Post-Traumatic Stress Disorder and Urban Violence: An Anthropological Study

The study aimed to understand how distress is experienced by patients with Post-Traumatic Stress Disorder (PTSD) in the social-cultural context of São Paulo, Brazil, an urban environment marked by social inequality and high levels of violence. A qualitative study was conducted between 2008 and 2010 with PTSD patients (F43.1, ICD-10, 1997) who had been victims of robberies and kidnappings in São Paulo. Dense ethnographic observations were carried out, as well as in-depth semi-structured interviews with ten adult patients. the analysis method used was based on anthropology. the results show that it is particularly important to distinguish between perceptions of different forms of the experience of social suffering and perceptions of health and illness held by victims and biomedical experts. the cause of PTSD is more often associated with the personal problems of the victim than with the specific traumatic event. the distress described in terms of what is considered a normal reaction to violence and what is considered a symptom of PTSD. the findings indicate that the diagnostic of PTSD can be understood in relation to the different contexts within a culture. the ethnographic approach serves not only to illuminate individual suffering but also the social suffering experienced by the residents of São Paulo.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Federal de São Paulo, BR-04038020 São Paulo, BrazilUniversidade Federal de São Paulo, BR-04038020 São Paulo, BrazilWeb of Scienc

Notion of meaning in health qualitative research: the Anthropology contribution

Universidade Federal de São Paulo (UNIFESP) Departamento de PsiquiatriaUniversidade Federal de São Paulo (UNIFESP) Escola de EnfermagemUNIFESP, Depto. de PsiquiatriaUNIFESP, Escola de EnfermagemSciEL

Prevalence and Concomitants of Arthritis in the Elderly in Rio Grande do Sul, Brazil

Objectives: Information on the prevalence and concomitants of arthritis in developing countries is sparse. It is unclear whether they are comparable to findings in developed countries. To ascertain the prevalence, demographic characteristics, and health-related concomitants of arthritis in older persons in the southern state of Rio Grande do Sul, Brazil, a middle income country.Methods: the state of Rio Grande do Sul, Brazil, was subdivided into nine regions. Stratified random sampling was used to identify 880 community residents age >= 60 years in each region. One region with suspect data was excluded. of 7040 community residents contacted in eight regions, 6963 participated (1.1% refusal rate). in 1995, trained, monitored interviewers, using structured questionnaires, conducted in-home interviews gathering information on demographic characteristics (age, sex, race/ethnicity, education, income, living arrangements, employment status), health behaviors (physical activity, tobacco use, social activity), functional limitations, depression, and 15 self-reported health conditions, including arthritis. Data were analyzed using descriptive statistics and logistic regression.Results: Arthritis, reported by 43% of the sample, was more prevalent in women, among the less educated, those with lower income, and higher age. Severity, but not prevalence, differed by race/ethnicity. Controlled analyses indicated significant association with female gender, lower education, and less social activity. Arthritis was associated with reduced odds of stroke, but increased odds of hypertension, varicosities, bronchitis, renal problems, headache, gastrointestinal disorders, and depression. Arthritis was not significantly associated with age or functional limitations, and associations did not differ by gender.Conclusions: the prevalence, demographic and health characteristics associated with self-reported arthritis in this southern state in Brazil are similar to findings elsewhere in Brazil, and in developed countries.Conselho Estadual do Idoso, Secretaria do Trabalho, Cidadania e Assistencia SocialGoverno do Estado do Rio Grande do Sul, the National Council for Scientific and Technological DevelopmentNational Institute on AgingUniversidade Federal de São Paulo, Dept Psychiat, Escola Paulista Med UNIFESP, São Paulo, BrazilDuke Univ, Med Ctr, Ctr Study Aging & Human Dev, Durham, NC 27710 USAVet Adm Med Ctr, Geriatr Res Educ & Clin Ctr, Durham, NC USAProject Sci Comm, Porto Alegre, RS, BrazilUniversidade Federal de São Paulo, Dept Psychiat, Escola Paulista Med UNIFESP, São Paulo, BrazilGoverno do Estado do Rio Grande do Sul, the National Council for Scientific and Technological Development: 470724/2011-0Governo do Estado do Rio Grande do Sul, the National Council for Scientific and Technological Development: 306156/2011-3National Institute on Aging: 1P30 AG028716-02Web of Scienc

The drugs misuse related harm reduction in the health promoting schools

The goal of this paper is to review the school-based drugs misuse prevention programs, and to establish a connection with the health promotion and health promoting school concepts, in an attempt to create a new proposal. There are several models of preventive intervention, but the results of its evaluations show little improvement. The most hopeful programs imply in giving up the restrict focus of prevention (of a specific disease) to adopt the health promotion concept. The application of the health promotion concept in the school environment resulted in the health promoting school concept, which can be defined as a school that has an organized set of policies, procedures, activities, and structures, designed to protect and promote the health and well-being of all school community members. The harm reduction proposal, as a prevention strategy, come together the health promoting school proposal, and in this way our proposal is a set of health promotion actions that includes: wider and progressive goals; breaking the manichaeism; inclusive actions; community partnerships including many sectors of society; youth autonomy; and the focus on the person in all its complexity, not only on the substance use or misuse. This proposal aims all students, regardless if they had or not already tried or they still are using any psychoactive substance.Este trabalho tem por objetivo revisar os modelos de prevenção do uso indevido de drogas em ambiente escolar, relacionando-os aos conceitos de promoção de saúde e escola promotora de saúde, e propor um modelo de intervenção. Os modelos de intervenção são múltiplos, os resultados provenientes das avaliações de impacto são modestos. As abordagens preventivas mais promissoras ampliam o campo de intervenções para o ambiente físico e social, enfocando a saúde como um todo, aproximando-se do conceito de promoção de saúde. A aplicação deste no âmbito escolar resultou no conceito de escola promotora de saúde. Esta pode ser definida como a escola com políticas, procedimentos, atividades e estrutura que resultem na proteção e promoção à saúde e ao bem-estar de todos os membros da comunidade escolar. A proposta da redução de danos, pensada como estratégia de prevenção, converge para a da escola promotora de saúde, e neste sentido propomos ações de promoção de saúde pautadas por: objetivos amplos e escalonados; ruptura com o maniqueísmo; ações inclusivas; parcerias intersetoriais; incentivo à autonomia dos alunos; abordagem do indivíduo em toda a sua complexidade. Esta proposta amplia a abrangência da intervenção para todos os alunos, independentemente se estes já experimentaram, já fizeram ou fazem algum uso de substâncias psicoativas.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Departamento de PsiquiatriaUnisantos Departamento de PsiquiatriaUNIFESP, EPM, Depto. de PsiquiatriaSciEL

Situations related to drug misuse in public schools in the city of São Paulo, Brazil

OBJECTIVE: To explore situations, attitudes and behavior of public elementary school education supervisors concerning psychoactive substance misuse. METHODS: The study was carried out in the city of São Paulo, Southeastern Brazil, in 2002. Data were collected using a semi-structured questionnaire applied to eight key informants in the administrative area experienced in education supervision. Qualitative content analysis with ethnographic reference was conducted. RESULTS: Most discourses show that knowledge transmission is thought as essential for drug use prevention, though supervisors reported being ill-informed on this subject. The most frequent attitudes toward drug users are impotence and inability to act and sometimes a repressive attitude. These are motivated by misinformation and fear due to mistaken association of drug users and criminals. In situations indirectly related to drug abuse (family and behavior problems) more understanding and inclusive attitudes are reported, following the harm reduction paradigm. CONCLUSIONS: Theoretical capacity building of educators for preventive attitudes would support their skills developed through dealing with situations (in)directly related to drug abuse in schools. Thus, educators would feel more confident to make interventions for harm or risk reduction among drug users.OBJETIVO: Investigar situações, atitudes e comportamentos dos coordenadores pedagógicos das escolas municipais de ensino fundamental relacionados ao uso indevido de substâncias psicoativas. MÉTODOS: Estudo realizado na cidade de São Paulo, em 2002. As informações foram colhidas por meio de entrevista semi-estruturada, com oito informantes-chave locados em setor administrativo e com experiência de coordenação pedagógica. Foi realizada a análise qualitativa de conteúdo, com o referencial etnográfico. RESULTADOS: A idéia da transmissão de conhecimentos como base da prevenção permeia a maioria dos discursos, entretanto, os coordenadores relataram sentirem-se mal informados. As atitudes mais freqüentes frente ao usuário de drogas são de impotência e paralisia e algumas vezes, repressora. Elas são motivadas pelo desconhecimento e medo devido à associação entre usuário e marginalidade. Nas situações indiretamente associadas ao abuso de drogas (problemas familiares e de comportamento) foram relatadas atitudes mais compreensivas e inclusivas, compatível com práticas do paradigma da redução de danos. CONCLUSÕES: Uma capacitação teórica dos educadores para uma prática preventiva teria a função de ratificar aquela desenvolvida a partir da sua vivência na escola com as situações (in)diretamente associadas ao abuso de drogas. Conseqüentemente, os tornaria mais seguros nas suas intervenções de redução de danos ou risco com os usuários.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Programa de Orientação e Atendimento a DependentesUniversidade Católica de Santos Programa de Mestrado em Saúde ColetivaUNIFESP, EPM, Programa de Orientação e Atendimento a DependentesSciEL

Validação da coerência estrutural do Questionário de Saúde Geral

OBJECTIVE: Investigate the structural coherency of the 60-item version of the General Health Questionnaire via exploratory and confirmatory factor analyses. METHOD: The study design is a cross-sectional survey. A random sample of 146 individuals from the city of Divinópolis-MG volunteered to participate in the present study and responded to the 60-item version of the General Health Questionnaire adapted and validated for use in Brazil. Statistics consisted of exploratory and confirmatory factor analysis. Reliability was estimated using Cronbach's alpha method. RESULTS: Alpha coefficients for all five content scales of the General Health Questionnaire were high (α > 0.8). For four of the five scales, a unifactorial model of constituent items provided a good fit to the data. Items comprising the fifth scale, Psychic Stress, exhibited a two-correlated factor structure. A factor analysis of scores for the five scales yielded strong evidence of coherency, with all scales loading substantially on a single common factor. CONCLUSION: The General Health Questionnaire shows good psychometric coherency as evidenced by high internal consistency and unidimensionality of all but one of its constituent scales, and uniformly high loadings of all scales on a single overarching factor. These results are consistent with prior findings from the General Health Questionnaire developmental study and Brazilian adaptation studies.OBJETIVO: Investigar a coerência estrutural da versão de 60 itens do Questionário de Saúde Geral de Goldberg por meio da aplicação de análises fatoriais exploratórias e confirmatórias. MÉTODO: Trata-se de um estudo de levantamento de desenho transversal. Uma amostra aleatória de 146 indivíduos voluntários da cidade de Divinópolis-MG participou do presente estudo respondendo à versão de 60 itens do Questionário de Saúde Geral. As estatísticas consistiram de análises fatoriais exploratórias e confirmatórias. Fidedignidade foi estimada pelo método alpha de Cronbach. RESULTADOS: Os coeficientes alpha para todas as cinco escalas do Questionário de Saúde Geral foram elevados (α > 0,8). Para quatro das cinco escalas, um modelo unifatorial com base em seus respectivos itens apresentou bom ajuste aos dados. Itens que compunham a quinta escala, Estresse Psíquico, exibiram uma estrutura de dois fatores correlacionados. Uma análise fatorial dos escores das cinco escalas produziu fortes evidências de coerência, com todas as escalas apresentando cargas fatoriais robustas em um único fator. CONCLUSÃO: O Questionário de Saúde Geral apresenta bons indicadores psicométricos de coerência deflagrados pela elevada consistência interna e unidimensionalidade de todas menos uma de suas escalas constituintes e pelas cargas fatoriais, univocamente elevadas, em uma única e inclusiva dimensão. Os resultados apresentados são congruentes tanto com os do estudo de elaboração do Questionário de Saúde Geral quanto com os de sua adaptação para o Brasil.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Department of PsychiatryThe Florida State University Department of Clinical Psychology and PsychopatologyUniversidade Católica de SantosUNIFESP, EPM, Department of PsychiatrySciEL