Navigating healthcare systems: A qualitative study on socially marginalised patients' experiences of hospital transition and support by social nurses.

BACKGROUND: Socially marginalised patients face many challenges related to their health condition and often have several contacts with healthcare and social service workers. The Danish social nursing initiative, whose nurses have experience and knowledge about marginalisation, aims to support socially marginalised patients during hospital admission and through hospital transitions. However, there is limited knowledge about the hospital transitions of patients being supported by a social nurse. OBJECTIVES: The objectives of this study were to explore (1) the perspectives of socially marginalised patients on the transition from hospital to home and (2) how these patients experience the importance of social nursing on patient trajectories after hospital discharge. METHODS: A qualitative study with a phenomenological and hermeneutic approach was performed at a large hospital in southern Denmark. Adult patients who had contact with a social nurse during hospital admission were purposely sampled. Data were collected between January 2023 and March 2023. Initial patient interviews were conducted during hospital admission with a second interview 7-22 days after discharge. Systematic text condensation was used for the analysis, and Nvivo 12 supported data storage and coding. ETHICAL APPROVAL: The study is registered with the Danish Data Protection Agency (22/47509). Informed consent was given by the participants. RESULTS: Sixteen patients participated in the study. The participants experienced major challenges in their transitions from the hospital, which were generally related to their interactions with many different social and healthcare services. While the social nurses supported the patients and helped facilitate care during hospital admission and after discharge, the participants identified transitional care gaps related to multidisciplinary cooperation and standardised care options. CONCLUSIONS: This study identifies challenges related to the hospital transition of socially marginalised patients, which indicates a gap in healthcare services. Future research should focus on improving interprofessional collaboration with socially marginalised patients across healthcare services.

Notas sobre o pesquisar em cena(s) / Notes on researching in scenes / Notas sobre la investigación en escena(s)

O presente artigo tem como objetivo apresentar a construção metodológica desenvolvida em uma pesquisa de mestrado, na qual sustentamos a escrita de cenas como método de pesquisa da escuta clínica. As cenas do trabalho em questão foram recolhidas ao longo do tempo, no contorno da experiência de um projeto de extensão universitária de atenção à infância e adolescência em situação de vulnerabilidade social, situado em uma comunidade periférica. Apresentamos, neste texto, as interrogações que se elaboraram em torno da escolha pelo trabalho com cenas, e compartilhamos o resgate histórico dessas como um método de escrever a clínica, bem como a retomada de sua análise a partir da tradição psicanalítica. Amparadas nesta teoria e em leituras e contribuições do filósofo francês Jacques Derrida, embasamos a noção de que a cena se constitui como um lugar de produção, ao engendrar a configuração particular de elementos significantes nos processos de subjetivação e de construção social. A cena não é, então, compreendida aqui como uma representação do que acontece na clínica, mas como um modo de produzir a escuta e os seus processos de investigação.(AU)

This article aims to present the methodological construction developed in a master's research, in which the writing of scenes as a method of clinical listening research was endorsed. The scenes from the study in question were collected over time, from the experience gained in a project conducted within a university extension program on care in childhood and adolescence in social vulnerability, in a peripheral community. In this study, we present some questions that were elaborated surrounding the choices of working with scenes; and we share the historical rescue of this work as a method of writing on clinic practices and resuming their analysis from the psychoanalytic tradition. Based on the psychoanalytic theory and on the readings and contributions of the French philosopher Jacques Derrida, we corroborate the notion that the scene is constituted as a place of production, engendering the particular configuration of significant elements in the processes of subjectivation and social construction. Here, the scene is not a representation of clinical practice but one mode of producing listening and its research processes.(AU)

Este artículo tiene como objetivo presentar la construcción metodológica desarrollada en una investigación de maestría, en la que sostenemos la escritura de escenas como método de investigación de la escucha clínica. Las escenas del trabajo en cuestión se recogieron a lo largo del tiempo desde la experiencia en un proyecto de extensión universitario de atención a la niñez y adolescencia en situación de vulnerabilidad social aplicado en una comunidad periférica. En este texto, presentamos los interrogantes que se elaboraron en torno a la elección por el trabajo con escenas y compartimos el rescate histórico de las mismas como un método de escribir la clínica y la reanudación del análisis a partir de la tradición psicoanalítica. Amparadas en el psicoanálisis y en lecturas y contribuciones del filósofo francés Jacques Derrida, nos basaremos en la noción de que la escena se constituye como un lugar de producción, engendrando la configuración particular de elementos significantes en los procesos de subjetivación y de construcción social. La escena no es aquí una representación de lo que pasa en la clínica, sino un modo de producir escucha y sus procesos de investigación.(AU)

Sistema de avaliação de práticas psicológicas Aluízio Lopes de Brito (SAPP) sobre políticas de cuidado / Aluízio Lopes de Brito psychological practices assessment system (SAPP) on care policies / Sistema de evaluación de prácticas psicológicas Aluízio Lopes de Brito (SAPP) sobre políticas de cuidado

O objetivo do presente manuscrito é caracterizar e descrever os fluxos do Sistema de Avaliação de Práticas Psicológicas Aluízio Lopes de Brito (SAPP), dispositivo instituído no âmbito do Sistema Conselhos de Psicologia e regulamentado pelo Conselho Federal de Psicologia através da Resolução CFP nº 15, de 18 de agosto de 2023. O SAPP surge da necessidade premente de orientação e qualificação profissionais frente às práticas emergentes que produzem o saber/ fazer da psicologia. Nesse sentido, trata-se de processo que busca orientar, qualificar e fazer conhecer práticas que sejam compatíveis ou não com o exercício profissional em psicologia. Com o trabalho realizado no SAPP serão produzidos pareceres que contribuirão minimamente para o conhecimento das fronteiras que delimitam os campos da psicologia e, por excelência, conheceremos melhor nossas próprias formas de atuação. Através da consideração do trinômio teoria-prática-ética, o CFP espera com o SAPP abrir diálogos com grupos, práticas e saberes fronteiriços e constantemente relegados pela psicologia hegemônica. Para tanto, parte do pressuposto de que os saberes e fazeres destas populações podem refinar as teorias psicológicas e fazer a psicologia avançar como ciência e profissão.(AU)

This manuscript aims to characterize and describe the flows of the Aluízio Lopes de Brito Psychological Practices Assessment System (SAPP), an instrument established within the framework of the Psychology Council System and regulated by the Federal Council of Psychology (CFP) with Resolution CFP No. 15, of August 18, 2023. The SAPP arises from the pressing need for professional guidance and qualification in the face of emerging practices that shape the knowledge/practice of psychology. In this sense, it is a process that seeks to guide, qualify, and make known practices that are compatible or not with the professional practice of psychology. The work carried out in the SAPP will produce opinions that will contribute minimally to the understanding of the boundaries that delimit the fields of psychology and, by excellence, we will better understand our own modes of operation. Considering the trinity of theory-practice-ethics, the CFP hopes with the SAPP to open dialogues with groups, practices, and knowledge that are in the borders and are constantly relegated by hegemonic psychology. To this end, it assumes that the knowledge and practices of these populations can refine psychological theories and advance psychology as a science and profession.(AU)

El objetivo de este manuscrito es caracterizar y describir los flujos del Sistema de Evaluación de Prácticas Psicológicas Aluízio Lopes de Brito (SAPP), un dispositivo establecido en el marco del Sistema de Consejos de Psicología y regulado por el Consejo Federal de Psicología a través de la Resolución CFP n.º 15, con fecha del 18 de agosto de 2023. El SAPP surge de la necesidad apremiante de orientación y calificación profesional frente a las prácticas emergentes que configuran el conocimiento y las habilidades de la psicología. En este sentido, es un proceso que busca orientar, calificar y dar a conocer prácticas que sean compatibles o no con el ejercicio profesional de la psicología. El trabajo realizado en el SAPP generará opiniones que contribuirán mínimamente a la comprensión de los límites que delimitan los campos de la psicología y, por excelencia, comprender mejor nuestras propias formas de actuación. A través de la consideración de la tríada teoría-práctica-ética, el CFP espera que con el SAPP puede llevar a cabo el diálogo con grupos, prácticas y conocimientos fronterizos y constantemente pasados por alto por la psicología hegemónica. Con este fin, se asume que los conocimientos y prácticas de estas poblaciones pueden refinar las teorías psicológicas y hacer avanzar la psicología como ciencia y profesión.(AU)

PsicoQuilombologia: escrevivência de uma psicologia das encruzilhadas em tempos pandêmicos / PsychoQuilombology: writexperience of a psychology of crossroads in pandemic times / PsicoQuilombología: escrivivencia de una psicología de la encrucijada en tiempos pandémicos

O texto é um relato de experiência da participação no Grupo de Estudos psicoQuilombologia ocorrida nos meses de setembro de 2020 a março de 2021, período atravessado pela segunda onda da pandemia de COVID-19 no Brasil. O objetivo do relato é apresentar o conceito-movimento de psicoQuilombologia como uma proposta epistemológica quilombola de agenciamento de cuidado e saúde, com base em uma escuta que se faça descolonial e inspirada no fecundo e ancestral acervo de cuidado dos povos africanos, quilombolas e pretos, preservado e atualizado em nossos quilombos contemporâneos. A metodologia utilizada é a escrevivência, método desenvolvido por Conceição Evaristo que propõe uma escrita em que as vivência e memórias estão totalmente entrelaçadas, imersas e imbricadas com a pesquisa. O resultado das escrevivências dessa pesquisa descortinam que os povos pretos desenvolveram práticas de cuidado e acolhimento às vulnerabilidades do outro, enraizadas no fortalecimento de laços e conexões coletivas de afetos e cuidado mútuos. Práticas de cuidado que articulam memória, ancestralidade, tradição, comunidade, transformação, luta, resistência e emancipação, engendrando modos coletivos de ser e viver. Nas quais cuidar do outro implica tratar suas relações e situar o cuidado como extensão de uma cura que se agencia no coletivo. O trabalho conclui apontando que o cenário pandêmico vigente acentua a pungência de se desenvolver estratégias de cuidado baseadas em epistemologias pretas e quilombolas, valorizando os sentidos de ancestralidade, comunidade, pertencimento e emancipação.(AU)

The text is an experience report of the participation in the psicoQuilombology Study Group that carried out from September 2020 to March 2021, during the second wave of the COVID-19 pandemic in Brazil. The purpose of the report is to introduce the concept-movement of psicoQuilombology as a quilombola epistemological proposal for the development of care and health, based on a decolonial listening and inspired by the rich care collection of African peoples, quilombolas and Blacks, preserved and updated in our contemporary quilombos. The methodology used is writexperience [escrevivências], a method developed by Conceição Evaristo who proposes a writing in that the experiences and memories are totally involved with the research. The result of the writability of this research show that Black people have developed practices of care and acceptance of the other's vulnerabilities, based on the strengthening of ties and collective connections of mutual affection and care. Care practices that mix memory, ancestry, tradition, community, transformation, struggle, resistance and emancipation, outlining collective ways of being and living. The core idea is that taking care of the other means treating your relationships and maintaining care as an extension of a cure that takes place in the collective. The paper concludes by pointing out that the current pandemic scenario demonstrates the urgent need to develop care strategies based on black and quilombola epistemologies, valuing the senses of ancestry, community, belonging and emancipation.(AU)

Este es un reporte de experiencia de la participación en el Grupo de Estudio psicoQuilombología que ocurrió en los meses de septiembre de 2020 a marzo de 2021, periodo en que Brasil afrontaba la segunda ola de la pandemia de la COVID-19. Su propósito es presentar el concepto-movimiento de psicoQuilombología como una propuesta epistemológica quilombola para el desarrollo del cuidado y la salud, basada en una escucha decolonial e inspirada en el rico acervo asistencial de los pueblos africanos, quilombolas y negros, conservado y actualizado en nuestros quilombos contemporáneos. La metodología utilizada es la escrivivencia, un método desarrollado por Conceição Evaristo quien propone una escrita en que las vivencias y los recuerdos están totalmente involucrados con la investigación. El resultado de la escrivivencia muestra que las personas negras han desarrollado prácticas de cuidado y aceptación de las vulnerabilidades del otro, basadas en el fortalecimiento de lazos y conexiones colectivas de afecto y cuidado mutuos. Prácticas de cuidado que mezclan memoria, ascendencia, tradición, comunidad, transformación, lucha, resistencia y emancipación, perfilando formas colectivas de ser y vivir. El cuidar al otro significa tratar sus relaciones y mantener el cuidado como una extensión de una cura que tiene lugar en lo colectivo. El trabajo concluye que el actual escenario pandémico demuestra la urgente necesidad de desarrollar estrategias de atención basadas en epistemologías negras y quilombolas, y que valoren los sentidos de ascendencia, comunidad, pertenencia y emancipación.(AU)

Um capítulo esquecido na história da psicologia? sexualidades desviantes, psicopatologia e normalidade / A forgotten chapter in the history of psychology? deviant sexualities, psychopathology, and normality / ¿Un capítulo olvidado en la historia de la psicología? sexualidades desviadas, psicopatología y normalidad

Este artigo tem como objetivo produzir uma análise histórica sobre as intersecções entre Psicologia e sexualidade desviantes da norma no Brasil, de fins do século XIX a meados da década de 1980. Esta temporalidade foi escolhida por abarcar o surgimento das pesquisas científicas sobre sexualidade e desvios sexuais, a consolidação dos estudos psicológicos sobre a temática e o processo mais recente de despatologização da homossexualidade. Em termos teóricos e metodológicos, foram adotados os pressupostos da História Social da Psicologia e da historiografia das homossexualidades no Brasil. Desse modo, buscou-se compreender como as ideias, concepções e práticas psicológicas foram mudando ao longo do tempo, em conexão com as transformações socioculturais e políticas que ocorreram durante o século XX. Para isto, foram utilizadas fontes primárias e secundárias de pesquisa com vistas à produção de interpretações sobre as conexões entre as ideias, os atores e os eventos narrados. Argumenta-se, ao longo do artigo, que as ideias e práticas psicológicas estão intrinsecamente conectadas aos contextos socioculturais e políticos de seu tempo, sendo os movimentos dinâmicos e os conflitos presentes nesses contextos fatores determinantes para a sua constituição.(AU)

This article aims to produce a historical analysis of the intersections between Psychology and sexualities that deviate from the norm in Brazil, from the late 19th century to the mid-1980s. This period was chosen because it encompasses the emergence of scientific research on sexuality and sexual deviations, the consolidation of psychological studies on the subject and the most recent process of de-pathologization of homosexuality. Theoretically and methodologically, the assumptions of the Social History of Psychology and the historiography of homosexualities in Brazil were adopted. Therefore, we sought to understand how psychological ideas, conceptions and practices have changed over time, in connection with the sociocultural and political transformations that occurred throughout the 20th century. For this, primary and secondary sources of research were used to produce interpretations about the connections between the ideas, the actors and the narrated events. It is argued, throughout the article, that the psychological ideas and practices are intrinsically connected to the sociocultural and political contexts of their time, being the dynamic movements and conflicts present in these contexts determining factors for their constitution.(AU)

Este artículo tiene como objetivo realizar un análisis histórico de las intersecciones entre la Psicología y las sexualidades desviadas de la norma en Brasil desde finales del siglo XIX hasta mediados de la década de 1980. Esta temporalidad fue elegida por abarcar el surgimiento de las investigaciones científicas sobre sexualidad y desvíos sexuales, la consolidación de los estudios psicológicos sobre el tema y el más reciente proceso de despatologización de la homosexualidad. En el marco teórico y metodológico, se adoptaron los presupuestos de la Historia Social de la Psicología y de la historiografía de las homosexualidades en Brasil. De esta manera, se pretende comprender cómo las ideas, concepciones y prácticas psicológicas han cambiado a lo largo del tiempo, en conexión con las transformaciones socioculturales y políticas ocurridas durante el siglo XX. Para ello, se utilizaron las fuentes de investigación primarias y secundarias con miras a generar interpretaciones sobre las conexiones entre las ideas, los actores y los eventos narrados. Se argumenta, a lo largo de este artículo, que las ideas y las prácticas psicológicas están intrínsecamente conectadas a los contextos socioculturales y políticos de su tiempo, y los movimientos dinámicos y los conflictos presentes en estos contextos fueron los factores determinantes para su constitución.(AU)

Equitable and Holistic Public Health Measures During the Singaporean COVID-19 Pandemic.

This Covid-19 pandemic has been a trying time for all countries, governments, societies, and individuals. The physical, social, and organizational infrastructure of healthcare systems across the world is being stressed. This pandemic has highlighted that the healthcare of the country is as strong as its weakest link and that no aspect of life, be it social or economic, is spared from this pandemic. The authors would like to highlight some of the lessons learned from Singapores management of the Covid-19 pandemic. During the Singaporean Covid-19 pandemic, public health policy planning was all encompassing in its coverage, involving various stakeholders in government and society. The important role of individuals, governments, industry, and primary healthcare practitioners when tackling COVID-19 are highlighted. Singapores management of the Covid-19 pandemic involved an approach that involved the whole of society, with a particular focus on supporting the vulnerable foreign worker population, which formed the majority of Covid-19 cases in the country. Hopefully amidst the trying times, valuable lessons are learnt that will be etched into medical history and collective memory. We hope to highlight these lessons for future generations, both for members of the public and fellow healthcare practitioners.

A capoeira na capital do estado de Rondônia: da quantidade de grupos à participação do profissional de educação física / Capoeira in the capital of the state of Rondônia: from the quantity of groups to the participation of the physical education professional

A capoeira é uma prática corporal e cultural afro-brasileira que contempla configurações e gestuais característicos. É sinônimo de resistência cultural e esteve presente em diferentes momentos da história do Brasil, sendo elemento marcante na formação da identidade de povo brasileiro. Apesar de sua popularidade, assim como a maioria das tradições de origem africana e/ou afrodescendente, permanece marginalizada em muitas regiões do país e carece de investigações científicas a seu respeito. O presente estudo teve como objetivo investigar e descrever a realidade da capoeira na cidade de Porto Velho, capital do estado de Rondônia. no que diz respeito: a) ao número de grupos e seu público-alvo, b) à organização destes através de Federação ou associação; e c) à participação do profissional de Educação Física (EDF). Trata-se de uma pesquisa de caráter qualitativo, observacional e descritivo. Para sua realização foram feitas entrevistas semiestruturadas com quatro professo res/mestres de capoeira. A pesquisa evidenciou que na cidade de Porto Velho não é possível definir com exatidão o número de grupos existentes; sendo 15 o total estimado. Crianças e adolescentes são seu público-alvo. Somente um grupo tinha professor de capoeira graduado em EDF responsável por ministrar aulas. Quanto aos mestres, apenas um grupo possuía mestre graduado em EDF. Portanto, apesar de ser um campo de atuação oportuno ao profissional de EDF, a participação deste na capoeira da cidade de Porto Velho é pequena, quase inexistente. Acredita -se que a graduação em Educação Física poderia somar ao planejamento, entendimento de prevenção de lesões, bem como na estruturação das aulas. De outra forma, o trabalho conjunto entre professores de capoeira e profissionais de EDF, realidade identificada na presente pesquisa, também se apresenta como uma alternativa potencialmente interessante....(AU)

Capoeira is an Afro-Brazilian corporal and cultural practice that includes characteristic configurations and gestures. It is synonymous with cultural resistance and has been present at different times in the history of Brazil, bein g an im p ortan t element in t he formation of the identity of the Brazilian people. Despite its popularity, as well as most traditions of African origin and/or African descent, it remains marginalized in many regions of the country and scientific research on it is lacking. This study aimed to investigate and describe the reality of capoeira in the city of Porto Velho, capital of the state of Rondônia with respect to: a) the n um ber o f gro up s and t h eir t arget audience; b) their organization through Federation or association; and c) the participation of the Physical Education (PE) professionals. This is a qualitative, observational and descriptive study. Semi-structured interviews were carried out with four capoeira teachers/m asters. This study showed that in the city of Porto Velho it is not possible to define exactly the number of existing groups; 15 being the estimated t otal. Children and teenagers are their target audience. Only one group had a capoeira teacher graduated in PE responsible for teaching classes. As for the masters, only one group had a master graduated in PE. Therefore, despite being an opportune field of activity for PE profession als, their participation in capoeira in the city of Porto Velho is small, almost nonexistent. It is believed that graduation in P h ysical Education could add to planning, understanding injury prevention, as well as structuring classes. Furthermore, joint work between capoeira teachers and PE professionals, a reality identified in this study, also presents itself as a potentially interesting alternative....(AU)

Nutritional Status Among School-Age Children of Bangladeshi Tea Garden Workers.

BACKGROUND: While considerable progress has been made in reducing undernutrition in Bangladesh, regional disparities are known to exist, and certain population subgroups may lag behind. OBJECTIVE: To characterize nutritional status among school-age children in a historically marginalized population of Bangladesh. METHODS: We conducted a cross-sectional assessment of children attending 14 nongovernmental organization-operated schools serving the tea estate population in Kulaura Upazila, Sylhet Division. We randomly selected 168 children from a population of 418 whose parents attended school-organized Parent-Teacher Association meetings. Parents provided consent and data on household food consumption in the past week, foods consumed by children in the past 24 hours, and household food insecurity. We drew venous blood from assenting children for the analysis of hemoglobin and plasma retinol, C-reactive protein, and α1-acid glycoprotein. Children were classified as stunted, underweight, or thin based on comparisons with the World Health Organization standards for height-for-age, weight-for-age, or body mass index-for-age, respectively. RESULTS: Food insecurity was highly prevalent, with ∼85% of households affected. Roughly half of children had low dietary diversity. Prevalence estimates for stunting, underweight, and thinness were 32%, 50%, and 49%, respectively. Approximately 60% of children had a hemoglobin concentration <11 g/dL. The mean (±SD) plasma retinol concentration was 0.79 µmol/L (±0.23 µmol/L), with 34% deficient using a 0.70 µmol/L cutoff. CONCLUSIONS: A heightened focus on tracking progress in underserved populations and appropriately targeted programming will be critical as Bangladesh seeks to accelerate progress toward global development goals for nutrition.

Racial and political resistance: an examination of the sociopolitical action of racially marginalized youth.

This paper reviews recent literature on racially marginalized youth's sociopolitical action in the United States by highlighting three trends regarding the nature of, the factors shaping, and the implications of youth action. First, we trace the nature of racially marginalized youth's individual/interpersonal action, collective action, and digital action. Then, we describe the sociopolitical, sociocultural, and contextual domains that shape their sociopolitical action. Importantly, we examine the significant implications for the mental health of youth, particularly as these actions have both positive and negative results. Finally, we highlight recent advances in the measurement of racially marginalized youth's sociopolitical action while imploring the field for more holistic and intersectional approaches to both measurement and theory.

Adverse Childhood Experiences, Trauma Symptoms, Mindfulness, and Intimate Partner Violence: Therapeutic Implications for Marginalized Men.

Adverse childhood experiences (ACEs) and trauma symptoms have been linked with intimate partner violence (IPV) perpetration and victimization among men, yet the field lacks depth in several key areas hampering progress toward violence intervention. Specifically, posttraumatic stress disorder (PTSD) dominates the field's scope of trauma symptoms under study, limiting understanding of other manifestations of trauma especially among men. Furthermore, most research focuses exclusively on men's physical IPV perpetration and rarely focuses on other types of IPV, severity of violence, or men's victimization. Also, few studies examine potential protective factors grounded in the ACE framework, such as mindfulness, among clinical populations. Finally, most research has not focused on men of color, despite some racial/ethnic minority groups disproportionate rates of IPV exposure. Therefore, the relationships between IPV frequency and severity (psychological, physical, injury) and ACEs, PTSD, trauma symptomology (separate from PTSD), and mindfulness self-efficacy were examined in a sample of 67 predominantly low-income men of color in a batterer intervention program. More than half of the sample (51.5%) reported exposure to four or more ACEs, and 31.1% met the clinical cutoff for a probable PTSD diagnosis. Higher ACE scores predicted increased rates for nearly all types of self-reported IPV perpetration and victimization. PTSD symptoms and complex trauma symptom severity together explained between 13% and 40% of IPV outcomes, and each was uniquely associated with certain types of self-reported IPV victimization and perpetration frequency and severity. Mindfulness self-efficacy was associated with decreased self-report psychological IPV perpetration and victimization frequency and severity. Clinical implications relevant to marginalized men are reviewed, including screening, training, and potential therapeutic interventions.

Las experiencias adversas en la infancia (EAI) y los síntomas de trauma se han asociado con la perpetración de violencia de pareja y la victimización entre los hombres, sin embargo, el ámbito carece de profundidad en varias áreas clave que obstaculizan el avance hacia la intervención en la violencia. Específicamente, el trastorno por estrés postraumático (TEPT) domina el alcance de los síntomas de trauma del ámbito estudiado, lo cual limita la comprensión de otras manifestaciones de trauma, especialmente entre los hombres. Además, la mayoría de las investigaciones se centran exclusivamente en la perpetración de violencia física de pareja por parte de los hombres y rara vez se centra en otros tipos de violencia de pareja, en la gravedad de la violencia o en la victimización de los hombres. Además, pocos estudios analizan posibles factores protectores basados en el marco de las EAI, como la conciencia plena, entre las poblaciones clínicas. Finalmente, la mayoría de las investigaciones no se han centrado en los hombres de color, a pesar de algunos índices desmesurados de exposición a la violencia de pareja de grupos raciales/étnicos minoritarios. Por lo tanto, se analizó la relación entre la frecuencia de la violencia de pareja y la gravedad de esta (psicológica, física, lesiones) y las EAI, el TEPT, la sintomatología del trauma (aparte del TEPT), y la autoeficacia de la conciencia plena en una muestra de 67 hombres de color, predominantemente de bajos recursos, en un programa de intervención para golpeadores. Más de la mitad de la muestra (el 51, 5 %) informó exposición a cuatro o más EAI y el 31, 1 % alcanzó el umbral de decisión clínica para un diagnóstico probable de TEPT. Los puntajes más altos de EAI predijeron índices mayores de casi todos los tipos de perpetración de violencia de pareja y victimización autoinformadas. Los síntomas de TEPT y la gravedad de los síntomas de trauma complejo explicaron juntos entre el 13 % y el 40 % de los resultados de la violencia de pareja, y cada uno estuvo asociado exclusivamente con ciertos tipos de gravedad y frecuencia de la victimización y la perpetración de violencia de pareja autoinformadas. La autoeficacia de la conciencia plena estuvo asociada con una menor victimización y perpetración autoinformadas de la frecuencia y la gravedad de la violencia psicológica de pareja. Se revisan las implicancias clínicas relevantes para los hombres marginados, entre ellas, la evaluación, la capacitación y las posibles intervenciones terapéuticas.

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.

Práticas discursivas e produção de sentidos: análise da aplicação em Saúde Mental no Brasil / Discursive practices and production of meanings: analysis of the application in Mental Health in Brazil / Prácticas discursivas y producción de sentidos: análisis de la aplicación en Salud Mental en Brasil

Este estudo analisou a aplicação das práticas discursivas e produção de sentidos na descrição e interpretação dos sentidos dados a diferentes fenômenos em saúde mental no Brasil. Trata-se de uma revisão bibliográfica baseada na literatura especializada, a partir da consulta a estudos científicos selecionados utilizando a Biblioteca Virtual em Saúde (BVS) com as palavras-chave 'práticas discursivas' e 'produção de sentidos', no título, resumo ou assunto, resultando na seleção de 21 estudos, dada sua relação com a saúde mental. A aplicação desta teoria se deu na abordagem profissional e usuário, assistência terapêutica, formação profissional, maternidade, paternidade, adoção e percepção pessoal de fenômenos como crise, vulnerabilidade social, doença, cuidado, self, exclusão social e violência. Compreender esses fenômenos possibilita a reflexão sobre a práxis de profissionais de saúde mental e afins, contribuindo com estratégias de acolhimento e formação de vínculo na relação entre profissional e usuário a partir da interpretação dos sentidos.

This study has analyzed the application of discursive practices and production of meanings in the description and interpretation of the meanings given to different phenomena in mental health in Brazil. This is a bibliographical review based on specialized literature from the inquiry to selected scientific studies employing the Virtual Health Library (VHL) with the following keywords: 'discursive practices' and 'production of meanings', in the title, abstract or subject, resulting in the selection of 21 studies, given their relation to the mental health. The application of this theory is on the professional approach and user, therapeutic assistance, professional training, maternity, paternity, adoption and personal perception of phenomena such as crisis, social vulnerability, illness, care, self, social exclusion and violence. Understanding these phenomena enables the reflection about the praxis of mental health professionals and the like, contributing with strategies of integration and formation of links in the relationship between the professional and the user from the interpretation of the meanings.

Este estudio analizó la aplicación de las prácticas discursivas y producción de los sentidos en la descripción e interpretación de los sentidos dados a diferentes fenómenos en salud mental en Brasil. Se trata de una revisión bibliográfica basada en la literatura especializada, a partir de la consulta a estudios científicos utilizando la Biblioteca Virtual en Salud (BVS) con las palabras clave: 'prácticas discursivas' y 'producción de sentidos', en el título, resumen o asunto, resultando en la selección de 21 estudios, dada su relación con la salud mental. La aplicación de esta teoría se dio en el enfoque profesional y usuario, asistencia terapéutica, formación profesional, maternidad, paternidad, adopción, y percepción personal de fenómenos como crisis, vulnerabilidad social, enfermedad, cuidado, self, exclusión social y violencia. Comprender estos fenómenos posibilita la reflexión sobre la praxis de profesionales de salud mental y afines, contribuyendo con estrategias de acogida y formación de vinculo en la relación entre profesional y usuario a partir de los sentidos.

Marginalisation, Ebola and Health for All: From Outbreak to Lessons Learned.

The Ebola epidemic in West Africa between 2014 and 2015 was the deadliest since the discovery of the virus four decades ago. With the second-largest outbreak of Ebola virus disease currently raging in the Democratic Republic of the Congo, (DRC) it is clear that lessons from the past can be quickly forgotten-or be incomplete in the first instance. In this article, we seek to understand the health challenges facing marginalised people by elaborating on the multiple dimensions of marginalisation in the case of the West Africa Ebola epidemic. We trace and unpack modes of marginalisation, beginning with the "outbreak narrative" and its main components and go on to examine other framings, including the prioritisation of the present over the past, the positioning of 'Us versus Them'; and the marginalisation-in responses to the outbreak-of traditional medicine, cultural practices and other practices around farming and hunting. Finally, we reflect on the 'lessons learned' framing, highlighting what is included and what is left out. In conclusion, we stress the need to acknowledge-and be responsive to-the ethical, normative framings of such marginalisation.

The role of social support and spiritual wellbeing in predicting suicidal ideation among marginalized adolescents in Malaysia.

BACKGROUND: The high number of adolescents and young adults harbouring suicidal ideation, as reported by the Ministry of Health Malaysia, is alarming. This cross-sectional study aims to examine the association between social support and spiritual wellbeing in predicting suicidal ideation among Malaysian adolescents. METHODS: A total of 176 adolescents in selected urban areas in the states of Wilayah Persekutuan and Selangor were selected. The Suicide Ideation Scale (SIS) was used to measure the level of severity or tendency of suicidal ideation. The Multidimensional Scale of Perceived Social Support (MSPSS) was used to measure the perceived social support received by the respondent while the Spiritual Wellbeing Scale (SWBS) was used to measure the religious wellbeing (RWB), the existential wellbeing (EWB) and the overall score of spiritual wellbeing (SWB). RESULTS: The study found that both RWB and EWB showed significant negative correlation with suicidal ideation. Similarly, support from family and friends also showed a negative correlation with suicidal ideation. Further analysis using multiple regressions showed that RWB and SWB, and family support predict suicidal ideation in adolescents. CONCLUSION: Spiritual wellbeing in combination with family support plays a major role in predicting suicidal ideation. Therefore, intervention for encompassing spirituality and family support may contribute to a more positive outcome in suicidal adolescents.

Substance use outcomes for mindfulness based relapse prevention are partially mediated by reductions in stress: Results from a randomized trial.

OBJECTIVE: Mindfulness based relapse prevention (MBRP) has demonstrated efficacy in alleviating substance use, stress, and craving but how MBRP works for marginalized young adults has not been investigated. The current study used a novel rolling group format for MBRP as an additional intervention for young adults in residential treatment. We tested the hypothesis that MBRP (plus Treatment as usual (TAU)) would reduce stress, craving, and substance use among young adults in residential treatment relative to treatment-as-usual plus 12-step/self-help meetings (TAU only). Further, we examined whether reduced stress during treatment was a potential mechanism of change operating in MBRP. METHOD: Seventy-nine young adults (Mage = 25.3,SD = 2.7;35 % female) were randomly assigned to MBRP (n = 44) or TAU (n = 35). Follow-up assessments were conducted bi-monthly for self-reported measures of stress, craving, and substance use. RESULTS: At treatment completion young adults receiving MBRP had lower substance use (d = -0.58, [-0.91, -0.26]), craving (d = -0.58, [-1.0, -0.14]), and stress (d = -0.77 [-1.2, -0.30]) relative to TAU condition. Reduced stress during treatment partially mediated observed outcome differences between MBRP and TAU for substance use (ßindirect = -0.45 [-0.79, -0.11]). CONCLUSIONS: Results suggest that MBRP is a useful and appropriate intervention for marginalized young adults. Further, our results suggest that the effects of MBRP on long-term substance use outcomes may be partially explained by reduced stress.

Social and emotional wellbeing assessment instruments for use with Indigenous Australians: A critical review.

RATIONALE: There is growing recognition that in addition to universally recognised domains and indicators of wellbeing (such as population health and life expectancy), additional frameworks are required to fully explain and measure Indigenous wellbeing. In particular, Indigenous Australian wellbeing is largely determined by colonisation, historical trauma, grief, loss, and ongoing social marginalisation. Dominant mainstream indicators of wellbeing based on the biomedical model may therefore be inadequate and not entirely relevant in the Indigenous context. It is possible that "standard" wellbeing instruments fail to adequately assess indicators of health and wellbeing within societies that have a more holistic view of health. OBJECTIVE: The aim of this critical review was to identify, document, and evaluate the use of social and emotional wellbeing measures within the Australian Indigenous community. METHOD: The instruments were systematically described regarding their intrinsic properties (e.g., generic v. disease-specific, domains assessed, extent of cross-cultural adaptation and psychometric characteristics) and their purpose of utilisation in studies (e.g., study setting, intervention, clinical purpose or survey). We included 33 studies, in which 22 distinct instruments were used. RESULTS: Three major categories of social and emotional wellbeing instruments were identified: unmodified standard instruments (10), cross-culturally adapted standard instruments (6), and Indigenous developed measures (6). Recommendations are made for researchers and practitioners who assess social and emotional wellbeing in Indigenous Australians, which may also be applicable to other minority groups where a more holistic framework of wellbeing is applied. CONCLUSION: It is advised that standard instruments only be used if they have been subject to a formal cross-cultural adaptation process, and Indigenous developed measures continue to be developed, refined, and validated within a diverse range of research and clinical settings.

Social networking site (SNS) use by adolescent mothers: Can social support and social capital be enhanced by online social networks? - A structured review of the literature.

AIMS AND OBJECTIVES: to critically appraise the available literature and summarise the evidence relating to adolescent mothers' use of social networking sites in terms of any social support and social capital they may provide and to identify areas for future exploration. BACKGROUND: social networking sites have been demonstrated to provide social support to marginalised individuals and provide psycho-social benefits to members of such groups. Adolescent mothers are at risk of; social marginalisation; anxiety disorders and depressive symptoms; and poorer health and educational outcomes for their children. Social support has been shown to benefit adolescent mothers thus online mechanisms require consideration. DESIGN: a review of original research articles METHOD: key terms and Boolean operators identified research reports across a 20-year timeframe pertaining to the area of enquiry in: CINAHL, Cochrane Library, Medline, Scopus, ERIC, ProQuest, PsychINFO, Web of Science, Health Collection (Informit) and Google Scholar databases. Eight original research articles met the inclusion criteria for this review. FINDINGS: studies demonstrate that adolescent mothers actively search for health information using the Internet and social networking sites, and that social support and social capital can be attributed to their use of specifically created online groups from within targeted health interventions. Use of a message board forum for pregnant and parenting adolescents also demonstrates elements of social support. There are no studies to date pertaining to adolescent mothers' use of globally accessible social networking sites in terms of social support provision and related outcomes. CONCLUSIONS: further investigation is warranted to explore the potential benefits of adolescent mothers' use of globally accessible social networking sites in terms of any social support provision and social capital they may provide.

[Alternative medicine, from North America to East Asia: between persistent exclusion and embodied pluralism]. / Médecines alternatives, du continent nord-américain à l'Asie orientale - Entre exclusion réitérée et pluralisme incorporé.

At a time of growing interest in integrative approaches to health and care, this article examines, from a historical perspective, the factors underlying the global popularity of so-called complementary and alternative medicines (CAM). Focusing on the multiple and changing meanings of the concepts used with reference to CAM since the nineteenth century, it emphasizes the agency of CAM practitioners' and calls into question a linear progression from outright exclusion to gradual inclusion into mainstream health care systems. This analysis concludes that biomedicine and "other" medical systems have mutually defined each other in a process of co-production that has had a significant impact on the medicalization of contemporary societies from North America to East Asia.

Habitantes de calle: entre el mito y la exclusión / Homeless people: between myth and exclusion

Al hablar del habitante de calle, resulta importante mencionar que es un fenómeno que ha tenido presencia milenaria, y que ha estado siempre permeado por las lógicas sociales de gobernanza, religión, cultura y economía. Han sido tan diversas las representaciones que se han tenido de esta población, que hoy inclusive sobreviven algunas de esas ideas que han hecho difícil su abordaje y comprensión. El objetivo de este texto es dar a conocer las reflexiones que han surgido de un ejercicio inicial de formación investigativa, en cuanto al fenómeno habitante de calle en Medellín. Para esta acción se revisaron algunos artículos sobre esta población, y se realizó una pequeña pasantía por el sistema de Atención al Habitante de Calle de Medellín, de donde surgieron algunas ideas referentes al concepto, historia y estrategias de intervención que se han implementado desde las diferentes administraciones para intentar dar solución a dicho fenómeno.

It is important to mention that homeless people is a phenomenon that has had a millennial presence, and that has always been permeated by the social logics of governance, religion, culture and economy. There had been so diverse representations about this population, that even today survive some of those ideas that have made it difficult to approach and understand them. The main objective of this text is to make known the reflections that have arisen from an initial exercise of investigative training, regarding that phenomenon of the homeless people in Medellin. Some articles on this specific population were reviewed, and a small internship was carried out by the Medellin homeless people Care System, emerging some ideas about the concept, history and intervention strategies that have been implemented since the different Governmental Administrations to try to solve this phenomenon.