"Mulher, você não precisa disso": discursos em embate sobre a pílula e a supressão da menstruação / "Woman, you don't need this": Negotiation of discourses on the pill and menstrual suppression / "Mujer, no necesitas esto": Discursos en conflicto sobre la píldora y la supresión de la menstruación

Resumo O discurso médico do século XIX listava uma série de desordens físicas e mentais associadas aos órgãos reprodutivos das mulheres (Rohden, 2009). Um fenômeno corporal até hoje frequentemente construído como patológico é a menstruação (Vieira, 2002), para o qual existe uma ferramenta médica de intervenção amplamente empregada: a pílula anticoncepcional. Como o período menstrual é muitas vezes visto como um problema, sua interrupção por meio da ingestão contínua da pílula é recorrentemente propagada como a solução (Kissling, 2013). À luz dessas ideias, analiso como duas mulheres autoidentificadas como feministas negociam significados sobre a pílula, a menstruação e a supressão menstrual em entrevistas orais semiestruturadas. O objetivo do trabalho é investigar como sentidos biomédicos sobre o corpo feminino são discursivamente reificados, desafiados e corporificados.

Abstract Nineteenth century's medical discourse listed a series of physical and mental disorders caused by women's reproductive organs (Rohden, 2009). A bodily function that until nowadays has been frequently constructed as pathological is menstruation (Vieira, 2002), for which there is a widely employed medical tool of intervention: the contraceptive pill. As the period is often seen as a problem, its suppression through the uninterrupted use of the pill is recurrently advertised as the solution (Kissling, 2013). In light of these ideas, I analyse how two self-identified feminist women negotiate meanings around the pill, menstruation and menstrual suppression in semi-structured oral interviews. The purpose of the work is to investigate how biomedical meanings of the female body are discursively reified, challenged and embodied.

Resumen El discurso médico del siglo XIX enumeraba una serie de trastornos físicos y mentales asociados a los órganos reproductivos de la mujer (Rohden, 2009). Un fenómeno corporal que con frecuencia se interpreta como patológico es la menstruación (Vieira, 2002), para la cual existe una herramienta médica intervencionista ampliamente utilizada: la píldora anticonceptiva. Como el período menstrual a menudo se ve como un problema, su interrupción a través de la toma continua de la píldora se propaga recurrentemente como la solución (Kissling, 2013). A la luz de estas ideas, analizo cómo dos mujeres autoidentificadas como feministas negocian significados sobre la píldora, la menstruación y la supresión menstrual en entrevistas orales semiestructuradas. El objetivo de este trabajo es investigar cómo los significados biomédicos sobre el cuerpo femenino son materializados, cuestionados y encarnados discursivamente.

La seguridad del parto planificado en casa: algunas consideraciones a partir de un estudio cualitativo / A segurança do parto domiciliar planejado: algumas considerações de um estudo qualitativo / The safety of planned home birth: some considerations from a qualitative study

Introduction: The search for safety also involves risks caused by the devices that arecreated to anticipate and control them. This is the case of unnecessary interventionism in hospitalbirths in relation to planned home deliveries. Objectives: To explore the relationship betweenphysiological delivery and obstetric interventionism, and to examine the debate on the safety ofhome delivery and its main repercussions. Methodology: Qualitative research. Collection ofinformation with a questionnaire of open questions completed in writing by 45 women who gave226Cultura de los Cuidados. 1º Cuatrimestre 2022. Año XXVI. nº 62birth at home in the province of Murcia between 2008 and 2017. For its analysis MAXQDAqualitative data analysis software was used. Results: obstetric interventionism hinders thephysiological delivery process; The debate over the safety of planned home birth is polarized,causing various repercussions for those involved. Conclusions: planned home birth in low-riskwomen favors the development of physiological delivery, which avoids many of the unnecessaryobstetric interventions associated in hospitals; Likewise, the polarized debate on the safety ofchildbirth at home does not provide consensual information, which has repercussions on thedifferent positioning of the two health groups that take care of childbirth (gynecologists andmidwives), and on the fact that women who decide to perform the home births are pressurized bymultiple sources (health system, family members, friends ...) that come face to face with therelevant information available to them about home birth and the support of the professional whoaccompanies them in the birth.

Introducción: La búsqueda de la seguridad también comporta riesgos provocados desdelos propios dispositivos que se crean para preverlos y controlarlos. Es el caso del intervencionismoinnecesario en los partos hospitalarios en relación a los partos planificados en el hogar. Objetivos:Explorar la relación entre el parto fisiológico y el intervencionismo obstétrico, y examinar eldebate sobre la seguridad del parto domiciliario y sus principales repercusiones.Metodología: Investigación cualitativa. Recogida de información con cuestionario de preguntasabiertas cumplimentadas por escrito por 45 mujeres que parieron en casa en la provincia deMurcia entre 2008 y 2017. Para su análisis empleamos el software de análisis cualitativo de datosMAXQDA. Resultados: el intervencionismo obstétrico dificulta el proceso del parto fisiológico;el debate de la seguridad del parto planificado en casa está polarizado, provocando diversasrepercusiones para los implicados. Conclusiones: el parto planificado en casa en mujeres de bajoriesgo propicia el desarrollo del parto fisiológico, lo que evita muchas de las intervencionesobstétricas innecesarias vinculadas al ámbito hospitalario; asimismo, el polarizado debate de laseguridad del parto en casa no provee una información consensuada, lo que repercute en eldiferente posicionamiento de los dos colectivos sanitarios que se ocupan del parto (ginecólogos ymatronas), y en que las mujeres que deciden realizar el parto en el hogar reciban múltiplespresiones (sistema sanitario, familiares, amigos…) que se confrontan con la relevanteinformación de que dispone sobre el nacimiento en el hogar y el apoyo del profesional que lasacompaña en el parto.

Introdução: A busca por segurança também envolve riscos causados pelos dispositivoscriados para antecipá-los e controlá-los. É o caso do intervencionismo desnecessário nos partoshospitalares em relação aos partos domiciliares planejados. Objetivos: Explorar a relação entreparto fisiológico e intervencionismo obstétrico e examinar o debate sobre a segurança do partodomiciliar e suas principais repercussões. Metodologia: Pesquisa qualitativa. Recolha deinformação com um questionário de perguntas abertas preenchido por escrito por 45 mulheres227Cultura de los Cuidados. 1º Cuatrimestre 2022. Año XXVI. nº 62que deram à luz em casa na província de Murcia entre 2008 e 2017. Para a sua análise utilizou-seo software de análise de dados qualitativos MAXQDA. Resultados: o intervencionismo obstétricodificulta o processo de parto fisiológico; O debate sobre a segurança do parto domiciliar planejadoé polarizado, causando diversas repercussões para os envolvidos. Conclusões: o parto domiciliarplanejado em mulheres de baixo risco favorece o desenvolvimento do parto fisiológico, o queevita muitas das intervenções obstétricas desnecessárias associadas ao ambiente hospitalar; Damesma forma, o debate polarizado sobre a segurança do parto no domicílio não traz informaçõesconsensuais, o que repercute nos diferentes posicionamentos dos dois grupos de saúde que cuidamdo parto (ginecologistas e parteiras), e no fato de as mulheres decidirem por realizar o partodomiciliar recebe múltiplas pressões (sistema de saúde, familiares, amigos ...) que se deparamcom as informações relevantes de que dispõem sobre o parto domiciliar e com o apoio doprofissional que os acompanha no parto.

Epidemia de drogas psiquiátricas: tipologias de uso na sociedade do cansaço / Epidemia de drogas psiquiátricas: tipologías de uso en la sociedad del cansancio / Epidemic of psychiatric drug: typologies of use in the burnout society

Resumo: Este artigo tem por objetivo analisar o fenômeno da epidemia de uso de drogas psiquiátricas a partir da perspectiva do consumo cada vez mais disseminado e sua relação com a criação de subjetividades sociais que se constituem pela medicalização. Foram considerados dois diferentes contextos de uso que não necessariamente estão vinculados a diagnósticos. Em uma extremidade do fenômeno, identifica-se o consumo voltado para melhoria de desempenho em atividades competitivas de mercado, utilizando drogas como metilfenidato com a perspectiva de ultrapassar o desenvolvimento usual das práticas sociais e produtivas. Em outra extremidade, populações vulnerabilizadas que utilizam os psicotrópicos com o intuito de suportar experiências cotidianas de sofrimento que seriam intoleráveis de outra forma. A análise, apresentada na forma de ensaio, indicou um processo de uso acentuado de drogas psiquiátricas relacionado aos ideais de produtividade e desempenho ditados pelo padrão normativo da subjetividade neoliberal, o qual atinge particularmente as mulheres.

Resumen: Este artículo tiene como objetivo analizar el fenómeno de la epidemia del consumo de drogas psiquiátricas desde la perspectiva de un consumo cada vez más extendido y su relación con la creación de subjetividades sociales que están constituidas por la medicalización. Se consideraron dos contextos de uso diferentes, que no están necesariamente vinculados a los diagnósticos. En un extremo del fenómeno, se identifica el consumo orientado a mejorar el desempeño en actividades competitivas de mercado, utilizando drogas como el metilfenidato con la perspectiva de ir más allá del desarrollo habitual de prácticas sociales y productivas. En el otro extremo, poblaciones vulnerables que consumen psicofármacos para sustentar las vivencias cotidianas de sufrimiento que de otro modo serían intolerables. El análisis, presentado en forma de ensayo, indicó un proceso de uso acentuado de drogas psiquiátricas relacionado con los ideales de productividad y desempeño dictados por el patrón normativo de la subjetividad neoliberal, que afecta particularmente a las mujeres.

Abstract: This article aims to analyze the phenomenon of the epidemic of psychiatric drug use from the perspective of increasingly widespread consumption and its relationship with the creation of social subjectivities that are constituted by medicalization. Two different contexts of use which are not necessarily linked to diagnoses were considered. At one end of the phenomenon, consumption aimed at improving performance in competitive market activities is identified, with drugs such as methylphenidate being used with the perspective of going beyond the usual development of social and productive practices. At the other end, there are vulnerable populations that use psychotropic drugs in order to support everyday experiences of suffering that would otherwise be intolerable. The analysis, presented in the form of an essay, indicated a process of accentuated use of psychiatric drugs related to the ideals of productivity and performance dictated by the normative pattern of neoliberal subjectivity, which particularly affects women.

Itinerário terapêutico e assistência à saúde de usuários de drogas na rede de atenção psicossocial / Therapeutic itinerary and health care for drug users in the psychosocial care network / Itinerario terapéutico y atención sanitaria para usuarios de drogas en la red de atención psicosocial

Objetivo: compreender a percepção de usuários de drogas acerca do itinerário terapêutico e da assistência à saúde na Rede de Atenção Psicossocial. Método: Pesquisa de abordagem qualitativa desenvolvida com usuários de drogas assistidos em um Centro de Atenção Psicossocial Álcool e outras drogas nos meses de março a maio de 2019. A coleta dos dados foi a partir da entrevista semiestruturada e analisados por meio da análise temática. Resultados: evidenciou-se que os usuários de drogas fazem uma ampla peregrinação na rede de saúde em busca de acolhimento e que a assistência à saúde está pautada em um modelo manicomial, centrado na medicalização em alguns serviços. Conclusão: a assistência prestada nos serviços de âmbito territorial não acolhe o usuário e nem garante a integralidade do cuidado, o que faz com que esses peregrinem pela Rede

Objective: to understand the perception of drug users about the therapeutic itinerary and health care in the Psychosocial Care Network. Method: Qualitative research conducted with drug users assisted at a Psychosocial Care Center for Alcohol and other drugs from March to May 2019. Data collection was based on the semi-structured interview and analyzed using thematic analysis. Results: it was evidenced that drug users make a wide pilgrimage in the health network in search of welcoming and that health care is based on a mental hospital model, centered on medicalization in some services. Conclusion: the assistance provided in the services of territorial scope does not welcome the user and does not guarantee the integrality of care, which makes these pilgrims through the Network

Objetivo: comprender la percepción de los usuarios de drogas sobre el itinerario terapéutico y asistencial en la Red de Atención Psicosocial. Método: investigación cualitativa realizada con usuarios de drogas atendidos en un Centro de Atención Psicosocial por Alcohol y otras drogas de marzo a mayo de 2019. La recolección de datos se basó en la entrevista semiestructurada y se analizó mediante análisis temático. Resultados:se evidenció que los usuarios de drogas realizan un amplio peregrinaje en la red de salud en busca de acogida y que la atención sanitaria se basa en un modelo de hospital psiquiátrico, centrado en la medicalización de algunos servicios. Conclusión: la asistencia prestada en los servicios territoriales no acoge al usuario y no garantiza la integralidad de la atención, que realizan estos peregrinos a través de la Red

Psicotrópicos e Atenção Primária à Saúde: a subordinação da produção de cuidado à medicalização no contexto da Saúde da Família / Psychotropic drugs and Primary Health Care: the subordination of care provision by medicalization in the context of Family Health / Psicotrópicos y Atención Primaria de la Salud: la subordinación de la producción de cuidado a la medicalización en el contexto de la Salud de la Familia

Este estudo teve como objetivo compreender o fenômeno da medicalização e do uso de psicotrópicos em longo prazo com base na percepção dos usuários de uma Unidade de Saúde da Família (USF). Trata-se de um estudo qualitativo, fundamentado no método autobiográfico e na narrativa do sujeito. Utilizou-se um roteiro para conduzir entrevistas semiestruturadas, realizadas com usuários intencionalmente selecionados. A análise temática possibilitou vislumbrar a incorporação da medicamentalização nas concepções de vida e de sofrimento dos usuários no contexto da Saúde da Família (SF), perspectiva que vai ao encontro da medicalização social e tem subsídio no modelo biomédico que subordina o processo de trabalho da Atenção Primária à Saúde (APS). (AU)

This study aimed to understand the medicalization of the long-term use of psychotropic drugs from the perception of users of the services provided by a Family Care Center. We conducted a qualitative study using autobiographical narrative analysis using semi-structured interviews with services users selected using purposeful sampling. The thematic analysis revealed that medicalization was incorporated into the life concepts and suffering of service users, which is consistent with social medicalization supported by the biomedical model, which subordinates Primary Health Care work processes. (AU)

El objetivo de este estudio fue entender el fenómeno de la medicalización y del uso de psicotrópicos a largo plazo a partir de la percepción de los usuarios de una Unidad de Salud de la Familia. Se trata de un estudio cualitativo, fundamentado en el método autobiográfico y narrativa del sujeto. Se utilizó un guion para realizar entrevistas semiestructuradas, realizadas con usuarios intencionalmente seleccionados. El análisis temático posibilitó vislumbrar la incorporación de la medicamentalización en las concepciones de vida y de sufrimiento de los usuarios en el contexto de la salud de la familia, perspectiva que sale al encuentro de la medicalización social y tiene subsidio en el modelo biomédico que subordina el proceso de trabajo de la Atención Primaria de la Salud. (AU)

Medicalización de la vida y daño poblacional: revisión bibliográfica no sistematizada / Medicalization of life and population damage: non-systematic bibliographic review

La práctica de la medicina se encuentra atravesando una crisis, en la cual muchas de las prácticas médicas que se realizan son de poco valor y con frecuencia generan daño a las personas. Se presenta una revisión bibliográfica no sistematizada en la que se analizan en conjunto los diversos factores que contribuyen al desarrollo de excesos médicos y a los daños que estos generan. Consideramos que su conocimiento puede contribuir a mejorar la calidad de los cuidados que se ofrecen a nuestros pacientes. (AU)

The practice of medicine is going through a crisis, in which many of the medical practices that are carried out are of little value and often cause harm to people. An unsystematic bibliographic review is presented in which various factors that contribute to the development of medical excesses are analyzed. Their knowledge can contribute to improving the quality of medical care offered to our patients. (AU)

Medicalization of female genital cutting in Malaysia: A mixed methods study.

BACKGROUND: Despite the clear stand taken by the United Nations (UN) and other international bodies in ensuring that female genital cutting (FGC) is not performed by health professionals, the rate of medicalization has not reduced. The current study aimed to determine the extent of medicalization of FGC among doctors in Malaysia, who the doctors were who practiced it, how and what was practiced, and the motivations for the practice. METHODS AND FINDINGS: This mixed method (qualitative and quantitative) study was conducted from 2018 to 2019 using a self-administered questionnaire among Muslim medical doctors from 2 main medical associations with a large number of Muslim members from all over Malaysia who attended their annual conference. For those doctors who did not attend the conference, the questionnaire was posted to them. Association A had 510 members, 64 male Muslim doctors and 333 female Muslim doctors. Association B only had Muslim doctors; 3,088 were female, and 1,323 were male. In total, 894 questionnaires were distributed either by hand or by post, and 366 completed questionnaires were received back. For the qualitative part of the study, a snowball sampling method was used, and 24 in-depth interviews were conducted using a semi-structured questionnaire, until data reached saturation. Quantitative data were analysed using SPSS version 18 (IBM, Armonk, NY). A chi-squared test and binary logistic regression were performed. The qualitative data were transcribed manually, organized, coded, and recoded using NVivo version 12. The clustered codes were elicited as common themes. Most of the respondents were women, had medical degrees from Malaysia, and had a postgraduate degree in Family Medicine. The median age was 42. Most were working with the Ministry of Health (MoH) Malaysia, and in a clinic located in an urban location. The prevalence of Muslim doctors practising FGC was 20.5% (95% CI 16.6-24.9). The main reason cited for practising FGC was religious obligation. Qualitative findings too showed that religion was a strong motivating factor for the practice and its continuation, besides culture and harm reduction. Although most Muslim doctors performed type IV FGC, there were a substantial number performing type I. Respondents who were women (adjusted odds ratio [aOR] 4.4, 95% CI 1.9-10.0. P ≤ 0.001), who owned a clinic (aOR 30.7, 95% CI 12.0-78.4. P ≤ 0.001) or jointly owned a clinic (aOR 7.61, 95% CI 3.2-18.1. P ≤ 0.001), who thought that FGC was legal in Malaysia (aOR 2.09, 95% CI 1.02-4.3. P = 0.04), and who were encouraged in religion (aOR 2.25, 95% CI 3.2-18.1. P = 0.036) and thought that FGC should continue (aOR 3.54, 95% CI 1.25-10.04. P = 0.017) were more likely to practice FGC. The main limitations of the study were the small sample size and low response rate. CONCLUSIONS: In this study, we found that many of the Muslim doctors were unaware of the legal and international stand against FGC, and many wanted the practice to continue. It is a concern that type IV FGC carried out by traditional midwives may be supplanted and exacerbated by type I FGC performed by doctors, calling for strong and urgent action by the Malaysian medical authorities.

Female genital mutilation/cutting: Emerging factors sustaining medicalization related changes in selected Kenyan communities.

Although female genital mutilation/cutting (FGM/C) has declined, it is pervasive albeit changing form among communities in Kenya. Transformation of FGM/C include medicalization although poorly understood has increased undermining abandonment efforts for the practice. We sought to understand drivers of medicalization in FGM/C among selected Kenyan communities. A qualitative study involving participants from Abagusii, Somali and Kuria communities and key informants with health care providers from four Kenyan counties was conducted. Data were collected using in-depth interviews (n = 54), key informant interviews (n = 56) and 45 focus group discussions. Data were transcribed and analyzed thematically using NVivo version 12. We found families practiced FGM/C for reasons including conformity to culture/tradition, religion, marriageability, fear of negative sanctions, and rite of passage. Medicalized FGM/C was only reported by participants from the Abagusii and Somali communities. Few Kuria participants shared that medicalized FGM/C was against their culture and would attract sanctions. Medicalized FGM/C was perceived to have few health complications, shorter healing, and enables families to hide from law. To avoid arrest or sanctions, medicalized FGM/C was performed at home/private clinics. Desire to mitigate health complications and income were cited as reasons for health providers performing of FGM/C. Medicalization was believed to perpetuate the practice as it was perceived as modernized FGM/C. FGM/C remains pervasive in the studied Kenyan communities albeit changed form and context. Findings suggest medicalization sustain FGM/C by allowing families and health providers to conform to social norms underpinning FGM/C while addressing risks of FGM/C complications and legal prohibitions. This underscores the need for more nuanced approaches targeting health providers, families and communities to promote abandonment of FGM/C while addressing medicalization.

El género como determinante de la salud mental y su medicalización. Informe SESPAS 2020 / Gender as a determinant of mental health and its medicalization. SESPAS Report 2020

La peor salud mental de las mujeres ha sido demostrada tanto en encuestas de salud como en estudios de base clínica. La hipótesis acerca de una mayor vulnerabilidad biológica de las mujeres es inconsistente, lo que haría que las condiciones de vida desiguales entre hombres y mujeres, junto con los modelos imperantes de masculinidad y feminidad hegemónicos, puedan estar explicando estas desigualdades de género en la salud mental. El artículo muestra la existencia de desigualdades de género en la salud mental, la relevancia de la intersección de diferentes ejes de desigualdad y un posible proceso de sobrediagnóstico y medicalización de la salud mental de las mujeres, por el cual los/las profesionales de la salud están etiquetando con más frecuencia como depresión y ansiedad estados de salud mental similares en hombres y mujeres, y prescribiendo con mayor intensidad psicofármacos a las mujeres, a igualdad de necesidad. Esta realidad, además, parece ser desigual en función de la edad y del nivel socioeconómico de los/las pacientes. En los últimos años se están desarrollando diferentes experiencias dirigidas a afrontar la creciente medicalización de la salud mental desde una perspectiva de género. En la medida en que el fenómeno de las desigualdades de género es complejo, resulta necesario actuar y promover cambios en los sectores político-estructural, cultural y asistencial, que reviertan en su conjunto en la reducción de las desigualdades de género en las sociedades y en una atención sanitaria sin sesgos de género

Women's worse mental health has been shown using both health survey and clinical-based data. Considering that the hypothesis about a greater biological vulnerability of women is inconsistent, unequal living conditions between men and women, together with hegemonic models of hegemonic masculinity and femininity emerge as explain factors of these gender inequalities in mental health. The article shows that gender inequalities in mental health, the intersection of different axes of inequality, and the existence of a possible process of medicalization of women's mental health, by which health professionals are labeling women more frequently as depressed and anxious given similar mental health status in men and women. Prescription of psychotropic drugs is also of greater intensity in women, given equal need. This reality, moreover, seems to be unequal depending on the age and socioeconomic level of the patients. In recent years, different experiences are being developed aimed at addressing the growing medicalization of mental health from a gender perspective. Given that the phenomenon of medicalization is complex, it is necessary to act and promote changes at political-structural, cultural and health care levels that ultimately reverse gender inequalities in societies and promote non gender-biased healthcare

Aprimoramento cognitivo e a produção de modos de subjetividade: um estudo sobre o uso de substâncias "nootrópicas" a partir de um blog brasileiro / Cognitive enhancement and the production of subjectivity modes: a study on the use of nootropics according to a Brazilian blog

Resumo O consumo de medicamentos para aprimorar processos mentais, como memória, concentração e estado de alerta, tem se expandido. As chamadas smart drugs e fármacos nootrópicos são utilizados na expectativa de obter melhor desempenho em tarefas profissionais e acadêmicas. Este artigo analisa a difusão do uso de medicamentos para aprimoramento cognitivo, a partir de um blog brasileiro chamado Cérebro Turbinado, com ênfase na discussão da categoria "nootrópicos". A metodologia adotada foi a pesquisa socioantropológica documental, baseada em materiais de divulgação científica que integram o conteúdo do blog, criado em 2015 por um estudante de medicina de uma universidade pública. O blog apresenta os nootrópicos como opções mais acessíveis, seguras e igualmente eficazes em comparação com os medicamentos psicotrópicos utilizados como smart drugs. Editor e leitores produzem um saber coletivo para otimizar o desempenho cerebral. As experiências pessoais evidenciam a maneira como os indivíduos interpretam seus estados corporais e os relacionam com os medicamentos. Na esteira dos processos de farmacologização da sociedade, a produção de modos de subjetividade baseadas em uma concepção individualista dos processos de saúde/doença/incapacidade, apoiada na compreensão neuromolecular do cérebro, fundamenta-se no compartilhamento de práticas e conhecimentos sobre tais substâncias.

Abstract The use of drugs to improve mental processes, such as memory, concentration and alertness, has been increasing. Nicknamed "smart drugs", nootropic drugs are used with the expectation that better performance can be achieved in professional and academic tasks. This analyzes the spread of cognitive enhancement drugs according to a Brazilian blog called Cérebro Turbinado focusing on the discussion of the nootropic drugs category. This is a documentary socio-anthropological research grounded on the scientific outreach materials that integrate the blog content, created in 2015 by a medical student from a public university. The blog presents nootropics as the most affordable, safe and equally effective options for psychotropic drugs used as smart drugs. Editor and readers turn to the production of collective knowledge to optimize brain performance. The narratives of personal experiences highlight the way individuals interpret their body states and relate them to medication. In the wake of society's medicalization processes, the production of subjectivity modes based on an individualistic conception of health/disease/disability processes, supported by neuromolecular understanding of the brain, is grounded on the sharing of practices and knowledge about such substances.

Tracking biomedicalization in the media: Public discourses on health and medicine in the UK and Italy, 1984-2017.

This article examines historical trends in the reporting of health, illness and medicine in UK and Italian newspapers from 1984 to 2017. It focuses on the increasing "biomedicalization" of health reporting and the framing of health and medicine as a matter of technoscientific interventions. Methodologically, we relied on two large datasets consisting of all the health- and medicine-related articles published in the online archives of The Guardian (UK) and la Repubblica (Italy). These articles underwent a quantitative analysis, based on topic modelling techniques, to identify and analyse relevant topics in the datasets. Moreover, we developed some synthetic indices to support the analysis of how medical and health news are "biomedicalized" in media coverage. Theoretically, we emphasise that media represent a constitutive environment in shaping biomedicalization processes. Our analyses show that across the period under scrutiny, biomedicalization is a relevant, even if sometimes ambivalent, frame in the media sphere, placing growing centrality on three dimensions: i) health and well-being as a matter of individual commitment to self-monitoring and self-surveillance; ii) biomedicine as a large technoscientific enterprise emerging from the entanglement between research fields and their technological embodiments; iii) the multiverse reforms of welfare systems in facing the trade-off between universal health coverage and the need to render the national healthcare system more sustainable and compatible with non-expansionary monetary policies and austerity approaches in managing state government budgets.

Health care providers' and mothers' perceptions about the medicalization of female genital mutilation or cutting in Egypt: a cross-sectional qualitative study.

BACKGROUND: Female genital mutilation/cutting (FGM/C) is a traditional harmful practice that has been prevalent in Egypt for many years. The medicalization of FGM/C has been increasing significantly in Egypt making it the country with the highest rate of medicalization. In this qualitative study, we explored the drivers and motives behind why healthcare professionals perform FGM/C and why mothers rely on them to perform the practice on their daughters. METHODS: The study drew on a "mystery client" approach, coupled with in-depth interviews (IDIs) and focus group discussions (FGDs) with health care providers (i.e. physicians and nurses) and mothers. It was conducted in three geographic areas in Egypt: Cairo, Assiut and Al Gharbeya. RESULTS: Study findings suggest that parents who seek medicalized cutting often do so to minimize health risks while conforming to social expectations. Thus, the factors that support FGM/C overlap with the factors that support medicalization. For many mothers and healthcare providers, adherence to community customs and traditions was the most important motive to practice FGM/C. Also, the social construction of girls' well-being and bodily beauty makes FGM/C a perceived necessity which lays the ground for stigmatization against uncut girls. Finally, the language around FGM/C is being reframed by many healthcare providers as a cosmetic surgery. Such reframing may be one way for providers to overcome the law against FGM/C and market the operation to the clients. CONCLUSION: These contradictions and contestations highlighted in this study among mothers and healthcare providers suggest that legal, moral and social norms that underpin FGM/C practice are not harmonized and would thus lead to a further rise in the medicalization of FGM/C. This also highlights the critical role that health providers can play in efforts to drive the abandonment of FGM/C in Egypt.

La desmedicalización de la vida cotidiana de las mujeres: los grupos socioeducativos en el Sistema Sanitario Público Andaluz / The demedicalisation of women's daily lives: socio-educational groups in the Andalusian Public Health System

Los grupos socioeducativos (GRUSE) constituyen una estrategia de promoción de la salud y el bienestar emocional desde un enfoque de salud positiva basada en activos. Mayoritariamente se dirigen a mujeres que acuden a los centros de salud con signos de malestar para los que no se encuentra base orgánica. La estrategia se evalúa mediante un diseño longitudinal y cuasi-experimental, con metodología mixta. Se ha recogido información de 228 mujeres con una batería de escalas y el análisis de bases de datos del sistema sanitario. Se han realizado 10 entrevistas en profundidad a mujeres y tres grupos de discusión con profesionales. El objetivo de este artículo es dar a conocer la estrategia GRUSE como intervención alternativa no medicalizadora y presentar el diseño de la investigación, con la que se espera identificar las evidencias de esta práctica implantada en los centros de salud de atención primaria de Andalucía

The socio-educational groups (GRUSE) are a health and emotional well-being promotion strategy, from an asset-based positive health approach. They principally target women who attend health centres with signs of discomfort with no organic basis finding. The strategy was evaluated through a quasi-experimental longitudinal design, with a mixed methodology. Information was collected from 228 women with a battery of scales and from an analysis of health system databases. Ten in-depth interviews with women were conducted, and 3 discussion groups with professionals. The aim of this article was to introduce the GRUSE strategy as a non-medical alternative intervention and to present the research design, seeking to identify the evidence of this practice implemented in primary health centres of Andalusia (Spain)

Prevención: ¿aún podemos ser amigos? / Prevention: can we still be friends?

La prevención ha pasado de ser un abordaje específico en el ámbito de algunas enfermedades a ser un valor central en los discursos y la organización de los sistemas de salud. No obstante, la prevención no es un valor absoluto sin externalidades negativas, problemas de gestión del conocimiento o utilización del poder, sino que su popularización y expansión ha supuesto el incremento de los inconvenientes derivados de la gestión inadecuada del riesgo, la utilización a nivel poblacional de valores éticos desarrollados en el ámbito de la ética clínica individual y la medicalización de la vida diaria, más acusada con los nuevos paradigmas surgidos de la medicina post-genómica. En este artículo se tratan de abordar los riesgos clave de la deriva preventiva de los sistemas de salud y destacar los aspectos que deberían caracterizar las actividades preventivas de las próximas décadas

Prevention has gone from being a specific approach in the field of some diseases to being a central value in discourses and the organization of health systems. However, prevention is not an absolute value without negative externalities, knowledge management problems or use of power, but its popularization and expansion have led to an increase in the drawbacks derived from inadequate risk management, population-level utilization of ethical values developed in the field of individual clinical ethics and the medicalization of daily life, more pronounced with the new paradigms arising from post-genomic medicine. This article tries to address the key risks of the preventive trend of health systems and highlight the aspects that should characterize the preventive activities of the coming decades

Los límites de la prevención del suicidio / The limits of suicide prevention

La prevención del suicidio es uno de los puntos principales y más controvertidos en las políticas de salud que se han desarrollado en la última década. Nuestro objetivo es revisar, desde una perspectiva crítica, las estrategias preventivas que se han propuesto y las limitaciones que aparecen en su diseño, implementación y efectividad, así como reflexionar sobre las consecuencias potencialmente iatrogénicas de estas intervenciones y recomendar otros abordajes más integradores de la cuestión

Suicide prevention is one of the main and most controversial points within health policies developed in the last decade. Our aim is to review, from a critical perspective, the available preventive strategies and the limitations we encounter in terms of design, implementation and effectiveness, as well as to reflect on the potentially iatrogenic consequences of these interventions and recommend other approaches, more integrative, to this question

The Incomplete Medicalization of Obesity: Physician Office Visits, Diagnoses, and Treatments, 1996-2014.

OBJECTIVES: Despite increased awareness of obesity-related health risks and myriad treatment options, obesity still affects more than one-third of persons in the United States and is a substantial public health problem. Studies show that physicians play a key role in obesity prevention and treatment. The objective of this study was to examine the extent to which obesity is diagnosed and treated at the level of patient-physician interaction. METHODS: We used data from the National Ambulatory Medical Care Survey (NAMCS), a nationally representative data set of US physician office visits. We estimated the number of obesity diagnoses and prescriptions of weight-loss management solutions (exercise counseling, diet counseling, or weight-loss drugs) in clinical practice from 1996 through 2014. We also calculated rates of obesity diagnosis and compared these rates with national rates of obesity based on body mass index data from the Behavioral Risk Factor Surveillance System (BRFSS) for the same period. RESULTS: The estimated number of weight gain-related physician office visits increased from 2.3 million in 1996 to a peak of 7.6 million in 2012, and then fell to 4.5 million in 2014. National estimates of obesity diagnoses resulting from physician office visits ranged from 7.1 million in 1996 to 12.7 million in 2014 and substantially outnumbered the estimates for weight gain-related physician office visits throughout the study period. Estimates of exercise counseling and diet counseling and weight-loss medication prescriptions resulting from physician office visits fluctuated over time but never exceeded obesity diagnoses. When compared with national rates of obesity from the BRFSS, rates of obesity diagnoses resulting from physician office visits were substantially lower in the NAMCS (17%-30% vs 1%). National trends for weight-loss medication prescriptions closely mirrored those of weight gain-related physician office visits, even though fluctuations were substantial. CONCLUSIONS: Our results suggest that obesity is largely underdiagnosed and undertreated in clinical encounters. Future studies should investigate the structural changes needed to better engage physicians in obesity prevention and care. Practitioners should also reflect on their biases in treating obesity as a chronic disease.

Shifts in FGM/C practice in Sudan: communities' perspectives and drivers.

BACKGROUND: Although Sudan has one of the highest prevalence of female genital mutilation or cutting (FGM/C), there have been shifts in e practice. These shifts include a reduction in the prevalence among younger age cohorts, changes in the types of FGM/C, an increase in medicalization, and changes in age of the practice. The drivers of these shifts are not well understood. METHOD: Qualitative data drawn from a larger study in Khartoum and Gedaref States, Family and Midwife individual interviews and focus group discussions. Analysis and categorization within a Social Norms theoretical framework. RESULTS: Major findings confirmed shifts in the type FGM/C (presumably from infibulation to non-infibulating types) and increasing medicalization in the studied communities. These shifts were reported to be driven by social, professional and religious norms. CONCLUSION: Changes in FGM practice in Sudan include drivers which will not facilitate abandonment of the practice instead lead to normalization of FGM/C. Yet professionalisation of Midwives including their oath to stop FGM/C has potential to facilitate abandonment rapidly if developed with other Sudan health professionals.

Medicalisation, pharmaceuticalisation, or both? Exploring the medical management of sleeplessness as insomnia.

In this paper we examine the medical management of sleeplessness as 'insomnia', through the eyes of general practitioners (GPs) and sleep experts in Britain. Three key themes were evident in the data. These related to (i) institutional issues around advocacy and training in sleep medicine (ii) conceptual issues in the diagnosis of insomnia (iii) and how these played out in terms of treatment issues. As a result, the bulk of medical management occurred at the primary rather than secondary care level. These issues are then reflected on in terms of the light they shed on relations between the medicalisation and the pharmaceuticalisation of sleeplessness as insomnia. Sleeplessness, we suggest, is only partially and problematically medicalised as insomnia to date at the conceptual, institutional and interactional levels owing to the foregoing factors. Much of this moreover, on closer inspection, is arguably better captured through recourse to pharmaceuticalisation, including countervailing moves and downward regulatory pressures which suggest a possible degree of depharmaceuticalisation in future, at least as far prescription hypnotics are concerned. Pharmaceuticalisation therefore, we conclude, has distinct analytical value in directing our attention, in this particular case, to important dynamics occurring within if not beyond the medicalisation of sleeplessness as insomnia.

"O problema é como você olha": de um conjunto amorfo de sintomas não-psicóticos ao nascimento de diagnósticos clínico-psiquiátricos / "The problem is the way you look": from an amorphous set of non-psychotic symptoms to the birth of clinical-psychiatric diagnoses

Este estudo objetivou analisar a construção de categorias diagnósticas que se inserem na interface entre a clínica médica e a psiquiatria, tomando como estudo de caso os Transtornos Mentais Comuns e examinar as possíveis consequências que essa construção produzirá. Para isso, foi realizada uma análise documental de fontes secundárias, orientada por indicações de informantes-chave que contribuíram para garimpagem de periódicos, publicados nas bases de dados Medline, LILACS e Scielo, para o levantamento de resumos em anais de congressos nacionais e internacionais, bem como à seleção de teses e dissertações sobre a temática no Banco de Teses da CAPES e na Biblioteca Digital Brasileira de Teses e Dissertações. Foram selecionados noventa e três documentos, sendo estes publicados desde 1960 até 2019. Para analisá-los, foram utilizados o método arqueológico foucaultiano e o conceito kuhniano de paradigma, com o intuito de observar as irrupções que marcaram a produção do conhecimento científico sobre os Transtornos Mentais Comuns, suas permanências e modificações, suas aproximações e afastamentos. Destarte, alguns movimentos foram observados no material analisado: incialmente, os estudos chamavam atenção às manifestações psiquiátricas não-psicóticas que ocorriam nos serviços de atenção primária na Grã-Bretanha, mas não estavam sendo visibilizadas pelos médicos generalistas. Esses casos foram "trazidos à luz" pelas pesquisas feitas nas décadas de 1960, 1970 e 1980, com o auxílio de instrumentos de rastreio, como o General Health Questionnaire (GHQ). Em seguida, o financiamento de pesquisas em saúde e o "fornecimento de ideias" para a formulação de políticas, realizados por agências internacionais, bem como os estudos em Saúde Global e o uso de índices de Carga Global de Doença, utilizados para analisar o impacto sanitário de transtornos mentais no cotidiano das pessoas ao redor do mundo, contribuíram para a realização de mais pesquisas na área. Esses movimentos prepararam um terreno fértil para ações em saúde mental no começo do séc. XXI, que colaboraram para a proposição de categorias diagnósticas a serem inseridas na nova Classificação Internacional de Doenças para Estatísticas de Mortalidade e Morbidade para Atenção Primária (CID-11-AP), as quais seriam: Depressão Ansiosa, Síndrome do Estresse Corporal e Ansiedade com a Saúde, que materializaram em diagnósticos específicos o conceito de Transtornos Mentais Comuns. Em decorrência das análises realizadas, foi considerado que um novo movimento de dissolução entre as fronteiras diagnósticas das perturbações mentais está em curso no Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM), na Classificação Internacional de Doenças (CID) e em sua versão para atenção primária (CID-AP), que pode efetuar uma "virada" na psiquiatria, especialmente na sua relação com a clínica médica. Tal "virada" constituiria uma mudança de paradigma no modo de elaboração das classificações diagnósticas, que ainda não vigora nesses sistemas classificatórios, mas pode efetuar-se num "vir a ser" futuro, mediante os resultados das articulações e dos jogos de forças existentes dentro e fora dos ambientes acadêmicos

This study aimed at analyzing the construction of diagnostic categories that are part of the interface between the medical clinic and psychiatry, taking as a case study the Common Mental Disorders and examining the possible consequences that this construction will produce. For this, a documentary analysis of secondary sources was conducted, guided by indications of key informants who contributed to the prospecting of journals, published in the Medline, LILACS and Scielo databases, for the abstraction of abstracts in annals of national and international congresses, as well as the selection of theses and dissertations on the subject in the Bank of Theses of CAPES and in the Brazilian Digital Library of Theses and Dissertations. ninety-three documents published from 1960 to 2019 were selected. The Foucaultian archaeological method and the Kuhnian paradigm concept were used to analyze them, in order to observe the irruptions that marked the production of scientific knowledge on Common Mental Disorders, its permanences and modifications, its approximations and separations. Thus, some movements were observed in the analyzed material: initially, the studies focuses on non-psychotic psychiatric manifestations that occurred in the primary care services in Great Britain, which were not being seen by general practitioners. These cases were "brought to light" by research done in the 1960s, 1970s and 1980s supported by screening instruments such as the General Health Questionnaire (GHQ). Then, health research funding and the "provision of ideas" for policymaking by international agencies, as well as studies on Global Health and the use of Global Disease Load Burden of Disease, used to analyze the health impact of mental disorders on people's daily lives around the world, have contributed to further research in the area. These movements has prepared a fertile ground for mental health actions at the beginning of the 21th century which collaborated in proposing diagnostic categories to be included in the new International Classification of Diseases for Mortality and Morbidity Statistics for Primary Health Care (ICD-11-PHC), which would be: Anxiety Depression, Body Stress Syndrome and Anxiety with Health, materializing in specific diagnostics the concept of Common Mental Disorders. As a result of the analyzes, it was considered that a new dissolution movement concerning the diagnostic boundaries of mental disorders is underway in the Diagnostic and Statistical Manual of Mental Disorders (DSM), in the International Classification of Diseases (ICD) and in its version for primary care (ICD-PHC), which can carry out a "turnabout" in psychiatry, especially in its relationship with the medical clinic. Such "turnabout" would constitute a paradigm shift in the mode of elaboration of diagnostic classifications, which is not yet in force in these classificatory systems, but may take place as a future "to come" by the results of joints and sets of forces within and outside academic settings

[Machines and artisanal health workers]. / Máquinas y arte-sanos.

This work discusses the dominant models and tensions within the health field regarding the conceptualization of the human body (as a machine), the process of health work (industrial and artisanal models), institutions (hospitals and health centers) and primary agents (the medical corporation and the medical industrial complex). The context of analysis is the United States from the end of the 19th century to the present. Economic-political, ideological-cultural, and scientific-technical dimensions are discussed, which permeate the historicity of the field. The purpose is to illustrate how the health field has transformed over time, as well as the role instrumental reason and financial capital has played in this process, to the detriment of relational aspects.

Este trabajo discute los modelos dominantes y las tensiones, al interior del campo de la salud, entre la concepción del cuerpo humano (máquina); el proceso de trabajo médico (modelos industriales o artesanales); las institucionalidades (hospitales y centros de salud) y los principales agentes (corporación médica y complejo médico industrial). El análisis se contextualiza en EEUU desde fines del siglo XIX a la actualidad. Se discuten dimensiones económico-políticas, ideológico-culturales y científico-técnicas, que atraviesan la historicidad del campo. El propósito es elucidar cómo se viene transformando el campo de la salud, y qué peso tiene la razón instrumental y el capital financiero en ese proceso, en detrimento de lo relacional.