Sobreviver nas ruas: percursos de resistência à negação do direito à saúde / Sobrevivir en las calles: resistencias a la negación del derecho a la salud / Surviving on the streets: paths of resistance to the denial of health rights

RESUMO. Contextos de exclusão conformam ciclos de marginalização de grupos populacionais, como a população em situação de rua (PSR). Nesse contexto violações de direitos humanos são recorrentes, em especial a dificuldade de acesso à saúde. A efetivação das políticas para a PSR nas cidades brasileiras ainda é escassa, por sua restrição a cidades de médio e grande porte e ao parco investimento público. Dessa forma, o estudo tem por objetivo investigar os percursos de cuidado à saúde da PSR em um município de pequeno porte. Foram realizadas observações de campo e entrevistas semiestruturadas para identificação e compreensão dos recursos acionados nas trajetórias de cuidado à saúde, que foram analisadas a partir da análise de conteúdo temática. Ressaltaram-se as diversas estratégias desenvolvidas pelo público diante da negação do direito à saúde e ao autocuidado. Destacam-se entre os resultados a precariedade de ofertas ao cuidado da saúde da mulher, a restrição do cuidado em saúde ao uso de substâncias psicoativas, de cunho medicalizante e centrado no paradigma da abstinência. Observou-se a importância da moradia para o cuidado integral, e das redes sociais e comunitárias como forma de restabelecimento da saúde nas ruas.

RESUMEN. Los contextos de exclusión conforman ciclos de marginación de grupos poblacionales, como la población en situación de calle (PSC). En este contexto, violaciones de derechos humanos son recurrentes, en especial la dificultad de acceso a la salud. La efectividad de las políticas para la PSC en las ciudades brasileñas sigue siendo escasa, por su restricción a ciudades de mediano y gran porte y a la poca inversión pública. Así, el estudio buscó investigar los recorridos de cuidado a la salud de la PSC en una ciudad de pequeño porte. Se realizaron observaciones de campo y entrevistas semiestructuradas para identificación y comprensión de los recursos accionados en las trayectorias de cuidado de la salud, que fueron analizadas a partir del análisis de contenido temático. Se resaltan las diversas estrategias desarrolladas por este público como forma de resistencia a la negación del derecho a la salud y autocuidado. Se destacan la precariedad de ofertas al cuidado de la salud de la mujer, la restricción del cuidado en salud al uso de sustancias psicoactivas, de cuño de medicalización y centrado en el paradigma de la abstinencia. Se observaron la importancia de la vivienda para el cuidado integral, y de las redes sociales y comunitarias como forma de restablecimiento de la salud en las calles.

ABSTRACT. Exclusion contexts constitute cycles of marginalization of population groups, such as the homeless people (HP). In this context, human rights violations are recurrent, especially related to the difficulty of access to health services. The effectiveness of the policies for HP in Brazilian cities is still scarce, due to its restriction to medium and large cities and the limited public investment. Thus, the study sought to investigate HP health care paths in a small city. Field observations and semi-structured interviews were carried out to identify and understand the resources used in health care trajectories, which were analyzed based on thematic content analysis. Several strategies developed by the public in the face of the denial to the health rights and self-care are highlighted. Among the results, the precariousness of offers to women's health care, the restriction of health care to the use of psychoactive substances, of medicalizing nature and centered on the abstinence paradigm were stood out. It was observed the importance of housing for comprehensive care, and social and community networks as a way of restoring health on the streets.

Bioethical analysis to the therapeutic use of Cannabis: Integrative review.

INTRODUCTION:: Despite being considered as a contravention under some countries' legislation, the therapeutic use of Cannabis sativa has been growing in Brazil, due to the promising results observed in many pathologies. Such a scenario has fostered the need to deepen discussions on the subject and possibly revise legislation governing the substance use and access. OBJECTIVES:: Identify the types of stigma related to the therapeutic use of Cannabis and describe the strategies people use to overcome stigma. METHODS:: This integrative review was carried out in the databases PubMed, Scopus, CINAHL, MEDLINE, PsycINFO, Web of Science, and Cochrane Library, with 565 articles being retrieved. Triads' cross-check were done, first maintaining the "cannabis" and "therapeutic use" pair, added by "stigma," "bioethics," "ethics," "social consequences," and "legal consequences." The final selection resulted in six articles. ETHICAL CONSIDERATION:: However, the ethical issues that pervade and regulate decisions on this subject must be considered. RESULTS:: Different dimensions and types of stigma related to the therapeutic use of Cannabis have been identified. The bioethical principle of autonomy was an expression of citizenship and human rights, mitigating internal conflicts related to self-stigma and the effects of external stigma on the person's life. CONCLUSION:: It was possible to identify the types of stigma related to the therapeutic use of Cannabis is an internal dimension represented (self-stigma) and an external dimension, represented (social and structural stigmas) and to identify strategies adopted to face this stigma: skills training group for users, elaboration of laws and specific programs to clarify the therapeutic use of Cannabis with a greater social scope, and support for family members. Thus, contributing to the building of people's autonomy in a broader context of decision-making autonomy and executive autonomy will provide the development of people's capacity to perform complex tasks of self-management and, consequently, to continue promoting and preserving their decision-making process and their capacity to plan and perform tasks associated with managing their lives and their treatments.

Promoting the Human Rights of Children With Neurologic Conditions.

Children with neurologic conditions benefit from international conventions, and national treaties, policies and regulations that safeguard their human rights. These regulations also exist to serve as guidance in the creation of comprehensive systems of care, inclusive environments, accessible societies and communities that allow these children to thrive and to achieve the best of their capacities. This narrative review of issues related to human rights and advocacy in pediatric neurologic disabilities will provide an overview of the human rights conventions that relate to children with disabilities, and the most current approaches implicating health care providers in rights promotion for these individuals and their families. We also suggest venues for professionals to advocate for their patients, and suggest strategies to consider rights-based approaches as a mean to provide holistic care in a social neurology framework.

"An Environment Built to Include Rather than Exclude Me": Creating Inclusive Environments for Human Well-Being.

Contemporary discourses which challenge the notion of health as the "absence of disease" are prompting changes in health policy and practice. People with disability have been influential in progressing our understanding of the impact of contextual factors in individual and population health, highlighting the impact of environmental factors on functioning and inclusion. The World Health Organization's (WHO) more holistic definition of health as "wellbeing" is now applied in frameworks and legislation, and has long been understood in occupational therapy theory. In practice, however, occupational therapists and other professionals often address only local and individual environmental factors to promote wellbeing, within systems and societies that limit equity in population health and restrict inclusion in communities. This paper presents an in-depth analysis of the supports and accommodations identified by a cohort of individuals (n-100) living with disability. A range of environmental facilitators and barriers were identified in peoples' experience of "inclusive community environs" and found to influence inclusion and wellbeing. The roles and responsibilities of individuals, professionals, and society to enact change in environments are discussed in light of these findings. Recommendations include a focus on the subjective experience of environments, and application of theory from human rights and inclusive economics to address the multiple dimensions and levels of environments in working towards inclusion and wellbeing.

Gut check: reappraisal of disgust helps explain liberal-conservative differences on issues of purity.

Disgust plays an important role in conservatives' moral and political judgments, helping to explain why conservatives and liberals differ in their attitudes on issues related to purity. We examined the extent to which the emotion-regulation strategy reappraisal drives the disgust-conservatism relationship. We hypothesized that disgust has less influence on the political and moral judgments of liberals because they tend to regulate disgust reactions through emotional reappraisal more than conservatives. Study 1a found that a greater tendency to reappraise disgust was negatively associated with conservatism, independent of disgust sensitivity. Study 1b replicated this finding, demonstrating that the effect of reappraisal is unique to disgust. In Study 2, liberals condemned a disgusting act less than conservatives, and did so to the extent that they reappraised their initial disgust response. Study 3 manipulated participants' use of reappraisal when exposed to a video of men kissing. Conservatives instructed to reappraise their emotional reactions subsequently expressed more support for same-sex marriage than conservatives in the control condition, demonstrating attitudes statistically equivalent to liberal participants.