Volcano: Between Structural Vulnerabilities and Collective Defence of Honor in Communities Surrounding an Open Dumpsite.

This study analyzes the dynamics in which structural vulnerabilities are shaped and expressed in the day-to-day lives of people making a living from a garbage dump in Argentina. It is a mixed methods case study, qualitative driven with a collaborative cycle (2016-2021). The study is embedded in medical anthropology, social epidemiology and Latin America Social Medicine, with the focus on the ways people respond to inequalities locally. The findings contribute to the field of health disparities in three directions: 1) the description of patterns of segregation in South America peripheries, shedding light on cumulative disadvantages and multiple exposures; 2) the experience of living enmeshed in places with strong stigmas, revising the ways this source of discrimination become social suffering; and 3) the detection of the impact of collective action and social capital in providing material and symbolic resources for restoring dignity and honour that challenge depreciated status.

Estrategias para el control de cáncer y rol de los sistemas de información en salud en el primer nivel de atención / Cancer control strategies and role of Health Information Systems in Primary Health Care Centers

INTRODUCCIÓN: El desarrollo de Sistemas de Información en Salud (SIS) permite mejorar los procesos de recolección automatizada de datos y generación de información vinculada con el control del cáncer. El objetivo de este trabajo consistió en identificar cuáles son y cómo se implementan los SIS de registro y vigilancia en efectores públicos del Primer Nivel de Atención (PNA) para la prevención del cáncer. MÉTODOS: Se trató de un estudio de caso múltiple en 8 efectores del PNA ubicados en el área rural y periurbana del departamento de Diamante (Entre Ríos). RESULTADOS: Se identificaron 3 indicadores: recursos humanos disponibles, características de la población objetivo y SIS implementados vigentes. Se relevaron procesos de registro, logística para su implementación y sentidos asignados a las prácticas. Estas categorías empíricas mostraron inconvenientes surgidos de la implementación de los SIS: multiplicidad de soportes, fragmentación de registros, resistencias iniciales a su incorporación y falta de instancias locales de articulación de registros enviados desde el PNA. DISCUSIÓN: Se propone la integración entre los SIS implementados para optimizar los procesos de recolección de datos y evitar errores humanos en la carga manual. Es importante que el personal responsable se apropie del sentido de la tarea de registro para mejorar su calidad, y adecuar la implementación de los SIS a los contextos locales de uso

Implementación del Liverpool Care Pathway en español en Argentina y en España: exploración de las percepciones de los profesionales ante el final de la vida / The Liverpool Care Pathway implementation in Spanish in Argentina and Spain: A study of health professional perceptions on end of life

Las percepciones de los profesionales de la salud ante el final de la vida pueden influir en la comunicación con pacientes y familias. Si bien en cuidados paliativos (CP) la muerte es algo esperable y natural, genera emociones de distinta intensidad y pone en evidencia la propia finitud y/o la de seres amados y pérdidas previas no elaboradas. El Liverpool Care Pathway (LCP) propone un programa de calidad de atención para personas en situación de últimos días (SUD). En Argentina y España se está implementando el LCP (en español) desde las ONG Pallium (programa PAMPA) y Cudeca respectivamente. Nuestro objetivo es explorar las condiciones subjetivas (percepciones) que enfrentan los profesionales de la salud en relación con la atención en el final de la vida, en el contexto previo y posterior a la implementación de una secuencia de cuidado integral LCP/PAMPA en un contexto binacional latino (Argentina-España). Proponemos identificar y describir los significados que los profesionales le asignan a: los cuidados del muriente, la comunicación, el trabajo en equipo, la documentación y las actitudes en SUD. METODOLOGÍA: Es un estudio de casos múltiples, conformado por 2 módulos independientes articulados en un análisis integrador. El primer módulo realizó un tipo de etnografía utilizada en instituciones sanitarias (EF) en el equipo hospitalario de CP que iniciaban la capacitación con el LCP/PAMPA en Argentina. El segundo módulo consistió en la aplicación de un cuestionario estructurado y pregunta abierta sobre las percepciones de los profesionales sobre las necesidades y condiciones de implementación del LCP (en ambos países). RESULTADOS: Módulo 1. Ejes de indagación: a) acercamiento a la intervención en SUD; b) expectativas sobre la capacitación con LCP; c) dudas y temores en la aplicabilidad del LCP y d) lugar de la intuición en las INTERVENCIONES: Los datos muestran la variabilidad en los motivos de elección a los CP como formación profesional (personales versus necesidades del sistema sanitario) y las expectativas favorables con respecto a la utilidad del LCP. Módulo 2. Se exploraron las categorías específicas para ambos países (España n: 23, Argentina n: 112), siendo lo más relevante el acuerdo pleno del 73,7% de los encuestados argentinos respecto a los indicadores que reflejan los objetivos de calidad del instrumento. En España el acuerdo pleno alcanza el 91,4% teniendo en cuenta la capacitación específica en CP de los profesionales del Plan Nacional de CP. En Argentina aparece como evidente la falta de formación específica en CP antes de la implementación del LCP/PAMPA (91%) CONCLUSIÓN: Este estudio pretendió explorar por primera vez en un contexto de habla hispana, tanto en España como en América latina, las condiciones subjetivas de profesionales de la salud que pueden implementar una secuencia de cuidado integral sistemática muy utilizada en el contexto cultural anglosajón

Health professionals' perceptions on the end of life (EoL) can influence communication with patients and families. Although death is expected in palliative care (PC), emotions of varying intensity are generated. The fears and difficulties encountered in facing this subject will be different according to previous personal experiences. The Liverpool Care Pathway (LCP) proposes a quality programme of care for people at the EoL. Both in Argentina, Pallium and in Spain, Cudeca, are implementing a Spanish version of LCP. Our goal is to explore the subjective conditions (perceptions) faced by health professionals concerning EoL, and the influence before and after the implementation of the LCPin a Latin-American cultural context (Argentina-Spain). We propose to: identify and describe the meanings that professionals assigned to the care of the dying, communication, teamwork, documentation, and attitudes to EoL. METHODOLOGY: A multiple case study, consisting of 2 independent modules articulated in integrative analysis. The first module performed a type of ethnography used in health institutions (focused ethnography) in a PC hospital team who started training with the LCP/PAMPA in Argentina. The second module was the implementation of a structured questionnaire and open questions about the professional's perceptions and conditions of the implementation of the LCP (in both countries). RESULTS: Module 1. Axes of inquiry: a) approach to intervention in EoL, b) expectations about training with LCP, c) doubts and fears in the applicability of LCP, and d) place of intuition in INTERVENTIONS: The data show the variability for choosing the PC as training and the favorable expectations regarding the use of the LCP. Module 2. Specific categories were explored for both countries (Spain n: 23, Argentina n: 112) the most relevant of the full agreement of 73.7% of Argentines respondents on indicators that reflect the quality goals of the instrument. In Spain the full agreement reached 91.4%, keeping in mind the specific training of professionals of the PC National Plan. Argentina showed evidence of the lack of specific training in PC before the implementation of the LCP/PAMPA (91%). CONCLUSIONS: This study aimed to explore, for the first time in a Spanish-speaking context, both in Spain and in Latin America, the subjective conditions of health professionals who can implement a systematic pathway widely used in the Anglo-Saxon cultural context

An examination of advanced cancer caregivers' support provided by staff interventions at hospices in Argentina.

The aim of the study was to describe the type of intervention provided by hospice staff in order to address the pragmatic, psycho-social, and spiritual needs of home-caregivers for patients in the last stage of cancer. The qualitative inquiry was carried out in real life contexts. The explicit demands that caregivers (n = 40) identified in the first interviews were: (1) helping to organize the care of the patient at home; (2) unspecific demands, with unclear or unrealistic purposes (e.g., curative treatment or a miracle expected to occur); (3) specific resources (such as formal caregivers to replace them), and (4) a place to leave the patient either for a temporary period (a respite for the family) or in a permanent way. The main issues discussed were the delays in the patients' referral to the hospice and the lack of time for long-term interventions; explicit focus is placed on the care by addressing the spiritual and emotional needs of caregivers, unlike in hospital settings where professionals avoid discussions of spiritual needs due to a lack of time, inadequate training and poor understanding of spirituality; hospices' interventions are based upon an ethos similar to the movement's original Christian spirit with emphasis placed on qualities of care such as love, charity, and compassion besides expertise and end-of-life competence, all while tolerating a sense of abandonment by health and social security systems following the patient's referral.

Morir en casa: el cuidado en el hogar en el final de la vida

Contenido: Contexto demográfico y epidemiológico. Algunas características demográficas y epidemiológicas de la Argentina. El final de la vida. Nociones sobre el cuidado. El cuidado en el final de la vida. Los cuidados paliativos en el domicilio: la experiencia argentina. El mundo del enfermo. El mundo del cuidador. Nuestro trabajo de campo. Los cuidados paliativos y las ONG: la experiencia de Pallium Latinoamérica

[Caregivers of palliative care home patients]. / Perfil de cuidadores de enfermos en cuidados paliativos.

Research suggests that patients spend most of the last year of their life at home and that this is the place where they often choose to stay. Family caregiving has become an important issue of palliative care. The purposes of this study were: 1) to identify salient issues of caregiving for family members of palliative care patients and 2) to propose a classification based on different profiles of caregivers. The research was exploratory-descriptive, based on a flexible design, specifically case studies. Caregivers (n=50) were selected randomly among relatives of home. Palliative care patients attended in the Lanari Institute (University of Buenos Aires, Argentina) during 2007-2008. Qualitative data were gathered through unstructured, open ended interviews in the home setting. Quantitative data were collected with a self-completion questionnaire and were analyzed with SPSS (12.01). Three dimensions were evaluated: a) attitudes of the caregiver towards the treatments, b) perceptions of the caregivers of the needs and wishes of the patient and c) evaluation of their own role as caregiver. Four types of informal caregivers were identified: 1) satisfactory carers, based on a well-organized system of relatives and friends involved in the caring situation, 2) potentially vulnerable carers, those involved in situations apparently controlled, but with factors which could trigger a spiral of deterioration, 3) overwhelmed carers, who explicitly express difficulties in being able to achieve the daily goals for the patients' comfort and 4) isolated carers, composed by lonely wives wishing "not to bother" others.

Perfil de cuidadores de enfermos en cuidados paliativos / Caregivers of palliative care home patients

Diversos estudios coinciden en señalar que el hogar es el ámbito que pacientes y familiares prefieren para el cuidado del enfermo terminal y donde transcurre la mayor parte del último año de vida. Los cuidadores informales se han convertido en un importante componente de los cuidados paliativos. Los objetivos de este estudio fueron: 1) identificar y describir aspectos relevantes relativos a las tareas del cuidado de pacientes con enfermedades terminales en el hogar, desde la perspectiva de los propios cuidadores y 2) proponer una clasificación de los diferentes tipos de cuidados provistos, elaborando perfiles de cuidadores. Se realizó una investigación cualitativa mediante un cuestionario auto-administrado, con un diseño flexible de alcance exploratorio-descriptivo que incorporó técnicas cuantitativas para medir determinados aspectos analizados con el paquete estadístico SPSS (12.01). La unidad de análisis estuvo constituida por 50 cuidadores de pacientes con enfermedades terminales atendidos en el Servicio de Cuidados Paliativos del Instituto de Investigaciones Médicas A. Lanari (Ciudad de Buenos Aires) durante los años 2007 y 2008. Tres aspectos fueron evaluados: a) el cuidado cotidiano del paciente, b) las percepciones sobre los deseos del enfermo y c) las reflexiones sobre el propio papel del cuidador. Fueron identificados cuatro perfiles de cuidadores: 1) los satisfechos con la provisión de la atención dada, con soporte en una red organizada de amigos y familiares involucrados, 2) los potencialmente vulnerables, con aparente control de la situación pero con factores de riesgo de deterioro, 3) los que se sentían desbordados en estas tareas y que explícitamente expresaban las dificultades de cuidar y 4) los aislados en su rol, compuesto por esposas solas que preferían no molestar ni pedir ayuda.

Research suggests that patients spend most of the last year of their life at home and that this is the place where they often choose to stay. Family caregiving has become an important issue of palliative care. The purposes of this study were: 1) to identify salient issues of caregiving for family members of palliative care patients and 2) to propose a classification based on different profiles of caregivers. The research was exploratory-descriptive, based on a flexible design, specifically case studies. Caregivers (n=50) were selected randomly among relatives of home. Palliative care patients attended in the Lanari Institute (University of Buenos Aires, Argentina) during 2007-2008. Qualitative data were gathered through unstructured, open ended interviews in the home setting. Quantitative data were collected with a self-completion questionnaire and were analyzed with SPSS (12.01). Three dimensions were evaluated: a) attitudes of the caregiver towards the treatments, b) perceptions of the caregivers of the needs and wishes of the patient and c) evaluation of their own role as caregiver. Four types of informal caregivers were identified: 1) satisfactory carers, based on a well-organized system of relatives and friends involved in the caring situation, 2) potentially vulnerable carers, those involved in situations apparently controlled, but with factors which could trigger a spiral of deterioration, 3) overwhelmed carers, who explicitly express difficulties in being able to achieve the daily goals for the patients´ comfort and 4) isolated carers, composed by lonely wives wishing "not to bother" others.

[Nonconventional therapies in cancer]. / Medicinas no convencionales en cáncer.

This paper describes the therapeutic complementation carried out by cancer patients, assisted at 4 hospitals of Buenos Aires City. The authors propose to classify non conventional medicines, taking into account the sociocultural and historical context of Argentina. These categories discriminate among complementary/alternative medicines (CAM), self-treatment, traditional medicines (TM), and religious healing. The unit of analyses was a sample of 200 patients. The information was collected in semi-structured and open interviews. Results show that 90% of patients consult other medicines, at least once. CAM: 72%, self-treatment: 97%, TM: 22%, religious healing 42%. Fourty four percent of patients with progressive tumor and long duration sickness consulted two or more medicines, while only 20% of patients with primary and located cancer consulted two or more medicines. The familiarization with traditional medicines is associated to the preference for traditional healers; it increases from 22 to 55% of the immigrants and patients from inside Argentina and neighboring countries. Taking into account religious identity, it was noted that pentecostals and evangelists without exception consulted their own therapeutic rituals and rejected traditional medicine. Among catholics, 75% prefer their own religious offering and 25% other religious practices, and do not reject traditional medicines because of religious factors. There were no differences in gender or age.

Medicinas no convencionales en cáncer. / [Nonconventional therapies in cancer]

This paper describes the therapeutic complementation carried out by cancer patients, assisted at 4 hospitals of Buenos Aires City. The authors propose to classify non conventional medicines, taking into account the sociocultural and historical context of Argentina. These categories discriminate among complementary/alternative medicines (CAM), self-treatment, traditional medicines (TM), and religious healing. The unit of analyses was a sample of 200 patients. The information was collected in semi-structured and open interviews. Results show that 90

of patients consult other medicines, at least once. CAM: 72

, self-treatment: 97

, TM: 22

, religious healing 42

. Fourty four percent of patients with progressive tumor and long duration sickness consulted two or more medicines, while only 20

of patients with primary and located cancer consulted two or more medicines. The familiarization with traditional medicines is associated to the preference for traditional healers; it increases from 22 to 55

of the immigrants and patients from inside Argentina and neighboring countries. Taking into account religious identity, it was noted that pentecostals and evangelists without exception consulted their own therapeutic rituals and rejected traditional medicine. Among catholics, 75

prefer their own religious offering and 25

other religious practices, and do not reject traditional medicines because of religious factors. There were no differences in gender or age.