Health mediation does not reduce the readmission rate of frequent users of emergency departments living in precarious conditions: what lessons can be learned from this randomised controlled trial?

BACKGROUND: Severe overcrowding of emergency departments (EDs) affects the quality of healthcare. One factor of overcrowding is precariousness, but it has rarely been considered a key factor in designing interventions to improve ED care. Health mediation (HM) aims to facilitate access to rights, prevention, and care for the most vulnerable persons and to raise awareness among healthcare providers about obstacles in accessing healthcare. The primary aim was to determine whether HM intervention for frequent users of EDs (FUED) living in precarious conditions could reduce the readmission rate at 90 days. METHODS: Between February 2019 and May 2022, we enrolled and interviewed 726 FUED in four EDs of southeastern France in this randomised controlled trial. The HM intervention started in the ED and lasted 90 days. In addition to the primary endpoint (first readmission at 90 days), secondary endpoints (readmission at 30 and 180 days, number of hospitalisations at 30, 90, 180 days, admissions for the same reasons as the first admission) were also studied. The outcomes were measured in the ED information systems. Statistical methods included an intention-to-treat analysis and a per-protocol analysis. Comparisons were adjusted for gender, age, ED, and health mediator. RESULTS: 46% of patients reported attending the ED because they felt their life was in danger, and 42% had been referred to the ED by the emergency medical dispatch centre or their GP; 40% of patients were considered to be in a serious condition by ED physicians. The proportion of patients who were readmitted at 90 days was high but did not differ between the control and the HM intervention groups (31.7% vs. 36.3%, p = 0.23). There was no significant difference in any of the secondary outcome measures between the control and HM intervention groups. Per-protocol analysis also showed no significant difference for the primary and secondary endpoints. CONCLUSIONS: This randomised controlled trial did not show that our health mediation intervention was effective in reducing the use of emergency services by FUED living in precarious conditions. Some limitations are discussed: the duration of the intervention (90 days), the long-term effects (> 6 months), the involvement of the ED staff. TRIAL REGISTRATION: Registered on clinicaltrials.gov as NCT03660215 on 4th September 2018.

Health mediation: an intervention mode for improving emergency department care and support for patients living in precarious conditions.

BACKGROUND: Severe overcrowding of emergency departments (EDs) impacts the quality of healthcare. One factor of this overcrowding is precariousness, but it has rarely been considered a key factor in designing interventions to improve ED care. Health mediation (HM) aims to facilitate access to rights, prevention, and care for the most vulnerable persons and to raise awareness among healthcare providers about obstacles in accessing healthcare. We here present the results of an ancillary qualitative study to explore the prospects regarding a health mediation intervention implemented in EDs for deprived persons who are frequent ED users, from professionals' and patients' perspectives. METHODS: Design, data collection, and data analysis were done according to a psychosocial approach, based on thematic content analysis and semi-structured interviews of 16 frequent ED users and deprived patients exposed to HM and of 14 professionals in 4 EDs of South-eastern France. RESULTS: All patients reported multifactorial distress. Most of them expressed experiencing isolation and powerlessness, and lacking personal resources to cope with healthcare. They mentioned the use of ED as a way of quickly meeting a professional to respond to their suffering, and recognized the trustworthy alliance with health mediators (HMrs) as a means to put them back in a healthcare pathway. The presence of HMrs in EDs was appreciated by ED professionals because HMrs responded to requests they were not able to access and were perceived as an efficient support for caring for deprived persons in emergency contexts. CONCLUSIONS: Our results are in favour of health mediation in EDs as a promising solution, requested by patients and ED professionals, to cope with frequent ED users and deprived patients. Our results could also be used to adapt other strategies for the most vulnerable populations to reduce the frequency of ED readmissions. At the interface of the patients' health experience and the medico-social sector, HM could complete the immediate responses to medical needs given in EDs and contribute in alleviating the social inequalities of health.

Evidence for indirect loss of significance effects on violent extremism: The potential mediating role of anomia.

Psychological research suggests that violent extremism (e.g., terrorism) stems partly from existential motives, such as individuals' need to achieve significance in life after experiencing failure, ostracism, or humiliation (Significance Quest Theory; SQT). Parallel investigations from sociology and criminology established similar findings by linking anomia-a syndrome including feelings of meaninglessness, powerlessness, isolation, self-estrangement, and normlessness-with violent behavior. In line with SQT, this contribution tested if anomia could mediate Loss of Significance effects on violent extremism. Accordingly, three studies conducted in France highlight indirect effects of exposure to discrimination on legitimation of political violence (Study 1, cross-sectional, minority population sample, N = 110), violent behavioral intentions (Study 2, experimental, undergraduate sample, N = 249), and support for ISIS fighters (Study 3, experimental, undergraduate sample, N = 221) through anomia. A subsequent study shows this indirect effect to be robust when controlled for Social Dominance Orientation and Political Extremism (Study 4, cross-sectional, undergraduate sample, N = 279). A final investigation re-analyzing data collected in Turkey highlights a reverse effect when the independent variable tapped into social inclusion (rather than exclusion; Study 5, cross-sectional, undergraduate sample, N = 321). This indirect effect was also robust to Political Extremism and Intolerance as control variables. These results support the usefulness of considering anomia as a proximal predictor of violent extremism in a SQT perspective.

Time perspective and associated factors in Brazilians living with HIV.

BACKGROUND: a person's time perspective can be an important variable for the understanding of behaviours that interfere with the quality of life of people living with HIV. AIMS: to analyse the relationships between socio-demographic, clinical, and behavioural variables and the time perspective in Brazilians living with HIV. METHODS: a cross-sectional study was conducted with a convenience sample of 281 people living with HIV in Brazil. The time perspective was evaluated using the Zimbardo Temporal Perspective Inventory (ZTPI-25). RESULTS: the main findings indicate that people living with HIV are more oriented towards a future and positive past perspective, and that socio-demographic, clinical, and behavioural factors may influence the different temporal perspective constructs in people living with HIV. CONCLUSION: health professionals can use the results of the present study to support strategies that encourage individuals living with HIV to self-care and lead healthier lives.

Emotional Labour of Caregivers Confronted With Aggressive Brain-injured Patients.

BACKGROUND: Aggressive behaviours are common with people who have suffered brain injuries and induce difficult emotions among certified nursing assistants and medical-psychological assistants who take care of them. These caregivers carry out emotional labour whose content and strategies are little known. AIM: The study explores the emotional labour of certified nursing assistants and medical-psychological assistants faced with the aggressive behaviours of brain-injured patients. METHODS: Semi-structured interviews were conducted with 37 caregivers. Interviews were analysed via a thematic content analysis. RESULTS: The analysis shows that the emotional labour of caregivers varies in accordance with the state of "consciousness" or "non-consciousness" that they attribute to the brain-injured patient with regard to this aggressive behaviour. This is a deep acting strategy. Moreover, caregivers shut off their emotions in order not to transmit them to the patient. This surface acting has the first objective for the caregiver of maintaining control of the situation and a second objective of protecting the patient emotionally and therefore of being perceived as a "good" caregiver. Emotional labour also meets a need to preserve the professional self-image and professional status negatively affected in the interaction with the aggressive brain-injured patient. CONCLUSIONS: Our study specifies the different strategies of the emotional labour of caregivers and their circumstances of use when they are confronted with aggressive behaviour by brain-injured patients. Targeted support for this emotional labour, such as training and practical analysis, is essential for the development of care practices promoting a caring relationship.

[The study of social representations of alcohol within French Navy]. / Représentations sociales de l'alcool au sein de la Marine nationale.

INTRODUCTION: The misuse of alcohol has harmful social and health impacts within a population. The French military must be particularly vigilant with alcohol, due to specificities linked with weaponry. This study was designed to explore social representations of alcohol based on a sample of the French Navy in order to prioritize prevention focuses on alcohol misuses in a military environment. METHODS: A semi-directed interview-based exploratory study was conducted in the south of France at the end of 2015. Data was submitted to manual categorical analysis and textual analysis (Iramuteq software). RESULTS: Sixty-two marines from the French Navy were interviewed including 30 Navy and 32 Marine Firefighters. Data analysis indicated that the motivation to consume alcohol comes more from a social influence (extrinsic motivations) than for pleasure induced by alcohol effects (intrinsic motivations). For Navy personnel, the sense of belonging to the Navy is strengthened by drinking habits with a strong social cohesion. In contrast, the Marine Firefighters had a negative perception of alcohol because of a possible degradation of their professional image for the civilian population. CONCLUSION: The identification of social representations of alcohol allows for a better apprehension of drinking behavior within a French military population, particularly by focusing on content and organization of discourses about alcohol. Following this survey, a quantitative study is currently being drawn up among military personnel from the French Navy in order to clarify some of the elements identified and presented within this article.

Social representations of nursing students on the rights of health users.

OBJECTIVE: To identify the social representations of undergraduate nursing students in the third and eighth term of the course on the rights of health users. METHODS: Qualitative research using the framework of the structural approach to the Theory of Social Representations. A total of 92 students participated. The free evocation technique was used and data was processed in the EVOC software. RESULTS: In the social representations of the third term students, words related to health policies were not observed, but there is an evaluation of the service in the institutions. Among the eighth-grade students, the concepts that support the policies of the Unified Health System are evident. FINAL CONSIDERATIONS: There is a consolidation of the students' knowledge throughout the course, with a more elaborated knowledge about the users' right, supported by principles of the SUS. Undergraduate education is an important space for discussing the construction and exercise of citizenship, including the right to health.

Explain the 'unexplainable': A qualitative enquiry of the representations of the caregivers of brain-injured people.

The aim of our research is to highlight the role of social representations of the traumatic brain-injured person in the adjustments made by caregivers in building and maintaining quality of care. Twenty-three semi-structured interviews were conducted with nursing assistants and medico-psychological assistants, working in a long-term care facility. The interviews were the subject of a thematic content analysis. The analysis shows the role of representations of the traumatic brain-injured person in the way caregivers explain behaviours and situations and in the orientation of their professional practices. In explaining the inexplicable, caregivers establish a more human relationship through individualized care.

Espiritualidade de pessoas vivendo com hiv/aids e suas representações sociais: encontro com Deus e a religião / Espiritualidad de las personas que viven con el vih/sida y sus representaciones sociales: encuentro con Dios y la religión / Spirituality of People Living with hiv/aids and their Social Representations: Encounter with God and Religion

Este estudo tem como objetivo analisar a estrutura das representações sociais da espiritualidade para pes-soas que vivem com o hiv/aids e identificar o núcleo central e os elementos periféricos superativados das representações sociais da espiritualidade. Trata-se de uma pesquisa descritiva e exploratória com abordagem quanti-qualitativa pautada na abordagem estrutural da teoria das representações sociais. Foram utilizadas diferentes técnicas de coleta de dados e análise, desta forma, o estudo foi realizado ao longo de três anos, os dados foram coletados entre os anos de 2015 a 2018. Participaram do estudo pessoas vivendo com hiv/aidsatendidas num serviço ambulatorial especializado vinculado a um hospital universitário estadual da Uni-versidade do Estado do Rio de Janeiro, dentre estes, 166 responderam ao questionário de evocações livres ao termo indutor de espiritualidade, 61 ao questionário de escolhas sucessivas por blocos, 60 ao de técnica do questionamento, e 50 aos esquemas cognitivos de base. Após os testes, chegou-se ao resultado de que os ele-mentos Deus e religião são centrais nas representações sociais da espiritualidade para o grupo participante, os elementos fé e amor foram identificados como periféricos superativados.

Este estudio pretende analizar la estructura de las re-presentaciones sociales de la espiritualidad de las personas que viven con el vih/sida e identificar el núcleo central y los elementos periféricos superactivados de las representaciones sociales de la espiritualidad. Se trata de una investigación descriptiva y exploratoria con un enfoque cuanti-cualitativo basado en el enfoque estructural de la teoría de las representaciones sociales. Se utilizaron diferentes técnicas de recolección y aná-lisis de datos, de esta manera, el estudio se realizó a lo largo de tres años, los datos fueron recolectados entre el 2015 y 2018. Participaron del estudio personas que viven con vih/sida, atendidas en un servicio ambula-torio especializado vinculado a un hospital universitario estadual de la Universidad Estadual de Río de Janeiro, entre ellas, 166 respondieron al cuestionario de evocaciones libres al término inductivo espiritualidad, 61 al cuestionario de elecciones sucesivas por bloques, 60 a la técnica de cuestionamiento, y 50 a los esquemas de base cognitiva. Después de las pruebas, el resultado fue que los elementos Dios y religión son centrales en las representaciones sociales de la espiritualidad para el grupo participante, los elementos fe y amor fueron identificados como periféricos superactivados.

This study aimed to analyze the structure of social representations regarding spirituality of people living with hiv/aids and to identify its central nucleus and peripheral superactivated elements. It was a quantitative and qua-litative descriptive and exploratory research based on the structural approach of social representations theory. Different techniques of data collection and analysis were used. Thus, the study was carried out over three years (2015-2018). The participants were people living with hiv/aids treated at a specialized outpatient service linked to the State University of Rio de Janeiro. Among these, 166 answered the questionnaire of free evocations to the inducing term spirituality, 61 to the questionnaire of successive choices by blocks, 60 to the questioning technique, and 50 to the basic cognitive schemes. After the tests, the result was that the elements 'God' and 'religion' are central to the social representations of spiritua-lity for the participating group. The elements 'faith' and 'love' were identified as peripheral superactivated ones.

Social representations of nursing students on the rights of health users / Representaciones Sociales de estudiantes de enfermería sobre los derechos de los usuarios de la salud / Representações sociais de estudantes de enfermagem sobre os direitos dos usuários da saúde

ABSTRACT Objective: To identify the social representations of undergraduate nursing students in the third and eighth term of the course on the rights of health users. Methods: Qualitative research using the framework of the structural approach to the Theory of Social Representations. A total of 92 students participated. The free evocation technique was used and data was processed in the EVOC software. Results: In the social representations of the third term students, words related to health policies were not observed, but there is an evaluation of the service in the institutions. Among the eighth-grade students, the concepts that support the policies of the Unified Health System are evident. Final considerations: There is a consolidation of the students' knowledge throughout the course, with a more elaborated knowledge about the users' right, supported by principles of the SUS. Undergraduate education is an important space for discussing the construction and exercise of citizenship, including the right to health.

RESUMEN Objetivo: Identificar las representaciones sociales de los estudiantes universitarios de enfermería del tercer y octavo período del curso, sobre los derechos de los usuarios de la salud. Métodos: Se trata de una investigación cualitativa con referencial del enfoque estructural de la Teoría de las Representaciones Sociales, realizada entre 92 estudiantes mediante la técnica de evocación libre y el software EVOC para el procesamiento de los datos. Resultados: En las representaciones sociales de los estudiantes del tercer período no se observan términos relacionados con las políticas de salud, aunque existe una evaluación de la atención de las instituciones. En los estudiantes del octavo, hay conceptos que demuestran apoyo a las políticas del Sistema Único de Salud. Consideraciones finales: A lo largo del curso se produce una reificación del conocimiento de los estudiantes, con un saber elaborado sobre el derecho de los usuarios y basado en los principios del SUS. La educación universitaria es un espacio importante de problematización para la construcción de la ciudadanía y su ejercicio, incluyendo el derecho a la salud.

RESUMO Objetivo: Identificar as representações sociais de estudantes de graduação em enfermagem, do terceiro e oitavo período do curso, sobre os direitos dos usuários da saúde. Método: Pesquisa qualitativa com referencial da abordagem estrutural da Teoria das Representações Sociais. Participaram 92 estudantes. Utilizou-se a técnica de evocações livres, sendo os dados processados pelo software EVOC. Resultados: Nas representações sociais dos estudantes do terceiro período, não se observam termos relacionados às políticas de saúde, mas há avaliação sobre o atendimento nas instituições. Nas dos estudantes do oitavo, evidenciam-se conceitos sustentadores de políticas do Sistema Único de Saúde. Considerações finais: Nas representações sociais dos estudantes do terceiro período, não se observam termos relacionados às políticas de saúde, mas há avaliação sobre o atendimento nas instituições. Nas dos estudantes do oitavo, evidenciam-se conceitos sustentadores de políticas do Sistema Único de Saúde.

A conceptual framework of clinical nursing care in intensive care.

OBJECTIVE: to propose a conceptual framework for clinical nursing care in intensive care. METHOD: descriptive and qualitative field research, carried out with 21 nurses from an intensive care unit of a federal public hospital. We conducted semi-structured interviews and thematic and lexical content analysis, supported by Alceste software. RESULTS: the characteristics of clinical intensive care emerge from the specialized knowledge of the interaction, the work context, types of patients and nurses characteristic of the intensive care and care frameworks. CONCLUSION: the conceptual framework of the clinic's intensive care articulates elements characteristic of the dynamics of this scenario: objective elements regarding technology and attention to equipment and subjective elements related to human interaction, specific of nursing care, countering criticism based on dehumanization.

Representações sociais e educação terapêutica: questões teórico-práticas / Social representations and therapeutic education: theoretical-practical questions

Resumo Apresentamos a contribuição da psicologia social da saúde por meio da abordagem sociorrepresentacional para refletir acerca da educação terapêutica do(a) adolescente com diabetes mellitus tipo 1. O adoecimento crônico na adolescência coloca desafios específicos para o cuidado, o olhar psicossocial permite compreender a prática de avaliação e o fortalecimento das habilidades do paciente contextualizando a educação terapêutica enquanto conjunto de relações sociossimbólicas entre os atores da situação. Essa abordagem pode servir como uma ferramenta teórico-metodológica e prática para alcançar um diagnóstico psicossocial e um planejamento de intervenção. Um programa de três pesquisas realizadas na França com adolescentes diabéticos, suas famílias e profissionais ilustra questões e desafios contemporâneos no campo da educação terapêutica, centrando sua análise nos significados que os atores mobilizam para, assim, determinar estratégias de intervenção adaptadas às tensões psicossociais que possam surgir no cuidado. Ressaltamos a importância das dinâmicas socioidentitária e ideológica advindas do contexto social e cultural de referência dos atores engajados na educação terapêutica.

Abstract We introduce the contribution of social psychology of health to the reflection on the therapeutic education of adolescents with type 1 diabetes mellitus via a socio-representational approach. Chronic illnesses during adolescence pose specific challenges for health care, and the psychosocial perspective allows one to understand the practice of evaluating and consolidating patient's abilities, contextualizing therapeutic education as a set of socio-symbolic relations between the social actors involved in such scenario. This approach can be used both as a theoreticalmethodological and practical instrument to achieve a psychosocial diagnosis and intervention planning. A program of three studies conducted in France with diabetic adolescents, their families and professionals, illustrates contemporary issues and challenges in the field of therapeutic education. This study is focused on the meanings mobilized by the social actors to determine intervention strategies adapted to the psychosocial tensions that may arise in health care. We emphasize the importance of the socio-identity and ideological dynamics arising from the social and cultural context of the social actors engaged in therapeutic education.

[Styles of nurses' caring in Intensive Therapy mediated by technology]. / Estilos de cuidar de enfermeiras na Terapia Intensiva mediados pela tecnologia.

The objective was to identify the social representations of the intensive therapy nurses about the care practices in face of the technology. Participant observation and interviews were conducted with twenty one nurses of an intensive therapy center, at a Rio de Janeiro public hospital. Lexical analysis was applied, using the Alceste 2010. The results were organized in two categories, each of them with three lexical classes. The first brought the meaning of the technology in intensive therapy and the organization of the styles of caring; the second showed the client's condition and its impact on nurses' care practices. It was concluded that the technology organizes the nurses' styles of caring, that are built on client assistance in the work context. These lead nurses to assign meaning to their practices driving them to the elaboration of ways of acting in face of the technologies.

Qualidade de vida de pessoas vivendo com HIV atendidas em serviços públicos de saúde / Quality of life of people living with HIV treated in public health services / Calidad de vida de personas viviendo con VIH atendidas en servicios públicos de salud

Objetivo: descrever o perfil e avaliar a qualidade de vida de pessoas vivendo com HIV atendidas em serviços públicos de saúde. Métodos: estudo transversal, quantitativo com 281 pessoas vivendo com HIV atendidas em serviços públicos de saúde nos municípios do Rio de Janeiro e Niterói. Os dados foram coletados por meio de instrumento de dados socioeconômicos e clínicos e do WHOQOL-HIV bref, analisados por estatística descritiva, após aprovação do Comitê de Ética em Pesquisa. Resultados: a amostra foi composta majoritariamente por homens, renda de até dois salários mínimos e percepção positiva da saúde. A qualidade de vida foi positivamente avaliada na maioria das facetas, as maiores médias foram nos domínios: psicológico, relações sociais, espiritualidade, religião e crenças pessoais e a menor no domínio meio ambiente. Conclusão: o perfil das pessoas vivendo com HIV corrobora, os dados nacionais e a avaliação da qualidade de vida foi mais positiva do que em outros estudos.

Objective: to describe the profile and evaluate the quality of life of people living with HIV treated in public health services. Methods: in this cross-sectional, quantitative study of 281 people living with HIV treated in public health services in the municipalities of Rio de Janeiro and Niteroi, data were collected using a socioeconomic and clinical instrument and the WHOQOL-HIV brief questionnaire, and analyzed by descriptive statistics, with research ethics committee approval. Results: the sample comprised mainly men, with income of up to two minimum wages and a positive perception of their health. Most facets of quality of life were positively assessed, with the highest averages in the psychological, social relations, spirituality, religion and personal beliefs domains, and the lowest, in the environmental domain. Conclusion: the profile of people living with HIV corroborates national data, and the assessment of quality of life was more positive than in other studies.

Objetivo: describir el perfil y evaluar la calidad de vida de personas viviendo con VIH atendidas en servicios públicos de salud. Métodos: estudio transversal, cuantitativo, junto a 281 personas viviendo con VIH, atendidas en servicios públicos de salud en los municipios de Río de Janeiro y Niterói. Se han recolectado los datos mediante un instrumento de datos socioeconómicos y clínicos y del WHOQOL-HIV bref, analizados por estadística descriptiva, después de la aprobación del Comité de Ética en Investigación. Resultados: la muestra se compuso mayoritariamente de hombres, con ingresos de hasta dos salarios mínimos y percepción positiva de la salud. Se evaluó positivamente la calidad de vida en la mayoría de las facetas, los promedios más altos en los dominios: psicológico, relaciones sociales, espiritualidad, religión y creencias personales y el más bajo en el dominio medio ambiente. Conclusión: el perfil de las personas que viven con VIH corrobora con los datos nacionales y la evaluación de la calidad de vida fue más positiva que en otros estudios

The study of social representations in children and adolescents: Lessons from a review of the literature / O estudo das representações sociais entre crianças e adolescentes: Lições de uma revisão de literatura / El estudio de las representaciones sociales de niños y adolescentes: Enseñanzas de una revista de literatura

An ad hoc review of the existing literature concerning the study of social representations (SRs; Moscovici, 1961/1976) in children and adolescents was conducted in order to put forward theoretical and methodological proposals on the study and development of SRs, and to highlight future directions. The review was performed using the PsycINFO database (up to September 2016), and included 60 eligible works. While the main part of the work sample does not mention theoretical and/or methodological implications (41.7%), other contributions highlight the necessity to take into account: (a) the active role of children/adolescents as well as their social interactions in the creation of SRs, (b) the relevance of studying SRs in these populations for developing the theory of SRs, (c) the expression of SRs in children's everyday actions, (d) the use of suitable methods for children/adolescents, and (e) the link between the psychology of development and the theory of SRs.

Foi realizada uma revisão da literatura existente sobre o estudo das representações sociais (RSs; Moscovici, 1961/1976) em crianças e adolescentes com a finalidade de apresentar propostas teóricas e metodológicas para o estudo do desenvolvimento das RSs, e de apontar futuras direções. Realizada a partir da base de dados PsycINFO (até setembro 2016) esta revisão incluiu 60 trabalhos. Enquanto a maior parte dos trabalhos analisados não menciona as suas implicações teóricas e/ou metodológicas (41,7%), outras contribuições salientam a necessidade de se considerar: (a) o papel ativo das crianças/adolescentes, assim como as suas interações sociais na elaboração de RSs; (b) a relevância de se estudar as RSs destas populações para o desenvolvimento da teoria das RSs; (c) a expressão das RSs nas ações cotidianas de crianças; (d) o uso de métodos adaptados à população de crianças/adolescentes e (e) a relação entre a psicologia do desenvolvimento e a teoria das RSs.

Una revista ad hoc de la literatura sobre el estudio de las representaciones sociales (RS; Moscovici, 1961/1976) de los niños y adolescentes ha sido realizada para profundizar las proposiciones teóricas y metodológicas de los estudios del desarrollo de las RSs, y para favorecer futuras orientaciones. Apoyándose en la plataforma PsycINFO (hasta septiembre de 2016), esta revista cuenta 60 investigaciones elegibles. La mayor parte de esos trabajos no evocan las consecuencias teóricas y/o metodológicas (41,7%). Pero otras contribuciones subrayan la necesidad de tomar en cuenta: (a) el papel activo de los niños/adolescentes, tanto como sus interacciones sociales, en la elaboración de la RSs, (b) la relevancia de estudiar las RSs de esas poblaciones para desarrollar la teoría de las RSs, (c) la expresión de las RSs en las acciones cotidianas de los niños, (d) el uso de metodologías adecuadas para niños/adolescentes, y (e) el vínculo entre la psicología del desarrollo y la teoría de las RSs.

Representações sociais da espiritualidade de quem vive com Aids: um estudo a partir da abordagem estrutural / Social representations about spirituality of people who lives with aids: un study according to structural approach

O objetivo do estudo é analisar os conteúdos que integram a representação social da espiritualidade entre pessoas que vivem com HIV/Aids assistidas no serviço de atendimento especializado de um hospital universitário no Rio de Janeiro. É um estudo descritivo, de natureza qualitativa, apoiado na teoria do núcleo central das representações sociais, realizado no período de março a setembro de 2015 com 166 pacientes assistidos no Serviço de Atendimento Especializado em aids do referido hospital. Utilizou-se a técnica de evocação livre de palavras ao termo indutor espiritualidade na coleta de dados e o questionário sociodemográfico para caracterização dos participantes. Os dados do questionário foram organizados no software excel e os conteúdos das evocações foram tratados pela técnica do quadro de quatro casas e analisados à luz dos pressupostos da teoria do núcleo central. Os resultados evidenciaram que houve predomínio de pessoas do sexo masculino com idade entre 41 a 60 anos. Declararam-se, por ordem de frequência, católicos, espíritas e evangélicos, sendo que 30 indivíduos afirmaram não professar nenhuma religião. Os elementos que compõem o núcleo central da representação são ter fé, Deus e religião, sendo que ter fé e Deus são os possíveis elementos centrais pelos fortes laços que estabelecem com os demais termos presentes na representação. Conclui-se que a representação da espiritualidade está organizada em dois polos, o divino e o humano, que têm uma relação direta ou é mediado pela religião. (AU)

the objective of the study is to analyze the contents that integrate the social representation of spirituality among people living with HIV/AIDS assisted in the specialized attention service of a university hospital in Rio de Janeiro. It is a descriptive and qualitative study based on the central core theory of social representations, carried out in the period from March to September 2015 with 166 patients assisted in the Specialized Attention Service in AIDS of the referred hospital. For data collection, it was used the sociodemographic questionnaire and the technique of words evocation to the term inducer spirituality in the data collection. The data of questionnaire were organized in excel software and the contents of the evocations were treated by the four-frame technique and analyzed considering the assumptions of the central core theory. The results showed a predominance of males aged between 41 and 60 years. They were declared, in order of frequency, Catholics, Spiritists and Evangelicals, and 30 individuals stated that they did not profess any religion. The elements that make up the central nucleus of representation are faith, God and religion, and to have faith and God are the possible central elements because of the strong ties they establish with the other terms present in the representation. It was concluded that the representation of spirituality is organized in two poles, the divine and the human, that have a direct relationship or is mediated by religion. (AU)

A conceptual framework of clinical nursing care in intensive care / Um marco conceitual da clínica do cuidado de enfermagem na terapia intensiva / Un marco conceptual de la clínica del cuidado de enfermería en la terapia intensiva

Objective: to propose a conceptual framework for clinical nursing care in intensive care.Method: descriptive and qualitative field research, carried out with 21 nurses from an intensive care unit of a federal public hospital. We conducted semi-structured interviews and thematic and lexical content analysis, supported by Alceste software.Results: the characteristics of clinical intensive care emerge from the specialized knowledge of the interaction, the work context, types of patients and nurses characteristic of the intensive care and care frameworks.Conclusion: the conceptual framework of the clinic's intensive care articulates elements characteristic of the dynamics of this scenario: objective elements regarding technology and attention to equipment and subjective elements related to human interaction, specific of nursing care, countering criticism based on dehumanization.

Objetivo: propor um marco conceitual para uma clínica do cuidado de enfermagem na terapia intensiva.Método: pesquisa de campo, descritiva e qualitativa, realizada com 21 enfermeiros de uma unidade de terapia intensiva de um hospital público federal. Realizou-se entrevista semiestruturada e análise de conteúdo temático e lexical, com apoio do software Alceste.Resultados: os elementos que caracterizam a clínica do cuidado na terapia intensiva emergem dos saberes especializados, da interação, do contexto do trabalho, dos tipos de paciente e de enfermeiro, próprios da terapia intensiva, e dos referenciais assistenciais.Conclusão: conclui-se que o marco conceitual da clínica do cuidado de terapia intensiva articula elementos próprios da dinâmica desse cenário: objetivos em relação às tecnologias e atenção aos equipamentos e subjetivos relacionados à interação humana, específicos dos cuidados de enfermagem, contrapondo-se às críticas pautadas na desumanização.

Objetivo: proponer un marco conceptual para una clínica del cuidado de enfermería en la terapia intensiva.Método: investigación de campo, descriptiva y cualitativa, desarrollada con 21 enfermeros de una unidad de terapia intensiva de un hospital público federal. Fue llevada a cabo entrevista semiestructurada y análisis de contenido temático y lexical, con apoyo delsoftwareAlceste.Resultados: los elementos que caracterizan la clínica del cuidado en la terapia intensiva emergen de los saberes especializados, de la interacción, delcontexto del trabajo, de los tipos de paciente y de enfermero, propios de la terapia intensiva, y de los referenciales asistenciales.Conclusión: se concluye que el marco conceptual de la clínica del cuidado de terapia intensiva articula elementos propios de la dinámica de ese escenario: objetivos con relación a las tecnologías y atención a los equipos y subjetivos relacionados a la interacción humana,específicos de los cuidados de enfermería, contraponiéndose a las críticas pautadas en la deshumanización.

Perceptions of Primary Health Care Professionals towards Alcoholic Patients: an Exploratory Study in a Brazilian Municipality / Percepciones de profesionales de atención primaria en salud sobre pacientes alcohólicos: un estudio exploratorio en una municipalidad brasileña

The objectives of the present research were to explore perceptions of Primary Health Care professionals towards alcoholic patients and to verify possible differences in the perceptions of male and female alcoholism. Participants read and responded to three case vignettes describing a male alcoholic, a female alcoholic and a male diabetic. Data were analyzed with repeated measures MANOVA and univariate F follow-up tests. Results showed that the alcoholic was objectified as an "atypical and difficult" patient towards whom there were negative attitudes and stigma-related socio-cognitive elements. Female alcoholism was possibly perceived as more difficult to explain than male alcoholism. The discussion highlights the importance of social representations and social identities in the continued training of health personnel.

Los objetivos de la presente investigación fueron la exploración de las percepciones de profesionales de atención primaria en salud sobre los pacientes alcohólicos y la verificación de posibles diferencias en las percepciones del alcoholismo masculino y femenino. Los participantes respondieron a tres viñetas que describían un paciente alcohólico, una paciente alcohólica y un paciente diabético. Los datos fueron analizados con MANOVA de medidas repetidas y con test univariados. El alcohólico fue objetivado como paciente "atípico y difícil" asociado a actitudes negativas y a elementos sociocognitivos de estigma. El alcoholismo femenino fue posiblemente percibido como más difícil de explicar que el alcoholismo masculino. La discusión destaca la importancia de las representaciones y identidades sociales para la formación continuada de profesionales de salud.