Body care of older people in different institutionalized settings: A systematic mapping review of international nursing research from a Scandinavian perspective.

Body care is considered a key aspect of nursing and imperative for the health, wellbeing, and dignity of older people. In Scandinavian countries, body care as a professional practice has undergone considerable changes, bringing new understandings, values, and dilemmas into nursing. A systematic mapping review was conducted with the aims of identifying and mapping international nursing research on body care of older people in different institutionalized settings in the healthcare system and to critically discuss the dominant assumptions within the research by adapting a problematization approach. Most identified papers reported on empirical research with a biomedical approach focusing on outcome and effectiveness. Conceptual papers, papers with a focus on the perspectives of the older people, or contextual and material aspects were lacking. The research field is dominated by four dominant assumptions: Body care as an evidence-based practice, body care as a relational ethical practice, the body as a body-object and a body-subject, the objects in the body care practices as nonrelational materialities. Given the complexities of professional body care practices, there is a need for other research designs and theoretical perspectives within nursing that expand our understanding of body care taking into consideration the multiple social and material realities.

Implantação curricular para curso de Medicina: superando desafios / Curriculum implementation for Medicine course: overcoming challenges

Resumo: Introdução: A Lei nº 12.871/2013, também conhecida como Lei do Mais Médicos, buscou, entre outras ações, reordenar a oferta de cursos de Medicina, priorizando regiões de saúde com menor relação de vagas e médicos por habitante e com estrutura de serviços de saúde, além de estabelecer novos parâmetros para a formação médica no país. Por sua vez, as Diretrizes Curriculares Nacionais (DCN) dos cursos de graduação em Medicina foram criadas para a organização, o desenvolvimento e a avaliação desses cursos no âmbito dos sistemas de ensino superior do país. As DCN decorrem de um longo processo de diagnóstico e propostas de intervenção nos cursos de Medicina desde os anos 1990, iniciado com o Projeto da Comissão Interinstitucional Nacional de Avaliação do Ensino Médico (Cinaem), mediante a observação de muitas experiências, nacionais e internacionais, que implementaram mudanças curriculares. Relato de experiência: Este trabalho tem como objetivo apresentar o processo de construção e implementação de um currículo orientado por competências, correlacionando, nesse processo, as metodologias de ensino aprendizagem e o modelo curricular. Discussão: Foram ofertadas oficinas de desenvolvimento docente com foco nas metodologias ativas de ensino-aprendizagem por meio de um movimento organizado entre os docentes, contemplando o aprendizado baseado em problemas, o aprendizado baseado em equipes, a preleção dialogada, a simulação realística e a problematização. Também se abordou, em módulos específicos, a avaliação do processo, do desempenho do estudante e da instituição. Conclusão: A implantação desse modelo curricular tornou-se um marco de mudanças na instituição, pois envolveu gestão educacional, infraestrutura e implementação no curso de Medicina, de modo a beneficiar a escola como um todo. A possibilidade de criação de cenários de ensino para além dos espaços das IES proporcionou maior conhecimento da realidade, abriu espaço para novos projetos destinados à comunidade e estimulou o intercâmbio entre o ensino, o serviço e a comunidade.

Abstract: Introduction: One of the aims of Law 12.871/2013, also known as the Mais Médicos (More Doctors) Law, was the implementation of actions to reorganize the provision of Medicine courses. These actions would prioritize health regions with a lower ratio of vacancies and doctors per inhabitant and with a health service structure, and establish new parameters for medical training in Brazil. In turn, the National Curriculum Guidelines (DCNs) for Undergraduate Medicine Courses were created for the organization, development, and evaluation of these courses within the scope of the country's higher education systems. The DCNs are the result of a long process of diagnosis and proposals for intervention in Medicine courses since the 1990s, which began with the CINAEM Project (National Interinstitutional Commission for the Evaluation of Medical Education), through the observation of many domestic and international experiences of curricular change implementations. Experience report: This work aims to present the process of construction and implementation of a competency-oriented curriculum, correlating, in this process, the teaching-learning methodologies and the curriculum model. Discussion: Teacher Development Workshops were offered with a focus on active learning methodologies through an organized movement among teachers, covering problem-based learning, team-based learning, dialogued lecture, realistic simulation and problematization. In specific modules, the evaluation of the process, the performance of the student and the institution were also addressed. Final Considerations: The implementation of this curriculum model became a landmark change in the institution, involving educational management, infrastructure, and implementation in the medical course, benefiting the whole school. The possibility of creating teaching scenarios beyond the HEI spaces provided greater knowledge of reality, opening space for new projects with the community, stimulating the exchange between teaching, service and the community.

Making pandemics big: On the situational performance of Covid-19 mathematical models.

In this paper, we trace how mathematical models are made 'evidence enough' and 'useful for policy'. Working with the interview accounts of mathematical modellers and other scientists engaged in the UK Covid-19 response, we focus on two weeks in March 2020 prior to the announcement of an unprecedented national lockdown. A key thread in our analysis is how pandemics are made 'big'. We follow the work of one particular device, that of modelled 'doubling-time'. By following how modelled doubling-time entangles in its assemblage of evidence-making, we draw attention to multiple actors, including beyond models and metrics, which affect how evidence is performed in relation to the scale of epidemic and its policy response. We draw attention to: policy; Government scientific advice infrastructure; time; uncertainty; and leaps of faith. The 'bigness' of the pandemic, and its evidencing, is situated in social and affective practices, in which uncertainty and dis-ease are inseparable from calculus. This materialises modelling in policy as an 'uncomfortable science'. We argue that situational fit in-the-moment is at least as important as empirical fit when attending to what models perform in policy.

The policy implications of 'thinking problematically': problematizing Big Food's role in obesity policymaking.

Practitioners need to engage with the contested nature of public health policymaking. This study, stemming from a concern that the involvement of Big Food is not widely problematized in health promotion practice, used 'What's the Problem Represented to Be?' discourse analysis to examine how Big Food, as a discursive actor, reacted to and shaped a problem representation of childhood obesity. Analysis of Big Food documents, including Coca-Cola and Burger King, developed during the regulation of broadcast advertising to children in Ireland found that Big Food constructs the problem of childhood obesity in a way which privileges its role as policy actor; it draws on and undermines public health discourses of obesity; and it negates the impact of corporate practices on obesity and on related policymaking. An in-depth analysis of Big Food's own documents provides access to the processes of knowledge production and governing undertaken by Big Food. The study offers two tools of resistance for health promotion practitioners to interrogate and challenge Big Food-problematization as a policy tool and 'corporate influence' as a critical public health discourse.

Educação permanente na atenção secundária: elaboração de protocolo de atendimento de urgência / Permanent education in secondary care: elaboration of an emergency care protocol

Os centros de especialidades, não somente médicas, são apontados como fundamentais na retaguarda à Atenção Primária e desempenham importante papel em Redes Regionalizadas de Saúde, não só no Brasil, sendo representado pela Atenção Secundária. O processo de trabalho no SUS, para ser constituído de forma a permitir a melhor interação interprofissional, requer o exercício cotidiano da Educação Permanente em nossas Unidades de Saúde. Objetivo geral: Elaborar um procedimento operacional padrão para a organização do processo de trabalho comum grupo de funcionários que atua direta e indiretamente no ambulatório de cardiologia da atenção secundária de um município de médio porte da região serrana do estado do Rio de Janeiro. Objetivos especificos: 1.Identificar os entraves encontrados pelos trabalhadores do ambulatório de atenção secundária para o atendimento ao paciente com diminuição do nível de consciência. 2.Descrever as dificuldades no processo de trabalho quanto à necessidade da implementação da Educação Permanente 3.Propor estratégias que poderão ser vivenciadas e experimentadas através da Educação Permanente, para a solução ou enfrentamento desses entraves. Método: Trata-se de uma pesquisa qualitativa,tendo como referencial político-pedagógico a Política Nacional de Educação Permanente. O tipo de pesquisa é a análise intencional de pesquisa-ação de Thiollent (1997), referencial teórico, sendo utilizado como referencial filosófico, o educador Paulo Freire. A técnica e instrumento para coleta e análise de dados mediante grupo focal e/ou Questionário Semiestruturado, sob análise temática em Bardin e Turato (2011). O projeto foi aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Medicina da Universidade Federal Fluminense sob nº 4.428.883Resultados: Os resultados apontam para melhorias no processo de trabalho cotidiano, calcado em premissas da Educação Permanente como uma prática transformadora. Propõe uma reflexão sobre a prática individual do profissional e, mais do que sua interação multiprofissional no processo de trabalho, apresenta uma experiência positiva originada da atuação em processo de Educação Permanente na Atenção Secundária da região serrana do estado do Rio de Janeiro. Conclusão: Esse estudo trouxe contribuições significativas para a prática, mediante elaboração de um protocolo de atendimento a pacientes com nível de consciência reduzido, em Posto de Saúde da Atenção Secundária, adequado à realidade local, produto da demanda do grupo de trabalho.

Specialty centers, not only medical, are seen as fundamental in the rear of Primary Care, and play an important role in Regionalized Health Networks, not only in Brazil, being represented by Secondary Care. The work process in the SUS, to be constituted in a way that allows the best interprofessional interaction, requires the daily exercise of Continuing Education in our Health Units. General objective: To develop a standard operating procedure for the organization of the work process with a group of employees who work directly and indirectly in the secondary care cardiology outpatient clinic of a medium-sized city in the mountainous region of the state of Rio de Janeiro. Specific Objectives: 1. Identify the obstacles encountered by workers at the secondary care clinic for patient care with a decreased level of consciousness. 2.Describe the difficulties in the work process regarding the need to implement Continuing Education. 3.Propose strategies that can be experienced and tried out, through Continuing Education, for the solution or confrontation of these obstacles. Method: This is a qualitative research, using the National Policy for Continuing Education as a political-pedagogical framework. The type of research is the intentional analysis of action research by Thiollent (1997), theoretical framework, being used as a philosophical framework, the educator Paulo Freire. The technique and instrument for data collection and analysis through focus group and/or Semi-structured Questionnaire, under thematic analysis in Bardin and Turato (2011). The project was approved by the Research Ethics Committee of the Faculty of Medicine of Universidade Federal Fluminense under nº 4.428.883Results: The results point to improvements in the daily work process, based on premises of Continuing Education as a transforming practice. It proposes a reflection on the professional's individual practice, and more than its multidisciplinary interaction in the work process, it presents a positive experience originating from the performance in the Permanent Education process in Secondary Care in the mountainous region of the state of Rio de Janeiro. Conclusion: This study brought significant contributions to the practice, through the elaboration of a care protocol for patients with reduced level of consciousness, in a Secondary Care Health Center, adequate to the local reality, product of the demand of the work group.

Control, power, and responsibility: a qualitative study of local perspectives on problem drinking in Peruvian Andean highlands.

BACKGROUND: Alcohol control has emerged as an important global health challenge due to the expanding influence of alcohol companies and limited control measures imposed by governments. In the Peruvian Andean highland, the ritual function of collective drinking is reported to have been weakened in response to the increased availability of alcohol and the experience of political violence. This study seeks to merge the broader political economy with local experience and culture to provide a deeper understanding of the dynamic between global processes and local realities. METHODS: We used purposive sampling to recruit participants. We conducted in-depth interviews (n = 28) and focus group discussions (n = 19) with community participants, teachers, health workers, alcohol vendors and police officers. Thematic analysis identified patterns of individual and collective meaning situated in relation to social, political and economic factors. RESULTS: Local perspectives and behaviour regarding loss of control over alcohol are shaped through the complex patterns of power and meaning exerted and experienced by different actors. Participants' emphasis on parents' lack of control over alcohol use by "abandoned" children reflects the structural vulnerability of some Andean families struggling with economic hardships. Participants also emphasized how alcohol consumption was tied to forms of control exerted by men in households. Participants expressed that some men demonstrated their masculine identity and symbolic power as the breadwinner through spending on alcohol. The third emphasis was tied to the market economy. Participants expressed that the expansion of the alcohol market and perceived absence of government control coupled with macroeconomic conditions, like poverty, shaped patterns of alcohol consumption. CONCLUSION: Our findings illustrate how problem drinking is shaped not simply by an individual drinker's lack of self-control but also by a regulatory environment that enables the unrestrained marketing of alcohol products and the creation of a culture of consumption. Harmful consumption is mediated by the reshaping of the Andean cultural practice of collective drinking. Attending to local perspectives is essential for policies and interventions that connect structural dynamics with the cultural and experiential aspects of alcohol consumption.

The problematization of child sexual abuse in policy and law: The Indonesian example.

BACKGROUND: Indonesia has a strong national child protection policy. Yet significant limitations exist in laws, policy implementation, and coordination of services, especially regarding child sexual abuse. This is related to a lack of knowledge about child sexual abuse in Indonesia and associated taboos that constrain policy development. OBJECTIVE: To understand how child sexual abuse problems have been represented in national child protection policy. METHOD: 'What's the problem represented to be' (Bacchi, 2009) is an analytic approach that uses discourse analysis. This method was employed to examine how child sexual abuse problems in Indonesia are constructed and represented in six government documents (two laws and four national policies). RESULTS: Three overarching problem representations of child sexual abuse were identified: (1) children are a vulnerable, at risk, and disempowered group; (2) service access is limited and services are not coordinated; and (3) there is a lack of agreement and clarity across laws and policy in child protection. For example, inconsistencies of policy and laws regarding the minimum age for marriage can result in gender discrimination and limit a child's access to justice, protection, and services. CONCLUSION: Policy discourses play a crucial role in the construction and representation of child sexual abuse problems in Indonesia. Current inconsistencies constrain the implementation of effective intervention and prevention programs. Further work on policy harmony is needed as well as improving community understanding of child sexual abuse.

The "problem" of health: An analysis of health care provision in Canada's federal prisons.

The United Nations states that prisoners should enjoy the same standards of health care that are available in the community. Despite this, persons in prison experience barriers to care and face unique health challenges. Given the ways in which prisons shape health outcomes for incarcerated persons, it is important to interrogate how the provision of health care is governed in custodial settings. In this article, we examine one important aspect of governance: legislation governing the provision of health care in prisons. We view this issue through a critical lens, building on a body of poststructural scholarship which has illuminated how laws and policies are not merely tools of governance but also key sites for the production of meanings around social "problems," including the "problem of health." Taking Canada's Corrections and Conditional Release Act as a case example and applying Carol Bacchi's "What's the Problem Represented to Be" analytical framework, we examine how the specific representation of "health" in this legislation works to produce effects for persons in federal prison. Three key themes are formed through this analysis. First, what constitutes "essential services" in the context of federal prisons is more limited compared with the broader community. Second, the dichotomy between the rights of persons in prison versus the protection of society that is produced in development of these laws has significant bearing on the treatment of those in prison. Third, this representation has negative effects on the health of persons in prison. In order to meet United Nations standards, greater attention must be paid to the ways in which laws and other governing practices reproduce inequities in health care provision in prisons.

Changing climate change: The carbon budget and the modifying-work of the IPCC.

Over the last 10 years, the concept of a global 'carbon budget' of allowable CO2 emissions has become ubiquitous in climate science and policy. Since it was brought to prominence by the Fifth Assessment Report of the IPCC, the carbon budget has changed how climate change is enacted as an issue of public concern, from determining the optimal rate of future emissions to establishing a fixed limit for how much emissions should be allowed before they must be stopped altogether. Exploring the emergence of the carbon budget concept, this article shows how the assessment process of the IPCC has offered scientific experts the means to modify how the climate issue is problematized, and discusses the implications of this 'modifying-work' for the politics of climate change. It finds that the 'modified climate issue' must be seen as an outcome of the ordinary work within established scientific and political institutions, and the agency these institutions afford scientists to enact the issue differently. On this basis, it argues that the case of the carbon budget holds important insights not only for the relationship between climate science and policy, but also for the pragmatist literature on 'issue formation' in STS.

Re-thinking the nature of day programs for people with dementia: Implications for research.

Day programs are commonly identified in dementia strategies as a solution for keeping people with dementia home for as long as possible. Limited research evidence is available to support these policy approaches, and much of what exists demonstrates equivocal results. While key day program researchers have called for improvements in methodological and theoretical efforts, we argue that basic assumptions concerning what a day program is, and how the effects of day programs should be studied, also require reconsideration. Problematization is a systematic review strategy used to identify and critique assumptions guiding research practices and knowledge development in a field of study. The approach entails a broad overview of a field of research alongside a close reading of key texts to identify prevailing assumptions about the object of study and how it can be known. The intent is to discern how these assumptions are influencing research practices and thus knowledge development. A review of historical texts and research literature reviews was used (1) to identify trends in day program research between 1990 and 2018 and (2) to support identification of influential and typical studies for closer analysis (n = 36). The outcome of our analysis of the research literature suggests three sets of assumptions that guide much of the day program research literature: dementia is mainly treated as a problem of the individual; day programs are treated as stand-alone units of substitute care; and the space of day programs is seen as a simple background to care. We argue that the assumptions regarding care and space have narrowed the field of research and contributed to the production of equivocal findings. We suggest alternative framings of notions of care and space, informed by a Science and Technology Studies' approach to care practices, to generate knowledge about day programs that can usefully inform policy and practice.

National nutrition policy in high-income countries: is health equity on the agenda?

OBJECTIVE: Equity-oriented policy actions are a key public health principle. In this study, how equity and socioeconomic inequalities are represented in policy problematizations of population nutrition were examined. DATA SOURCES: We retrieved a purposive sample of government nutrition-policy documents (n = 18) from high-income nations. DATA SYNTHESIS: Thematic analysis of policy documents was informed by a multitheoretical understanding of equitable policies and Bacchi's "What's the Problem Represented to be?' analysis framework. Despite common rhetorical concerns about the existence of health inequalities, these concerns were often overshadowed by greater emphasis on lifestyle "problems" and reductionist policy actions. The notion that policy actions should be for all and reach everyone were seldom backed by specific actions. Rhetorical acknowledgements of the upstream drivers of health inequalities were also rarely problematized, as were government responsibilities for health equity and the role of policy and governance in reducing socioeconomic inequalities in nutrition. CONCLUSION: To positively influence health equity outcomes, national nutrition policy will need to transition toward the prioritization of actions that uphold social justice and comprehensively address the upstream determinants of health.

Plantear y formular un problema de investigación: un ejercicio de razonamiento / Raise and formulate a research problem: an exercise of reasoning / Apresentar e formular um problema de pesquisa: um exercício de raciocínio

Resumen Introducción: Plantear un problema de investigación requiere aclarar la diferencia entre problema real, problemática, problematización y problema de investigación. A su vez requiere pensar el investigador como fuente del problema y de razonamiento, considerando los tres tipos de razonamiento: deductivo, inductivo y abductivo. Propone cuatro criterios para construir un problema de investigación: 1. Descripción del fenómeno 2. Descripción del desequilibrio 3. Descripción espacio-temporal 4. Descripción de los sujetos de investigación. Finalmente se considera la diferencia entre los paradigmas en la construcción de problemas de investigación.

Abstract Introduction. Raising a research problem requires clarifying the difference between real problem, problem, problematization and research problem. At the same time, it requires thinking of the researcher as the source of the problem and of reasoning, considering the three types of reasoning: deductive, inductive and abductive. It proposes four criteria to build a research problem: 1. Description of the phenomenon 2. Description of the imbalance 3. Description of the time space 4. Description of the research subjects. Finally, the difference between the paradigms in the construction of research problems is considered.

Resumo Introdução: Colocar um problema de pesquisa requer esclarecer a diferença entre problema real, problemático, problematização e problema de pesquisa. Por sua vez, o pesquisador precisa pensar como fonte do problema e do raciocínio, considerando os três tipos de raciocínio: dedutivo, indutivo e abdutivo. Ele propõe quatro critérios para construir um problema de pesquisa: 1. Descrição do fenômeno 2. Descrição do desequilíbrio 3. Descrição espaço-temporal 4. Descrição dos sujeitos da pesquisa. Por fim, considera-se a diferença entre paradigmas na construção de problemas de pesquisa.

COVID-19 HAPPENING: SO WHAT? / ACONTECIMENTO COVID-19: E DAÍ?

In the context of the new coronavirus pandemic, when Brazil exceeds the number of deaths  in China, the response of the president of the republic So what? it becomes an invitation to reflec-tion, asking us to make a decision, in the direction of building analyzes of the effects of the COVID-19 event, or adhering to the trivialization of this moment. Based on the experimental mode of thought and criticism, without the intention of encompassing the totality or the truth, this essay aims to problematize the meanings produced by the pandemic and the dimension of an ethics of responsibility before the world, which calls us to think "what are we doing" of and in the world.

No contexto da pandemia pelo novo coronavírus, quando o Brasil ultrapassa o número de mortes na China, a resposta do presidente da república E daí? torna-se um convite à reflexão, interpelando-nos a uma tomada de decisão, na direção de construir análises dos efeitos do acontecimento COVID-19, ou aderir à banalização deste momento. Pautando-se no modo experimental do pensamento e da crítica, sem a pretensão de abarcar a totalidade ou a verdade, este ensaio tem como objetivo problematizar os sentidos produzidos pela pandemia e a dimensão de uma ética da responsabilidade diante do mundo, que nos convoca a pensar "o que estamos fazendo" do e no mundo.

Dissonances and disconnects: the life and times of community based accountability in the national rural health mission in Tamilnadu, India.

BACKGROUND: There are increasing calls for developing robust processes of community-based accountability as key components of health system strengthening. However, implementation of these processes have shown mixed results over time and geography. The Community Action for Health (CAH) project was introduced as part of India's National Rural Health Mission (now National Health Mission) to strengthen community-based accountability through community monitoring and planning. In this study we trace the implementation process of this project from its piloting, implementation and abrupt termination in the South Indian state of Tamil Nadu. METHODS: We framed CAH as an innovation introduced into the health system. We use the framework on integration of innovations in complex systems developed by Atun and others. We used qualitative approaches to study the implementation. We conducted interviews among a range of individuals who were directly involved in the implementation, focusing on the policy making organizational level. RESULTS: We uncover what we have termed "dissonances" and "disconnects" at the state level among individuals with key responsibility of implementation. By dissonances we refer to the diversity of perspective on the concept of community-based accountability and its perceived role. By disconnects we refer to the lack of spaces and processes for "sense-making" in a largely hierarchically functioning system. These constructs we believe contributes significantly to making sense of the initial uptake and the subsequent abrupt termination of the project. CONCLUSIONS: This study contributes to the overall field of policy implementation, especially the phase between the emergence on the policy agenda and its incorporation into the day to day functioning of a system. It focuses on the implementation of contested interventions like community-based accountability, in Low- and Middle-income country settings undergoing transitions in governance. It highlights the importance of "problematization" a dimension not included in most currently popular frameworks to study the uptake and spread of innovations in the health system. It points not only to the importance of diverse perspectives present among individuals at different positions in the organization, but equally importantly the need for spaces and process of collective sense-making to ensure that a contested policy intervention is integrated into a complex system.

Producing the 'problem' of new psychoactive substances (NPS) in English prisons.

BACKGROUND: There has been a significant change in the types of substances consumed within English prison settings in the last eight years. There have been particular concerns regarding the acceleration in the use and availability of New Psychoactive Substances (NPS), mainly synthetic cannabinoids. Although NPS were identified as a 'problem' in prisons in 2011, government responses emerged only in 2015. As yet, there is no overarching policy document or strategy for dealing with NPS. This paper analyses the various strands of the response to NPS in prisons published from January 2015 to December 2016. METHODS: Drawing on Bacchi's 'What's the problem represented to be' framework, the ways in which the NPS 'problem' in prisons has been represented is analysed through a number of related policy texts including press releases, new legislative and regulatory measures, government documents and training package. RESULTS: From the various measures introduced to deal with the 'problem', NPS use is produced primarily as a law, order and control 'problem' requiring regulation, penalties and control, rather than a 'demand problem' calling for prevention, education, treatment and harm reduction or a 'regime problem' demanding greater emphasis and resources for purposeful activities such as education, training and work opportunities. This problematisation of drug use in prisons has a history dating back to the 1995 prison drug strategy and has become entrenched and reproduced within policy development over time. CONCLUSION: The law, order, and control problematization blames the volatility of the substances and the individual prisoners who use them as key factors contributing to the current prison crisis, rather than as consequences of the wider practices, cultures, contexts, and conditions. Multiple representations of the problem of NPS in prisons are needed in order to address the regime and structural issues which lead those imprisoned to use substances.

"No! You can't have it": Problematizing choice in institutionalized adults with intellectual disabilities.

Institutionalized adults with profound intellectual disabilities (ID) face significant challenges to having their choice-making cultivated and supported. Based on observational and interview data from an institutional ethnographic study, this article explores how choice-making during mealtimes is acknowledged and problematized by staff. First, we suggest that Foucauldian problematization offers a lens through which to better understand how mealtime intervention plans passed down over time become embodied restrictive practices. Second, we provide examples and analyses of mealtime negotiations between staff and residents. Analyses revealed staff infantilize and misrepresent residents' choice-making during meals as manipulation; additionally, analyses suggest that past experiences of staff with residents and historical meal plans color how they acknowledge and interpret residents' choices. Our argument is an attempt to move forward discussions concerning the implementation of quality habilitation services by highlighting the ways contemporary institutional systems perpetuate misrepresentations of nonverbal behaviors in adults with profound ID.

Percepção dos Estudantes de Medicina sobre o Uso da Metodologia da Problematização durante a Graduação / How Medicine Students view the Use of Problematization Methodology in Undergraduate Training

Resumo: Introdução: As Diretrizes Curriculares Nacionais (DCN) para Graduação em Medicina estabelecem que o curso deve ser centrado no aluno como sujeito da aprendizagem. Devem-se utilizar metodologias que privilegiem a participação do aluno na construção do conhecimento. O objetivo deste estudo foi compreender a percepção do aluno de Medicina acerca da metodologia da problematização na unidade Problema Integrador de Competências (PIC) da Pontifícia Universidade Católica de Goiás (PUC Goiás). Método: Trata-se de uma pesquisa transversal descritiva com abordagem qualitativa. Os dados foram coletados por meio de entrevista semiestruturada que se utilizou de um roteiro de temas previamente confeccionado. Entrevistaram-se 30 acadêmicos do primeiro ao décimo segundo módulo sobre a unidade PIC que é desenvolvida por meio da metodologia da problematização com a inserção do arco de Charles Maguerez. Para a análise dos dados, adotou-se Teoria Fundamentada nos Dados ou Grounded Theory. Resultados: Com os resultados obtidos após realização da transcrição e análise das entrevistas, foi possível criar as seguintes categorias explicativas do fenômeno investigado: pontos fortes, frágeis e melhorias; características do aluno e do professor no PIC; contribuições do PIC para formação médica. Por meio da análise das categorias explicativas, evidenciaram-se a eficiência e as contribuições da funcionalidade e aplicabilidade da metodologia da problematização na unidade do PIC. Constatou-se que os discentes que participaram desta pesquisa conseguiram desenvolver habilidades relacionadas à comunicação, pesquisa, resolutividade e proatividade, aprenderam a trabalhar em equipe e ouvir e respeitar a opinião dos colegas, tornaram-se pessoas mais críticas e entenderam a importância de enxergar o paciente de forma holística; todos aspectos imprescindíveis para a formação em Medicina. A partir da percepção dos acadêmicos de Medicina, foi possível evidenciar que a metodologia da problematização inserida no campo da formação médica ainda tem fragilidades tanto na formação do aluno quanto na atuação do professor mediador. Conclusões: Os resultados aqui apresentados poderão servir para que os cursos de Medicina que se utilizam dessa metodologia possam fomentar estratégias que visem à sua correta aplicabilidade.

Abstract: Introduction: The National Curriculum Guidelines (DCN) for undergraduate medical training establish that courses should be centered on the student as a subject of learning and use methodologies geared toward student participation in the construction of knowledge. The aim of this study was to understand how medical students view the use of problematization methodology in the Competence Integrating Problem (PIC) unit at the Pontifical Catholic University of Goiás (PUC Goiás). Method: This cross-sectional, descriptive study adopts a qualitative approach. The data were collected through semi-structured interviews based on a list of topics prepared in advance. Interviews were conducted with thirty academics from the first to the twelfth modules of the PIC unit, the methodology of which course is based on problematization combined with the incorporation of the Charles Maguerez Arch. Grounded Theory was used for the data analysis. Results: The results from the interview transcription and analysis, three explanatory categories were created for the investigated phenomenon, namely: Positive, negative and improvement points; PIC student and teacher characteristics; PIC contributions to medical training. Analysis of the explanatory categories demonstrated functional and applicable contributions made by and efficiency of problematization methodology in the PIC unit, such as communication skills, research, problem solving, proactivity, learning to work in a team and to listen and respect the opinions of colleagues, critical thinking, and a holistic understanding of the patient, for the purposes of medical training. Drawing on the views of the medical students, problematization methodology used in the field of medical education was shown to still have weaknesses both in terms of the student's training and the performance of the mediating teacher. Conclusions: The results of this study may be used to ensure that medical courses that use this methodology adopt strategies aimed at its correct applicability.

Corruption - Taking a Deeper Dive Comment on "We Need to Talk About Corruption in Health Systems".

This commentary while agreeing broadly with the points raised by the editorial by McKee et al, seeks to broaden and deepen those arguments. The commentary contends that unless we understand corruption as deeply embedded in and propping up systems of power differentials, we will not be able to design interventions that will tackle corruption at its roots. The commentary further points to the context specific nature of corruption and hence the futility of attempting a single definition. This it contends will merely hide the deeper context specific causes. It calls for the using theoretical insights that draw from post-positivist approaches to enhance the conceptualization of corruption as systemic. Further it points to the importance of the underlying problematization of corruption in attempts to tackle it. It ends with a call for attempts at multiple levels with the broader aim of evolving caring and just systems of healthcare rather than focusing on narrow 'politically feasible' interventions.

'We are still obsessed by this idea of abstinence': A critical analysis of UK news media representations of proposals to introduce drug consumption rooms in Glasgow, UK.

BACKGROUND: Drug consumptions rooms (DCRs) are a well-established and evidence-based harm reduction response to drug use. Recently, a consortium led by health services in Glasgow, United Kingdom (UK), proposed piloting a DCR. In this article, we examine how the proposals were represented in news media reporting, and the possible effects of such reporting. METHODS: A quantitative content and qualitative thematic analysis of UK news media (n = 174 articles) representations of the proposals to introduce DCRs in the city of Glasgow, UK, was conducted. Analysis was informed by Bacchi's (2009, 2012, 2017) approach to policy analysis, 'What's the problem represented to be?' FINDINGS: Competing representations of the 'problem' of injecting drug use (IDU) were contested by a range of actors with different political visions. The applicability of the 'evidence base', potential benefits of DCRs to both users and the public, and the associated economic costs, were presented in differing ways depending on the underlying assumptions and presumptions of the arguments constructed (e.g. harm reduction vs recovery). As a result, a number of conflicting subject positions were presented that may have implications for the way that people who inject drugs (PWID) see themselves, and how they are viewed and treated by society. Whilst proponents positioned DCRs within a discourse of public health, an underlying rhetoric of abstinence and recovery underpinned the arguments against DCRs. It was this latter discourse that underpinned the UK Government's rejection of the proposals, which the Scottish Government were prevented from overruling within the political constraints of their devolved powers, with the lived effect of people who use drugs (PWUD) being denied access to public health services that mitigate harm. CONCLUSION: We conclude that attempts to introduce and gain public and political support for harm reduction responses such as DCRs through the news media face challenges within the historical and political context of prohibitionist UK drugs policy.