Percepções de familiares sobre uma rede de cuidados de saúde mental infantojuvenil / Family perceptions about a children's mental health network / Percepciones familiares sobre una red de atención de salud mental infantojuvenil

Este artigo pretende conhecer como a rede de cuidados em saúde tem se operacionalizado a partir da percepção de familiares de crianças com demanda de cuidado em saúde mental (SM). Foram realizados dois grupos focais, um com familiares da Atenção Básica (AB) e outro com familiares do Centro de Atenção Psicossocial Infantojuvenil (CAPSij), totalizando 15 participantes. Seguiu-se com a análise lexical do tipo classificação hierárquica descendente, com o auxílio do software R Interface, a fim de análises multidimensionais de textos e questionários (IRaMuTeQ), resultando em cinco classes: A Pílula Mágica; Forças e Fraquezas dos serviços; Procurando por ajuda; Aceitando o diagnóstico da criança e Onde procurei ajuda. Os resultados apontam para dificuldades presentes na AB em identificar e manejar situações de Saúde Mental Infantojuvenil (SMIJ), por meio de uma lógica ainda medicalizante. Ressalta-se que a escola é apresentada como lugar de destaque na produção da demanda por cuidado e a família ainda é pouco convocada à construção das ações. Conclui-se, então, que avanços ainda são necessários para operacionalização de um cuidado pautado nas diretrizes da política de SMIJ.(AU)

This article aims to know how the healthcare network has been operationalized from the perception of family members of children with demand for mental health care (MH). Two focus groups were held, one with family members from Primary Care (PC) and the other with family members from the Child Psychosocial Care Center (CAPSij), totaling 15 participants. A lexical analysis of the descending hierarchical classification type was performed with the help of the software R Interface for multidimensional analyzes of texts and questionnaires (IRAMUTEQ), resulting in five classes: The Magic Pill; Strengths and Weaknesses of services; Looking for help; Accepting the child's diagnosis; and Where did I look for help. The results point to difficulties present in PC in identifying and managing situations of mental health in children and adolescents (MHCA), with a medicalization logic. Note that the school is presented as a prominent place in producing the demand for care, and the family is still not very much involved in the actions. It is, thus, concluded that advances are still needed for operationalization of care guided by MHCA policy guidelines.(AU)

Este artículo tuvo por objetivo conocer cómo opera una red asistencial a partir de la percepción de familiares de niños con demanda de atención en salud mental (SM). Se realizaron dos grupos focales, uno con familiares de Atención Primaria (AP) y otro con familiares del Centro de Atención Psicosocial Infantojuvenil (CAPSij), totalizando 15 participantes. Se realizó análisis léxico del tipo clasificación jerárquica descendente con la ayuda del software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRAMUTEQ), lo que resultó en cinco clases: "La píldora mágica"; "Fortalezas y debilidades de los servicios"; "En busca de ayuda"; "Aceptar el diagnóstico del niño" y "¿Dónde busqué ayuda?". Los resultados apuntan las dificultades presentes en AP para identificar y manejar situaciones de salud mental infantojuvenil (SMIJ) mediante una lógica aún medicalizante. La escuela tiene un lugar destacado en la producción de la demanda de cuidados y la familia aún no está muy involucrada en la construcción de acciones. Se concluye que se necesitan avances para ofertar una atención guiada por lineamientos de la política del SMIJ.(AU)

Stress response asymmetries in African American emerging adults exposed to chronic social adversity.

Chronic stress is linked to social adversity and underlies many health disparities among ethnic minorities. Cortisol and salivary alpha-amylase (sAA) reflect sensitivity to adversity and are related to health outcomes. Our aim was to understand how social adversity influences biological responses to experimental and daily stressors in a sample of low-income African American emerging adults. In the three-week study, participants completed questionnaires, the Trier Social Stress Task (TSST), and provided four salivary samples. In week 2, participants collected saliva at home immediately after waking and just before bed for three days. Results demonstrated an asymmetrical pattern between cortisol and sAA reactivity that was related to experiences with racism and interpersonal trauma. Further, daily stress was related to lower morning and higher nighttime cortisol, indicating atypical diurnal rhythm. These findings are consistent with other forms of social adversity that lead to long-term changes in the HPA axis response pattern.LAY SUMMARYAfrican American emerging adults showed divergent cortisol and sAA responses.Social adversity predicted an asymmetrical response pattern for sAA and cortisol.Atypical diurnal rhythms were found for participants reporting high daily stress.

Aspects of protection and social vulnerability of teenagers in public all-day schools.

OBJECTIVE: identify and analyze aspects related to social vulnerability of a group of teenagers of a public all-day school with regard to harmful and abusive use of psychoactive drugs. METHODS: a strategic social study, with a qualitative approach, was carried out with 49 teenagers of a public all-day secondary school. Focus groups were carried out between 2016 and 2017, and the resulting material was transcribed and analyzed by means of thematic content analysis, resulting in the following categories: The family I come from; Birds of a feather; If I'm studying, how can I work?; Drugs: a non-parallel universe. RESULTS: social vulnerability was associated with unequal income distribution, fragile social relations affected by the harmful use of drugs and vulnerability of public all-day schools. Final considerations: all-day schools did not appear as an effective tool to break away with the context of social vulnerability regarding the use of drugs.

Scars of disengagement: perspectives on community leadership and youth engagement in rural South Africa.

Given the emerging global youth disengagement epidemic, anticipated population growth, and the threat of continued rural-urban migration among young adults, recent research has focused on community leadership practice and the factors that influence youth engagement at the local level. Studying these practices and factors can elicit interventions that can improve youth engagement and youth health. This study engaged South African rural community leaders in interviews to collect perceptions and experiences on community leadership and factors that influence youth engagement and their health behaviors. Content analysis was used to analyze the data. Emergent themes are categorized into four domains: conceptualizations of leadership, current youth behaviors, barriers to youth engagement, and youth leadership opportunities and potential solutions. Findings demonstrate a clear grasp of the concept of community leadership among community leaders, and an awareness of the complex interplay of social, economic and environmental factors on youth disengagement and the potential interventions to promote more youth participation.

Income distribution and health: can polarization explain health outcomes better than inequality?

Utilizing data from the China Health and Nutrition Survey (CHNS) from 1991 to 2011, we aim to analyze the effects of income distribution on two risks for chronic diseases: body mass index (BMI) and blood pressure. Unlike the previous studies, we consider two different kinds of indicators of income distribution: inequality and polarization. Different from relative inequality indicators such as the Gini index, which measure income gaps only, the recently developed polarization indicator captures group clustering and social alienation, in addition to income gaps. Our empirical results demonstrate that both BMI and blood pressure are positively correlated with income polarization, while inequality is a weaker predictor of these health outcomes. Thus, polarization, rather than inequality, should be used when analyzing the relationship between health outcomes and income distribution. We also examine the polarization-to-health transmission mechanism using mediation and moderation analytic frameworks. The results suggest that social networks mediate the effect of polarization on BMI and neutralize the effect on blood pressure.

Alienação do trabalho médico: tensões sobre o modelo biomédico e o gerencialismo na atenção primária / Alienation of the medical work: tensions about the biomedical model and the managerialism in primary health care / Alienación del trabajo médico: tensiones sobre el modelo biomédico y el directivismo en la atención primaria

Resumo Com base na observação de que a perda de autonomia ante o mercado de capital e o gerencialismo contribuiu para o surgimento da alienação no trabalho médico no Sistema Único de Saúde, procuramos analisar como se dá esse fenômeno na atenção primária à saúde. Em 2015 e 2016, entrevistamos e observamos o trabalho de 15 médicos do município de Campinas (São Paulo), refletindo a respeito de autonomia profissional, clínica e gestão sobre o trabalho médico. A análise se deu por meio da construção de narrativas por núcleos temáticos, segundo referencial teórico marxista e os principais estudos acerca da profissão médica no Brasil. A partir de semelhanças nos discursos, forma de atuação e grau de alienação, dividimos os médicos em quatro modalidades: militante, sacerdote, missionário e tecnoburocrata. Concluímos que algumas dinâmicas aprofundam a alienação: o afastamento do planejamento; a fragmentação do cuidado; a predominância do modelo biomédico. Por sua vez, algumas características da atenção primária se relacionam a menor grau de alienação: a prática ampliada no território e menos focada em ações programáticas; a constituição em equipes; o diálogo e o compartilhamento de saberes; a maior participação dos usuários no próprio cuidado e no serviço de saúde.

Abstract Based on the observation that the loss of autonomy in the capital market and managerialism have contributed to the emergence of alienation in the medical work of the Brazilian Unified Health System, we tried to analyze how this phenomenon occurs in primary health care. In 2015 and 2016, we interviewed and observed the work of 15 physicians in the municipality of Campinas (in the state of São Paulo, Brazil), reflecting upon the professional and clinical autonomy, and the management of the medical work. The analysis was made by constructig narratives by groups of topics, following a Marxist theoretical framework and the main studies regarding the medical profession in Brazil. Taking the similarities in the discourses, ways of working and degree of alienation, we divided the physicians into four groups: activist, priest, missionary and technobureaucrat. We concluded that some dynamics intensify the alienation: the estrangement from planning; the fragmentation of care; and the prevalence of the biomedical model. In turn, some features of primary health care are related to a lower degree of alienation: the practice expanded on the territory and less focused on programmatical actions; the constitution on teams; the dialogue and the sharing of knowledge; a greater participation of the individuals in the care itself and in the health service.

Resumen Con base en la observación que la pérdida de autonomía ante el mercado de capital y el directivismo contribuyó para el surgimiento de la alienación en el trabajo médico en el Sistema Único de Salud Brasileño, buscamos analizar cómo se da este fenómeno en la atención primaria de la salud. En el 2015 y 2016, entrevistamos y observamos el trabajo de 15 médicos del municipio de Campinas (São Paulo), reflexionando al respecto de la autonomía profesional, clínica y la gestión sobre el trabajo médico. El análisis se realizó a través de la construcción de relatos por núcleos temáticos, con base en la referencia teórica marxista y los principales estudios acerca de la profesión médica en Brasil. A partir de semejanzas en los discursos, forma de trabajo y grado de alienación, dividimos a los médicos en cuatro modalidades: militante, sacerdote, misionario y tecnoburócrata. Concluimos que algunas dinámicas profundizan la alienación: el alejamiento de la planificación; la fragmentación del cuidado; el predominio del modelo biomédico. Por su parte, algunas características de la atención primaria se relacionan un menor grado de alienación: la práctica ampliada en el territorio y menos enfocada en acciones programáticas; la conformación de equipos; el diálogo y el intercambio de conocimientos; la mayor participación de los usuarios en el propio cuidado y en el servicio de salud.sigualdad.

Young people's power of action in a peripheral community: confrontations and challenges. / Potência de ação da juventude em uma comunidade periférica: enfrentamentos e desafios.

This article, based on doctoral research, aims to understand and draw attention to forms of social participation by young people living in a peripheral community on the coast of São Paulo State. It also examines the manners of health production encountered by the subjects themselves, to reveal how young people have approached this in a context of marked inequality. The young study participants were involved in the activities of an NGO and a hip hop group, where the researcher was placed. The results were constructed on the basis of observations recorded in field diaries and semi-structured interviews, and analysed using the Depth Hermeneutics methodology. They indicate that building community ties expresses the participation of young people and contributes to tackling inequalities and social exclusion. Participation in groups has proven potent and able to shape processes of autonomy, self-care and care for others. However, they appear as isolated initiatives by other institutions. It is also challenging to think of ways of understanding young people's participation, participating together with them in their lives in their contexts, making for horizontal relationships and surmounting the ideas of homogenisation, control and tutelage of this population.

O artigo baseia-se em uma pesquisa de doutoramento e tem como objetivo compreender e dar visibilidade a formas de participação social de jovens moradores de uma comunidade periférica localizada no litoral de São Paulo. Intenta também pensar a produção de saúde, encontrada pelos próprios sujeitos, buscando revelar como os jovens em contexto marcado pela desigualdade têm a enfrentado. Os participantes do estudo estavam envolvidos nas atividades de uma ONG e de um grupo de hip hop, onde se deu a inserção do pesquisador. Os resultados foram construídos, com base nas observações registradas em diários de campo e entrevistas semiestruturadas, e analisados segundo a metodologia da Hermenêutica de Profundidade. Apontam que a construção de vínculos comunitários expressa a participação dos jovens e contribuem no enfrentamento das desigualdades e exclusão. A participação nos grupos tem se mostrado potente e capaz de configurar processos de autonomia, cuidado de si e do outro. Entretanto, mostram-se como iniciativas isoladas de outras instituições. Consiste ainda um desafio pensarmos em formas de compreender a participação dos jovens, participando junto com ele de suas vidas em seus contextos, tornando horizontais as relações e superando a ideia de homogeneização, controle e tutela dessa população.

Risk of Exclusion in People with Disabilities in Spain: Determinants of Health and Poverty.

In this paper, we analyze data from the 2012 Encuesta de Integración Social y Salud (Social Integration and Health Survey) of the Instituto Nacional de Estadística (Spanish National Institute of Statistics) to obtain profiles created by combining disability, poverty and social exclusion. We hypothesize that the probability that people will experience social exclusion increases if they have a disability, chronic illness or limitation in conducting everyday activities, and that this probability is greater for women than for men. To conduct our analysis, we constructed a social exclusion model based on a series of social determinants that acts as a dependent variable. In this context, social exclusion is understood to go beyond the concept of financial poverty. We performed bivariate analyses, in which we calculated the Odds Ratios (OR) for certain variables considered to be predictors of social exclusion. We also performed a means comparison test and an ANOVA test to observe differences between individuals with recognized disability and those without. Finally, we conducted logistic regression analysis to determine which vulnerability profiles are most likely to experience a situation of social exclusion. We also discuss the limitations of our study, and suggest areas in, which the relationships between health, social exclusion and disability can be further investigated.

Potência de ação da juventude em uma comunidade periférica: enfrentamentos e desafios / Young people's power of action in a peripheral community: confrontations and challenges

Resumo O artigo baseia-se em uma pesquisa de doutoramento e tem como objetivo compreender e dar visibilidade a formas de participação social de jovens moradores de uma comunidade periférica localizada no litoral de São Paulo. Intenta também pensar a produção de saúde, encontrada pelos próprios sujeitos, buscando revelar como os jovens em contexto marcado pela desigualdade têm a enfrentado. Os participantes do estudo estavam envolvidos nas atividades de uma ONG e de um grupo de hip hop, onde se deu a inserção do pesquisador. Os resultados foram construídos, com base nas observações registradas em diários de campo e entrevistas semiestruturadas, e analisados segundo a metodologia da Hermenêutica de Profundidade. Apontam que a construção de vínculos comunitários expressa a participação dos jovens e contribuem no enfrentamento das desigualdades e exclusão. A participação nos grupos tem se mostrado potente e capaz de configurar processos de autonomia, cuidado de si e do outro. Entretanto, mostram-se como iniciativas isoladas de outras instituições. Consiste ainda um desafio pensarmos em formas de compreender a participação dos jovens, participando junto com ele de suas vidas em seus contextos, tornando horizontais as relações e superando a ideia de homogeneização, controle e tutela dessa população.

Abstract This article, based on doctoral research, aims to understand and draw attention to forms of social participation by young people living in a peripheral community on the coast of São Paulo State. It also examines the manners of health production encountered by the subjects themselves, to reveal how young people have approached this in a context of marked inequality. The young study participants were involved in the activities of an NGO and a hip hop group, where the researcher was placed. The results were constructed on the basis of observations recorded in field diaries and semi-structured interviews, and analysed using the Depth Hermeneutics methodology. They indicate that building community ties expresses the participation of young people and contributes to tackling inequalities and social exclusion. Participation in groups has proven potent and able to shape processes of autonomy, self-care and care for others. However, they appear as isolated initiatives by other institutions. It is also challenging to think of ways of understanding young people's participation, participating together with them in their lives in their contexts, making for horizontal relationships and surmounting the ideas of homogenisation, control and tutelage of this population.

[Implementation of a health promotion programme for women in social exclusion in the city of Seville (Spain)]. / Implantación de un programa de promoción de la salud de las mujeres en zonas de exclusión social de la ciudad de Sevilla.

Health promotion can contribute towards reducing inequality and ensuring equal opportunities, providing the means to enable the entire population to develop its maximum health possibilities. Women living in areas with social transformation needs (ASTN) are an especially vulnerable group due to the situation of material deprivation and social exclusion in which they live. Health promotion programmes for this group can bring about an improvement in their health. This paper describes the health promotion programme Socio-educational Groups of Primary Care for Women (SEGPC-W), and evaluates its implementation in ASTN in the city of Seville (Spain), as well as the benefits and difficulties of its development through a documentary analysis and interviews with participating professionals.

[Migration, risks and opportunities]. / Migration : risques et opportunités.

The migration is considered for a long time as a risk for mental health, to which are exposed both migrants and their descendants. Indeed, the risk of developing schizophrenia, particularly, is multiplied by 2 to 3. Today, it is offending in the 'jihadist' terrorism that bruises in countries of immigration, including France. In fact, the majority of the perpetrators of deadly attacks come from the immigrant minority. We will show that the main common factor to both phenomenons is not migration but the social exclusion which is, unfortunately often linked to it. We will also show that this exclusion is as much the fact of the host society which advocates the cultural assimilation of immigrants as that of the migrant community, trapped by its cultural defector status and its conflict of loyalty. We conclude that migration is above all an opportunity for mutual enrichment if you advocate the integration, therefore, interculturality, that is an exchange reciprocal customs and values.

Lived experiences of Jordanian mothers caring for a child with disability.

PURPOSE: Caring for a child with a disability in the family is associated with a major increase in care-giving demands and burden. This qualitative study explores the perspectives, challenges and adaptations of Jordanian mothers living with a child with disability. METHODS: Phenomenological qualitative tradition was utilized. Seven Jordanian mothers of children with disability were purposefully selected as having rich experiences for caring for a child with a disability. In-depth interviews were conducted using a semi-structured guide, audio-taped and transcribed verbatim. Interpretive phenomenological analysis was used to extract main themes and subthemes. RESULTS: Mothers' experiences were reflected into four main themes: (1) increased perceived stigma, (2) fear for the future, (3) increased perceived care-giving burden and (4) adaptations to the child's disability. CONCLUSIONS: This study highlights key gaps in the provision of family-centered services for this population as well as multiple sociocultural issues impacting participation and quality of life. Healthcare professionals must deal with the child's disability from a family-centered and cultural perspective. Implications for rehabilitation When therapists meet the whole family's needs through a family-centered approach, the child with disability is less likely to be ignored, maltreated or abused. Family-centered practice adopts a sociocultural model which looks at the child from a wider point of view rather than just the disability itself. It requires therapists to review the context in which the child lives and address the specific needs of parents, siblings and other involved family members. Culture plays a huge role in shaping the family's perspective on disability and has a huge impact and implications for service delivery and development, quality of life and participation for children with disability and their families. Rehabilitation professionals must accommodate their time schedules to provide families with the communication, education, advocacy and consultations needed.

A qualitative analysis of low income smokers' responses to tobacco excise tax increases.

BACKGROUND: While increasing the excise tax applied to tobacco products reduces consumption and smoking prevalence, it may also cause hardship among smokers who do not quit. We explored how smokers living on a low income respond to increasing tobacco excise taxes. METHODS: Using a social justice perspective, we explored the increasing costs of tobacco with a sample of 27 adult smokers who live below the poverty line (i.e., with an income less than 60% of the median New Zealand income). Face-to-face interviews were conducted in Dunedin, New Zealand, a city with marked income differences, and were undertaken shortly after a further tobacco excise tax increase. The interview guide explored participants' smoking practices, their perceptions of excise tax as a strategy to reduce smoking prevalence, and the strategies they used to manage their tobacco needs. RESULTS: We identified three key themes: depriving the poor; tobacco as a precious commodity, and desperation. While many participants described smoking as a pleasure or coping mechanism, they also saw it as a burden that they struggled to manage. Despite trying to quit, most had failed to become smokefree and felt victimised by a punitive policy system that coerced change without supporting it. They managed financial pressure by reducing their tobacco consumption but also used increasingly desperate measures, including recycling waste tobacco; participants reported feeling demeaned by measures they saw as their only option. CONCLUSION: Providing intensive cessation support for lower income smokers could avoid further alienating a group already experiencing considerable disadvantage.

Documenting the Effects of Armed Conflict on Population Health.

War and other forms of armed conflict have profound adverse effects on population health. It is important to document these effects to inform the general public and policy makers about the consequences of armed conflict, provide services to meet the needs of affected populations, protect human rights and document violations of international humanitarian law, and help to prevent future armed conflict. Documentation can be accomplished with surveillance, epidemiological surveys, and rapid assessment. Challenges include inadequate or absent data systems, social breakdown, forced migration, reporting biases, and the fog of war. The adverse effects of the Iraq War on population health demonstrate how the effects of armed conflict on population health can be documented. We recommend the establishment of an independent mechanism, operated by the United Nations or a multilateral organization, to investigate and document the effects of armed conflict on population health.

Factors That Promote and Impede the Academic Success of African American Students in Prelicensure Nursing Education: An Integrative Review.

BACKGROUND: The aim of this review is to identify factors that impact the academic success of African American nursing students in prelicensure nursing education programs, given the need for RN health care workers to be more reflective of the general U.S. METHOD: A literature review was conducted to integrate the findings of the research related to African American nursing students in entry-level nursing programs to identify perceived barriers and supports to their retention and graduation. RESULTS: The review revealed alienation, isolation, and being different as barriers to success. Academic support, mentoring, and integration and inclusivity were factors that helped promote success. CONCLUSION: Recommendations for the establishment of diversity and inclusivity plans, structured enrichment and academic support services, mentorship, and activities that fostered student engagement and integration were actions that could contribute to the academic success of African American nursing students.

Do relatório ao relato, da alienação ao sujeito: a experiência de uma prática clínica com refugiados em uma instituição de saúde / From story to narrative, from alienation to subject: clinic with asylum seekers / Du récit à la parole, de l'aliénation au sujet: clinique en institution avec des demandeurs d'asile / Del relato a la palabra, de la alienación a lo sujeto: la experiencia de una práctica clínica con los refugiados en una institución de salud

Neste artigo, buscaremos evidenciar a especificidade e os limites de uma consulta transcultural no Serviço de Psiquiatria do Hospital Avicenne (França) com sujeitos requerentes de refúgio, originários principalmente da África e Ásia do Sul, atendidos por distúrbios psicotraumáticos. Tratar-se-á de tentar mostrar que uma abordagem clínica, que leve em conta o contexto sociopolítico e a situação jurídica desses pacientes "migrantes", irá possibilitar a emergência da palavra do sujeito. A partir da construção de dois fragmentos de caso, mostraremos como as representações político-sociais acerca do "migrante", "refugiado", "vítima", "suspeito", deixam suas marcas concretas e simbólicas nos sujeitos bem como influenciam os modos de condução do trabalho clínico. Isso nos permitirá, em um segundo momento, questionar a noção de alienação. Por fim, iremos lançar uma proposição clínica que tem a finalidade de esvaziar o espaço da consulta em psicoterapia das amarras impostas pelas representações sociais que calam o sujeito...

In this article, we will aim to highlight the specificity and limits of a transcultural consultation in the Psychiatry Service of the Avicenne Hospital (France) with asylum seekers from Africa and South Asia affected by traumatic experiences that resulted in psychological disturbances. We will try to show that a clinical approach that takes into account the social and political context and the legal status of these "migrant" patients will allow the emergence of the word of the subject. Based on the construction of two case fragments, we will demonstrate how the political and social representations concerning the "migrant", "refugee", "victim", "suspect" leave their concrete and symbolic marks in the subject as well as influence the way the therapy is carried out. This will allow us, in a second step, to question the notion of alienation. Lastly, we will make a clinical proposition that aims to empty the clinical space from the constraints imposed by social representations that silence the subject...

Cet article interroge les spécificités et les limites de la consultation de psycho-traumatologie du service de psychiatrie de l'hôpital Avicenne avec des demandeurs d'asile originaires principalement d'Asie du Sud et d'Afrique. Seul un abordage clinique qui prend en compte la particularité du contexte socio-politique et de la situation juridique des patients peut permettre au sujet de faire entendre sa parole. A partir de deux cas cliniques, nous montrerons comment les représentations qui entourent le sujet, successivement catégorisé comme migrant, réfugiés, victime ou suspect, ont un impact concret et symbolique sur le patient et sur la dynamique clinique. A partir de ce constat, nous interrogerons la notion d'aliénation. Dans un troisième temps, nous ferons des propositions cliniques afin de dégager l'espace clinique des impositions aliénantes qui imposent le silence au sujet...

En este artículo, se destaca la especificidad y los límites de un servicio de consulta de psiquiatría transcultural en el Servicio de Psiquiatría del Hospital Avicena (Francia) con los solicitantes de refugio, originarios principalmente de África y Asia del Sur, y que buscan atención psicológica por presentaren trastornos psicotraumáticos. Se trata de demostrar que un enfoque clínico que tiene en cuenta el contexto socio-político y la situación jurídica de los pacientes 'migrantes' permitirá la reaparición de la palabra al sujeto. Desde la construcción de dos fragmentos clínicos, tratamos de mostrar cómo las representaciones políticas y sociales del "migrante", "refugiado", "víctima", "sospechoso" dejan sus marcas concretas y simbólicas en los sujetos así como influyen en nuestra forma de conducir el trabajo clínico. Esto nos permitirá, en un segundo momento, cuestionar la noción de alienación. Por último, vamos a lanzar una proposición clínica que tiene como objetivo eliminar de la consulta en psicoterapia las limitaciones impuestas por las representaciones sociales que callan a los hombres...

Reconciling reintegration: the complexity of economic and social reintegration of ex-combatants in Burundi.

The extent to which disarmament, demobilisation and reintegration (DDR) programmes initiated by state or multilateral agencies can realise the reintegration of ex-combatants remains debated. While some consider that DDR should have the ambition to result in long-term reintegration, others argue that DDR should focus on short-term goals. This paper explores experiences with the reintegration of ex-combatants in Burundi. It shows the interconnectedness of economic and social reintegration processes, and demonstrates that the reintegration of ex-combatants cannot be seen in isolation from the wider recovery and development context in which DDR is taking place. Moreover, the case demonstrates that reconciliation and social reintegration are deeply interconnected, to the extent that social reintegration may fail if reconciliation is not taken into account. Rather than a debate between long- and short-term goals, the focus should therefore be on increasing the understanding of reintegration processes and finding ways in which programmes can contribute to those.

The effect of parent and peer attachment on suicidality: the mediation effect of self-control and anomie.

We explore the influence of psycho-social factors including the attachment to parent and peer, self-control, and anomie on suicidality. Research questionnaires were distributed among 336 students of Shahid Chamran University of Ahvaz in Iran. The results demonstrated that mother and peer attachments had an indirect effect on suicidality via self-control and anomie, and self-control had a direct effect on suicidality and an indirect effect via anomie. Self-control and anomie had the most efficient role in the model with a large effect size. Findings are discussed theoretically and with regards to the socio-cultural sphere of Iranian society.

Medos e expectativas de usuários de drogas em situação de rua / Drug users homeless fears and expectations / Temores y expectativas de los usuarios de drogas en las calles

Para as pessoas em situação de rua, drogas psicoativas surgem como adicionais à vulnerabilidade social. Foram coligidos sete relatos de um documentário sobre a vida de pessoas em situação de rua, cujo objetivo foi identificar os medos e expectativas de pessoas em situação de rua que fazem uso abusivo de drogas em uma cidade do Triângulo Mineiro. Os dados foram analisados a partir da técnica do Discurso do Sujeito Coletivo. O principal medo é perder o contato com a família e a principal expectativa é a de sair daquelas condições de vida com auxílio do CR. Ressalta-se a importância de conhecer as demandas (incluindo medos e expectativas) dessa população para melhor implementar ações interdisciplinares de saúde.

For people on the streets, psychoactive drugs emerge in addition to social vulnerability. Thus, seven reports were collected in a documentary about the lives of people on the streets who abuse drugs in a city of the Triângulo Mineiro region (Brazil), aimed at identifying their main fears and expectations. Data were analyzed using the technique of the Collective Subject Discourse. The main fear is losing touch with family and the main expectation was that one day they would be able to "leave this life" (homeless and drugs) with the help of the CR. It is highlighted the importance to know this population's demands in order to better implement multidisciplinary actions in healthcare.

Para la gente en la calle las drogas aumentan la vulnerabilidad social. Así, siete informes fueron recogidos en un documental sobre la vida de la gente en las calles con el objetivo de identificar sus principales temores y expectativas de la gente en las calles que abusan de las drogas en una ciudad de la región del Triángulo Minero (Brasil). Los datos se analizaron mediante la técnica del Discurso del Sujeto Colectivo. El principal temor es perder el contacto con la familia y la expectativa principal es que algún día podrían dejar "esta vida" (calle y drogas). La importancia de este estudio es conocer las demandas (incluyendo los temores y expectativas) de esta población para aplicar mejor las acciones de salud.

Aging out: a qualitative exploration of ageism and heterosexism among aging African American lesbians and gay men.

African Americans elders, like their non-African American counterparts, are not a homogeneous group; however an early characteristic placed on all African Americans is in their shared history in the United States. As members of multiple minority groups, older lesbian, gay, bisexual, and transgender (LGBT) people of African descent have survived racism, heterosexism, homophobia, and now ageism. This article describes a qualitative study grounded in Black feminist and minority stress theories that explored the issues of perceived social discrimination and alienation of 15 older African American lesbians and gay males whose lived experiences were captured using in-depth, face-to-face interviews. Several themes were identified in the study, including (a) Sense of Alienation in the African American Community, (b) Deliberate Concealment of Sexual Identity and Orientation, (c) Aversion to LGBT Labels, (d) Perceived Discrimination and Alienation From Organized Religion, (e) Feelings of Grief and Loss Related to Aging, (f) Isolation, and (g) Fear of Financial and Physical Dependence. The implication of the findings suggests that the ethos and needs of older African American lesbian women and gay men need to be addressed to eliminate potential barriers to successful aging for this cohort.