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Assistive technologies have allowed people with disabilities to perform daily tasks with greater independence and autonomy, especially for visually impaired people. Using smart home solutions allows these users to control their homes with less cognitive and physical demand. However, making such applications accessible to meet the needs of visually impaired users, especially in developing countries, remains a challenge. This paper investigates the perceptions of these users about home automation technologies through semi-structured interviews. A total of 20 visually impaired people participated in the interviews. A thematic analysis revealed results concerning the following themes: (1) how people go about their lives at home and around, how people interact with current appliances, objects and environments, (3) how people perceive their attitude to technologies, (4) the Brazilian context of smart homes, (5) what people think smart homes should do and (6) envisaging ways of interacting with smart home systems. The results obtained provide significant insight into the needs of visually-impaired people in Brazil, with analysis of issues that are common with previous studies in more developed countries and specific issues that have important particularities and implications in Brazil and other developing countries. [ABSTRACT FROM AUTHOR]

This paper reports on a study of maternal sensitivity in 22 primiparous women and their infants from Rio de Janeiro, Brazil. A semi-structured interview was conducted about sociodemographic risk, as and videotaped home observations to assess maternal sensitivity, and its relation with warmth, verbal and physical engagement, and camera awareness. A K-means cluster analysis was performed to examine patterns of risk in relation to maternal sensitivity. Compared to the 15 mothers with higher sensitivity scores, the seven mothers with lower sensitivity scores were characterized by lower educational levels, lower income, lower age, living in a slum, unplanned and unwanted pregnancies, and later onset of prenatal care. Whether father was resident did not appear to distinguish between the lower and higher sensitivity groups. The pattern of social-contextual risk for Brazilian mothers showing less sensitive caregiving to their infants provide a clear direction for future research in this cultural context. [ABSTRACT FROM AUTHOR]

Prior studies on substance use in Brazil have not focused on opioid misuse, previously thought to be nearly non-existent. This paper presents new findings on heroin and non-medical use of opioid analgesics. Data come from the 2015 Brazilian Household Survey on Substance Use (BHSU-3), a nationally representative survey estimating epidemiological parameters related to substance use by residents across Brazil. BHSU-3 used stratified multi-stage probability sampling across multiple geographic domains of interest, resulting in 16,273 interviews with household residents. Lifetime heroin use among Brazilians was 0.3 (95% C.I:0.2–0.4). Lifetime, past-year, and past-month non-medical use of opioid analgesics were respectively 2.9 (95%C.I.:2.3–3.4), 1.4 (95%C.I.:1.1–1.7) and 0.6 (95%C.I.:0.4–0.8). Past-year prevalence of non-medical opioid analgesics use was lower among males [Prevalence Ratio (PR): 0.54 (95% C.I.:0.36–0.78)], those aged 12–24 [0.56 (95% C.I.:0.34–0.92)], persons with monthly family incomes between R$1,501–3,000 [0.59 (95% C.I.:0.38–0.92)] or greater than R$3,000 [0.64 (95% C.I.:0.42–0.98)], and persons who were unemployed [0.65 (95% C.I.:0.46–0.92)]. Non-medical use of opioids in Brazil may be more prevalent than previously recognised. Proper measurement and evaluation of opioid misuse across Brazil and other Latin American countries is critical to understand and prevent opioid-related harms. [ABSTRACT FROM AUTHOR]

The global health community is increasingly advocating for the local production of pharmaceuticals in developing countries as a way to promote technology transfer, capacity building and improve access to medicines. However, efforts to advance drug manufacturing in these countries revive an old dilemma of fostering technological development versus granting access to social services, such as healthcare. This paper explores the case of Brazil, a country that has developed large-scale health-inspired industrial policies, but is, yet, little understood. Brazil’s experience suggests that progressive healthcare bureaucrats can create innovative practices for technology and knowledge transfers. It also demonstrates that highly competitive pharmaceutical firms can collaborate with each other, if a government provides them the right incentives. Reforming regulatory policies is crucial for guaranteeing high-quality products in developing countries, but governments must play a crucial role in supporting local firms to adapt to these regulations. These findings send a strong message to global health policymakers and practitioners on the conditions to create a suitable environment for local production of medical products. [ABSTRACT FROM PUBLISHER]

The professional work of small animal veterinary staff encompasses a wide diversity of demanding tasks. This has prompted a number of studies covering physical, chemical, biological, ergonomic, or psychological hazards, as well as their health effects upon veterinary workers. However, such results were obtained from self-reported surveys (via paper or online). This study reports the identification of potential hazards and provides a risk assessment of 15 veterinary clinics based on data from walk-through surveys, interviews with workers, and quantification of indoor air quality parameters including concentration of volatile organic compounds (total, isoflurane, and glutaraldehyde). The risk arising from X-ray exposure was unacceptable in seven clinics; X-ray examination should be discontinued in the absence of isolated radiation rooms, poor safety practices, and lack of personal protective equipment. Ergonomic-related hazards and work practices should be revised as soon as possible, considering that improper postures, as well as moving and lifting heavy animals are major causes of musculoskeletal disorders. The risk levels were, in general, small or medium (acceptable) with regard to exposure to physical hazards (such as bites, scratches, cuts, and burns) and biological hazards. It was observed that the indoor air quality parameters including temperature, respirable particulate matter and total volatile organic compounds do not indicate a comfortable workplace environment, requiring clinics' attention to keep the safe environment. The veterinarians and nurses were exposed to isoflurane (above 2 ppm) during surgery if an extractor system for waste gas was used instead of a scavenging system. Finally, veterinary workers did not possess any type of training on occupational safety and health issues, even though they recognized its importance. [ABSTRACT FROM AUTHOR]

This paper focuses on challenges faced by heterosexual couples of mixed HIV status in Porto Alegre, Brazil, and argues for more conceptual nuance in our understanding of ‘serodiscordance’. Couples’ stories, collected over 11 months of qualitative research, demonstrate how profoundly serodiscordance involves both partners and suggest that the timing of relationship formation relative to HIV diagnosis influenced the particular challenges they confronted. In recognition of this variation, we propose the distinction of ‘sero-discovering’ from ‘sero-cognisant’ couples. Though Brazilian health policy strives to address the needs of individuals diagnosed with HIV, the needs of seronegative partners in this cohort received relatively little attention. In addition, the transformation of HIV from a death sentence to a chronic condition both facilitated the formation of serodiscordant unions and raised special challenges for such couples. Conceiving of any person receiving an HIV diagnosis as ‘potentially partnered’ may help address some of these lacunae while promoting primary prevention within mixed-status couples, and HIV testing more generally. More research with this population is needed. [ABSTRACT FROM PUBLISHER]

This study explored the experiences of the first generation of adolescents who acquired HIV through vertical transmission when disclosing their diagnosis to friends and romantic partners. The study sample was selected by convenience, with 20 patients (13–20 years old) participating in a qualitative investigation using individual interviews (language: Portuguese; duration: 45 minutes). The participants were followed in specialized clinics for the treatment of pediatric AIDS in São Paulo, Brazil. The results suggest that families who live with HIV tend to keep it a secret, and such behavior is learned and accepted unquestioningly as natural. Respect for privacy and the fear of rejection, coupled with the belief that information about their disease will be spread, are the main beliefs with which participants justify their secrecy. In terms of romantic relationships, adolescents were aware that their HIV status should at some point be shared with current or future sexual partners. However, the decision to reveal an HIV diagnosis in romantic relationships is permeated by anxieties, uncertainties about the right time, and fear of abandonment. In any case, telling the truth requires trust, guarantees of the other’s love, and, in some cases, probing romantic partners beforehand to learn their perceptions about the disease. Participants who had experiences disclosing their HIV status shared positive and negative results, including emotional support, acceptance, and understanding, along with ostracism, discrimination, and abandonment by family members. The findings of this paper reinforce the challenges of revealing an HIV diagnosis to third parties. It requires understanding the meaning and importance of the secret for each patient, along with the conflict between the right to confidentiality and the responsibility of treating others exposed to the disease. All these aspects should be discussed extensively with this population and incorporated into clinical practice. [ABSTRACT FROM PUBLISHER]

This paper examines family planning in Brazil as biopolitics and explores how the democratization of the State and of reproductive health services after two decades of military dictatorship (1964–1984) has influenced health professionals’ and family planning users’ discourses and practices. Do health professionals envisage family planning as a ‘right’ or do they conceive it, following the old neo-Malthusian rationale, as a ‘moral duty’ of poor people, whose ‘irrational’ reproduction jeopardizes the family's and the nation's well being? And how do their patients conceptualize and embody family planning? To answer these questions, this paper draws on 13 months of multi-sited ethnographic research undertaken between 2003 and 2005 in two public family planning services in Salvador da Bahia, where participant observation was undertaken and unstructured interviews were conducted with 11 health professionals and 70 family planning users, mostly low income black women. The paper examines how different bio-political rationalities operate in these services and argues that the old neo-Malthusian rationale and the current, dominant discourse on reproductive rights, gender equality and citizenship coexist. The coalescence of different biopolitical rationalities leads to the double stigmatization of family planning users as ‘victims’ of social and gender inequalities and as ‘irrational’ patients, ‘irresponsible’ mothers and ‘bad’ citizens if they do not embody the neo-Malthusian and biomedical rationales shaping medical practice. However, these women do not behave as ‘docile bodies’: they tactically use medical and non-medical contraceptives not only to be good mothers and citizens, but also to enhance themselves and to attain their own goals. [ABSTRACT FROM PUBLISHER]

This paper focuses on one of the ‘child-trafficking scandals’ that occurred in Brazil in the 1990s. Ethnographic research was carried out between 2000 and 2001 within a movement of poor families formed in São Paulo to put pressure on the authorities to review the legal procedures that had led to their children being placed for national and international adoption. Fieldwork was supplemented by other data, including reports by legislative bodies, articles in the press, and case files involving the termination of parental rights. This paper explores views on international adoption among members of the Brazilian elites such as judges, agents in the field of child protection and journalists, in the context of old but persistent neo-Malthusian ideas. Although the Brazilian birth rate is now below the replacement level, it is still common to blame ‘irresponsible’ reproduction among the urban poor for violence in large cities. Drawing a parallel with the routine sterilization of women that prevailed for decades and was encouraged by Brazilian physicians, the paper examines how, in a ‘struggle against poverty’, judicial agents took it upon themselves to enforce ‘birth control’ through adoption, bypassing family consent and the law in the process. The paper concludes by arguing that discrimination against poor families who are viewed as disorganized, immoral and irresponsible – characteristics frequently associated with criminality by a sector of the elites – has contributed to the view that lower-class families do not have the right to bear children, or to keep them. [ABSTRACT FROM PUBLISHER]

This paper is a comparative ethnography of the therapeutic practices at two different spa locations: Caldas da Imperatriz, SC, Brazil, and Termas da Sulfurea in Cabeco de Vide, Portugal. The comparison reveals the existence of contrasting 'explanatory models' held by the spa-goers as well as by the official medical systems. In the Portuguese context this model is highly medicalized; in the Brazilian case, spa treatments are viewed as 'alternative' or 'complementary' therapy and are also related to religious philosophies. Each model corresponds to a different idiom expressing certain experiences and world views, one focusing on 'pains' (dores) and the other on 'energy' (energia), the former leading to the rationale of 'curing', the latter to the notion of 'energizing'. In this paper the author intends to analyze and contrast the categories found in these models, which originate from different conceptions of health, illness and healing for Brazilian and Portuguese spa-goers. [ABSTRACT FROM AUTHOR]

Background: Since the publication of the reports by the Commission on Social Determinants of Health (CSDH), many research papers have documented inequities, explaining causal pathways in order to inform policy and programmatic decision-making. At the international level, the sustainable development goals (SDGs) reflect an attempt to bring together these themes and the complexities involved in defining a comprehensive development framework. However, to date, much less has been done to address the monitoring challenges, that is, how data generation, analysis and use are to become routine tasks. Objective: To test proposed indicators of social determinants of health (SDH), gender, equity, and human rights with respect to their relevance in tracking progress in universal health coverage and population health (level and distribution). Design: In an attempt to explore these monitoring challenges, indicators covering a wide range of social determinants were tested in four country case studies (Bangladesh, Brazil, South Africa, and Vietnam) for their technical feasibility, reliability, and validity, and their communicability and usefulness to policy-makers. Twelve thematic domains with 20 core indicators covering different aspects of equity, human rights, gender, and SDH were tested through a review of data sources, descriptive analyses, key informant interviews, and focus group discussions. To test the communicability and usefulness of the domains, domain narratives that explained the causal pathways were presented to policy-makers, managers, the media, and civil society leaders. Results: For most countries, monitoring is possible, as some data were available for most of the core indicators. However, a qualitative assessment showed that technical feasibility, reliability, and validity varied across indicators and countries. Producing understandable and useful information proved challenging, and particularly so in translating indicator definitions and data into meaningful lay and managerial narratives, and effectively communicating links to health and ways in which the information could improve decision-making. Conclusions: This exercise revealed that for monitoring to produce reliable data collection, analysis, and discourse, it will need to be adapted to each national context and institutionalised into national systems. This will require that capacities and resources for this and subsequent communication of results are increased across countries for both national and international monitoring, including the successful implementation of the SDGs. [ABSTRACT FROM AUTHOR]

Given that mental symptoms might interfere with the quality of life (QOL) of people living with HIV/AIDS (PLHAs), the goal of this paper was to examine the correlation between depression, anxiety, and QOL in a sample of HIV-positive Brazilians. A cross-sectional study was designed to analyze the correlations between the presence of mental symptoms and the QOL scores of PLHAs. Depression and anxiety symptoms were measured using the Beck Depression Inventory and the State-Trait Anxiety Inventory, respectively. The QOL was assessed using theWorld Health Organization Quality of Life instrument – HIV module. A convenience sample of 308 men and women living with HIV (131 asymptomatic, 91 symptomatic, and 86 with AIDS) in Porto Alegre/RS-Brazil was selected. The depression scores were higher in patients with AIDS compared with asymptomatic and symptomatic patients, yet there were no differences in the anxiety scores between the stages of infection. Better QOL scores were observed in the earlier stages of infection (asymptomatic and symptomatic groups). In the correlation between mental symptoms and QOL scores, the Pearson’s coefficient values were of a moderate (r = .47) to a large (r = .65) magnitude for depressive symptoms, and the scores for the anxiety symptoms were small to moderate (r ⩽ .35). After adjusting for the disease stage and clinical and sociodemographic variables in a multiple regression model (using QOL as the dependent variable), the depressive symptoms showed significantly higher beta-coefficient values compared with the remaining variables. The data obtained from this study indicate that the QOL of PLHAs is primarily affected by depression. Thus, it has been strongly recommended that treatment programs dedicated to PLHAs assess depressive symptoms, providing subsequent referrals and treatments. Treating depression might be effective for PLHAs and might potentially improve both the overall QOL and the health outcomes. [ABSTRACT FROM PUBLISHER]

Sex education has been included in the National Curriculum of the Brazilian Ministry of Education since 1996 as a cross-cutting theme that should be linked to the contents of each school subject in primary and high schools. This paper presents a study of the implementation of this policy in the primary schools of Novo Hamburgo, Rio Grande do Sul, Brazil, based on interviews between January 2011 and April 2012 with 82 teachers working in those schools. We found that sex education was not being taught as a cross-cutting theme in any of the schools, and that any lessons were mostly dominated by a biomedical discourse focusing primarily on the reproductive organs, fertility, pregnancy, and contraception. Sexual health and relationships and non-heterosexual sex and relationships were being neglected. Sex education was also considered a possible means of correcting or controlling sexual identities and behaviours deemed abnormal or immoral. We recommend far more discussion of how to implement the National Curriculum recommendations. We call for education courses to provide theoretical and methodological training on sex education for teachers, and recommend that the boards of educational institutions take up sex education as a priority subject. Lastly, we suggest that each school studies local sexuality-related problems and based on the findings, each teacher presents a pedagogical proposal of how to integrate sex education into the subjects they teach. L'éducation sexuelle est au programme d'études national du Ministère brésilien de l'éducation depuis 1996 comme discipline transversale devant être liée aux contenus de chaque matière scolaire dans l'enseignement primaire et secondaire. L'article présente une étude sur la mise en łuvre de cette politique dans les écoles primaires de Novo Hamburgo, Rio Grande do Sul, Brésil, sur la base d'entretiens menés entre janvier 2011 et avril 2012 avec 82 enseignants de ces écoles. Nous avons constaté qu'aucune des écoles n'enseignait l'éducation sexuelle comme discipline transversale et que les cours étaient le plus souvent dominés par un discours biomédical se centrant principalement sur les organes reproducteurs, la fécondité, la grossesse et la contraception. Ils négligeaient la santé et les relations sexuelles, de même que les rapports non hétérosexuels. L'éducation sexuelle était aussi considérée comme un moyen possible de corriger ou de contrôler les identités et les comportements sexuels jugés anormaux ou immoraux. Nous recommandons d'intensifier les discussions sur la manière d'appliquer les recommandations relatives au curriculum national. Nous demandons que les cours dispensent aux enseignants une formation théorique et méthodologique sur l'éducation sexuelle et préconisons que les conseils d'administration des institutions éducatives considèrent l'éducation sexuelle comme une discipline prioritaire. Enfin, nous suggérons que chaque école étudie les problèmes locaux relatifs à la sexualité et, sur la base des conclusions, que chaque enseignant présente un projet pédagogique sur la manière d'intégrer l'éducation sexuelle dans la matière qu'il enseigne. En 1996, la educación sexual fue incluida en el Currículo Nacional del Ministerio de Educación de Brasil como un tema transversal que debería vincularse con el contenido de cada materia de enseñanza primaria y secundaria. En este artículo se presenta un estudio de la aplicación de esta política en las escuelas primarias de Novo Hamburgo, Rio Grande do Sul, en Brasil, basado en entrevistas realizadas entre enero de 2011 y abril de 2012 con 82 maestros que trabajaban en esas escuelas. Encontramos que en ninguna de las escuelas se estaba enseñando la educación sexual como un tema transversal y que, si había lecciones, éstas eran dominadas en su mayoría por un discurso biomédico centrado principalmente en los órganos reproductivos, fertilidad, embarazo y anticoncepción. Se hizo caso omiso de la salud y relaciones sexuales y del sexo y las relaciones no heterosexuales. Además, la educación sexual era considerada como un posible medio de corregir o controlar identidades sexuales y comportamientos considerados anormales o inmorales. Recomendamos discutir más a fondo cómo poner en práctica las recomendaciones del Currículo Nacional. Hacemos un llamado a que en los cursos educativos se ofrezca a los profesores formación teórica y metodológica sobre la educación sexual y recomendamos que los consejos de las instituciones educativas den prioridad a la educación sexual. Por último, sugerimos que cada escuela estudie los problemas locales relacionados con la sexualidad y, según los hallazgos, que cada maestro presente una propuesta pedagógica sobre cómo integrar la educación sexual en las materias enseñadas. [ABSTRACT FROM AUTHOR]

Interprofessional education (IPE) is an important issue to insert in the debate on the reform of the education of health professions in Brazil. This paper provides details on an emerging study, based in Brazil, whose aim is to explore the use of IPE as a strategy to reform health professional education to become more collaborative in nature. The study has adopted a sequential mixed-methods approach, and will conduct focus groups, individual interviews and surveys with students, teachers and administrators based in two universities. Initial findings have indicated that, at present, participants were not aware of systematic strategies to bring students from different courses together for IPE, which has created problems for the development of knowledge and skills for collaborative work. Further data will be gathered to expand this analysis. Nevertheless, there is already clear evidence that there is a need to integrate and strengthen the use of IPE in Brazil, as a key route forward to strengthening the process of reorientation training of health professionals. [ABSTRACT FROM AUTHOR]