A Critical Ethnography of Outreach Nursing for People Experiencing Homelessness.

People experiencing homelessness have a high prevalence of substance abuse and mental and physical problems. Although they have very complex health needs, they face many barriers that reduce their access to health care and social services. Several research studies have shown the need to implement adapted nursing interventions to address these crucial access issues. In this article, we present the results of a critical ethnography of outreach nurses who work with homeless people (n = 12). Robert Castel's theoretical model, which focuses on the process of social disaffiliation, provided the conceptual underpinnings for this research. Our qualitative data analysis revealed four categories, namely 1) the professional role and identity of nurses; 2) the social function of outreach nursing; 3) clinical realities and 4) disaffiliation and stigmatization. Our findings highlight the need to raise awareness among health care providers about the ethical, clinical and organizational issues of homelessness, particularly the mechanisms of exclusion and stigmatization in health care settings that affect people experiencing homelessness.

Medical labour under neoliberalism: an ethnographic study in Colombia.

OBJECTIVES: In order to increase the knowledge about the impacts of neoliberal market forces on physician's labour, this article's objectives are to analyse how and why the labour of physicians is transformed by neoliberalism, and the implications of these transformations for patient care. METHODS: Ethnographic investigation is carried out through semi-structured interviews with 20 general practitioners at public and private facilities in Colombia. The interviews were contrasted with national studies of physician's labour since the 1960s. A "mock" job search was also simulated. The analysis was guided by Marxian frameworks. The study was approved by a Human Research Ethics Committee, and informed consent was obtained from all participants. RESULTS: The overpowering for-profit administration of the Colombian healthcare system imposes productivity mechanisms on physicians as a result of a deregulated labour market characterized by low salaries, reduced and self-funded social security benefits, and job insecurity. Overworked physicians with reduced autonomy become frustrated for not being able to provide the care their patients need according to clinical standards. CONCLUSIONS: Under neoliberal conditions, medical labour becomes exploitable and directly productive through its formal and real subsumption to Capital. The negative consequences of a progressive loss in physician's autonomy unveil the incompatibility between neoliberal health systems and people's health.

Caring experiences of family caregivers of patients with heart failure: A meta-ethnographic review of the past 10 years.

BACKGROUND: Living with heart failure, a debilitating disease with an unpredictable course, requires ongoing adaptation and management not only from patients but also from their families. Family caregivers have been known to be key facilitators of self-management of heart failure. An integrative understanding of the experiences of family caregivers will provide essential information for improving the quality of life of persons with heart failure and their families. AIMS: This study aimed to integrate and synthesize the findings of qualitative studies on family members' experiences of caring for patients with heart failure. METHODS: We employed the meta-ethnography methodology. Five electronic bibliographic databases were used to retrieve studies published from April 2009-March 2019 that explored family caregivers' experiences of caring for patients with heart failure. Twelve qualitative studies were finally included for the synthesis, based on the eligibility criteria. RESULTS: Three themes were identified: "shouldering the entire burden," "starting a new life," and "balancing caregiving and everyday life." These three themes illustrate how family caregivers fulfilled caregiving roles, what helped them juggle their multiple responsibilities, and how they struck a balance between life as caregivers and individuals in their own right. CONCLUSION: This review provides a deeper understanding of family caregivers' experiences of caring for patients with heart failure. The findings can help healthcare providers in the development and implementation of tailored interventions for both patients and family caregivers.

Patient and Public Involvement (PPI) in evidence synthesis: how the PatMed study approached embedding audience responses into the expression of a meta-ethnography.

BACKGROUND: Patient and public involvement (PPI) has become enshrined as an important pillar of health services empirical research, including PPI roles during stages of research development and analysis and co-design approaches. Whilst user participation has been central to qualitative evidence synthesis (QES) for decades, as seen in the Cochrane consumer network and guidelines, meta-ethnography has been slow to incorporate user participation and published examples of this occurring within meta-ethnography are sparse. In this paper, drawing upon our own experience of conducting a meta-ethnography, we focus on what it means in practice to 'express a synthesis' (stage 7). We suggest the methodological importance of 'expression' in Noblit and Hare's seven stage process (Noblit, GW and Hare, RD. Meta-ethnography: synthesizing qualitative studies, 1988) has been overlooked, and in particular, opportunities for PPI user participation within it. METHODS: Meta-ethnography comprises a seven-stage process of evidence synthesis. Noblit and Hare describe the final 7th stage of the meta-ethnography process as 'expression of synthesis', emphasizing co-construction of findings with the audience. In a previous study we conducted a meta-ethnography exploring patient and student experience of medical education within primary care contexts. We subsequently presented and discussed initial meta-ethnography findings with PPI (students and patients) in focus groups and interviews. We transcribed patient and student PPI interpretations of synthesis findings. As a research team, we then translated these into our existing meta-ethnography findings. RESULTS: We describe, with examples, the process of involving PPI in stage 7 of meta-ethnography and discuss three methodological implications of incorporating PPI within an interpretative approach to QES: (1) we reflect on the construct hierarchy of user participants' interpretations and consider whether incorporating these additional 1st order, 2nd level constructs implies an additional logic of 3rd order 2nd level constructs of the QES team; (2) we discuss the link between PPI user participation and what Noblit and Hare may have meant by ideas of 'expression' and 'audience' as integral to stage 7; and (3) we link PPI user participation to Noblit and Hare's underlying theory of social explanation, i.e. how expression of the synthesis is underpinned by ideas of translation and that the synthesis must be 'translated in the audience's (user participants) particular language'. CONCLUSIONS: The paper aims to complement recent attempts in the literature to refine and improve guidance on conducting a meta-ethnography, highlighting opportunities for PPI user participation in the processes of interpretation, translation and expression. We discuss the implications of user participation in meta-ethnography on ideas of 'generalisability'.

Patients' Perceptions of mHealth Apps: Meta-Ethnographic Review of Qualitative Studies.

BACKGROUND: Mobile phones and tablets are being increasingly integrated into the daily lives of many people worldwide. Mobile health (mHealth) apps have promising possibilities for optimizing health systems, improving care and health, and reducing health disparities. However, health care apps often seem to be underused after being downloaded. OBJECTIVE: The aim of this paper is to reach a better understanding of people's perceptions, beliefs, and experience of mHealth apps as well as to determine how highly they appreciate these tools. METHODS: A systematic review was carried out on qualitative studies published in English, on patients' perception of mHealth apps between January 2013 and June 2018. Data extracted from these articles were synthesized using a meta-ethnographic approach and an interpretative method. RESULTS: A total of 356 articles were selected for screening, and 43 of them met the inclusion criteria. Most of the articles included populations inhabiting developed countries and were published during the last 2 years, and most of the apps on which they focused were designed to help patients with chronic diseases. In this review, we present the strengths and weaknesses of using mHealth apps from the patients' point of view. The strengths can be categorized into two main aspects: engaging patients in their own health care and increasing patient empowerment. The weaknesses pointed out by the participants focus on four main topics: trustworthiness, appropriateness, personalization, and accessibility of these tools. CONCLUSIONS: Although many of the patients included in the studies reviewed considered mHealth apps as a useful complementary tool, some major problems arise in their optimal use, including the need for more closely tailored designs, the cost of these apps, the validity of the information delivered, and security and privacy issues. Many of these issues could be resolved with more support from health providers. In addition, it would be worth developing standards to ensure that these apps provide patients accurate evidence-based information.

A methodological systematic review of meta-ethnography conduct to articulate the complex analytical phases.

BACKGROUND: Decision making in health and social care requires robust syntheses of both quantitative and qualitative evidence. Meta-ethnography is a seven-phase methodology for synthesising qualitative studies. Developed in 1988 by sociologists in education Noblit and Hare, meta-ethnography has evolved since its inception; it is now widely used in healthcare research and is gaining popularity in education research. The aim of this article is to provide up-to-date, in-depth guidance on conducting the complex analytic synthesis phases 4 to 6 of meta-ethnography through analysis of the latest methodological evidence. METHODS: We report findings from a methodological systematic review conducted from 2015 to 2016. Fourteen databases and five other online resources were searched. Expansive searches were also conducted resulting in inclusion of 57 publications on meta-ethnography conduct and reporting from a range of academic disciplines published from 1988 to 2016. RESULTS: Current guidance on applying meta-ethnography originates from a small group of researchers using the methodology in a health context. We identified that researchers have operationalised the analysis and synthesis methods of meta-ethnography - determining how studies are related (phase 4), translating studies into one another (phase 5), synthesising translations (phase 6) and line of argument synthesis - to suit their own syntheses resulting in variation in methods and their application. Empirical research is required to compare the impact of different methods of translation and synthesis. Some methods are potentially better at preserving links with the context and meaning of primary studies, a key principle of meta-ethnography. A meta-ethnography can and should include reciprocal and refutational translation and line of argument synthesis, rather than only one of these, to maximise the impact of its outputs. CONCLUSION: The current work is the first to articulate and differentiate the methodological variations and their application for different purposes and represents a significant advance in the understanding of the methodological application of meta-ethnography.

Service users' first accounts of experiencing endings from a psychological service or therapy: A systematic review and meta-ethnographic synthesis.

PURPOSE: To review and synthesize the qualitative literature on service users' experiences of endings from a psychological service or therapy. METHODS: A systematic search of the peer-reviewed literature identified qualitative studies meeting specific inclusion criteria. A modified CASP tool was used to critically appraise their quality, and a meta-ethnographic approach was used to synthesize their findings. RESULTS: Twelve papers met the inclusion criteria. The interpretation of findings suggested three key themes: anticipation of ending, service user control, and sense of responsibility. Although studies varied in geographical location and type of service, they were consistently of high quality. CONCLUSIONS: The review highlights the importance of service users' perspectives in understanding the experiences of endings. The findings complement existing literature and provide new interpretations. Considerations for practice were limited; however, the review provides useful directions for future research. PRACTITIONER POINTS: When ending therapy, clinicians should consider the dyadic nature of the therapeutic relationship and the emotional impact this may have upon both service users and staff. Further consideration should be given to how staff manage their responses to the ending. The time-limited structure of therapy may aid the ending process by relieving staff and service users of responsibility.

Fuentes de información alimentaria que utilizan las mujeres embarazadas y lactantes / Which are the sources of food information for pregnant and lactating women?

Objetivo: Conocer las fuentes de información dietética que utilizan las mujeres embarazadas y lactantes. Metodología: Investigación etnográfica cualitativa. Realización de 21 entrevistas semiestructuradas a embarazadas y lactantes asistentes a 14 sesiones de preparación del parto y 14 sesiones de posparto, 15 diarios de alimentación cumplimentados la semana siguiente a la entrevista y 3 etnografías realizadas en las provincias de Barcelona y Tarragona. Resultados: Las fuentes de información son: 1) Medios de comunicación: televisión, internet, libros y revistas (los dos últimos son los más empleados); el principal inconveniente es que las mujeres creen que hay demasiada información y no se entiende, por lo que consideran esta fuente la menos fiable. 2) Amistades y conocidos, que aconsejan según la experiencia propia; destaca el rol del «amigo-experto» en una cuarta parte de las mujeres entrevistadas. 3) Familiares, entre los que también se puede observar el doble rol de «familiar-experto»; las madres de las informantes desempeñan un papel importante a la hora de informar sobre la alimentación, aunque sus consejos son puestos en duda. 4) Expertos: la información que dan los profesionales es la más valorada por las gestantes y lactantes. Conclusiones: Las fuentes de información son diversas: medios de comunicación, amistades, familia y profesionales de la salud. La más respetada por las mujeres embarazadas y mujeres lactantes, es la ofrecida por profesionales de la salud

Objective: The aim of this study was to investigate the sources of dietary information and advice used by pregnant and lactating women and their adherence to this information. Methods: Qualitative etnographic research. 21 semi structured interviews were carried out with pregnant and breastfeeding women. They attended 14 sessions of childbirth preparation and 14 postpartum sessions, 15 feeding diaries completed the week after the interview and 3 ethnographies performed in the provinces of Barcelona and Tarragona. Results: Sources of information. 1) Media: television, internet, books, magazines were the most used. The most common complaint by the participants was the quantity of information and that they did not understand it. 2) Friends and acquaintances: advice was given according to own experience, 'the expert-friend' was significant in a quarter of the women interviewed. 3) Family: The double role of family/expert. Mothers of the participants played an important role. 4) Experts: mid-wives, gynecologists, pediatricians. Conclusions: The sources of information are diverse: media, friends, family and health professionals. The one most respected by pregnant women and lactating women, is that offered by health professionals

A mega-ethnography of eleven qualitative evidence syntheses exploring the experience of living with chronic non-malignant pain.

BACKGROUND: Each year over five million people develop chronic non-malignant pain and can experience healthcare as an adversarial struggle. The aims of this study were: (1) to bring together qualitative evidence syntheses that explore patients' experience of living with chronic non-malignant pain and develop conceptual understanding of what it is like to live with chronic non-malignant pain for improved healthcare; (2) to undertake the first mega-ethnography of qualitative evidence syntheses using the methods of meta-ethnography. METHODS: We used the seven stages of meta-ethnography refined for large studies. The innovation of mega-ethnography is to use conceptual findings from qualitative evidence syntheses as primary data. We searched 7 bibliographic databases from inception until February 2016 to identify qualitative evidence syntheses that explored patients' experience of living with chronic non-malignant pain. RESULTS: We identified 82 potential studies from 556 titles, screened 34 full text articles and included 11 qualitative evidence syntheses synthesising a total of 187 qualitative studies reporting more than 5000 international participants living with chronic pain. We abstracted concepts into 7 conceptual categories: (1) my life is impoverished and confined; (2) struggling against my body to be me; (3) the quest for the diagnostic 'holy grail'; (4) lost personal credibility; (5) trying to keep up appearances; (6) need to be treated with dignity; and (7) deciding to end the quest for the grail is not easy. Each conceptual category was supported by at least 7 of the 11 qualitative evidence syntheses. CONCLUSIONS: This is the first mega-ethnography, or synthesis of qualitative evidence syntheses using the methods of meta-ethnography. Findings help us to understand that the decision to end the quest for a diagnosis can leave patients feeling vulnerable and this may contribute to the adversarial nature of the clinical encounter. This knowledge demonstrates that treating a patient with a sense that they are worthy of care and hearing their story is not an adjunct to, but integral to health care.

Vaginal birth after caesarean section: why is uptake so low? Insights from a meta-ethnographic synthesis of women's accounts of their birth choices.

OBJECTIVE: To identify what women report influences their preferred mode of birth after caesarean section. DESIGN: Systematic review of qualitative literature using meta-ethnography. DATA SOURCES: Medline, EMBASE, ASSIA, CINAHL and PsycINFO (1996 until April 2013; updated September 2015). Hand-searched journals, reference lists and abstract authors. STUDY SELECTION: Primary qualitative studies reporting women's accounts of what influenced their preferred mode of birth after caesarean section. DATA EXTRACTION AND SYNTHESIS: Primary data (quotations from study participants) and authors' interpretations of these were extracted, compared and contrasted between studies, and grouped into themes to support the development of a 'line of argument' synthesis. RESULTS: 20 papers reporting the views of 507 women from four countries were included. Distinctive clusters of influences were identified for each of three groups of women. Women who confidently sought vaginal birth after a caesarean section were typically driven by a long-standing anticipation of vaginal birth. Women who sought a repeat caesarean section were strongly influenced by distressing previous birth experiences, and at times, by encouragement from social contacts. Women who were more open to information and professional guidance had fewer strong preconceptions and concerns, and viewed a range of considerations as potentially important. CONCLUSIONS: Women's attitudes towards birth after caesarean section appear to be shaped by distinct clusters of influences, suggesting that opportunities exist for clinicians to stratify and personalise decision support by addressing relevant ideas, concerns and experiences from the first caesarean section birth onwards.

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

Lived experiences and challenges of older surgical patients during hospitalization for cancer: an ethnographic fieldwork.

This paper explores the lived experiences of older surgical patients' (aged 74 years and older) experienced challenges during a brief admission to hospital. Age, gender, polypharmacy, and the severity of illness are also factors known to affect the hospitalization process. For an ethnographic study using participant observation and interviews, surgical cancer patients (n = 9, aged 74 years and older) were recruited during admission to a Danish teaching hospital. Using ethnographic strategies of participant observation and interviews, each patient was followed through the course of 1 day during their stay at the hospital. Interviews were carried out with all patients during this time. Three areas of concern were identified as prominent in the patients' experiences and challenges during their short hospital stay: teeth and oral cavity, eating in a hospital setting, and medication during hospitalization. Short-term hospitalization requires focused collaboration between staff and patient concerning individual challenges from their teeth and oral cavity as support of nutritional needs during surgical treatment for cancer.

A observação de visitantes em museus: sobre ratos e seres humanos

O artigo apresenta uma revisãobibliográfica de estudos de públicoem museus que utilizam a observaçãodos visitantes como métodode coleta de dados. Estudosinicialmente baseados na psicologiacomportamental foram realizadosnos Estados Unidos desde os anos1920 e inspiraram muitas pesquisasposteriores. Abordagens etnográficasfavoreceram a melhor compreensãodos comportamentos dosvisitantes assim como o métododa “Lembrança Estimulada”. Doisestudos realizados pela autora emmuseus de arte de São Paulo sãodescritos e discutidos à luz da revisãobibliográfica inicial.

The article presents a literaturereview of museums’ audience studiesthat use timing and tracking asa method of data collection. Studiesinitially based on behavioralpsychology were performed in theUnited States since the 1920s andinspired many later studies. Ethnographicapproaches favored a betterunderstanding of the behaviorof visitors as well as the method of“Stimulated Recall.” Two studies bythe author in art museums of SãoPaulo are described and discussedin light of the initial literature review.

Organizing "mountains of words" for data analysis, both qualitative and quantitative.

Qualitative research creates mountains of words. U.S. federal funding supports mostly structured qualitative research, which is designed to test hypotheses using semiquantitative coding and analysis. This article reports on strategies for planning, organizing, collecting, managing, storing, retrieving, analyzing, and writing about qualitative data so as to most efficiently manage the mountains of words collected in large-scale ethnographic projects. Multiple benefits accrue from this approach. Field expenditures are linked to units of work so productivity is measured, many staff in various locations have access to use and analyze the data, quantitative data can be derived from data that is primarily qualitative, and improved efficiencies of resources are developed.

'I guess my own fancy screwed me over': transitions in drug use and the context of choice among young people entrenched in an open drug scene.

BACKGROUND: There is growing interest in describing the broader risk trajectories experienced by young people who use drugs - that is, in describing the sequences of drug use transitions experienced by youth in relation to evolving understandings of risk and harm. This study sought to examine young people's perspectives regarding the evolution of their drug use in the context of a local drug scene in Vancouver, Canada. METHODS: Semi-structured qualitative interviews with 38 individuals recruited from a cohort of young drug users known as the At-risk Youth Study (ARYS) were supplemented by ongoing ethnographic fieldwork (e.g., observations and informal conversations with youth) conducted within the same cohort population. Interviews were transcribed verbatim and a thematic analysis was conducted. RESULTS: The majority of youth characterized past transition events as non-exceptional, largely 'spur-of-the-moment' decisions motivated by evolving feelings of curiosity. At the same time, participants' reflections indicated that the social, structural and material contexts of drug scene entrenchment play a powerful role in shaping these decisions and transition experiences. CONCLUSIONS: Importantly, as young people become increasingly entrenched in the local drug scene, drug use transitions seem to constitute increasingly relevant (and even 'inevitable') choices congruent with everyday lived experience. The implications of these findings for the development of meaningful interventions for youth are discussed.

Civic norms and etiquettes regarding marijuana use in public settings in New York City.

This paper shows that active police enforcement of civic norms against marijuana smoking in public settings has influenced the locations where marijuana is smoked. It has subtly influenced the various marijuana etiquettes observed in both public and private settings. The ethnographic data reveal the importance of informal sanctions; most marijuana consumers report compliance with etiquettes mainly to avoid stigma from nonusing family, friends, and associates-they express limited concern about police and arrest.

La llamada por la vida: necesidades / The call for life

Objetivo: identificar las situaciones por las cualeslas personas solicitan atención de urgencias desdela casa. Metodología: se utilizó el enfoque etnográfico.La información fue recolectada mediante 7entrevistas y 100 horas de observaciones a adultosque recibieron atención urgente en la casa, en Medellín,Colombia, entre enero de 2005 y diciembrede 2006. Resultados y discusión: las personasllaman a pedir ayuda de urgencia desde su casa,porque atraviesan una circunstancia y sienten unanecesidad. La circunstancia es el resultado de lasuma del evento de salud que altera la cotidianidad,las situaciones en el entorno que se consideran críticas,el autodiagnóstico después de la valoración,y la emoción, que da el significado de urgente ono urgente. La necesidad es individual e impulsa abuscar ayuda de manera inmediata cuando le da a lacircunstancia el significado de urgente. Las necesidadesencontradas en este estudio fueron; compañía;seguridad, transporte y tranquilidad. Conclusiones:las situaciones que hacen que una persona soliciteayuda no programada desde su casa, son eventosde salud que alteran su cotidianidad, generan unsignificado y necesidades, Las circunstancias ynecesidades son asuntos individuales que requierende la capacidad del prestador de servicios de saludpara descubrirlas y solucionarlas.

An anthropological study about epilepsy in native tribes from Central and South America.

PURPOSE: Epilepsy was a well-recognized disease in pre-Columbian cultures. However, anthropological studies about epilepsy in native cultures living at the present time are scarce. The objective of this paper was to study native perception and myths about epilepsy, their magic-religious healing rites and ceremonies, and the natural treatments that archaic cultures used. METHODS: An anthropological fieldwork was performed in Central and South America with Tzeltal Maya (Chiapas, Mexico, 1995), Kamayurá (Matto Grosso, Brazil, 1999) and Uru-Chipaya people (Bolivian Andes, 2004). We collected information from shamans and medicine men about epilepsy beliefs and the use of traditional treatments. RESULTS: Epilepsy is called tub tub ikal by Tzeltal people. It is caused by an attack suffered by the animal spirit who accompanies the person, after a fight between the spirits who serve the forces of good and evil. People with chronic epilepsy are considered witches. Epilepsy is called teawarup by Kamayurá, and is caused by the revenge of the spirit (mama'e) of the armadillo killed by a huntsman. It is treated with two roots, tsimó and wewurú, kneaded and diluted in water. Epilepsy is called tukuri by the Chipaya people, and is originated by a witchcraft that enters into the nose and the head, as a wind. Tukuri is treated with a ritual animal sacrifice called willancha, and by taking several dried insect infusions and bird's blood. CONCLUSION: These American native cultures have developed a system of orally transmitted knowledge about epilepsy based on magic-religious traditions.

Mood disorders and migration: meta-analysis.

BACKGROUND: Migration is a risk factor for the development of schizophrenia. AIMS: To examine whether migration is also a risk factor for bipolar affective disorder, unipolar depressive disorder and mood disorders in general. METHOD: Medline was searched for population-based incidence studies concerning mood disorders among migrants and mean relative risks were computed using a mixed-effects statistical model. RESULTS: Only a few studies of unipolar depressive disorder were retrieved. The mean relative risk of developing bipolar affective disorder among migrants was 2.47 (95% CI 1.33-4.59). However, after excluding people of African-Caribbean origin in the UK this risk was no longer significantly increased. The mean relative risk of mood disorders of unspecified polarity was 1.25 (95% CI 1.04-1.49) and that of any mood disorder was 1.38 (95% CI 1.17-1.62). CONCLUSIONS: There is no conclusive evidence for a large increase in the risk of mood disorders associated with migration.

Schizophrenia and migration: a meta-analysis and review.

OBJECTIVE: The authors synthesize findings of previous studies implicating migration as a risk factor for the development of schizophrenia and provide a quantitative index of the associated effect size. METHOD: MEDLINE was searched for population-based incidence studies concerning migrants in English-language publications appearing between the years 1977 and 2003. Article bibliographies and an Australian database were cross-referenced. Studies were included if incidence reports provided numerators and denominators and if age correction was performed or could be performed by the authors. Relative risks for migrant groups were extracted or calculated for each study. Significant heterogeneity across studies indicated the need for a mixed-effects meta-analytic model. RESULTS: The mean weighted relative risk for developing schizophrenia among first-generation migrants (40 effect sizes) was 2.7 (95% confidence interval [CI]=2.3-3.2). A separate analysis performed for second-generation migrants (seven effect sizes) yielded a relative risk of 4.5 (95% CI=1.5-13.1). An analysis performed for studies concerning both first- and second-generation migrants and studies that did not distinguish between generations (50 effect sizes) yielded a relative risk of 2.9 (95% CI=2.5-3.4). Subgroup comparisons yielded significantly greater effect sizes for migrants from developing versus developed countries (relative risk=3.3, 95% CI=2.8-3.9) and for migrants from areas where the majority of the population is black (relative risk=4.8, 95% CI=3.7-6.2) versus white and neither black nor white. CONCLUSIONS: A personal or family history of migration is an important risk factor for schizophrenia. The differential risk pattern across subgroups suggests a role for psychosocial adversity in the etiology of schizophrenia.