Caregiver Values and Preferences Related to Surgical Decision-Making for Children with Medical Complexity.

OBJECTIVE: To uncover the values and preferences of the caregivers for children with medical complexity using the test case of surgical treatment decision-making for pediatric neuromuscular scoliosis that will inform the future development of a decision support tool in this population. STUDY DESIGN: We conducted a qualitative study of semistructured interviews of English- and Spanish-speaking caregivers of children with neuromuscular scoliosis from 2 geographically distinct children's hospitals. We used purposive sampling of language and treatment options selected to capture diverse experiences. Analysis was on the basis of grounded theory with synthesized caregiver values and preferences themes. RESULTS: From 47 participants, we completed 41 interviews (9 in Spanish). Caregivers had a mean age of 43.2 years, were mostly White (66%), and had children with a mean age of 15.6. In total, 64% chose surgery. The following values and preferences were important to many caregivers: reducing scoliosis-related pain, minimizing mobility limitations to optimize socioemotional quality of life, limiting the impact of comorbidities on overall quality of life, information provided by peer support, the uncertainty of outcomes due to underlying comorbidities, and the uncertainty related to the anticipated progression of their child's scoliosis curve. Caregivers experienced immense uncertainty related to treatment outcomes due to their child's comorbidities. CONCLUSIONS: Caregivers of children with medical complexity may benefit from decision support that includes both values clarification exercises to help caregivers identify what of the many possible values and preferences are important to them and novel methods to communicate uncertainty in the care of CMC.

Sexual Health Implications of Return Migration for Women and Their Partners in Rural Mexico: A Critical Ethnography.

ABSTRACT: The return of a migrant partner can negatively impact the sexual health of women who stayed in their communities. Understanding their sexual health needs is crucial for developing targeted interventions and support systems. Our study used a critical ethnographic approach in Agua Dulce, a rural community in Mexico, involving 50 key informants: women who stayed behind ( n = 20), returnees ( n = 12), community leaders ( n = 12), and health care professionals ( n = 6). We used participant observation, policy analysis, and interviews, using purposeful and snowball sampling methods. A gender-based thematic analysis revealed economic hardships and early separations affect the sexual well-being of women who stay behind. Infidelity, discovered through social media or calls, causes emotional distress and family disruptions. Male migrants spend an average of 8.85 years abroad, leading to fears of risky sexual behaviors. Our study highlights the urgent need for specialized support centers and comprehensive health interventions.

Routine Outcome Monitoring from Psychotherapists' Perspectives: A Framework Analysis Study of Expected Benefits and Difficulties.

Psychotherapists' attitudes and expectations towards routine outcome monitoring can impact the likelihood of its fruitful implementation. While existing studies have predominantly focused on Europe and North America, research in Latin America remains limited. The aim of this study is to explore therapists' expected benefits and difficulties prior to implementing a routine outcome monitoring system in a university psychotherapy service in Ecuador. An exploratory and descriptive cross-sectional qualitative study was carried out with 20 participants aged 21 to 47. Semi-structured interviews were conducted to explore participants' knowledge about routine outcome monitoring, their expectations of the difficulties, benefits, usability and risks of using a monitoring system, as well as their expectations about their role in the process. The data analysis adhered to the framework analysis methodology, leading to the identification of six overarching themes, 36 specific themes and 82 subthemes. The interviews highlighted a spectrum of positive and negative expectations at several levels: institutional/general, therapeutic process, therapists, and clients. Perceived benefits encompassed various aspects, including the availability of supplementary information, continuous adaptation of the therapeutic process, facilitation of organization and treatment planning, opportunities for professional development, and fostering patient trust and empowerment. On the other hand, anticipated difficulties comprised concerns such as discomfort among therapists and clients, increased workload, system usage and technical difficulties, and the risk of excessive quantification. Overall, participants expressed more anticipated benefits than difficulties. We present recommendations that can support and optimize the current local implementation efforts of routine outcome monitoring, both within this service and in other settings. These recommendations consider ways to meet positive expectations and address or mitigate negative ones.

Intersectional Anticipated Discrimination Among Women Experiencing Homelessness in Argentina.

Women experiencing homelessness constitute a group with idiosyncratic characteristics and needs that have largely remained invisible. Their discriminatory situation has been studied very little which may limit the design of specific intervention strategies. Buenos Aires (Argentina) is one of the main megalopolises in Latin America, where information on women experiencing homelessness is scarcely available. The main objective of this paper is to analyze different aspects related to intersectional anticipated discrimination perceived by women experiencing homelessness in Buenos Aires (n = 72). A structured interview was used to collect the information. The findings show that the vast majority of women experiencing homelessness in Buenos Aires reported experiencing unfair treatment and anticipated discrimination. In addition, more than two-thirds of the women interviewed indicated that they felt they could be insulted or detained without cause, among other unfair treatment. Among the main reasons attributed by the interviewees to these situations of discrimination were the fact of being homeless, being women (cis or trans), and being poor. The results obtained may be useful to guide the design and implementation of policies, services, and programs for women experiencing homelessness with a gender perspective.

Neonatology Staffing Practices: An In-Depth Exploration of Leaders' Perspectives.

OBJECTIVE: To describe neonatology leaders' perspectives on ideal staffing practices, including clinical work, nonclinical roles, shift characteristics, and flexibility. Although the current state of neonatology staffing issues is reported in the literature, a description of ideal, recommended staffing practices is lacking. STUDY DESIGN: We performed a qualitative study, using purposive sampling to interview 26 neonatology leaders. Semi-structured interviews included open-ended questions on ideal staffing practices in 4 categories: clinical and nonclinical aspects of work, shift characteristics, and flexibility in the work environment. We conducted a directed content qualitative analysis of interview transcripts. RESULTS: Leaders described their perspectives of ideal staffing practices. All clinical hours should count toward total clinical time and clinical full-time equivalent, and many nonclinical efforts should be compensated with time or money. Most stated varying workloads reflective of team structures and patient factors should be considered. Maximum in-house shift length should be ≤ 24 hours and weekend assignments should be equitable, irrespective of career track. Most endorsed flexibility at the individual physician level with a clear plan for covering variable staffing acute and chronic needs. CONCLUSIONS: Neonatology leaders recognize current staffing challenges and the need to evolve toward more ideal staffing practices. However, competing interests and complexities drive maintenance of the status quo and make change difficult for healthcare organizations and academic departments. Future work needs to create and measure optimal, standardized, and transparent staffing practices with appropriate adjustments for clinical, administrative, teaching, and scholarly obligations.

[Racism and mental health in indigenous youth living in the Metropolitan Area of Oaxaca, Mexico]. / Racismos y salud mental en jóvenes indígenas residentes en la Zona Metropolitana de Oaxaca, México.

Indigenous populations show high prevalence rates of mental disorders and limited access to mental health services. The aim of this study was to analyze the mental health care trajectories of indigenous youth living in the Metropolitan Area of Oaxaca, Mexico. Between May and August 2023, we conducted a qualitative study involving non-participant observation, in-depth interviews with seven indigenous youth, and semi-structured interviews with nine health professionals, healers, or leaders of mutual support groups. We identified processes, not exempt of tensions, in how these young people perceive themselves as both young and indigenous, in the development of their mental disorders, and in the ways they seek treatment. Their care involved the use of psychological and psychiatric services, mutual support groups, and, to a limited extent, traditional medicine. This study concludes that these dynamics are interwoven and amplified by interpersonal, institutional and epistemic racism, which must be dismantled to improve the mental health of indigenous youth.

Las poblaciones indígenas presentan altas prevalencias de trastornos mentales y limitado acceso a servicios de salud mental. El objetivo del estudio fue analizar las trayectorias de atención a trastornos mentales de jóvenes indígenas residentes en la Zona Metropolitana de Oaxaca, México. Entre mayo y agosto de 2023, se llevó a cabo un estudio cualitativo basado en observación no participante, entrevistas en profundidad a siete personas jóvenes indígenas y entrevistas semiestructuradas a nueve personas profesionales de la salud, curanderas o responsables de grupos de ayuda mutua. Se identificaron procesos de occidentalización, no exentos de tensiones, en la forma de concebirse como jóvenes e indígenas, en el desarrollo de sus trastornos mentales y en la atención de estos, para lo cual utilizaron servicios psicológicos, psiquiátricos, grupos de ayuda mutua y, de manera limitada, medicina tradicional. Se concluye que en estos procesos se articulan y potencian racismos interpersonales, institucionales y epistémicos, que será necesario desarticular para mejorar la salud mental de personas jóvenes indígenas.

Covid-19 and Diaguita communities: structural inequalities and (inter)community strategies in the Santa María department (Catamarca, Argentina). / Covid-19 y comunidades diaguitas: desigualdades estructurales y estrategias (inter)comunitarias en el departamento Santa María (Catamarca, Argentina).

The aim was to investigate and analyze the social, health, and economic impact of the Covid-19 pandemic on Indigenous communities in the province of Catamarca (Argentina), while also identifying the various strategies developed by these communities to address this phenomenon. The research was conducted between December 2021 and December 2022, with an exploratory nature and a predominantly qualitative methodological design. During the fieldwork, 15 in-depth interviews were conducted with community authorities, community members, territorial technicians, and health workers, complemented by 30 structured interviews with individuals from different communities in the Santa María Department. Although tensions between the official health system and Indigenous communities (with their worldviews and ancestral practices) are evident, the importance of community self-management and territorial control over Indigenous organizational processes is also observed in health prevention and care actions, as well as in establishing dialogues and negotiations with local health authorities regarding the implementation of measures in the territories.

El objetivo fue indagar y analizar el impacto social, sanitario y económico de la pandemia covid-19 en comunidades indígenas de la provincia de Catamarca (Argentina), buscando identificar también las diferentes estrategias construidas por parte de estas comunidades para hacer frente a este fenómeno. El trabajo de investigación se llevó a cabo entre diciembre de 2021 y diciembre de 2022, y ha tenido un carácter exploratorio y un diseño metodológico predominantemente cualitativo. Durante el trabajo de campo, se llevaron a cabo 15 entrevistas en profundidad a autoridades comunitarias, personas de la comunidad, técnicos territoriales y agentes de salud, las cuales fueron complementadas con 30 entrevistas estructuradas realizadas a personas de diferentes comunidades del departamento Santa María. Si bien se evidencia la existencia de tensiones entre el sistema de salud oficial y las comunidades indígenas (con sus cosmovisiones y sus prácticas ancestrales), también se observa la relevancia que ha asumido la autogestión comunitaria y el control territorial de los procesos organizativos indígenas en las acciones de prevención y atención de la salud, y en el establecimiento de diálogos y negociaciones con las autoridades del sistema de salud local respecto a la implementación de medidas en los territorios.

[Perceptions of pediatric service professionals on the "Brief Anti-Alcohol Counseling in Pediatric Age" intervention in Asturias, Spain]. / Percepciones de profesionales del servicio de pediatría sobre la intervención "Consejo breve anti-alcohol en edad pediátrica" en Asturias, España.

The aim of this study, based on health care and social learning theories, is to understand the degree of implementation and reach of the "Brief Anti-Alcohol Counseling in Pediatric Age" protocol, a preventive intervention addressing alcohol consumption among minors within the Health Service of the Principality of Asturias, Spain. Using a qualitative methodology, based on thirteen semi-structured interviews conducted in June 2022, the study analyzes the development of the protocol, the perceptions of pediatric service professionals regarding its implementation, and their cultural representations of alcohol consumption within the Asturian and Spanish context. The results reveal limited reach due to the heterogeneity in its application and the difficulty in measuring its impact compared to other areas of pediatric health. Furthermore, the importance of the educational and caregiving dimensions of the pediatric and nursing areas is emphasized, as well as the need for a comprehensive approach that involves families and other institutions to improve alcohol consumption prevention from an early age.

El objetivo de este estudio, fundamentado en las teorías del cuidado de la salud y del aprendizaje social, es conocer el grado de implementación y alcance del protocolo del "Consejo breve anti-alcohol en edad pediátrica", una intervención preventiva sobre el consumo de alcohol en menores del Servicio de Salud del Principado de Asturias, España. A partir de una metodología cualitativa, basada en trece entrevistas semiestructuradas realizadas en junio de 2022, se analiza el desarrollo del protocolo, las percepciones de profesionales del servicio de pediatría sobre su implementación, y sus representaciones culturales sobre el consumo de alcohol en el contexto asturiano y español. Los resultados revelan un alcance limitado debido a la heterogeneidad en su aplicación y la dificultad de medir su impacto, comparado con otras áreas de la salud pediátrica. Asimismo, se subraya la importancia de la dimension educadora y cuidadora de las áreas de pediatría y enfermería, y la necesidad de un enfoque integral que involucre a las familias y otras instituciones para mejorar la prevención del consumo de alcohol desde edades tempranas.

Exploring Stigma Towards People with Schizophrenia in Mass Media and Their Private Discourses.

INTRODUCTION: It has been shown that public stigma towards people with schizophrenia hinders their psychosocial integration. Public stigma expresses itself through lexical labels used in the print media and social networks, heightening the internalization of stigma in this population, a phenomenon known as internalised stigma or self-stigma. This paper analyses the diffusion in the mass media of two dimensions of stigma: public stigma and self-stigma. METHODS: For public stigma, we searched for the lexical labels "schizophrenia", "schizophrenic", "psychosis" and "psychotic" in Chilean newspapers from 2010 to 2020, and for self-stigma, we used semi-structured interviews with people with a diagnosis of schizophrenia who are users of mental health services in Santiago de Chile. The findings were organised into four categories per stigma dimension. Lexical frequencies and semantic relationships were then analysed using the UAM Corpus tool and AntConc software. RESULTS: The results showed frequent use of stigmatising labels in the written press, with harmful semantic associations such as violence, delinquency, unpredictability and danger. CONCLUSIONS: Such labels tend to be accepted by those affected, evidence of their internalisation of the stigma towards the disease, and create a barrier to integration and inclusion.

[Qualitative analysis of voluntary abortion in the Hospital Italiano de Buenos Aires]. / Análisis cualitativo de la interrupción voluntaria del embarazo en el Hospital Italiano de Buenos Aires.

INTRODUCTION: The Voluntary Interruption of Pregnancy (IVE) law 27.610, enacted in 2020, urges healthcare providers to guarantee this practice. Previous investigations at the Hospital Italiano de Buenos Aires (HIBA) revealed that the lack of clear institutional protocols hindered the management of abortion. The objective of this research was to explore the management of abortion before and after the enactment of law 27.610, the institutional modifications implemented in response to it, and the opportunities for improvement in care from the perspective of the healthcare staff. MATERIALS AND METHODS: Qualitative study using an interpretative phenomenological approach. Professionals from the IVE office at HIBA were selected through purposive and snowball sampling between March 2022 and May 2023. Eighteen semi-structured interviews were conducted, manually analyzed using in vivo and descriptive coding, resulting in the emergence of 3 thematic areas. RESULTS: 1) Professionals experienced four stages in management of abortion, with increasing institutional support: referral to informal networks, risk reduction, legal abortion, and the IVE office. 2) A multidisciplinary team implemented changes starting in 2021 that expanded access to IVE. 3) Improving communication between services is necessary to standardize access to different abortion methods and emergency care. DISCUSSION: The evolution of abortion management at the HIBA reflects adaptations to national legislative frameworks and underscores the importance of clear institutional protocols and hierarchical support. Access to IVE is ensured through an integrated network of providers that continually seek improvements.

Introducción: La Ley 27.610 de Interrupción Voluntaria del Embarazo (IVE), sancionada en 2020, insta a los efectores de salud de Argentina a garantizar esta práctica. Investigaciones previas en el Hospital Italiano de Buenos Aires (HIBA) revelaron que la ausencia de protocolos institucionales claros obstaculizaba el manejo del aborto. El objetivo de este trabajo fue explorar dicho manejo antes y después de la Ley 27.610, las modificaciones institucionales implementadas en respuesta a la misma y oportunidades de mejora en la atención desde las experiencias del personal de salud. Materiales y métodos: Estudio cualitativo de enfoque fenomenológico interpretativo. Mediante muestreo intencional y el uso de bola de nieve, se seleccionó a profesionales del consultorio IVE del HIBA entre 03-2022 y 05-2023. Se realizaron 18 entrevistas semiestructuradas, analizadas manualmente con codificación in vivo y descriptiva, emergiendo 3 áreas temáticas. Resultados: 1) Los profesionales experimentaron cuatro etapas de manejo del aborto, con creciente apoyo institucional: derivación a circuitos informales, reducción de riesgos, interrupción legal del embarazo y consultorio IVE. 2) Un equipo multidisciplinario implementó cambios desde 2021 que ampliaron el acceso a la IVE. 3) Se requiere mejorar la comunicación entre servicios para homogeneizar el acceso a diferentes métodos de interrupción del embarazo y a la guardia. Discusión: La evolución del manejo del aborto en el HIBA refleja adaptaciones a los marcos legislativos nacionales y subraya la importancia de protocolos institucionales claros y apoyo jerárquico. El acceso a la IVE está garantizado a través de un circuito de efectores integrados que buscan mejoras continuas.

Social Determinants as Mediators of the Emotional State of People With Type 2 Diabetes and/or Hypertension During the COVID-19 Pandemic in Ecuador and Spain.

INTRODUCTION: We aimed to explore the impact of the COVID-19 pandemic and the resulting restrictions on the emotional state of people with type 2 diabetes mellitus (T2DM) and/or hypertension in Ecuador and Spain. Given the differences in sociopolitical and socioeconomic contexts between these two countries, the research focused on how these diverse environments and their management of social policies and pandemic strategies influenced the emotional well-being of individuals with chronic illnesses. METHODS: We conducted 36 semi-structured telephone interviews between August and December 2020 with adults diagnosed with T2DM and/or hypertension (19 in Ecuador, 17 in Spain). The interviews were recorded, anonymized and transcribed for thematic analysis. This approach allowed us to systematically identify and analyse themes related to the participants' emotional experiences during the pandemic. RESULTS: The results revealed a significant deterioration in the emotional state of participants, attributable to the stress generated by the health crisis and concerns related to their chronic illnesses. The situation elicited a range of emotions among participants, from boredom and apathy to fear, uncertainty and depression. The study highlighted how the impact on emotional well-being was shaped by the interplay between conjunctural determinants (measures to control COVID-19 infections) and structural factors driving inequalities (social class, gender, ethnicity). CONCLUSION: We developed a conceptual framework illustrating how measures to control COVID-19 infections directly influenced economic, health and social determinants, which interacted with pre-existing inequalities and had a differential impact on individuals' emotional well-being. This framework can be useful for designing more effective and equitable social policies during future health crises, ensuring they address social needs and safeguard psychological and emotional well-being, particularly among vulnerable groups such as those with chronic illnesses. PATIENT AND PUBLIC CONTRIBUTION: Thirty-six participants diagnosed with T2DM and/or hypertension (19 in Ecuador, 17 in Spain) contributed to the study by sharing their emotional experiences during the pandemic. Their detailed accounts enriched the research by providing valuable insights into how the pandemic affected their emotional well-being. There was no additional involvement or contribution from the public in the design, conduct, analysis or interpretation of the study, nor in the preparation of the manuscript.

Nursing team's perceptions about care for pregnant women in a psychiatric unit.

OBJECTIVES: to understand the nursing team's perception in relation to the care provided to pregnant women with mental disorders admitted to a psychiatric hospital unit. METHODS: Convergent Care Research carried out between August and December 2021, through semi-structured interviews with 25 nursing professionals from a Psychiatric Unit from a reference Hospital in Southern Brazil. RESULTS: the organized and analyzed data resulted in two thematic categories: Technical, generic and impersonal care; and From impersonality to the singularity of nursing care. Ensuring unique care for pregnant women with mental disorders means giving them a meaning of existence and providing care from a multidimensional and continuous perspective. FINAL CONSIDERATIONS: nursing care for pregnant women in psychiatric hospitalization requires continuous professional qualification, interactive technologies and support for the nursing process, in addition to promoting singular and multidimensional care.

Childbirth care by health professionals: conflicting practices in obstetrics.

OBJECTIVES: to understand the perceptions of women and health professionals regarding childbirth care at a teaching hospital in the western state of Paraná, Brazil. METHODS: this qualitative study employed Grounded Theory, conducted in an obstetric care service with 38 participants (women and health professionals) through semi-structured interviews. RESULTS: limitations in physical infrastructure and management of care, along with the women's limited knowledge about the childbirth process and the decision-making and guidance of professionals, show conflicting obstetric practices-a discrepancy between good practices and obstetric violence. Training in obstetric nursing and active participation in care, alongside the presence of a companion, were identified as intervening conditions and strategies in the process. FINAL CONSIDERATIONS: childbirth care is characterized by dichotomous practices. While some professionals base their practices on scientific evidence, others rely on teachings and experiences from the time of their training.

Narratives of sex workers: intimate partner violence and coping strategies.

OBJECTIVES: to understand the narratives of sex workers about violence suffered by intimate partners and their coping strategies. METHODS: qualitative research, focused on thematic oral history, carried out with six sex workers in southern Brazil, who responded to in-depth interviews using a flexible script. Thematic content analysis was used. RESULTS: the study included cisgender women who self-identified as half black and half white. Most had children and were separated. They reported abusive relationships by their intimate partners, with emphasis on verbal, psychological, financial, and physical violence and attempted femicide. Such violence resulted in coping strategies, such as avoiding emotional bonds and maintaining a discreet life. FINAL CONSIDERATIONS: intimate partner violence is prevalent among participants, leading them to adopt strategies to preserve their safety and well-being, highlighting the need for public policies that meet their particularities and guarantee protection.

Repercussions of the pandemic on tuberculosis control actions from the perspective of health professionals.

OBJECTIVES: to analyze the repercussions of the COVID-19 pandemic on tuberculosis control actions from the perspective of primary health care professionals. METHODS: this descriptive study with a qualitative approach was conducted from November 2022 to April 2023, using semi-structured interviews with 11 key informant professionals from primary health care units in a Brazilian capital. Data were organized using Atlas.ti 22.0 software and subjected to thematic-categorical content analysis. RESULTS: the pandemic scenario caused alterations in the work process, necessitating abrupt adaptations, and led to detrimental impacts on the health of professionals and tuberculosis control actions, which were reduced or discontinued. FINAL CONSIDERATIONS: there was evident unpreparedness and a lack of resources from various governmental levels and health services to handle the public health emergency situation without severe harm to the provision of essential services.

Nurses' experience regarding patient safety in mobile pre-hospital care.

OBJECTIVES: to understand nurses' experience regarding patient safety in mobile pre-hospital care. METHOD: a qualitative, exploratory and descriptive study, conducted with nurses active in mobile pre-hospital care services. Semi-structured interviews were conducted, audio-graved and submitted to Bardin's content analysis. RESULTS: from four thematic categories established, nurses reported the care and management skills necessary to work in this service. They demonstrated a commitment to ensuring safe care for patients, staff and spectators. They highlighted the actions taken to prevent and mitigate incidents. However, they based their experiences on practice protocols and individual actions, expressing the need to improve knowledge about patient safety. FINAL CONSIDERATIONS: mobile pre-hospital care nurses' experience in relation to patient safety was limited, suggesting the need for training on the subject, alignment of work processes and implementation of strategies, aiming to guarantee safe care.

Stress in nursing workers caring for people with COVID-19.

OBJECTIVES: to analyze stress from the perspective of nursing workers caring for people with COVID-19 in a public hospital in the Recôncavo region of Bahia. METHODS: this is an exploratory qualitative study, conducted through semi-structured interviews. The data were analyzed using word clouds, similarity trees, and content analysis. RESULTS: nursing workers were exposed to stress while attending to patients with COVID-19. The reported stressors in the workplace included: work overload, lack of planning, speed in performing tasks, fatigue, lack of participation in decision-making, lack of support from management, technological changes, excessive responsibility without preparation, interpersonal conflicts, and professional undervaluation. CONCLUSIONS: exposure to these stressors leads to emotional exhaustion and demotivation, which were intensified during the COVID-19 pandemic.

Exploring the complexities and challenges of healthcare access for transgender people in Minas Gerais state: a qualitative study a decade following the implementation of the transsexualization process in the Brazilian National Health System.

OBJECTIVE: This article explores the complexities and challenges of healthcare access for transgender people in Minas Gerais. METHODS: : This study is based on a subsample from the Manas Survey, comprised of 15 semi-structured interviews with transgender people, conducted between May 2018 and May 2020, analyzed using the content analysis method and organized into a thematic network. RESULTS: : The results highlight the need for adequate structures, specific training for healthcare professionals, the influence of support networks and challenges in mental health. CONCLUSIONS: : Despite advances in transgender health policies, access barriers persist, underscoring the importance of training strategies, accurate record-keeping and the expansion of specialized services and the role of primary health care. The study makes progress by including the perceptions from residents of small and medium-sized cities across different regions of the state, aiming to improve access and care for the transgender population via the Brazilian National Health System in Minas Gerais. MAIN RESULTS: The findings underscore the need for adequate structures, specific training for healthcare professionals, the influence of support networks and challenges in mental health, in addition to including the perceptions of residents from small and medium-sized cities. IMPLICATIONS FOR SERVICES: Improving the use of social name and gender identity in records. There is a need for training healthcare professionals in gender identity, expanding transgender-specific services and the role of primary health care (PHC) in this topic. PERSPECTIVES: Expansion of specialized services and the role of PHC for this population, in order to improve access and care for the transgender population via the Brazilian National Health System in Minas Gerais state.

Meanings and senses of Hansen's disease for health workers from a Vygotskian perspective: a qualitative study.

BACKGROUND: Hansen's disease is an infectious disease with a slow and chronic evolution that can manifest itself through skin lesions, with changes in thermal, painful and tactile sensitivity, and also affect peripheral nerves, causing significant physical disabilities. This study aimed to analyze the meanings and senses for health workers from outpatient services who provide care to people diagnosed with Hansen's disease. METHODS: This is an exploratory qualitative study that used the Vygotskian theoretical-methodological framework based on the dimension of historical-dialectic materialism that bases its procedures on the use of meaning cores. The study was carried out in Ribeirão Preto, in the inland state of São Paulo, Brazil. In total, 13 health professionals participated in the study, including two nurses, three physicians, five nursing assistants, a physiotherapist and two social workers. RESULTS: To understand the meanings and senses of Hansen's disease, we take three cores of meaning as a basis: (1) personal, professional and social aspects of health workers and Hansen's disease, the health workers report that their view of what Hansen's disease was based on the understanding that it was an infectious disease that caused deformities, known as "leprosy", and that those affected needed to be isolated; (2) Hansen's disease - neglected, invisible and unknown, the invisibility of Hansen's disease continues to haunt those affected by it, and diagnosis is still late, referring to the marks carried in the history of Hansen's disease that remain today; and (3) challenges and potential in the world of work in the Hansen's disease reference services, the dichotomies, challenges and potential of working with those affected by Hansen's disease are linked to the creation of bonds, love for the profession, religious beliefs and problems related to the lack of resources for the rehabilitation of those affected. CONCLUSIONS: The re-elaboration of meaning can occur when professionals are inserted in the world of work. The socially produced senses and meanings surrounding leprosy are related to its invisibility and late diagnosis. Changing the meanings and senses requires mediation and the use of critical active methodologies in health education, with investments from training bodies, social movements and health services.

Challenges for cultural relevance of physiotherapy in the care of the Mapuche population in Chile. / Desafíos para la pertinencia cultural de fisioterapia en la atención de población mapuche en Chile.

Physiotherapy rehabilitation must address the cultural preferences of the population, and as its main tool, physical activity should be analyzed from an intercultural health approach. This study aims to characterize the experiences of physical therapy care related to physical activity from an intercultural perspective. Using a qualitative approach, between June 2021 and March 2023, eight semi-structured individual interviews were conducted with adult Mapuche individuals, professionals in the field, and workers from the Indigenous Health Program in primary care centers in an urban municipality in Santiago, Chile. There are challenges to implementing interculturality, such as the gap between health programs, lack of professional training, and discrimination against the Mapuche community. In rehabilitation services, particularly in physical activity practices as a treatment strategy for Mapuche individuals, cultural relevance is limited or nonexistent.

La rehabilitación en fisioterapia debe atender a las preferencias culturales de la población y, como principal herramienta, la actividad física debe analizarse desde un enfoque intercultural en salud. Este estudio busca caracterizar las experiencias de atención kinésica/fisioterapéutica relacionadas con la actividad física desde una visión intercultural. A partir de un abordaje cualitativo, entre junio de 2021 y marzo de 2023, se realizaron ocho entrevistas individuales semiestructuradas a personas adultas mapuches, profesionales del área y trabajadoras del programa de salud indígena de centros de atención primaria de una comuna urbana de Santiago de Chile. Existen desafíos para la implementación de la interculturalidad, como el distanciamiento entre programas de salud, falta de formación profesional y la discriminación hacia la comunidad mapuche. En las prestaciones de rehabilitación, en particular en las prácticas de actividad física como estrategia de tratamiento hacia personas mapuches, la pertinencia cultural es escasa o inexistente.