Cambio social y transformación del cuidado en la familia / Social change and the transformation of care in the family

A pesar de los cambios sociales: ¿se sigue erigiendo la familia como una institución cuidadora?, ¿cómo ha cambiado su estructura?, ¿se han debilitado los lazos familiares o se están transformando? En este texto, se analiza la evolución de la familia desde las teorías sociológicas más clásicas hasta los pensadores posmodernos. Se reflexiona sobre las implicaciones de un cambio social y si las transformaciones del presente se han hecho permeables a la dinámica familiar y la función cuidadora de la misma. Como conclusión, se vislumbra que, tanto la familia como sus habilidades cuidadoras, son el espejo de una sociedad en continuo cambio. Está emergiendo un nuevo espacio que, en forma de resistencia, permite hacer uso de los modos de hacer heredados con una visión renovada. (AU)

Despite social changes: does the family still stand as a caring institution, how has its structure changed, have family ties weakened or are they being transformed? This text analyses the evolution of the family from the most classical sociological theories to postmodern thinkers. It reflects on the implications of social change and whether the transformations of the present have become permeable to family dynamics and the caregiving function of the family. As a conclusion, it is envisaged that both the family and its caregiving skills are the mirror of a society in continuous change. A new space is emerging which, as a form of resistance, allows inherited ways of doing things to be used with a renewed vision. (AU)

Access and use of medicines by elderly individuals with dementia

The objective is to reveal the difficulties concerning the access and use of medicines by elderly individuals with dementia, reported by their caregivers. This qualitative study applied the participant observation method during pharmaceutical appointments performed in a specialized geriatrics service of the University Hospital of Brasília. Caregivers reported facing difficulties regarding the itinerary for medicines access in public pharmacies, as well as the high cost of these technologies in private establishments. Psychiatric symptoms, cognitive deficits, behavioral changes, apraxia, dysphagia, among other clinical manifestations of dementia syndromes, incapacitates the elderly for self-responsibility concerningthe use of drugs, which accentuates the complexity of medicines administration within the care process. In conclusion, it is fundamental to recognize caregivers' role in promoting the rational use of medicines, and so this theme should be highlighted within the pharmaceutical services context.

Strategic voices of care and compassion. Describing the mad, their afflictions and situations in Amsterdam and Utrecht in the seventeenth and eighteenth centuries.

Painting a picture of the lives of the early modern mad outside institutions has not yet been done in the Netherlands. However, by looking at notarial documents and admission requests, we can learn more about how the mad were cared for outside the institutions, and the impact their behaviour had on the people close to them. Investigating these sources for both Amsterdam and Utrecht in the seventeenth and eighteenth centuries has unravelled a story of community care in which families played a key role and used their options strategically. Furthermore, it has also revealed a complicated story about the way communities dealt with the behaviour of the mad, involving great personal struggles, breaking points and compassion.

Acompanhamento terapêutico (at) e reforma psiquiátrica: história de uma prática / Therapeutical accompaniment and psychiatric reform: history of a practice / Acompañamiento terapéutico (at) y reforma psiquiátrica: historia de una práctica

O presente trabalho versa sobre o processo histórico de consolidação do AT como prática no percurso da reforma psiquiátrica. Trata-se de uma revisão sistemática de literatura sobre o tema por meio da identificação e análise de artigos publicados nas bases de dados SciELO, PePSIC e Portal de Periódicos Capes, a partir das palavras-chave: acompanhamento terapêutico (AT) e acompanhante terapêutico (at). Como os artigos demonstram, o histórico do AT não se deu de forma linear, apresentando avanços e retrocessos em seu processo. Apesar das divergências apresentadas pelos autores em relação ao tempo de surgimento do AT, houve, nos trabalhos revisados concordância quanto aos movimentos que influenciaram o AT, sendo os principais a reforma psiquiátrica e luta antimanicomial. Após discussão dos argumentos apresentados nos diferentes artigos, conclui-se pela importância da visibilidade e promoção dessas práticas em saúde mental, de modo a afirmar o AT enquanto dispositivo clínico e político em saúde mental.

The present work deals with the historical process of consolidation of Therapeutic Accompaniment (TA) as a practice in the course of the Psychiatric Reform. It is a systematic review of literature on the subject through the identification and analysis of articles published in the SciELO, PePSIC and CAPES Periodicals Portal, from the following keywords: therapeutic accompaniment and therapeutic companion. As the articles demonstrate, the history of TA was not linear, presenting advances and setbacks in its process. Despite the divergences presented by the authors regarding the TA's time of onset, there was, in the reviewed papers, agreement about the movements that influenced the TA, the main ones being the Psychiatric Reform and the Antimanicomial Campaign. After discussion of the arguments presented in the different articles, we conclude about the importance of visibility and promotion of these practices in Mental Health, in order to affirm the TA as a clinical and political device in Mental Health.

En este estudio se discute el proceso histórico de consolidación del Acompañamiento Terapéutico (AT) como práctica en curso en la reforma psiquiátrica. Se trata de una revisión sistemática de la literatura sobre el tema, mediante la identificación y análisis de textos publicados en las bases de datos SciELO, PePSIC y Portal de Revistas CAPES, utilizándose las palabras clave: acompañamiento terapéutico y compañero terapéutico. Los textos demuestran que la historia del AT no sucedió de forma lineal, ocurriendo avances y retrocesos en el proceso. Aunque haya diferencias entre los autores en relación a el tiempo de aparición del AT, en los estudios revisados hubo acuerdo en cuanto a los movimientos que influyeron esta práctica, siendo los principales la Reforma Psiquiátrica y Lucha Antimanicomial. Después de la discusión de los argumentos en diferentes artículos, es evidente la importancia de haber visibilidad y promoción de estas prácticas en la salud mental, con el fin de afirmar el AT como dispositivo clínico y político de Salud Mental.

El origen de la mujer cuidadora: apuntes para el análisis hermenéutico de los primeros testimonios / The origin of the medical assistant women: notes for the hermeneutical analysis of the original testimonies

El objetivo principal de este trabajo es analizar los testimonios primigenios del trabajo de la mujer cuidadora para comprender mejor su significado actual. Se ha llevado a cabo primero una búsqueda de testimonios de diversos tipos y después se intenta dar una interpretación por medio de la hermenéutica. Llegamos así a la comprensión del valor de la mujer en el ámbito de la medicina desde la antigüedad, concluyendo además la estrecha relación que guarda el arte de la curación con la naturaleza femenina, representado ya en su símbolo

The main objective of this paper is to analyze the very first testimonies of the assistant women in society in order to understand its significance nowadays. Firstly, we came through a research of those testimonies in different areas, and afterwards, they were interpreted by the hermeneutics. So, we can come to understand the value of the women in medicine from the ancient times, concluding also the close relationship between the arts medical and the feminine nature, which becomes a visual fact in its symbol

Policy and system change and community coalitions: outcomes from allies against asthma.

Objectives. We assessed policy and system changes and health outcomes produced by the Allies Against Asthma program, a 5-year collaborative effort by 7 community coalitions to address childhood asthma. We also explored associations between community engagement and outcomes. Methods. We interviewed a sample of 1,477 parents of children with asthma in coalition target areas and comparison areas at baseline and 1 year to assess quality-of-life and symptom changes. An extensive tracking and documentation procedure and a survey of 284 participating individuals and organizations were used to ascertain policy and system changes and community engagement levels. Results. A total of 89 policy and system changes were achieved, ranging from changes in interinstitutional and intrainstitutional practices to statewide legislation. Allies children experienced fewer daytime (P = .008) and nighttime (P = .004) asthma symptoms than comparison children. In addition, Allies parents felt less helpless, frightened, and angry (P = .01) about their child's asthma. Type of community engagement was associated with number of policy and system changes. Conclusions. Community coalitions can successfully achieve asthma policy and system changes and improve health outcomes. Increased core and ongoing community stakeholder participation rather than a higher overall number of participants was associated with more change.

Family influence and psychiatric care: physical treatments in Devon mental hospitals, c. 1920 to the 1970s.

'What is it that appears to make the mentally ill so vulnerable to therapeutic experimentation?'(1) One commentator wrote in the 1990s, regarding mental hospitals as repressive, coercive and custodial institutions where medical staff subjected patients to orgies of experimentation. A careful study of surviving documents of the Devon County Lunatic Asylum (DCLA), however, paints a different picture. Rather than medical staff, patients' relatives and the wider community exercised a considerable influence over a patient's hospital admission and discharge, rendering the therapeutic regime in the middle of the 20th century the result of intense negotiations between the hospital and third parties.

Un nuevo profesional para una nueva sociedad. Respuestas desde la educación médica: la formación basada en competencias / New professionals for a new society. Responses from a medical education perspective: competency-based medical education

La formación de profesionales de Ciencias de la Salud exige una reflexión permanente para dar respuesta a una sociedad en continua transición, máxime cuando se viven momentos sociales y económicos tan delicados como el actual que influyen directamente en el mundo sanitario. En un mundo globalizado, en continuo cambio, lleno de incertidumbres, donde la movilidad de profesionales entre países es creciente, se precisan profesionales con nuevas competencias para que sean capaces de adaptarse con flexibilidad a los nuevos tiempos, nuevos roles de docentes y discentes, así como nuevas metodologías de educación y evaluación. La Formación basada en Competencias (FBC) es el camino a seguir para dar una respuesta a los retos socio-sanitarios actuales. En este artículo desarrollamos los fundamentos de la FBC, exponemos algunos de los modelos más aceptados a nivel internacional, describimos cual debe ser el perfil básico de un profesional en Ciencias de la Salud hoy para el mañana, y mostramos la experiencia puesta en marcha por la Unidad de Docencia Médica del Hospital Universitario Cruces de implementar la FBC en el programa de especialidades (AU)

Ongoing reflection on the training of Health Sciences professionals is essential to respond to changes in society. This is particularly important in testing times, such as those of the current economic and social conditions, which have a direct impact on health systems. In the era of globalisation, with the world in constant change, full of uncertainties, and increasing movement of professionals between countries, we need: professionals with new competencies, flexible in adapting to the new times; and new teaching and learning roles, as well as new educational and assessment methods. Competency-based medical education (CBME) is the best approach to respond to the current social and healthcare challenges. In this paper, we outline the principles of CBME, present some of the models most widely adopted internationally, describe the framework of basic competencies that Health Science professionals need today to meet the challenges of tomorrow, and report our experience of the introduction of CBME in specialty training programmes at the Medical Education Unit of Cruces University Hospital (AU)

La presencia de criados particulares en la Casa de Dementes de Santa Isabel / No disponible

No disponible

["My reward is being able to serve". Housemother's retrospective memories of the loss of power in their position in houses "for the sick and needy" between 1945 and 1995]. / «Mein Lohn ist, dass ich darf¼.Wie Hausmütter den Machtverlust ihrer Position in Häusern für «Kranke und Pflegebedürftige¼ zwischen 1945 und 1995 im Rückblick erinnerten.

Institutional families were widespread in the 20th century. As there is very little empirical material on the function of the housemother, a qualitative study was launched to explore members' memories of the function of the housemother between 1945 and 1995 and how communal life in the institutional families of the period was possible. The study was methodologically oriented towards oral history techniques and the principles of Grounded Theory as well as towards sequential line by line analysis. For the purposes of this article, the interviews with nine housemothers were selected from the interviews conducted for the wider study (n=42). The central question concerned how housemothers experienced professional developments in retrospect and the influence these had on the function of the housemother. The interviews resulted in the definition of three phases which the housemothers passed through during their role as housemother. This article describes the third phase: "Leaving the function of the housemother - lost and frustrated power and dominance". Housemothers were not only housekeepers but also carers. Together with the husbands, they represented the heads of their institutional families. Housemothers found living in one house with the other members of the "family" a burden, but at the same time they benefitted from the great freedom they had. This aspect is described using the core categories of power and dominance.

Care workers, care drain, and care chains: reflections on care, migration, and citizenship.

In this article, we discuss a case study that deals with the care chain phenomenon and focuses on the question of how Poland and the Ukraine as sending countries and Poland as a receiving country are affected and deal with female migrant domestic workers. We look at the ways in which these women organize care replacement for their families left behind and at those families' care strategies. As public discourse in both countries is reacting to the feminization of migration in a form that specifically questions the social citizenship obligations of these women, we also look at the media portrayal of the situation of nonmigrating children. Finally, we explore how different aspects of citizenship matter in transnational care work migration movements.

Hierarchization and segmentation of informal care markets in Slovenia.

The article is the result of qualitative research of informal care markets in Slovenia in the field of childcare, elder care, and cleaning. The author assesses Slovenia's position in the "global care chain" and finds that "local care chains" prevail in the field of childcare and elder care, while a co-occurrence of female gender, "other" ethnicity, and poverty is typical in the field of household cleaning. The main emphasis of the article is on the analysis of hierarchization of the informal market of care work according to following two criteria: social reputation of individual type of care work and citizenship status of care workers.

Care of older people in migration contexts: local and transnational arrangements between Peru and Spain.

Care arrangements for the elderly are becoming a main social process in contemporary societies due to socio-political and lifestyle changes over the last few decades. The family and the State play a basic role in the construction of care systems and in the establishment of strategies to access care resources. In the present context of migration, these resources interact at a transnational level, challenging family and State migratory regimes. These new realities need the recognition of basic international social rights, as the experiences of Peruvians living in a migration context in Spain show.

Rethinking care through social reproduction: articulating circuits of migration.

Care has come to dominate much feminist research on globalized migrations and the transfer of labor from the South to the North, while the older concept of reproduction had been pushed into the background but is now becoming the subject of debates on the commodification of care in the household and changes in welfare state policies. This article argues that we could achieve a better understanding of the different modalities and trajectories of care in the reproduction of individuals, families, and communities, both of migrant and nonmigrant populations by articulating the diverse circuits of migration, in particular that of labor and the family. In doing this, I go back to the earlier North American writing on racialized minorities and migrants and stratified social reproduction. I also explore insights from current Asian studies of gendered circuits of migration connecting labor and marriage migrations as well as the notion of global householding that highlights the gender politics of social reproduction operating within and beyond households in institutional and welfare architectures. In contrast to Asia, there has relatively been little exploration in European studies of the articulation of labor and family migrations through the lens of social reproduction. However, connecting the different types of migration enables us to achieve a more complex understanding of care trajectories and their contribution to social reproduction.

Grandfather caregivers: race and ethnic differences in poverty.

We use data from the 2006 American Community Survey to examine race and ethnic differences in the effects of marital status and co-residence of the middle generation on the likelihood of poverty among grandfathers who have primary responsibility for co-resident grandchildren (N = 3,379). Logistic regression results indicate that race/ethnicity and household composition are significant predictors of poverty for grandfather caregivers: non-Hispanic white grandfathers, those who are married, and those with a co-resident middle generation are the least likely to be poor. The effects of race/ethnicity, marital status, and the presence of a middle generation are, however, contingent upon one another. Specifically, the negative effect of being married is lower among grandfathers who are Hispanic, African American, non-Hispanic, and non-Hispanics of other race/ethnic groups compared to whites. In addition, having a middle generation in the home has a larger negative effect on poverty for race/ethnic minority grandfathers than for non-Hispanic whites. Finally, the combined effects of marriage and a middle generation vary across race/ethnic group and are associated with lower chances of poverty among some groups compared with others. We use the theory of cumulative disadvantage to interpret these findings and suggest that race/ethnicity and household composition are synergistically related to economic resources for grandfather caregivers.