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2.
Cult Med Psychiatry ; 43(4): 686-709, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31729691

RESUMO

Drawing on a historical ethnography conducted in Southern Brazil, this article explores how public health programs for adolescent reproductive and mental health have emerged in Brazil and begun to intersect with the growing field of "global mental health" (GMH). The story I recount begins not in the 2010s with the rapid rise of expert interest in adolescent health within GMH, but in the 1990s, the decade when young teens in Brazil were first coming into contact with practices and approaches in research, schools and clinics that have both underpinned and critiqued the production of an adolescent mental and reproductive health sub-field. In parsing what young women's encounters with the then newly-emerging questionnaires, measurement tools, school-based programs and clinical practices came to mean to them, I use a genealogical approach to consider how histories of education reform, population control, psychoanalysis, social medicine, the transition to democracy, feminism and grass-roots politics all entered the fold, shaping the way adolescent sex-and-psyche materialized as a contested object of expertise. I end by exploring what this case can teach global mental health advocates and social theorists about practices of critique.

3.
Med Anthropol ; 37(1): 75-90, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28453300

RESUMO

Research linking teen motherhood to psychoneurodevelopmental causes and pathologies has proliferated in the past two decades. In Brazil, a psychodevelopmental project of teen motherhood has gained traction despite many experts' long-standing commitment to psychodynamic psychiatry and social epidemiology, generating epistemic tension rather than substitution. Drawing on historical ethnography conducted in Southern Brazil, I explore how this project materialized through the co-production of epistemic struggles, remedial interventions, and ontological politics. In showing how this co-production became interwoven with incremental changes in young women's emotions, sexualities, relationships, and bodies, I describe how one particular "kind" of teen motherhood emerged and became entangled with both psychiatric knowledge-production and the angst of working-class political agency. In giving women a contested psychiatric language with which to rework their social-moral worlds, I argue that science did more than conceptualize teen childbearing in pathological terms; it contributed to its troubled transformation.


Assuntos
Mães/psicologia , Gravidez na Adolescência , Psicologia do Adolescente , Sexualidade , Adolescente , Antropologia Médica , Brasil/etnologia , Feminino , Humanos , Gravidez , Gravidez na Adolescência/etnologia , Gravidez na Adolescência/psicologia , Psiquiatria , Sexualidade/etnologia , Sexualidade/psicologia
5.
Crit Public Health ; 27(2): 163-176, 2017 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-28392630

RESUMO

The MMR - maternal mortality ratio - has risen from obscurity to become a major global health indicator, even appearing as an indicator of progress towards the global Sustainable Development Goals. This has happened despite intractable challenges relating to the measurement of maternal mortality. Even after three decades of measurement innovation, maternal mortality data are widely presumed to be of poor quality, or, as one leading measurement expert has put it, 'guilty until proven innocent'. This paper explores how and why leading epidemiologists, demographers and statisticians have devoted the better part of the last three decades to producing ever more sophisticated and expensive surveys and mathematical models of globally comparable MMR estimates. The development of better metrics is publicly justified by the need to know which interventions save lives and at what cost. We show, however, that measurement experts' work has also been driven by the need to secure political priority for safe motherhood and by donors' need to justify and monitor the results of investment flows. We explore the many effects and consequences of this measurement work, including the eclipsing of attention to strengthening much-needed national health information systems. We analyse this measurement work in relation to broader political and economic changes affecting the global health field, not least the incursion of neoliberal, business-oriented donors such as the World Bank and the Bill and Melinda Gates Foundation whose institutional structures have introduced new forms of administrative oversight and accountability that depend on indicators.

6.
Health Policy Plan ; 31(8): 992-1000, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27106911

RESUMO

A decade ago, the Partnership for Maternal, Newborn and Child Health (PMNCH) was established to combat the growing fragmentation of global health action into uncoordinated, issue-specific efforts. Inspired by dominant global public-private partnerships for health, the PMNCH brought together previously competing advocacy coalitions for safe motherhood and child survival and attracted support from major donors, foundations and professional bodies. Today, its founders highlight its achievements in generating priority for 'MNCH', encouraging integrated health systems thinking and demonstrating the value of collaboration in global health endeavours. Against this dominant discourse on the success of the PMNCH, this article shows that rhetoric in support of partnership and integration often masks continued structural drivers and political dynamics that bias the global health field towards vertical goals. Drawing on ethnographic research, this article examines the Safe Motherhood Initiative's evolution into the PMNCH as a response to the competitive forces shaping the current global health field. Despite many successes, the PMNCH has struggled to resolve historically entrenched programmatic and ideological divisions between the maternal and child health advocacy coalitions. For the Safe Motherhood Initiative, the cost of operating within an extremely competitive policy arena has involved a partial renouncement of ambitions to broader social transformations in favour of narrower, but feasible and 'sellable' interventions. A widespread perception that maternal health remains subordinated to child health even within the Partnership has elicited self-protective responses from the safe motherhood contingent. Ironically, however, such responses may accentuate the kind of fragmentation to global health governance, financing and policy solutions that the Partnership was intended to challenge. The article contributes to the emerging critical ethnographic literature on global health initiatives by highlighting how integration may only be possible with a more radical conceptualization of global health governance.


Assuntos
Serviços de Saúde da Criança/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Serviços de Saúde Materna/organização & administração , Parcerias Público-Privadas/organização & administração , Antropologia Cultural , Pré-Escolar , Países em Desenvolvimento , Feminino , Saúde Global , Prioridades em Saúde , Humanos , Lactente , Recém-Nascido , Política , Gravidez
8.
Soc Sci Med ; 143: 320-8, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25533870

RESUMO

In the late 1990s researchers in Pelotas Southern Brazil began documenting what they considered to be unacceptably high rates of licensed psychotropic use among individuals of all ages, including youth. This came as a surprise, since the vast majority of psychiatrists in Pelotas draw on psychoanalytic theory and approach pharmaceutical use, especially for children and adolescents, in a consciously tempered way. Drawing from a longitudinal ethnographic sub-study, part of a larger 1982 birth cohort study, this paper follows the circuitous trajectories of emergent pharma-patterns among "shantytown" youth over a ten-year period, exploring the thickly layered and often moralized contingencies in which psychodynamic psychiatrists' intention to resist excessive pharmaceuticalization both succeed and crumble. I juxtapose these trajectories with the growing salience of an "anti-biologizing" explanatory framework that psychiatrists and researchers are using to pre-empt the kind of diagnostics-driven "biopsychiatrization" so prevalent in North America. My analysis suggests that psychiatrists' use of this framework ironically contributes to their failed attempts to "resist" pharmaceuticalization.


Assuntos
Medicalização/tendências , Padrões de Prática Médica , Psicologia do Adolescente , Psicotrópicos/uso terapêutico , Adolescente , Antropologia Cultural , Biologia , Brasil , Humanos , Prescrição Inadequada/tendências , Estudos Longitudinais , Pobreza , Estudos Prospectivos , Psiquiatria/tendências , Adulto Jovem
9.
Med Anthropol Q ; 28(2): 260-79, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24599672

RESUMO

Based on an ethnography of the international Safe Motherhood Initiative (SMI), this article charts the rise of evidence-based advocacy (EBA), a term global-level maternal health advocates have used to indicate the use of scientific evidence to bolster the SMI's authority in the global health arena. EBA represents a shift in the SMI's priorities and tactics over the past two decades, from a call to promote poor women's health on the grounds of feminism and social justice (entailing broad-scale action) to the enumeration of much more narrowly defined practices to avert maternal deaths whose outcomes and cost effectiveness can be measured and evaluated. Though linked to the growth of an audit- and business-oriented ethos, we draw from anthropological theory of global forms to argue that EBA-or "playing the numbers game"-profoundly affects nearly every facet of evidence production, bringing about ambivalent reactions and a contested technocratic narrowing of the SMI's policy agenda.


Assuntos
Política de Saúde , Bem-Estar Materno , Defesa do Paciente , Países em Desenvolvimento , Feminino , Saúde Global , Promoção da Saúde , Humanos , Pobreza , Gravidez
10.
Cult Health Sex ; 13(2): 201-15, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20972914

RESUMO

In Brazil, as in many other countries, teenage pregnancy is widely recognised as a public health problem. Buttressed by a public health science of the economics of teenage pregnancy that emphasises the postponement of parenthood as key to poverty reduction, young people's lack of appreciation for medical knowledge of contraceptives is most often credited for failed attempts to reduce teenage pregnancy. Based on a longitudinal ethnographic study conducted in Pelotas, Brazil, with young people over the course of 10 years, our study found that young women who became teenage parents did not lack medical knowledge but were, rather, highly medicalised. Not only were they intensely concerned with the ill-effects of oral contraceptives on possible future fertility, they also engaged in intricate routines of contraceptive-use as a way of testing and safeguarding their fecundity. Our analysis attends to the way these practices are shaped by the problematisation of the economics of teenage pregnancy, as well as by the gendering of cultural norms relating to the transition to adulthood. We theorise the results by considering how contraceptive medicalisation enabled some women to engage with the authority of normative society, while developing a potent off-stage critique of this authority and of what they considered to be discriminatory messages imbedded in scientific discourses on teenage pregnancy.


Assuntos
Comportamento do Adolescente/psicologia , Comportamento Contraceptivo/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Infertilidade Feminina/epidemiologia , Gravidez na Adolescência/psicologia , Adolescente , Antropologia Cultural , Brasil/epidemiologia , Estudos de Coortes , Comportamento Contraceptivo/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos , Humanos , Infertilidade Feminina/psicologia , Estudos Longitudinais , Masculino , Gravidez , Gravidez na Adolescência/prevenção & controle , Gravidez na Adolescência/estatística & dados numéricos , Pesquisa Qualitativa , Comportamento Sexual/psicologia , Adulto Jovem
11.
Br J Psychiatry ; 196(1): 18-25, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20044654

RESUMO

BACKGROUND: Little is known about the impact of life-threatening obstetric complications ('near miss') on women's mental health in low- and middle-income countries. AIMS: To examine the relationships between near miss and postpartum psychological distress in the Republic of Benin. METHOD: One-year prospective cohort using epidemiological and ethnographic techniques in a population of women delivering at health facilities. RESULTS: In total 694 women contributed to the study. Except when associated with perinatal death, near-miss events were not associated with greater risk of psychological distress in the 12 months postpartum compared with uncomplicated childbirth. Much of the direct effect of near miss with perinatal death on increased risk of psychological distress was shown to be mediated through wider consequences of traumatic childbirth. CONCLUSIONS: A live baby protects near-miss women from increased vulnerability by giving a positive element in their lives that helps them cope and reduces their risk of psychological distress. Near-miss women with perinatal death should be targeted early postpartum to prevent or treat the development of depressive symptoms.


Assuntos
Complicações do Trabalho de Parto/psicologia , Complicações na Gravidez/psicologia , Maus-Tratos Conjugais/psicologia , Saúde da Mulher , Adolescente , Adulto , Benin/epidemiologia , Feminino , Humanos , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/etnologia , Gravidez , Complicações na Gravidez/economia , Estudos Prospectivos , Fatores de Risco , Estresse Psicológico/economia , Estresse Psicológico/psicologia , Adulto Jovem
12.
Med Anthropol Q ; 23(4): 455-82, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20092054

RESUMO

The world-wide emergence of categories for diagnosing mental health problems in children and youth such as conduct disorder is often attributed to the globalization of a highly biomedical form of psychiatry. In Brazil, a small group of therapists are resisting biomedicalization by keeping psychodynamic traditions alive and aiming to transform psychotherapy into a resource for politicized youth empowerment. Nevertheless, clinical practices demonstrate an increased use of biomedical diagnoses and therapeutic routines. On the basis of fieldwork with therapists and teachers, and a nine-year-long ethnography of young people, this article explores the localized effects of these potentially contradictory developments. Results show that the growth of biomedical practices alongside politicized therapeutic approaches is not indicative of underlying ambiguities but has, rather, emerged from the purposefully equivocal nature of Brazilian social, medical, and professional life. The article uses this Brazilian case study to critically debate theories of medicalization in the anthropology of psychiatry.


Assuntos
Transtorno da Conduta/diagnóstico , Política , Psiquiatria/normas , Adolescente , Antropologia , Brasil , Criança , Feminino , Humanos , Masculino , Psiquiatria/tendências , Classe Social
13.
Rev. saúde pública ; 42(supl.2): 115-124, dez. 2008.
Artigo em Inglês, Português | LILACS | ID: lil-502519

RESUMO

OBJETIVO: Embora a relação entre Epidemiologia e Antropologia tenha uma longa história, geralmente, ela tem sido compreendida por meio da integração dos métodos quantitativos e qualitativos em pesquisa. Recentemente, esses dois campos têm convergido para linhas conceituais e teóricas, enfatizando mais a explicação do que a simples descrição dos fenômenos investigados. O objetivo do estudo foi mostrar como a análise de dados etnográficos auxilia na interpretação aprofundada e teórica de dados epidemiológicos. MÉTODOS: As análises antropológicas do artigo foram obtidas usando métodos etnográficos, de 1997 a 2007, de uma amostra pertencente ao estudo de coorte de nascimento de 1982 em Pelotas (RS). As análises etnográficas foram estruturadas de acordo com os resultados de dois artigos epidemiológicos sobre os determinantes de morbidade mental e da idade de iniciação sexual. RESULTADOS E CONCLUSÕES: As análises etnográficas indicam diversos caminhos de influência e causalidade presentes nas associações estatísticas e que correspondem a experiências únicas de grupos específicos...


OBJECTIVE: Although the relationship between epidemiology and anthropology has a long history, it has generally been comprised of the integration of quantitative and qualitative methods. Only recently have the two fields begun to converge along theoretical lines, leading to a growing mutual interest in explaining rather than simply describing phenomena. This paper aimed to illustrate how ethnographic analyses can be used to assist with the in-depth and theoretically-imbued interpretation of epidemiological results. METHODS: The anthropological analysis presented in this paper used ethnographic data collected as part of the ongoing 1982 birth cohort study, between 1997 and 2007 in Pelotas, Southern Brazil. Analyses were framed according to the results presented in two of the epidemiological articles published in this series on the determinants of mental morbidity and age of sexual initiation. RESULTS AND CONCLUSIONS: The ethnographic results show that statistical associations consist of multiple pathways of influence and causality that generally correspond to the unique experiences of specific subgroups...


OBJETIVO: A pesar de que la relación entre Epidemiología y Antropología tiene una larga historia, generalmente, ella ha sido comprendida por medio de la integración de los métodos cuantitativos y cualitativos en investigación. Recientemente, esos dos campos han convergido en líneas conceptuales y teóricas, enfatizando más la explicación que la simple descripción de los fenómenos investigados. El objetivo del estudio fue mostrar como el análisis de datos etnográficos auxilia en la interpretación profunda y teórica de datos epidemiológicos. MÉTODOS: Los análisis antropológicos del artículo fueron obtenidos usando métodos etnográficos, de 1997 a 2007, de una muestra perteneciente al estudio de cohorte de nacimientos de 1982 en Pelotas (Sur de Brasil). Los análisis etnográficos fueron estructurados de acuerdo con los resultados de dos artículos epidemiológicos sobre las determinantes de morbilidad mental y de la edad de iniciación sexual. RESULTADOS Y CONCLUSIONES: Los análisis etnográficos indican diversos caminos de influencia y causalidad presentes en las asociaciones estadísticas y que corresponden a experiencias únicas de grupos específicos...


Assuntos
Humanos , Adulto Jovem , Antropologia , Causalidade , Epidemiologia , Brasil/epidemiologia , Estudos de Coortes , Conhecimentos, Atitudes e Prática em Saúde , Comunicação Interdisciplinar , Saúde Pública , Classe Social , Sexualidade/psicologia , Violência , Adulto Jovem/psicologia
14.
Rev. saúde pública ; 42(supl.2): 34-41, dez. 2008. graf, tab
Artigo em Inglês, Português | LILACS | ID: lil-502122

RESUMO

OBJETIVO: Analisar determinantes sociais da iniciação sexual precoce de jovens pertencentes a uma coorte de nascimentos. MÉTODOS: Foram entrevistados em 2004-5 os indivíduos da coorte de nascimentos de Pelotas (RS), em 1982 (N=4.297). A iniciação sexual precoce (<13 anos) foi o desfecho. Análises descritivas e estratificadas foram realizadas segundo o sexo. As variáveis analisadas foram renda familiar em 1982, cor da pele, escolaridade do jovem e mudança de renda (1982-2004-5). Usaram-se dados etnográficos para complementar a análise dos resultados. RESULTADOS: A prevalência de iniciação sexual precoce foi maior para homens com cor da pele preta/parda, baixa escolaridade, renda familiar baixa em 1982 e em 2004-5. As exigências para que os papéis sexuais masculinos mais tradicionais (virilidade, iniciativa sexual) mostraram ter maior repercussão e adesão desde cedo no grupo dos homens. Jovens mulheres de família com maior renda e de maior escolaridade tenderam a postergar a iniciação sexual...


OBJECTIVE: To analyze social determinants of early sexual initiation among young adults from a birth cohort. METHODS: Individuals from the 1982 birth cohort (N=4,297) were interviewed in 2004-5, city of Pelotas, Southern Brazil. Early sexual initiation (<13 years of age) was the outcome. Descriptive and stratified analyses were performed according to sex. Variables analyzed were family income in 1982, ethnicity, young adult's level of education and change in income (between 1982 and 2004-5). Ethnographic data were used to complement result analysis. RESULTS: Prevalence of early sexual initiation was higher among black and mixed men, and those with low level of education and low family income in 1982 and 2004-5. More traditional male sexual role requirements, such as virility and sexual initiative, showed more repercussion and adherence from an early age among men. Young family women with higher income and level of education tended to delay their sexual initiation...


OBJETIVO: Analizar las determinantes sociales de la iniciación sexual precoz de jóvenes pertenecientes a una cohorte de nacimientos. MÉTODOS: Fueron entrevistados en 2004-5 los individuos de la cohorte de nacimientos de Pelotas (Sur de Brasil), en 1982 (N= 4.297). La iniciación sexual precoz (<13 anos) fue el desenlace. Análisis descriptivos y estratificados fueron realizados según el sexo. Las variables analizadas fueron renta familiar en 1982, color de la piel, escolaridad del joven y mudanza de renta (1982-2004-5). Se usaron datos etnográficos para complementar el análisis de los resultados. RESULTADOS: La prevalencia de iniciación sexual precoz fue mayor en hombres con color de piel negra/parda, baja escolaridad, renta familiar baja en 1982 y en 2004-5. Las exigencias para los papeles sexuales masculinos más tradicionales (virilidad, iniciativa sexual) mostraron tener mayor repercusión y adhesión desde temprano en el grupo de hombres. Jóvenes mujeres de familia con mayor renta y de mayor escolaridad tendieron a postergar la iniciación sexual...


Assuntos
Feminino , Humanos , Masculino , Adulto Jovem , Atitude Frente a Saúde , Coito/fisiologia , Fatores Etários , Brasil , Estudos de Coortes , Coito/psicologia , Escolaridade , Identidade de Gênero , Renda , Distribuição por Sexo , Fatores Sexuais , Sexualidade , Comportamento Sexual/estatística & dados numéricos , Adulto Jovem
15.
Am J Public Health ; 98(4): 644-9, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18309123

RESUMO

Using the international maternal health field as a case study, we draw on ethnographic research to investigate how public health researchers and policy experts are responding to tensions between vertical and horizontal approaches to health improvement. Despite nominal support for an integrative health system approach, we found that competition for funds and international recognition pushes professionals toward vertical initiatives. We also highlight how research practices contribute to the dominance of vertical strategies and limit the success of evidence-based policymaking for strengthening health systems. Rather than support disease-and subfield-specific advocacy, the public health community urgently needs to engage in open dialogue regarding the international, academic, and donor-driven forces that drive professionals toward an exclusive interest in vertical programs.


Assuntos
Medicina Baseada em Evidências , Política de Saúde , Cooperação Internacional , Bem-Estar Materno , Saúde Pública , Antropologia Cultural , Feminino , Humanos , Entrevistas como Assunto , Modelos Teóricos , Gravidez
16.
Sociol Health Illn ; 30(4): 489-510, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18298632

RESUMO

This paper explores the social and institutional processes that constrain and enable obstetric patients in Benin to critically evaluate quality of healthcare and to stimulate positive changes in the health system. Based on qualitative data collected as part of a hospital auditing system, the paper analyses semi-structured patient feedback interviews and their function as a primary mechanism through which critical patient evaluation can develop constructively. Using a Bourdieuan framework, we explore the dynamic social conditions that give rise to transformative agency and institutional change. Our results show that hospitals are often permeated with the habitus of employment, kinship and reproductive social fields, through which a number of social, economic and healthcare conflicts, power struggles and blame-inducing interactions emerge. These conflicts generally serve to keep patients quiescent and passive when it comes to developing critical statements of quality of care. In a subset of cases, however, these conflicts are transformed by patients and their family members into opportunities for modifying the values and practices of each habitus in new and creative ways. The active negotiation of social conflict and blame enabled a minority of patients actively to divert blame from themselves and to develop and maintain critical healthcare evaluations.


Assuntos
Unidade Hospitalar de Ginecologia e Obstetrícia/normas , Satisfação do Paciente , Qualidade da Assistência à Saúde , Bode Expiatório , Benin , Entrevistas como Assunto , Auditoria Médica
17.
Rev Saude Publica ; 42 Suppl 2: 34-41, 2008 Dec.
Artigo em Inglês, Português | MEDLINE | ID: mdl-19142343

RESUMO

OBJECTIVE: To analyze social determinants of early sexual initiation among young adults from a birth cohort. METHODS: Individuals from the 1982 birth cohort (N=4,297) were interviewed in 2004-5, city of Pelotas, Southern Brazil. Early sexual initiation (<13 years of age) was the outcome. Descriptive and stratified analyses were performed according to sex. Variables analyzed were family income in 1982, ethnicity, young adult's level of education and change in income (between 1982 and 2004-5). Ethnographic data were used to complement result analysis. RESULTS: Prevalence of early sexual initiation was higher among black and mixed men, and those with low level of education and low family income in 1982 and 2004-5. More traditional male sexual role requirements, such as virility and sexual initiative, showed more repercussion and adherence from an early age among men. Young family women with higher income and level of education tended to delay their sexual initiation. Imposition of traditional values was found to influence early sexual initiation among men and women with lower level of education and income. CONCLUSIONS: Results found re-established the economic factor as a determinant of behavior or uses of sexuality for both sexes. To focus on political efforts that help the economically disadvantaged to have opportunities and egalitarian future perspectives is an important strategy for health outcomes.


Assuntos
Atitude Frente a Saúde , Coito/fisiologia , Fatores Etários , Brasil , Estudos de Coortes , Coito/psicologia , Escolaridade , Feminino , Identidade de Gênero , Humanos , Renda , Masculino , Distribuição por Sexo , Fatores Sexuais , Comportamento Sexual/estatística & dados numéricos , Sexualidade , Adulto Jovem
18.
Rev Saude Publica ; 42 Suppl 2: 115-23, 2008 Dec.
Artigo em Inglês, Português | MEDLINE | ID: mdl-19142353

RESUMO

OBJECTIVE: Although the relationship between epidemiology and anthropology has a long history, it has generally been comprised of the integration of quantitative and qualitative methods. Only recently have the two fields begun to converge along theoretical lines, leading to a growing mutual interest in explaining rather than simply describing phenomena. This paper aimed to illustrate how ethnographic analyses can be used to assist with the in-depth and theoretically-imbued interpretation of epidemiological results. METHODS: The anthropological analysis presented in this paper used ethnographic data collected as part of the ongoing 1982 birth cohort study, between 1997 and 2007 in Pelotas, Southern Brazil. Analyses were framed according to the results presented in two of the epidemiological articles published in this series on the determinants of mental morbidity and age of sexual initiation. RESULTS AND CONCLUSIONS: The ethnographic results show that statistical associations consist of multiple pathways of influence and causality that generally correspond to the unique experiences of specific subgroups. In exploring these pathways, the paper highlights the importance of an additional set of mediating factors that account for epidemiological results; these include the awareness and experience of inequities, the role of violence in everyday life, traumatic life events, increasing social isolation and emotional introversion as a response to life's difficulties, and differing approaches towards socio-psychological maturation. Theoretical and methodological collaboration between anthropology and epidemiology is important for public health, as it has positively modified both fields.


Assuntos
Antropologia , Causalidade , Epidemiologia , Brasil/epidemiologia , Estudos de Coortes , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Comunicação Interdisciplinar , Saúde Pública , Sexualidade/psicologia , Classe Social , Violência , Adulto Jovem/psicologia
19.
Cad Saude Publica ; 19(5): 1241-56, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-14666206

RESUMO

Given the growing recognition of the importance of the life course approach for the determination of chronic diseases, birth cohort studies are becoming increasingly important. This paper describes the methods used in the 1982 Pelotas (Brazil) birth cohort study, one of the largest and longest studies of this type in developing countries. All 5,914 hospital births occurring in Pelotas in 1982 (over 99% of all deliveries) were studied prospectively. The main stages of the study took place in 1983, 1984, 1986, 1995, 1997, 2000, and 2001. More than two thousand variables are available for each subject who participated in all stages of the study. Recent phases of the study included the examination of 2,250 males when presenting for the army recruitment exam in 2000, the study of a 27% sample of men and women in 2001 through household visits, and the study of over 400 children born to the cohort women. Follow-up rates in the recent stages of the cohort were 78.9% for the army examination and 69.0% for the household visits. Ethnographic and oral health studies were conducted in sub-samples. Some recent results on blood pressure, adolescent pregnancy, and asthma are presented as examples of utilization of the data. Suggestions on lessons learned for other cohort studies are proposed.


Assuntos
Doença Crônica/epidemiologia , Estudos de Coortes , Adolescente , Adulto , Brasil/epidemiologia , Criança , Pré-Escolar , Países em Desenvolvimento , Fatores Epidemiológicos , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Estudos Prospectivos , Fatores Socioeconômicos , População Urbana
20.
Cad. saúde pública ; 19(5): 1241-1256, set.-out. 2003. ilus, graf
Artigo em Inglês | LILACS | ID: lil-349764

RESUMO

Given the growing recognition of the importance of the life course approach for the determination of chronic diseases, birth cohort studies are becoming increasingly important. This paper describes the methods used in the 1982 Pelotas (Brazil) birth cohort study, one of the largest and longest studies of this type in developing countries. All 5,914 hospital births occurring in Pelotas in 1982 (over 99 percent of all deliveries) were studied prospectively. The main stages of the study took place in 1983, 1984, 1986, 1995, 1997, 2000, and 2001. More than two thousand variables are available for each subject who participated in all stages of the study. Recent phases of the study included the examination of 2,250 males when presenting for the army recruitment exam in 2000, the study of a 27 percent sample of men and women in 2001 through household visits, and the study of over 400 children born to the cohort women. Follow-up rates in the recent stages of the cohort were 78.9 percent for the army examination and 69.0 percent for the household visits. Ethnographic and oral health studies were conducted in sub-samples. Some recent results on blood pressure, adolescent pregnancy, and asthma are presented as examples of utilization of the data. Suggestions on lessons learned for other cohort studies are proposed


Assuntos
Bem-Estar da Criança , Estágios do Ciclo de Vida , Estudos de Coortes , Indicadores Básicos de Saúde
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