Search

Objective: To establish the association of the mother's breastfeeding self-efficacy with infant feeding in the first six months of the child's life and identify the mothers' perception of their confidence to breastfeed. Background: Breastfeeding is a multi-determined process. Many factors contribute to a mother's ability to exclusively breastfeed until a child reaches six months of age. Among these factors is a mother's confidence in her abilities to breastfeed her baby, referred to as breastfeeding self-efficacy. Thus, self-efficacy for breastfeeding could be an essential predictor of reducing the risk of early weaning. Study design and methods: This is a mixed-method sequential explanatory study. The short form of the Breastfeeding Self-Efficacy Scale was used to determine the level of the mothers' confidence. 158 mothers were surveyed during their postpartum hospital stay, and 128 were included in a follow-up six months after delivery. Additionally, 22 participants were randomly selected for an in-depth interview (qualitative stage). Data were analysed using inferential statistics and thematic content analysis. Results: High levels of breastfeeding efficacy were identified during the hospitalisation and after discharge among all participants. Exclusive breastfeeding was practised among 45.31% of mothers six months after delivery. Return to work was a key factor contributing to early weaning. Family and health professional support during the breastfeeding process were associated as crucial for the duration of exclusive breastfeeding. Discussion: Exclusive breastfeeding for the first six months after delivery involves various factors, such as the mother's confidence in her breastfeeding skills and the specific circumstances she faces while breastfeeding. Thus, through the mixed qualitative and quantitative approaches, it was possible to identify the convergence of self-efficacy scores and the breastfeeding mothers' perception of their confidence and intention to maintain exclusive breastfeeding. Conclusion: High self-efficacy to breastfeed alone was not enough to maintain exclusive breastfeeding. It is necessary to combine self-efficacy and family or health service support and guidance to clarify the mother's doubts about potential difficulties that may appear throughout the breastfeeding process, the maintenance of lactation when she plans to return to work, and the breastfeeding technique. Implication for practice: Applying the Breastfeeding Self-Efficacy Scale associated with the breastfeeding mothers' interview during the prenatal and perinatal period facilitates early identification of mothers at risk for early weaning and helps nurses in planning interventions to support the breastfeeding mother and her child in favour of exclusive breastfeeding duration. What is already known about the topic? * Exclusive breastfeeding (EBF) is recommended for the first six months of a child's life; however, many mothers do not follow this recommendation due to multiple barriers such as mental health issues (i.e., postpartum depression or anxiety), educational gaps, physical discomfort like sore nipples, engorgement, return to work, and lack of support. * Breastfeeding self-efficacy has been associated with the duration of breastfeeding. What this paper adds * Breastfeeding mothers' self-efficacy is essential for stimulating maintenance. * Questions 3 (I always feed my baby without using powdered milk as a supplement) and 11 (I always breastfeed my baby on one breast and then switch to the other) of the Breastfeeding Self-Efficacy Scale (short form) predicted early weaning risk. * Planning nursing care intervention for breastfeeding mothers in their follow-up after birth should include assessing their breastfeeding self-efficacy and factors that could contribute to early weaning, such as returning to work and the lack of a support network. [ABSTRACT FROM AUTHOR]

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 presents findings based on over 40 hrs of rich, phenomenological narrative interview data in which five Syrian refugees describe their experiences of transitioning to a new life in Brazil. Using the Social Identity Model of Identity Change (SIMIC) as a framework for examining the relationship between a period of vulnerability, multiple social identities and wellbeing, interviews were combined with a "talking stones" technique. Key themes of identity "recovery" and "discovery" were consistent with the identity "gain" and "continuity" components of SIMIC. A theme of "adaptation" suggested that a process of continual identity construction and reconstruction is central to both outcomes. Further, themes relating to identity "constraint" suggests how some contexts can actively freeze identities, thus undermining agency and compromising wellbeing. The refugee stories analysed in this paper demonstrate how the SIMIC is a robust model for capturing many of the identity complexities within post‐migration life. Please refer to the supplementary material section to find this article's Community and Social Impact Statement. [ABSTRACT FROM AUTHOR]

Background: The current paper discusses the results of a study realized with 66 seekers of 12 psychosocial healthcare services (CAPS) in Brazil, by investigating their social representations. Aims: Throughout a quali-quantitative approach, unstructured interviews have been conducted and focused on two themes: one related to mental suffering and another to the CAPS itself. Method: The data were processed adopting the Iramuteq software for text-mining-analysis. Results: Out of the findings emerged four lexical classes due to the discursive representation of: (1) CAPS (39.7%); (2) social life (29.7%); (3) family (13.6%) and (4) medication and care (17%), where the utterance NÃO (NO) occupies a central position. Accordingly, the NO is associated with ' not there ' and ' not here ', contrasting the care provided outside the CAPS, represented as inhumane or inadequate, to that provided inside the CAPS, linked to feelings of 'not being discriminated, mistreated and unrecognized'. The underlying social representations expressed in the interviews show an opposition between what was experienced outside and what was experienced inside the CAPS. Conclusion: The care received in CAPS units is the expression of a new psychosocial paradigm in a process of implementation, focused on participation and interdisciplinarity, as opposed to the biomedical paradigm focused on the disease. [ABSTRACT FROM AUTHOR]

Leisure-time physical activity (LTPA) is a crucial behavior to reduce the global burden of disease. The objective of this study was to understand the relationship between LTPA, employment status, and physical workload (PWL). This study analyzed data from 38 449 individuals interviewed in the National Health Survey (NHS), representative of the Brazilian population. This paper examines LTPA in the last 30 days and whether participants achieved the recommended physical activity (≥150 min week−1) according to employment status and PWL utilizing Poisson regression models. One third and ¼ of the participants reported LTPA in the last 30 days and achieved the recommended LTPA, respectively. Intense PWL was reported by 28.7% [95% confidence interval (CI): 27.8–29.6%] of participants; 32.2% among men (95% CI: 31.0–33.5%); 24.3% among women (95% CI: 23.1–25.5%). Precarious employment was associated with a lower prevalence of physical activity among men [adjusted prevalence ratio (PRa) = 0.92; P = 0.016], but not among women (PRa = 1.11; P = 0.039). Employment policies and protection of the work environment are relevant aspects to stimulate physical activity, and may vary by gender. [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]

Accessible summary: What is known on the subject?: Relapse rates are high among patients who have experienced first‐episode psychosis (FEP).Psychotic relapses are associated with worse quality of life and poorer functionality of the FEP patient.The use of psychoactive substances, non‐adherence to drug treatment, and high expressed emotion (EE) are notable predictors of relapse after the FEP.Although some studies have suggested that psychotic relapse may be associated with a family environment with high levels of emotional over‐involvement (EOI), this finding is still inconsistent across different cultures.EE specific components must be evaluated and interpreted according to the context of cultural norms.There is a scarcity of studies on the role of depression in the occurrence of relapses after the FEP, and the results remain uncertain. What the paper adds to existing knowledge?: This study explored the predictors of psychotic relapses in Brazilian patients who experienced FEP.Our results indicate that 29.2% of the patients relapsed after the FEP.Patients diagnosed with depression and high‐EOI in the family environment were predictors of psychotic relapses in this population.This study expands knowledge about the cultural specificity of EOI and the role of depression in psychotic relapse. What are the implications for practice?: Nursing professionals must consider the implications of the family environment and depression in the course of psychosis.Family interventions and the appropriate treatment of depression are important for improving the prognosis of FEP patients. Introduction: Psychotic relapse may be associated with relatives' high emotional over‐involvement (EOI) and with a diagnosis of major depressive episode (MDE) among first‐episode psychosis (FEP) patients, but the results are still inconsistent across different cultures. Aim: Evaluate the predictors of relapse in FEP patients. Method: Prospective cohort study with 6‐month follow‐up conducted with 65 dyads of patients and relatives from an early intervention unit in Brazil. At the baseline interview, relatives answered to a sociodemographic data form and to the Family Questionnaire. Patients provided sociodemographic and clinical data and answered the Measurement of Treatment Adherence; the Alcohol, Smoking and Substance Involvement Screening Test; the Severity of Dependence Scale to assess cannabis dependence, and the MDE module of the Mini‐International Neuropsychiatric Interview. Psychotic relapses were evaluated using items from the Brief Psychiatric Rating Scale. The data were analysed using multiple logistic regression. Results: 29.2% of the patients presented at least one psychotic relapse. High‐EOI and MDE were predictors of psychotic relapses. Discussion: Our findings expand the knowledge about the cultural specificity of EOI and the role of depression in psychotic relapse. Implications for practice: Family nursing interventions and the appropriate treatment of MDE must be considered in the care of FEP patients. [ABSTRACT FROM AUTHOR]

There are only a small number of reported intervention studies to improve health literacy among older populations. This paper reports on a study designed to investigate the feasibility and potential impact on health literacy and health practices of embedding an intervention programme to improve health literacy with older people through established primary health care units (PHCUs) in a disadvantaged urban community in Brazil. This investigation utilized a quasi-experimental design, with 42 participants recruited for the intervention group and comparison group. The Alfa-Health Program was offered by a nurse in a PHCU as part of the public universal health system over a period of 5 months, and was compared for its impact on a range of health literacy and self-reported health outcomes with routine health care available for older people. The intervention achieved relatively high levels of participation, and positive feedback from participants. Some improvements in vaccination rates, health literacy and reported health behaviours related to food choices and physical activity were observed. The intervention made good use of existing facilities; the content and methods were well received by the participants. However, there were some difficulties in recruitment and in retention of participants. The study has demonstrated the practical feasibility of delivering a comprehensive health education programme designed to improve health literacy in a PHCU in Brazil. [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]

Extractive Reserves (Resex) are established from territorial spaces to contribute towards the conservation of certain environmental areas. There is a concern for the conservation of natural resources through sustainable use and permanence and maintenance of the life of populations traditionally inhabiting these areas. These spaces are the product of historical struggles, initially in the northern region of Brazil. The process of Resex constitution is the stage of several interests featuring conflicts, especially social and environmental struggle. In the case of Marine Resex, the conflicts have acquired a greater dimension due to the privileged sites where it was established. Current paper contributes to the debate on the main perspectives and challenges involved in the founding of a Resex. Current descriptive research comprises bibliographic information on the theme, and data from interviews with extractivists of the Marine Resex of Canavieiras BA Brazil. Results show that the conservation of certain environments through the establishment of a Resex is basic for territorial protection and the maintenance of the populations' lifestyle. However, the organization and the mobilization of traditional peoples are crucial for its establishment. This is due to contrary interests to their establishment because of their specificities, localization and the different forms of social-environmental conflicts inherent to the process. [ABSTRACT FROM AUTHOR]

Introduction: This paper argues the role of Discourse Analysis - DA (Michel Pêcheux, Eni Orlandi) as a theoretical-methodological contribution to the evaluation of health campaigns. Objectives: It shows how DA can be applied to identify and understand discourses of resistance to health promotion campaigns. Methodology: It analyses the HIV prevention campaign of the Brazilian Ministry of Health designed for the carnival of 2010, as well as individual interviews with two people living with HIV. Results: By comparing the discourses mapped in the campaign and those present in the interviews, some dissonance of senses, understood as forms of resistance, are identified. Discussion: Such results also lead to the discussion regarding biopower issues (Michel Foucault) and the relationship between power and resistance in historical processes of subjectivation. Conclusion: It is concluded that, before trying with campaigns to change individual's practices towards behaviors that promote health, institutional practices must be changed in order to prioritize listening to people when designing such campaigns, by applying Discourse Analysis's theoretical-methodological contributions. [ABSTRACT FROM AUTHOR]

Community health workers in developing countries usually perform house calls in degraded and violent territories. Thus, in this paper we study the effects of urban violence in the performance of CHWs in poorly developed territories, in order to understand the challenges of delivering care to dangerous communities in developing countries. We conducted telephone surveys for 5 months in 2017, within a systematic sample of 2.000 CHWs based on clinics distributed along the health regions of the city of Rio de Janeiro, Brazil. We completed 766 interviews, approximately 40% of the sample, 86% man and 14% women. Most participants are 30 to 39 years old (35%), followed by 27% of 40 to 49 years old participants. As CHWs work on the sharp end of the healthcare system, responsible for outreaching, community education, counseling, and social support, our study presents contributions to government and management levels on working conditions inside communities, constraints in assistance, and difficulties in implementing primary care policies. [ABSTRACT FROM AUTHOR]

The goal of this paper is to assess the frequency of depression symptoms among Brazilian immigrants living in Massachusetts, the second largest Brazilian immigrant population in the United States, and to identify correlates of depression. A convenience sample of Brazilian immigrants aged 18 or older residing in Massachusetts was used. Data were collected from December 2013 to March 2014, in the Consulate General of Brazil in Boston and in three religious events, using a structure questionnaire and the Center for Epidemiological Studies Depression Scale (CES-D). Depression symptoms were observed in 35.3% of the respondents, with equal distribution by sex. Correlates of depression were low income, being single, poor English proficiency, and poor self-perception of health. These results suggest a need for community outreach, sensitization, and counseling, in Portuguese and adapted to the culture of Brazilian immigrants. [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 aims to discuss the public policy of sports developed by the Municipal Department of Culture, Sports and Recreation of the city of Campinas, by examining the Segundo Tempo program, a ministerial project for the democratization of sports practice. A document analysis, observations and interviews were used during the investigation. As technical support, the paper presents a discussion on the genesis and function of sports in contemporary society) and dialogues with the contradictions, limitations and advances of the Segundo Tempo project, as a public policy for sports. [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]

In this paper, we make explicit the changing configurations of power relations that currently characterize the Brazilian Emergency Care System (SAMU) team in Belo Horizonte, Brazil. The SAMU is a recent innovation in Brazilian healthcare service delivery. A qualitative case study methodology was used to explore SAMU's current organizational arrangements, specifically the power relations that have developed and that demonstrate internal team struggles over space and defense of particular occupational interests. The argument advanced in this paper is that these professionals are developing their work in conditions of exposure, that is, they are always being observed by someone, and that such observational exposure provides the conditions whereby everyday emergency care practices are enacted such that practice is shaped by, as well as shapes, particular, yet recognizable power relationships. Data were collected through the observation of the SAMU's work processes and through semi-structured interviews. Research materials were analyzed using discourse analysis. In the emergency care process of work, visibility is actually embedded in the disciplinary context and can thus be analyzed as a technique applied to produce disciplined individuals through the simple mechanisms elaborated by Foucault such as hierarchical surveillance, normalizing judgment, and the examination. [ABSTRACT FROM AUTHOR]

Introduction and Aims: This paper describes how substance use features in the accounts of intimate partner violence (IPV) perpetrators in treatment in England and Brazil. The aim of the research was to better understand cross cultural constructions of IPV perpetration amongst men in treatment for substance use.Design and Methods: Semi-structured interviews were conducted with 40 men in community substance use treatment in Sao Paolo, Brazil and London and the South East of England who had reported IPV perpetration in a questionnaire survey. A thematic, narrative analysis was carried out of men's explanations for IPV perpetration.Findings: Three types of narratives were distinguished: (i) disputes, centred on substance use, that escalate to IPV perpetration; (ii) IPV perpetration that is explained by uncharacteristic loss of control, as a result of intoxication; and (iii) IPV perpetration provoked by a perceived betrayal, in which substance use is incidental. In all types of accounts hegemonic principles of male and female roles and behaviour provided a context for and make IPV perpetration explicable.Discussion and Conclusions: Substance use and IPV are culturally constructed and contextually defined. Understanding the meaning-making of substance using IPV perpetrators has implications for the treatment of both substance abuse and IPV. [Radcliffe P, d'Oliveira AFPL, Lea S, dos Santos Figueiredo W, Gilchrist G. Accounting for intimate partner violence perpetration. A cross-cultural comparison of English and Brazilian male substance users' explanations. Drug Alcohol Rev 2017;36:64-71]. [ABSTRACT FROM AUTHOR]

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]

An increase in the number of older people with dementia is currently a trend around the world. In low and middle countries, effective public health services are not yet well‐developed, and family care‐givers may be overwhelmed by the requirements of care. This paper has two purposes: to share findings from an ethnographic study about family dementia care practices in Brazil and to draw attention to the significance of the materiality of care practices in the family context. The study was conducted in Belo Horizonte, Brazil. We describe the care trajectory of one family and, analysing data using the insights of Actor Network Theory, show the significance of objects in a networked relation of care. In particular, we show how incontinence products such as adult diapers assume different positions in the network, acting as either mediator or intermediary of care in relation to other elements of the network composed of family members and their living situation, the person with dementia herself, the doctor, and Brazilian health policies. Although the diaper is often seen as an ordinary object for care providers, its participation in a care network shapes relations, activating conflict, financial constraint, and disciplining the body of the person with dementia. [ABSTRACT FROM AUTHOR]

Introduction Breastfeeding is an important determinant of child survival and normal growth and development, but breastfeeding prevalence is generally low in Brazil. Factors associated with infant feeding practices there are not well understood. This paper examines factors associated with breastfeeding cessation in a township in the western Brazilian Amazon. Methods A cross-sectional, population-based study was conducted among children younger than 25 months and collected information on maternal and child characteristics. Survival analysis based on a proximal-distal framework examined the association between breastfeeding duration and socioeconomic and maternal/child biological factors. Results The median breastfeeding duration among 101 children who were no longer breastfeeding was 120 days. Almost two-thirds (63 %) of these children stopped breastfeeding before 6 months of age. In the larger sample of 209 children, 74.6 % had previously been bottle-fed. Considering the full proximal-distal model, a child who had ever been bottle-fed was expected to cease breastfeeding about 88 % sooner than one who was never bottle-fed ( p < 0.001). Children in the second-poorest wealth quartile stopped breastfeeding sooner than children in the poorest quartile ( p < 0.05). Discussion Breastfeeding cessation in the study area occurred much earlier than the recommended 2 years of age. Factors associated with ending breastfeeding early included ever-use of a bottle, having a single mother, and belonging to the second-poorest wealth quartile. Further research is needed to better understand these factors and other barriers women face to continuing breastfeeding. [ABSTRACT FROM AUTHOR]

Background: This paper contributes to the development of theoretical and methodological approaches that aim to engage indigenous, technical and academic knowledge for environmental management. We present an exploratory analysis of a transdisciplinary project carried out to identify and contrast indigenous and academic perspectives on the relationship between the Africanized honey bee and stingless bee species in the Brazilian Amazon. The project was developed by practitioners and researchers of the Instituto Socioambiental (ISA, a Brazilian NGO), responding to a concern raised by a funding agency, regarding the potential impact of apiculture development by indigenous peoples, on the diversity of stingless bee species in the Xingu Park, southern Brazilian Amazon. Research and educational activities were carried out among four indigenous peoples: Kawaiwete or Kaiabi, Yudja or Juruna, Kīsêdjê or Suyá and Ikpeng or Txicão. Methods: A constructivist qualitative approach was developed, which included academic literature review, conduction of semi-structured interviews with elders and leaders, community focus groups, field walks and workshops in schools in four villages. Semi-structured interviews and on-line surveys were carried out among academic experts and practitioners. Results: We found that in both indigenous and scientific perspectives, diversity is a key aspect in keeping exotic and native species in balance and thus avoiding heightened competition and extinction. The Africanized honey bee was compared to the non-indigenous westerners who colonized the Americas, with whom indigenous peoples had to learn to coexist. We identify challenges and opportunities for engagement of indigenous and scientific knowledge for research and management of bee species in the Amazon. A combination of small-scale apiculture and meliponiculture is viewed as an approach that might help to maintain biological and cultural diversity in Amazonian landscapes. Conclusion: The articulation of knowledge from non-indigenous practitioners and researchers with that of indigenous peoples might inform sustainable management practices that are, at the same time, respectful of indigenous perspectives and intellectual property rights. However, there are ontological, epistemological, political and financial barriers and constraints that need to be addressed in transdisciplinary research projects inter-relating academic, technical and indigenous knowledge systems for environmental management. [ABSTRACT FROM AUTHOR]

Background: This paper discusses the results of ethno-ornithological research conducted on the local ecological knowledge (LEK) of artisanal fishers in northeast Brazil between August 2013 and October 2014. Methods: The present study analyzed the LEK of 240 artisanal fishermen in relation to Nearctic shorebirds and the factors that may be affecting their populations. We examined whether differences occurred according to the gender and age of the local population. The research instruments included semi-structured and check-list interviews. Results: We found that greater knowledge of migratory birds and the areas where they occur was retained by the local men compared with the local women. Half of the male respondents stated that the birds are always in the same locations, and most of the respondents believed that changes in certain populations were caused by factors related to habitat disturbance, particularly to increases in housing construction and visitors to the island. The main practices affecting the presence of migratory birds mentioned by the locals were boat traffic and noise from bars and vessels. According to the artisanal fishermen, the population of migratory birds that use the area for foraging and resting has been reduced over time. Conclusions: Changes in the local landscape related to urbanization and tourism are most likely the primary causes underlying the reduced migratory shorebird populations as reported by local inhabitants. Thus, managing and monitoring urbanization and tourism are fundamental to increasing the success of the migration process and improving the conservation of migratory shorebird species. [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]

Background: Game theory enables the predictive study of the behavior of agents that recognize the mutual interdependence of their decisions and act rationally and strategically to maximize their own gains. In this paper, the extractivism of pequi (Caryocar coriaceum Wittm.) and fava d'anta (Dimorphandra gardneriana Tul.) in an area of common use of the semiarid region of northeastern Brazil is described as a model to illustrate a practical application of game theory in the interpretation of the phenomena analyzed in ethnobiological research. Methods: Field research was conducted in the Araripe-Apodi National Forest. Semi-structured interviews were conducted with 55 informants recognized as knowledgeable and experienced in the extractivism of pequi and fava d'anta in the region. In the interviews, information that could contribute to the identification and understanding of the focal points of extractivism in the region was surveyed. Data were analyzed under an analytical/descriptive approach using the “content analysis” technique. Results: There was a logic of competitive entrepreneurship around the commercial extractivism of pequi and fava d'anta in the region. Among the extractivists of pequi, one of the main collection rules refers to the prohibition of removing immature fruits by using sticks or shaking the branches. In the extractivism of fava d'anta, no specific rules have been established by collectors, but there is a predominant behavior of withdrawing all available fruits (pods) on a tree in a single visit. In an analysis guided by game theory, the collection decisions adopted by extractivists to maximize gain from the activity can be considered justifiable from the standpoint of economic rationality. Conclusions: The “game of extractivism” of pequi and fava d'anta operates under conditions similar to the “tragedy of the commons.” In this game, the non-cooperative solution is converted to the Nash equilibrium. The approach used in this study contributed to the identification of strategies and solutions to problems arising from the extractivism of pequi and fava d'anta. [ABSTRACT FROM AUTHOR]

With a growing ageing population and the advent of interactive TV (iTV), understanding how older people use iTV services is a timely and important task. Working towards this end, this paper reports on in situ conversations of, and observations with, almost 400 older people, with different levels of educational attainment and experience with ICTs, while talking about and using online video portals and similar interactive systems in Spain, Brazil and Denmark. The results show more similarities than differences in their reasons for adopting online video portals and patterns of use. All our participants used these portals for keeping or remaining in touch with people they trusted. The results also show that privacy online was a common concern to all the participants. Differences in the acceptance of e-government services and the type of content that drove most of their interactions were also found. Implications for designing more accessible and meaningful iTV services are discussed. [ABSTRACT FROM AUTHOR]

Background: In the Amazon rainforest, biodiversity is a significant resource for traditional communities, as it can be used as a relevant source of protein and it has a promising zootherapeutic potential. Studies on knowledge and ways how local peoples use the fauna are still incipient. This paper presents both the knowledge on and food and medicinal uses of common opossum (Didelphis marsupialis) by riverine communities in an Amazon floodplain region. Methods: The study was conducted with riverine communities in the municipality of Abaetetuba, Pará, Brazil. The main methods used were structured and semi-structured interviews, the "snowball" technique, and participant observation. Results: The study showed that D. marsupialis has an undeniable cultural significance for the local community, both in terms of food and medicine. Its meat is prized by inhabitants as it is classified as tasty, soft and, in some cases, it is designated as the best bushmeat in the region. The interviewees have demonstrated a thorough knowledge on various aspects of the animal's biology, such as its diet, behavior, and places of occurrence. The hunting activity is practiced by men, but the preparation of meat and medicinal oil are tasks mainly performed by women. In medical terms, common opossum is used in the treatment of various diseases, such as rheumatism, asthma, sore throat, and inflammation. Given the importance of this species, its meat or live individuals are often sold in the city fair at prices that can reach R$ 40.00 (U$D 18,00) per individual. Conclusions: D. marsupialis is an important source of protein for riverine communities in the region studied. Its fat is used as a traditional medicine and it is indicated for many types of diseases. Although the species concerned is treated with hostility in various Brazilian regions, in the case of Abaetetuba this animal is strongly prized due to the good quality of its meat. However, despite the value assigned to the species, its consumption should be the subject of further studies, as this marsupial species has been described as a reservoir for parasites that cause severe diseases. [ABSTRACT FROM AUTHOR]

Background In the last 20 years, Brazil has undergone dramatic changes in terms of socioeconomic development and health care. In the first decade of the 2000s, the Ministry of Health (MoH) developed a series of programs focused on reducing infant mortality, including the Family Health Program as a national policy for primary care. In this paper, we propose a method to correct underreporting of deaths and live births. After vital statistics are corrected, infant mortality trends are analyzed for the period 2000-2010 by macro-geographical region. Methods A proactive search of live births and deaths was carried out in the Amazon and Northeast regions in 2010 to find vital events that occurred in 2008 and were not reported to the Ministry of Health. The probabilistic sample of 133 municipalities was stratified by adequacy of vital information reporting. For each municipality, the adequacy analysis was based on the reported age-standardized mortality rate per 1,000 population and the ratio between reported and estimated live births. Correction factors were estimated by strata based on additional vital events found in the proactive search. The procedure was generalized to correct municipal vital statistics for the period 2000-2010. Results In the proactive search, 35% of non-reported deaths were found within the health system (hospitals and other health establishments), but 28% were found in non-official sources, like illegal cemeteries. In areas of extreme poverty and unreliable vital information, the estimated completeness of infant death reporting was only 33%. After correction of vital information, the estimated infant mortality rate decreased from 26.1 in 2000 to 16.0 in 2010, with an annual rate of decrease of 4.7%, greater than the required rate to achieve the Millennium Development Goal. Among Brazilian regions, the Northeast showed the largest decrease, from 38.4 to 20.1 per 1,000 live births. Conclusions The proactive search for vital events was shown to be a good strategy both in terms of understanding local irregularities and for correcting vital statistics. The methodology could be applied in other countries to routinely assess the pattern and extent of birth and death under-registration in order to improve the utility of these data to inform health policies. [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]

This paper aims to identify the perceptions of elderly hypertensive patients about therapy, related or not to adherence to medication. The qualitative sample consisted of 16 elderly of both sexes, aged 60 and older living in two rural districts of the municipality of Governador Valadares, Brazil, who used some medication to control blood pressure and had independent functional status and cognitive function preserved. Data was collected through open interview at depth, with the aid of a digital voice recorder, conducted between June and September 2010. The assessment of information obtained was performed according to the technique of content analysis of Bardin, which found these categories: Practice and knowledge, Hygienic and dietetic Measures (Food, Exercise, Stress and nervousness) and drug treatment. The results showed that older people have adequate knowledge about hypertension and treatment, but are driven, during therapy, to act according to their socially shared opinions and experiences. Moreover, elderly hypertensive non-adherent tend to consider hypertension as an acute, symptomatic and linked to emotional states. We conclude that, because of this misperception, it is necessary to reevaluate the guidance given to hypertensive patients by the health staff, and viable alternatives to promote health must be created, to change attitudes and practices regarding the disease. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of undernutrition, which is closely associated with socioeconomic and sanitation conditions, is often higher among indigenous than non-indigenous children in many countries. In Brazil, in spite of overall reductions in the prevalence of undernutrition in recent decades, the nutritional situation of indigenous children remains worrying. The First National Survey of Indigenous People's Health and Nutrition in Brazil, conducted in 2008-2009, was the first study to evaluate a nationwide representative sample of indigenous peoples. This paper presents findings from this study on the nutritional status of indigenous children < 5 years of age in Brazil. Methods: A multi-stage sampling was employed to obtain a representative sample of the indigenous population residing in villages in four Brazilian regions (North, Northeast, Central-West, and Southeast/South). Initially, a stratified probabilistic sampling was carried out for indigenous villages located in these regions. Households in sampled villages were selected by census or systematic sampling depending on the village population. The survey evaluated the health and nutritional status of children < 5 years, in addition to interviewing mothers or caretakers. Results: Height and weight measurements were taken of 6,050 and 6,075 children, respectively. Prevalence rates of stunting, underweight, and wasting were 25.7%, 5.9%, and 1.3%, respectively. Even after controlling for confounding, the prevalence rates of underweight and stunting were higher among children in the North region, in low socioeconomic status households, in households with poorer sanitary conditions, with anemic mothers, with low birthweight, and who were hospitalized during the prior 6 months. A protective effect of breastfeeding for underweight was observed for children under 12 months. Conclusions: The elevated rate of stunting observed in indigenous children approximates that of non-indigenous Brazilians four decades ago, before major health reforms greatly reduced its occurrence nationwide. Prevalence rates of undernutrition were associated with socioeconomic variables including income, household goods, schooling, and access to sanitation services, among other variables. Providing important baseline data for future comparison, these findings further suggest the relevance of social, economic, and environmental factors at different scales (local, regional, and national) for the nutritional status of indigenous peoples. [ABSTRACT FROM AUTHOR]

Over the last years the scholarly literature on careers has been enriched by the proposal of new career models which present a rhetoric that asks for the end of career boundaries: individual, hierarchical, organizational and geographical. However, in the real world, many constrains continue to exist. This paper tries to contribute to the understanding of the new boundaries of the 21st century careers. To do so we look at the case of careers in the arts. We review existing literature on careers, present a historical, contextual perspective of artistic careers, and conduct field work in the city of São Paulo based on in-depth interviews with 18 Brazilian artists from nine different occupations in the field of arts, whose data were subjected to qualitative content analysis. Our results show that career boundaries exist even in a sector we could consider as historically boundaryless. We identify and discuss four boundaries of the artistic career, seeking to reflect on the importance of considering the relationship of the individual and the context in which he/she operates in order to understand careers today. [ABSTRACT FROM AUTHOR]

Abstract: Over the last decade, the Brazilian alcohol industry – which for years has ignored alcohol problems – inaugurated responsible drinking programs (RDPs). This paper reports findings from an exploratory study that investigated the RDP-related activities of six leading alcohol companies in Brazil (three national, three transnational) focusing on program goals and components, target populations and evaluation methods. Interviews were conducted from October 2007 to February 2008 with nine key-informants, and 71 corporate documents were collected along with additional web information about the programs. Content analysis of interviews and institutional documents was used to identify the companies’ RDP activities. Three types of RDPs were found that focused respectively on institutional action, drinking and driving, and underage drinking. All three transnational firms were involved in RDPs, whereas national firms demonstrated limited involvement. The majority of RDPs were implemented using television. No targeted research appears to have been undertaken by the companies to assess the efficacy of the strategies in terms of changes in drinking behavior. The evidence for both national and transnational firms means that is difficult to confirm that the responsible drinking programs produced so far in Brazil have been undertaken to systematically reduce alcohol problems, or mainly as part of a public relations strategy to reduce criticism and potentially forestall government regulations (). [Copyright &y& Elsevier]

This paper aims to analyze the change of entrepreneur's behavioral characteristics before, during and after business failure. The theoretical framework was covered by the following topics: entrepreneur and its types, and entrepreneur's behavior face the business failure. The types used were based on entrepreneur's behavioral characteristics and supported by the following authors of the entrepreneurship literature: Vesper (1980), Miner (1996) and Filion (1999). This study is characterized as exploratory, descriptive and uses semi-structured interviews as data collection instrument. The analysis unit are seven entrepreneurs who experienced the disruption of its business in Sao Paulo. The analysis of behavioral changes and typology of entrepreneurs was performed in a qualitative way, by applying the technique of content analysis. Three categories were defined a priori based on the focus of classification of types of each author: performance (Vesper, 1980), personality (MINER, 1996), and values and entrepreneurial thinking (Filion, 1999). The main result emphasized that behavior of the entrepreneurs interviewed was affected when facing adversity of business failure, influencing their performance, personality, values and entrepreneurial thinking. From this, the changes in their behavioral characteristics caused changes in their entrepreneur's type in the different times of research - before, during and after business failure [ABSTRACT FROM AUTHOR]

Abstract: Community Health Workers (CHWs) play a pivotal role in primary care, serving as liaisons between community members and medical providers. However, the growing reliance of health care systems worldwide on CHWs has outpaced research explaining their praxis – how they combine indigenous and technical knowledge, overcome challenges and impact patient outcomes. This paper thus articulates the CHW Praxis and Patient Health Behavior Framework. Such a framework is needed to advance research on CHW impact on patient outcomes and to advance CHW training. The project that originated this framework followed Community-Based Participatory Research principles. A team of U.S.-Brazil research partners, including CHWs, worked together from conceptualization of the study to dissemination of its findings. The framework is built on an integrated conceptual foundation including learning/teaching and individual behavior theories. The empirical base of the framework comprises in-depth interviews with 30 CHWs in Brazil’s Unified Health System, Mesquita, Rio de Janeiro. Data collection for the project which originated this report occurred in 2008–10. Semi-structured questions examined how CHWs used their knowledge/skills; addressed personal and environmental challenges; and how they promoted patient health behaviors. This study advances an explanation of how CHWs use self-identified strategies – i.e., empathic communication and perseverance – to help patients engage in health behaviors. Grounded in our proposed framework, survey measures can be developed and used in predictive models testing the effects of CHW praxis on health behaviors. Training for CHWs can explicitly integrate indigenous and technical knowledge in order for CHWs to overcome contextual challenges and enhance service delivery. [Copyright &y& Elsevier]

The variety of interactions between human cultures and herpetofauna is the subject matter of Ethnoherpetology, a subdivision of Ethnozoology. In the semi-arid region of Brazil, many reptiles interact with human communities because of their utility or because of the risks they represent. These interactions have obvious implications for the conservation of reptiles from this region. In this context, ethnoherpetology studies are crucial because they serve as subsidies for guiding strategies for the handling and conservation of reptiles. This paper presents ethnozoological and taxonomic informations of hunted reptiles in the semiarid region of Brazil and analyse the implications on conservation that are related to the interactions between people and reptiles in this region. Taxonomic keys to identifying recorded reptiles are provided. Records of humans interacting with 38 reptile species that belong to 31 genuses and 16 families have been found. The groups with the largest numbers of recorded species were snakes (18 species), and this group was followed in number by lizards (13), chelonians (4), and crocodilians (3). The reptiles that were recorded may be used for the following purposes: medicinal purposes (24 species), food (13 species), ornamental or decorative purposes (11 species), in magical/religious practices (10 species), and as pets (10 species). Some species (n = 16) may have multiple uses. Furthermore, more than half of the species (n = 19) are commonly killed because they are considered potentially dangerous. Strategies for conserving the reptiles of the Brazilian semi-arid region must reconcile and integrate human and conservation needs. [ABSTRACT FROM AUTHOR]

Medical Education 2011:: 748-755 Research activity is not a mandatory component of medical education in many developing countries, including Brazil, although such experiences can have a positive impact on the quality of medical education. The interest and involvement of medical students in research and the barriers they face in accessing research training in developing countries have not been adequately addressed. We sought to assess the availability of scientific training programmes in Brazilian medical schools, the degree of involvement of medical students in these programmes, the main barriers to student involvement in research and possible reasons for the lack of scientific training programmes. This study examined 13 medical programmes conducted in six Brazilian states. A total of 1004 medical students were interviewed. We evaluated the availability of scientific training in the institutions attended by these students, the participation of the students in such activities and students' reasons for not joining such programmes based on student answers to our questionnaire. Although only 7% of the medical students expressed no interest in research, only 60% of them were involved in research training. Students regarded a lack of institutional incentive as the most significant barrier to their participation in research activities. Other significant barriers included defective infrastructure and insufficient time available for professors to mentor undergraduate students. According to the feedback from the students, eight of the 13 schools investigated featured structured programmes for scientific training. However, a mean of only 47% of students participated in scientific training programmes on their campuses and 13% of students were compelled to pursue such activities off-campus. Although scientific training during medical education in Brazil is still less frequent than expected, most of the students were interested in research activities. The barriers to undergraduate scientific training described in this paper may help the Brazilian government improve research training in medical schools. These issues might also be explored in other developing countries. [ABSTRACT FROM AUTHOR]

This paper analyses the use of oral history in the context of land struggle in Brazil. Land concentration, a marked feature of Brazilian society, has been challenged by different social movements, notably the Movimento dos Sem Terra, the Landless Workers Movement (1984). By their collective agency, the landless workers resisted exploitation and expropriation of their means of production, fostering agrarian reform. Based on the remarkable case of land struggle in the São Joaquim Farm, in the southern state of Paraná, it discusses the use of oral history not only as a way of writing and understanding a history from below, but also as a way of empowering social movements, reinforcing a collective identity and enhancing the agency of the participants. Life history or in-depth interviews are understood as part of a biographic method (Marre, 1991), which aims to reconstruct the structural and sociological history of social groups, and to understand how each individual reorganises a collective story in his/her narrative. It concludes that, by taking the experience and the understanding of the history of the invisibles, oral history has implications on the collective agency of the peasantry and the theorization of their social struggle. [ABSTRACT FROM AUTHOR]

A large body of literature describes the internationalization process of diverse firms worldwide; however it is imperative to understand how firms from emerging countries behave when they decide to internationalize. This paper provides a comprehension of the main factors that increase the probability of success of the internationalization process of Information Technology - IT firms in Brazil according to three internationalization theories OLI, RBV and Networks. Ivia's case was selected and in-depth interviews were held with the three key Ivia executives. This research used the Analytic Hierarchy Process - AHP in order to evaluate the relative importance of factors and sub-factors proposed by the theories considered. The results indicated that Ivia's internationalization strategy focused primarily on the formation of strong and steady partnerships with foreign IT service providers, clients, and research and development institutions in order to seize opportunities abroad. The company exploited location advantages and resources, which include the international knowledge and experience of the top managers and the capability to satisfy its clients' specific needs through the development of customized products and services. The results may be useful to executives and researchers of strategic management and to those who want to study deeper this field. [ABSTRACT FROM AUTHOR]

This paper emphasizes the importance of narrative as a way of describing life experiences, in the special case of the illness' experience. Its starting point is the narrative as a research tool. The material collected in this interview was twofold: served for training graduate students in interviews and placed the issue of health of a group of workers with diagnoses of chronic diseases like hypertension, diabetes, back pain, etc. We searched for reports made in a single interview, putting the illness in the context of life history, in order to grasp the "experience" of the subject and to solve the problem of disease as users of a health center in a city in São Paulo State. Concerning the organization of the material, we chose the reorganization of oral history by developing a narrative with such information. So this is a narrative of an original narrative that, from a semi-structured interview, was organized as case study, with biographic approach, aiming to observe life history elements, personal illness trajectory, and therapeutic itinerary. We concluded that the narrative represents important resources to produce knowledge, in teaching, research and care perspectives. [ABSTRACT FROM AUTHOR]

This paper presents the results of an investigation about the ressignification process of gender identities by imprisoned women in a female prison, in the North of Paraná State - South Brazil. The data analyses of semistructured interviews showed that is possible to identify negotiated, desired or negated identities as well as identity conflicts caused by their own realities andcultures, lower-socio-economic level, dysfunctional families, low literacy level, besides prison stigma. The analyses show that representations and identities rebuilt in the prison environment, especially those of prison and society, reinforce the construction of stigmas which may contribute to create reoccurring imprisonments. Prisons should be revaluated as a place for inclusion, social rehabilitation and re-insertion intro society through specific projects, in which writing should be included, considering it's social role in this context. [ABSTRACT FROM AUTHOR]

This article is result of the one a sequence of interviews achieved with the master ambassador Antonio Francisco, of the Companhia de Reis Santa Luzia, thus as the work of the participant observation of the journey of Kings 2007/ 2008 how achieved close the Company in the district of a city the municipality of Londrina/ PR. Have for objective to sight in the paper something's elements how defined the popular Catholicism traditional Brazilian, in your expression cultural, configured across of this perspective the formation of yours rituals-masters and the structure ritualistic and organizational the journey of Kings of this cultural universe. [ABSTRACT FROM AUTHOR]

Background: Health is recognized as a fundamental right in Brazil's constitution. In the absence of a clearly defined benefit packages of healthcare services that are financed under the Unified Health System (Sistema Único de Saúde, SUS), courts have become important in adjudicating coverage decisions. Empirical assessments of equity and the right to health tend to focus on simple measures of access. However, these empirical perspectives belie the significant inequalities and rights violations that arise in the case of more complex health needs such as cancer. To shed light on these issues, this paper focuses on the care pathways for breast and cervical cancer and explores access and quality issues that arise at different points along the care pathway with implications for the realization of the right to health in Brazil. Method: A mixed method approach is used. The analysis is primarily based on a quantitative analysis of national representative administrative data principally from the cervical and breast cancer information systems and the hospital cancer registry. To gain more insights into the organization of cancer care, qualitative data was collected from the state of Bahia, through document analysis, direct observation, roundtable discussions with health workers (HWs), and structured interviews with health care administrators. Results: The paper reveals that the volume of completed screening exams is well below the estimated need, and a tendency toward lower breast cancer screening rates in poorer states and for women in the lowest income brackets. Only 26% of breast cancer cases and 29% of cervical cancer cases are diagnosed at an early stage (stage 0 or I), thereby reducing the survival prospects of patients. Waiting times between confirmed diagnosis and treatment are long, despite new legislation that guarantees a maximum of 60 days. The waiting times are significantly longer for patients that follow the recommended patient pathways, and who are diagnosed outside the hospital. Conclusion: The study reveals that there are large variations between states and patients, where the poorest states and patients fare worse on key indicators. More broadly, the paper shows the importance of collecting data both on patient characteristics and health system performance and carry out detailed health system analysis for exposing, empirically, rights violations and for identifying how they can be addressed. [ABSTRACT FROM AUTHOR]

Neglect is a type of child abuse that leads to a variety of consequences on child development. Although neglect is present in any social class, a lot of parents that live in poverty are not negligent; but poverty has many characteristics that contribute to the presence of neglect. Considering the importance of preventing and better understanding neglect, the present paper aims to describe and discuss similarities and differences among negligent families, comparing them to other families in terms of socioeconomic aspects and risk factors related to neglect. A total of 90 parents of children aged 6–8 years participated in the data collection. They were divided into three groups: (1) 30 caregivers of substantiated cases of child neglect from Child Protection Services; (2) 30 caregivers of suspected cases of child neglect based on teachers' observations, but that were not notified to Child Protection Services; and (3) 30 caregivers of children who were not suspected of child neglect. All participants were interviewed. Results showed that poverty is not a determining factor for neglect, but it presents a highly favorable context for neglect to be expressed. Considering participant's working status, group 1 showed a significant difference (p-value = 0,003) when compared with groups 2 and 3. In groups 2 and 3, most participants worked (53% and 67%), but in group 1 the majority were unemployed. When comparing the groups in relation to educational years, it was noted that groups 1 and 2 were equivalent (average of 4,5 and 5,1 respectively), and significant different (p = 0,001) from group 3 (average of 9,4 years). Considering the social support provided for mothers after their first child was born, 70% of mothers from group 3, 26,7% of mothers from group 2 and 30% from group 1 had support. When comparing the three groups, there were statistical differences (p-valor = 0,001) between group 3 and groups 1 and 2. As for alcohol abuse, groups 1 and 2 had similar results (30% group 1 and 20% group 2) and the groups were statistically different (p-valor = 0,003) from group 3 (0%), indicating that, although they were a minority, there were participants from groups 1 and 2 consuming alcohol. No participant declared to use drugs. Although they live in the same neighborhoods and study in the same schools as do the reference group, groups of children suspected of being neglected had less favorable economic conditions, and their caregivers had fewer years of education and less specialized employment. Presence of risk factors and lack of social support favor the occurrence of child neglect. According to the results obtained by the present study, we must also point out that the condition of poverty is not a determining factor for neglect, but it is presented as a highly favorable context for the expression of neglect. [ABSTRACT FROM AUTHOR]