disorder and performance anxiety, a problem whose public health importance is still unknown.

Uso de bebidas alcoólicas por estudantes: análise de propagandas de festas em um campus universitário / Student drinking: an analysis of parties advertisements on an university campus / Uso de bebidas alcohólicas por parte de estudiantes: análisis de anuncios de fiestas en un campus universitario

A proposta deste trabalho foi interpretar as imagens de propagandas de festas veiculadas em um campus universitário em relação ao consumo de álcool por estudantes. Os elementos plásticos, icônicos e linguísticos das propagandas foram submetidos a uma análise semiótica de imagens. Organizaram-se os 85 temas levantados em seis categorias: bebidas alcoólicas, sexualidade, gênero, produção das festas, estilos musicais e estilo de vida-grupos-comportamento. Foram veiculados diversas motivações festivas, atrações, questões de gênero, valores, tradições e finalidades econômicas. Menções a bebidas alcoólicas foram praticamente ubíquas. Os elementos persuasivos ao consumo de álcool foram variados, envolvendo a associação álcool-sexualidade e a apresentação de novos comportamentos e estilos de vida relacionados à bebida. A indústria de produção e comércio de bebidas parece inserir-se mercadologicamente no território do campus, de modo informal e quase sempre sem seguir a legislação de marketing desses produtos.(AU)

This study interpreted the images of parties advertisements distributed on a university campus in relation to student drinking. A semiotic image analysis was conducted of the plastic, iconic, and linguistic elements of the advertisements. Eighty-five themes were organized into six categories: alcoholic drinks, sexuality, gender, party production, musical styles, and lifestyle-groups-behavior. The advertisement encompassed various festive motives, attractions, gender issues, values, traditions, and economic purposes. The mention of alcoholic drinks was practically ubiquitous. Various persuasive elements were used to promote alcohol consumption involving the association between alcohol and sexuality and the presentation of new drink-linked behaviors and lifestyles. The alcohol industry was shown to have a strong informal presence on-campus, almost always failing to comply with legislation governing alcohol advertizing.(AU)

El objetivo fue interpretar las imágenes de anuncios de fiestas exhibidas en un campus universitario con relación al consumo de alcohol por parte de los estudiantes. Los elementos plásticos, icónicos y lingüísticos de las propagandas se sometieron a un análisis semiótico de imágenes. Se organizaron los ochenta y cinco temas examinados en seis categorías: bebidas alcohólicas, sexualidad, género, producción de las fiestas, estilos musicales y estilo de vida-grupos-comportamiento. Se exhibieron motivaciones festivas, atracciones, cuestiones de género, valores, tradiciones y finalidades económicas. Las menciones a bebidas alcohólicas fueron prácticamente ubicuas. Los elementos persuasivos para el consumo de alcohol fueron variados, envolviendo la asociación alcohol-sexualidad y la presentación de nuevos comportamientos y estilos de vida relacionados con la bebida. La industria de producción y comercio de bebidas parece inserirse mercadológicamente en el territorio del campus de manera informal y casi siempre sin seguir la legislación del marketing de estos productos.(AU)

Violência doméstica contra a mulher e os profissionais da APS: predisposição para abordagem e dificuldades com a notificação / Domestic violence against women and PHC professionals: positive predisposition to approach and difficulties with notification / Violencia doméstica contra las mujeres y profesionales de la APS: predisposición al abordaje y dificultades con la notificación

Introdução: As notificações de casos de violência doméstica contra a mulher são essenciais para o dimensionamento epidemiológico dessa questão. As unidades de saúde brasileiras devem realizá-las, embora essas notificações compulsórias tenham sido repetidamente apontadas pela literatura da área da saúde como não efetivadas ou realizadas com muitas incompletudes. Objetivos: Contribuir para compreender as dificuldades subjetivas de notificar a violência doméstica contra a mulher por profissionais da atenção primária à saúde no Brasil. Métodos: Uma amostra intencional de 14 profissionais da atenção primária à saúde foi entrevistada; eles tinham diferentes formações educacionais e trabalhavam em uma cidade do interior do estado de São Paulo, Brasil. As transcrições das entrevistas semiestruturadas, com questões abertas, foram submetidas a uma análise de conteúdo. Resultados: A análise resultou em seis categorias temáticas: falta de conhecimento dos meios de notificação; serviços de saúde "apropriados" para notificar; boletim de ocorrência policial como principal instrumento de notificação; a notificação seria opcional; o papel da notificação para a prevenção; e a burocracia excessiva. Discussão: Levanta-se a hipótese de uma oposição entre uma disposição atitudinal positiva para atender as mulheres vítimas de violência e aprender como relatar essas situações e, por outro lado, a falta de preparação profissional para realizar as notificações; a oposição entre notificar e denunciar também é discutida, dada a ambiguidade dos termos utilizados na ficha de notificação e no próprio Código Penal brasileiro. Discute-se também se a violência contra a mulher é considerada pelos entrevistados como uma questão de atenção básica à saúde.

Introduction: Reports of cases of domestic violence against women are essential for the epidemiological dimensioning of this issue. Brazilian health units must carry them out, although these mandatory reporting have been repeatedly pointed out as not been made effective or done with many incompleteness. Objectives: To contribute to understand the subjective difficulties of reporting domestic violence against women by Brazilian primary health care professionals. Methods: A purposive sample of 14 primary health care professionals were interviewed; they had different educational backgrounds and worked in a countryside city of the state of São Paulo, Brazil. The transcripts of the semi-structured interviews, with open questions, underwent a content analysis. Results: The analysis resulted in six thematic categories: lack of knowledge of the means of notification; "appropriate" health services to notify; a police incident report as the main instrument of notification; notification would be optional; the role of notification for prevention and excessive bureaucracy. Discussion: The discussion raised the hypothesis of an opposition between an attitudinal readiness to serve women victims of violence and learn how to report these situations and, on the other hand, the lack of professional preparation to carry out the notifications; the opposition between to notify and to denunciate is also discussed, given the ambiguity of the terms used in the notification form and in the Brazilian Penal Code itself. Finally, it is discussed if violence against women is considered by the interviewees as a question for basic health care.

Introducción: Las notificaciones de casos de violencia doméstica contra las mujeres son esenciales para el dimensionamiento epidemiológico de este tema. Las unidades de salud brasileñas las deben llevar a cabo, aunque estos informes obligatorios se han señalado repetidamente en la literatura en el área de la salud como no efectivas o llevadas a cabo de forma incompleta. Objetivos: Contribuir a comprender las dificultades subjetivas de notificarse la violencia doméstica contra las mujeres por parte de los profesionales de atención primaria a la salud. Métodos: Se entrevistó a una muestra intencional de 14 profesionales de atención primaria a la salud; tenían diferentes formaciones educacionales y trabajaban en una ciudad del interior del estado de São Paulo, Brasil. Las transcripciones de las entrevistas semiestructuradas, con preguntas abiertas, se han sometido a un análisis de contenido. Resultados: El análisis resultó en seis categorías temáticas: falta de conocimiento de los medios de notificación; servicios de salud "adecuados" para notificar; un informe de incidente policial como principal instrumento de notificación; la notificación sería opcional; El papel de la notificación para la prevención y la burocracia excesiva. Discusión: La discusión planteó la hipótesis de una oposición entre una disposición actitudinal positiva para servir a las mujeres víctimas de la violencia y aprender cómo notificar estas situaciones y, por otro lado, la falta de preparación profesional para llevar a cabo las notificaciones; también se discute la oposición entre notificar y denunciar, dada la ambigüedad de los términos utilizados en la ficha de notificación y en el propio Código Penal brasileño. Finalmente, se discute si la violencia contra las mujeres es considerada por los entrevistados como un problema de la atención básica a la salud.

[Affection, proximity, frequency and hesitant clinical practice: basis of the "bond" between Down syndrome patients and primary health care?]. / Afeto, proximidade, frequência e uma clínica hesitante: bases do "vínculo" entre pacientes com síndrome de Down e a Atenção Primária à Saúde?

The national policy of comprehensive care in clinical genetics propounds that families and individuals with genetic disorders should receive ongoing assistance at primary health care (PHC) level. In this study, the social representation of professionals working in family health care units (FHCU) is investigated based on their "bond" with Down syndrome patients, bearing in mind that this expression currently contains relevant meanings in the clinical practice and service management routine. Sixteen practitioners were interviewed, and the sample was defined by theoretical saturation. The statements given by the participants expressed knowledge based mainly on affective skills, physical proximity and patients' frequency of attendance at the family health care unit (FHCU). Clinical skills of other kinds, especially cognitive skills, do not appear to justify the notion of "bond." The results indicate the need of continuous professional education and definition of guidelines and approaches in care to the most common syndromes in the context of primary health care (PHC).

[AIDS prevention in the period of sexual initiation: aspects of the symbolic dimension of the conduct of young men]. / Prevenção da AIDS no período de iniciação sexual: aspectos da dimensão simbólica das condutas de homens jovens.

To acquire an in-depth grasp of the non-consistent use of condoms, an attempt was made to characterize aspects of the symbolic meanings of sexual conduct in a group of young males. Interviews with forty-two subjects whose sexual initiation occurred in the late 1990s were qualitatively assessed by an analysis of statements interpreted under the theoretical perspectives of sexual scripts and male lifestyle and values. Participants emphasized the importance of blood testing and a biographical analysis of their partners (to generate 'trust') and tended to use personal criteria to assess the state of their partners' health. They established a dyadic typology of these relationships divided into "infrequent" and "steady" partners respectively, exercising two kinds of approaches to condom use, namely prevention of AIDS-STD and pregnancy on the one hand and only for pregnancy prevention on the other. The narratives seem to result, among other factors, from a biomedical approach to aspects of their sex lives and a desire for a stable and monogamous sexual-affective relationship. The important and recent changes in the intrapsychic and interpersonal sexual scripts do not seem to be currently accompanied by equally profound changes in cultural scripts or male lifestyle and values.

[Sampling in qualitative research: a proposal for procedures to detect theoretical saturation]. / Amostragem em pesquisas qualitativas: proposta de procedimentos para constatar saturação teórica.

A qualitative study's methodological transparency is considered a key factor for achieving its reliability and should be guaranteed by the researchers. Closing the sampling process by saturation is a common approach, but it is rarely made explicit in research reports. Qualitative researchers also commonly experience technical difficulties in objectively identifying saturation. This article proposes a method to organize sample closing by saturation, with a sequence of eight procedural steps for treating and analyzing data collected through open or semi-structured interviews or focus groups. The article aims to help researchers objectively explain how and when saturation occurred and to allow their readers to know how this process occurred.

Possíveis novos determinantes da qualidade de vida de pacientes com câncer de tireoide tratado: um estudo qualitativo / New possible determinants of the quality of life of patients with treated thyroid cancer: a qualitative study

Resumo Objetivou-se uma abordagem qualitativa de fatores que determinariam a qualidade de vida de pacientes com carcinoma papilífero de tireoide tratados. Foram feitas 16 entrevistas em profundidade com indivíduos de 18 a 45 anos sobre suas representações e experiências com esta enfermidade, seguidas por análise de conteúdo de enunciados. Os resultados contêm aspectos já previstos em questionários estruturados sobre qualidade de vida, mas outros estão parcialmente presumidos nesses questionários (manejo do conceito de etiologia da doença, a inserção “forçada” dos pacientes no universo conceitual médico, o medo do prognóstico e as mudanças “positivas” no estilo de vida). A interpretação desses resultados beneficiou-se de elaborações teóricas de desenvolvimento recente: as angústias sobre a experiência da doença parecem configurar-se, para os participantes, como um “risco moderno”, no contexto de uma “sociedade de riscos”. O desenvolvimento de questionários estruturados de qualidade de vida requer constantes estudos qualitativos que captem mudanças nos aspectos subjetivos do construto, dada a dinamicidade dos significados histórico-culturais e psicológicos do processo saúde-doença, constantemente influenciados por inovações tecnológicas e sucessivas interpretações epidemiológicas.

Abstract The aim of this study was to develop a qualitative approach of determinant factors of the quality of life of treated patients with papillary thyroid carcinoma. Sixteen in-depth interviews were conducted with individuals 18 to 45 years old regarding their disease representations and experiences, followed by statements content analysis. The results show issues already provided in structured questionnaires about quality of life, although others were only partially assumed in these surveys (management of the concept of disease etiology; the “forced” patient introduction into the medical conceptual universe; the fear of the prognosis and positive changes in lifestyle). The results interpretation were benefited from recently developed theoretical elaborations: the anxieties related to illness experience seem to be configured as a “modern risk”, in the context of a “risk society”. The development of structured questionnaires on quality of life requires frequent qualitative studies to capture changes in subjective aspects of the construct, given the dynamic changes of historical, cultural and psychological meanings of the health disease process, constantly influenced by technological innovations and continuing epidemiological interpretations.

Sexual health care of two generations of men: continuities and volatilities of scripts and habitus / Cuidados à saúde sexual de duas gerações de homens: permanências e volatilidades de roteiros e habitus

To acquire in-depth understanding of meanings attributed by young men to sexual health care, the similarities and asymmetries present in a corpus of 60 reports of men from two different generations were analyzed regarding this type of care. A process of in-depth hermeneutics was undertaken under the theoretical sociological perspectives of sexual scripts, male habitus and generation. Fifteen analytical categories were grouped together into the three dimensions of sexual scripts (intra-psychic, interpersonal and cultural). Some findings indicate the presence of provisions which were not enduring and have not been transposed to the next generation. However, striking cultural similarities or habitus around male sexuality were also found in the two different socio-historical contexts, allowing for an interpretation on the as yet inconstant use of condoms among the young.

Para aprofundar a compreensão sobre os sentidos atribuídos por homens jovens aos cuidados de saúde sexual, analisaram-se as similitudes e as assimetrias presentes em um corpus de 60 relatos de homens de duas diferentes gerações, em que estavam presentes enunciados sobre este tipo de cuidado. Empreendeu-se um processo de hermenêutica em profundidade, sob as perspectivas teóricas sociológicas dos roteiros sexuais, habitus e geração. As quinze categorias analíticas formuladas foram agrupadas nas três dimensões dos roteiros sexuais: intrapsíquica, interpessoal e cultural. Alguns achados apontam para disposições que não se demonstraram duráveis e que não foram transpostas para a geração seguinte. Porém, também foram constatadas marcantes similaridades culturais ou de habitus em torno da sexualidade masculina nos dois diferentes contextos sócio-históricos analisados, permitindo uma interpretação sobre o uso ainda inconstante do preservativo entre os jovens.

Os "daltônicos" e suas dificuldades: condição negligenciada no Brasil? / Colorblind individuals and their difficulties: a neglected condition in Brazil?

O termo "discromatopsia congênita" ("daltonismo") designa os defeitos de visão cromática, cuja taxa de prevalência entre homens é de 6% a 10%. Este estudo investigou as percepções de discromatópsicos quanto ao diagnóstico, suas dificuldades e mecanismos de enfrentamento do problema. Foi realizada pesquisa com metodologia clínica-qualitativa, na qual participaram 13 homens universitários, compondo uma amostra intencional, fechada por saturação teórica. Os dados foram coletados por meio de entrevistas individuais semiestruturadas. Os relatos foram gravados, transcritos e compuseram um corpus investigado pela técnica de análise de conteúdo categorial temática. Os participantes relataram dificuldades objetivas e subjetivas com materiais didáticos, práticas de ensino, interações com colegas e professores, já a partir do início da socialização secundária. Posteriormente, foram referidas, sobretudo, dificuldades relacionadas à decodificação de sinais de trânsito. Os participantes desenvolveram algumas habilidades de enfrentamento dessas dificuldades, mas aguardam ações a serem desencadeadas pelos poderes públicos, dirigidas ao atendimento das suas necessidades sociais, educacionais e trabalhistas...

The term congenital dyschromatopsia (colorblindness) refers to color vision genetic deficiency, whose prevalence rate is 6 to 10% among men. This study investigated the perceptions of subjects with congenital dyschromatopsia regarding diagnosis, their difficulties and coping mechanisms of the condition. This research was carried out using a clinical-qualitative methodology, in which 13 male university students took part, consisting of a purposeful sample concluded by theoretical saturation. Data were collected by conducting semi-structured individual interviews. Reports were recorded, transcribed and a corpus was made investigated by the technique of thematic categorical content. Participants reported objective and subjective difficulties with didactic material, teaching practice, interactions with colleagues and teachers, already from the beginning of their secondary socialization. Subsequently, difficulties in decoding traffic lights were mainly reported. Participants developed some coping skills to face these challenges, but await actions to be initiated by the Brazilian government to meet their social, education and labor needs...

Afeto, proximidade, frequência e uma clínica hesitante: bases do "vínculo" entre pacientes com síndrome de Down e a Atenção Primária à Saúde? / Affection, proximity, frequency and hesitant clinical practice: basis of the "bond" between Down syndrome patients and primary health care?

A Política Nacional de Atenção Integral em Genética Clínica preconiza que famílias e indivíduos com doenças genéticas sejam acompanhados na Atenção Primária à Saúde (APS). Neste trabalho investigamos as representações sociais de profissionais que trabalham em Unidades de Saúde de Família (USF) sobre o "vínculo" entre eles e os pacientes com síndrome de Down, considerando que esta expressão concentra atualmente significados relevantes no cotidiano clinico e gerencial dos serviços. Dezesseis profissionais foram entrevistados, tendo a amostra sido fechada por saturação teórica. Os enunciados proferidos pelos participantes expressaram saberes baseados sobretudo nas ideias de habilidades afetivas, de proximidade física e de frequência de comparecimento dos pacientes às USF. Habilidades clínicas de outras dimensões, notadamente as cognitivas, não parecem fundamentar a noção de "vínculo". Os resultados sugerem a necessidade de educação profissional continuada e de estabelecimento de diretrizes e linhas de cuidado para as síndromes genéticas mais comuns no âmbito da APS.

The national policy of comprehensive care in clinical genetics propounds that families and individuals with genetic disorders should receive ongoing assistance at primary health care (PHC) level. In this study, the social representation of professionals working in family health care units (FHCU) is investigated based on their "bond" with Down syndrome patients, bearing in mind that this expression currently contains relevant meanings in the clinical practice and service management routine. Sixteen practitioners were interviewed, and the sample was defined by theoretical saturation. The statements given by the participants expressed knowledge based mainly on affective skills, physical proximity and patients' frequency of attendance at the family health care unit (FHCU). Clinical skills of other kinds, especially cognitive skills, do not appear to justify the notion of "bond." The results indicate the need of continuous professional education and definition of guidelines and approaches in care to the most common syndromes in the context of primary health care (PHC).