Innovating the Study of Context: Using a Qualitative Study on Subjugation and Resistance to Explore the Utility of Foucauldian Governmentality as a Framework for Enriching Situational Analyses

Situational analysis has, as an emerging poststructuralist approach to grounded theory, recently grown in use across a diverse range of disciplines and substantive areas. In this paper, we consider the complementarity of Foucauldian governmentality as a theoretical framework for supporting and enriching situational analyses. Our work is based on the findings of a recent study, informed by situational analysis, in which we interviewed 27 HIV-positive (n=16) and HIV-negative (n=11) gay men ages 50 and over about their health care experiences, and used these data to examine processes of subjugation and resistance reflected in their accounts. Drawing on our analytical process, we consider the utility of governmentality in identifying salient discursive forces within a situation of interest, in theorizing how contextual factors operate on and influence the experiences of key actors in a field of inquiry, and in generating insight on fluid uses of power within an area under examination

Comorbidade entre abuso/dependência de drogas e o sofrimento psíquico, Brasília - Brasil

O objetivo deste estudo foi investigar a prevalência de sofrimento psíquico entre pacientes atendidos em centros públicos especializados em álcool e drogas, no Distrito Federal, Brasília, Brasil. Trata-se de um estudo de prevalência nos Centros de Atenção Psicossocial - álcool e drogas. Foi realizado autopreenchimento de um questionário, ou entrevista em pacientes analfabetos. Foi utilizada a escala K-10 de sofrimento psíquico. Os resultados mostram que participaram 165 pessoas, sendo 90% homens (média de idade 42,9; mediana 43). Foi relatado diagnóstico prévio de depressão em 40,8% e de ansiedade em 37,9%. Houve diagnóstico atual de depressão e ansiedade em 42,9% e 48,8% dos pacientes, respectivamente. K-10 revelou que 31% tinham níveis severos e 39,0% muito severos de sofrimento. Conclui-se que os níveis encontrados de sofrimento psíquico (severo e muito severo ~70%), cuja escala é mais sensível para ansiedade e depressão, são maiores que os reportados em estudos internacionais.We aimed to ascertain the prevalence of psychological distress among patients under treatment at specialized health care centers for alcohol and drugs, at the Federal District, Brasília, Brazil. Was conducted a cross-sectional study at the three Centers for Psycho-social Health Care - alcohol and drugs, using a self-administered questionnaire or interviews when patients were illiterate. We used the K-10 Psychological Distress scale. Results shown of the 165 patients who participated, 90% were male (age mean=42.9; median=43). Previous diagnosis of depression was reported by 40.8%; anxiety by 37.9%. Current diagnosis of depression and anxiety were reported by 42.9% and 48.8%, respectively. K-10 scale showed that 31% had severe and ~39% very severe psychological distress. Conclude that levels of psychological distress found in this research (severe and very severe ~70.0%), whose scale is more sensible for anxiety and depression, are higher than those found in the literature.El objetivo del estudio fue investigar la prevalencia de distrés psicológico en pacientes atendidos en centros públicos especializados en alcohol y drogas en Brasilia, Distrito Federal, Brasil. Es un estudio de prevalencia, en pacientes atendidos en los Centros de Atención Psicosocial - alcohol y drogas. Fue realizado auto-diligenciamiento de un cuestionario, o entrevista en pacientes analfabetos. Fue utilizada la escala K-10 de distrés psicológico. Los resultados muestran que 165 personas participaron, 90% hombres, edad promedio 42.9 (mediana=43). Fue relatado diagnóstico previo de depresión en 40.8% y ansiedad en 37.9%. Hubo diagnóstico actual de depresión y ansiedad en 42.9% y 48.8%, respectivamente. K-10 mostró que 31% tenían niveles severos y ~39% muy severos de distrés. Se concluye que los niveles encontrados de distrés psicológico (severo y muy severo, ~70%), cuya escala es más sensible para ansiedad y depresión, son mayores que los relatados en estudios internacionales

Governing through community-based research: Lessons from the Canadian HIV research sector

AbstractThe “general public” and specific “communities” are increasingly being integrated into scientific decision-making. This shift emphasizes “scientific citizenship” and collaboration between interdisciplinary scientists, lay people, and multi-sector stakeholders (universities, healthcare, and government). The objective of this paper is to problematize these developments through a theoretically informed reading of empirical data that describes the consequences of bringing together actors in the Canadian HIV community-based research (CBR) movement. Drawing on Foucauldian “governmentality” the complex inner workings of the impetus to conduct collaborative research are explored. The analysis offered surfaces the ways in which a formalized approach to CBR, as promoted through state funding mechanisms, determines the structure and limits of engagement while simultaneously reinforcing the need for finer grained knowledge about marginalized communities. Here, discourses about risk merge with notions of “scientific citizenship” to implicate both researchers and communities in a process of governance

How do existing HIV-specific instruments measure up? Evaluating the ability of instruments to describe disability experienced by adults living with HIV

Background: Despite the multitude of health challenges faced by adults living with HIV, we know of no HIV-specific instrument developed for the purpose of describing the health-related consequences of HIV, a concept known as disability. In a previous phase of research, adults living with HIV conceptualized disability as symptoms/ impairments, difficulties carrying out day-to-day activities, challenges to social inclusion, and uncertainty that may fluctuate on a daily basis and over the course of living with HIV. In this paper, we describe the extent to which existing HIV-specific health-status instruments capture the experience of disability for adults living with HIV. Methods: We searched databases from 1980 to 2006 for English language, HIV-specific, self-reported questionnaires consisting of at least two items that were tested for reliability and validity. We then conducted a content analysis to assess how well existing questionnaires describe disability as defined by the Episodic Disability Framework, a framework that conceptualizes this experience from the perspective of adults living with HIV. We matched items of the instruments with categories of the framework to evaluate the extent to which the instruments capture major dimensions of disability in the framework. Results: We reviewed 4274 abstracts, of which 30 instruments met the inclusion criteria and were retrieved. Of the four major dimensions of disability, symptoms/impairments were included in all 30 instruments, difficulties with day-to-day activities in 16, challenges to social inclusion in 16, and uncertainty in 9. Seven instruments contained at least 1 item from all 4 dimensions of disability (breadth) however, the comprehensiveness with which the dimensions were represented (depth) varied among the instruments. Conclusions: In general, symptoms/impairments and difficulties carrying out day-to-day activities were the disability dimensions characterized in greatest depth while uncertainty and challenges to social inclusion were less well represented. Although none of the instruments described the full breadth and depth of disability as conceptualized by the Episodic Disability Framework, they provide a foundation from which to build a measure of disability for adults living with HIV

Giving away used injection equipment: missed prevention message?

Abstract Background Our objective was to examine factors associated with distributive injection equipment sharing and how needle exchange programs (NEPs) can help reduce distributive sharing among injection drug users (IDUs). Methods 145 English speaking Canadian IDUs ages 16 years and over who had injected in the past 30 days were recruited for a cross-sectional survey. Participants were asked about their socio-demographic characteristics, HIV risk behaviours, social support, drug treatment readiness, program satisfaction, health and social service use and NEP drug use. Bivariate statistics and logistic regression were used to characterize the population and examine correlates of sharing behaviour. Results More IDUs reported distributive sharing of cookers (45%) than needles (36%) or other types of equipment (water 36%; filters 29%; swabs 8%). Regression analyses revealed the following factors associated with distributing used cookers: a history of cocaine/crack injection, an Addiction Severity Index (ASI) score indicative of a mental health problem, and older than 30 years of age. Factors associated with giving away used water included: male, injected methadone, injected other stimulants and moved 3+ times in the past 6 months. Factors associated with giving away used filters included: injected cocaine/crack or stayed overnight on the street or other public place. Factors associated with giving away swabs included: an ASI mental health score indicative of a mental health problem, and HCV negative status. Conclusions Our findings show that more IDUs give away cookers than needles or other injection equipment. While the results showed that correlates of sharing differed by piece of equipment, each point to distributive sharing by the most marginalized IDUs. Targeting prevention efforts to reduce equipment sharing in general, and cookers in particular is warranted to reduce use of contaminated equipment and viral transmission

Norma percebida de consumo de maconha sobre os pares de estudantes universitários

This article describes the relationship between the perceived norm for marijuana use among peers and the use reported by university students in Chile. This is a qualitative, multicenter, cross-sectional study. A total 449 students participated with free consent. Data collection was performed using a self-administered questionnaire, and SPSS 15.0 was used for data analysis. RESULTS: most participants were women, single, between 20 and 21 years of age, students of nursing and education. The perceived norm is higher than reports from national studies (32.1% against 21%) and higher than the self-reported use (32.1% against 5.6%). Marijuana use is higher among women, in nursing and education courses. It was confirmed that marijuana use among women begins at the university; as it was used as a recreational drug and there was more tolerance among peers. It was observed that marijuana use was overestimated, which, according to the Theory of Social Norms and Normalization, has an effect on the increase of drug use. This study is a contribution for the country's and the university's policies.En este estudio se describe la relación entre la norma percibida del consumo de marihuana en los pares y el consumo real informado por alumnos de una universidad chilena. Se trata de un estudio cuantitativo, multicéntrico y transversal. Participaron 449 estudiantes previa firma del consentimiento informado. La información se recolectó con un cuestionario autoaplicado y se analizó con el programa SPSS 15.0. Fue encontrado que la mayoría son mujeres solteras, entre 20 y 21 años de edad, estudiantes de enfermería y educación. La norma percibida fue mayor que la de estudios nacionales (32,1% versus 21%); también el consumo autoinformado fue mayor que el nacional (32,1% versus 5,6%). Se observa un mayor consumo entre las mujeres, en educación y enfermería. Se confirma la feminización del consumo; el inicio del consumo en la universidad, el uso recreativo y la mayor tolerancia al consumo en los pares. Existe una sobreestimación del consumo de marihuana, lo que de acuerdo a la Teoría de las Normas Sociales y de Normalización influye en el aumento del consumo. Esta investigación constituye un aporte a las políticas de la salud del país y de la universidad.Descreve-se, aqui, a relação entre norma percebida de consumo de maconha entre os pares e consumo reportado em alunos de uma universidade chilena. Este é um estudo quantitativo, multicêntrico, transversal. Participaram 449 estudantes, com livre consentimento. As informações foram coletadas mediante questionário autoaplicado e analisadas através do programa SPSS 15.0. RESULTADOS: a maioria são mulheres, solteiras, entre 20 e 21 anos, estudantes de enfermagem e educação. A norma percebida é maior do que nos estudos nacionais (32,1% vs 21%) e maior do que o consumo autorreportado (32,1% vs 5,6%). Observa-se maior consumo nas mulheres, e dos cursos de educação e de enfermagem. Confirma-se a feminização do consumo, o qual se inicia na universidade, por uso recreativo, e haver maior tolerância ao consumo entre os pares. Observa-se, também, maior estimação do consumo de maconha o que, de acordo a Teoria das Normas Sociais e de Normalização, tem influência no aumento do consumo. Esta pesquisa constitui-se em contribuição às políticas do país e da universidade

Normas percebidas por estudantes universitários de enfermagem sobre seus pares e o uso de drogas, em Lima, Peru

This quantitative, cross-sectional study was performed to estimate the difference between the perceived norms among university students, based on a survey of 196 nursing students from Lima, Peru. A questionnaire was used to measure the students' perception about drug use and their actual use. Descriptive statistical analysis was performed, considering a value greater, smaller or equal to 10 to establish the difference. The perceived norms for alcohol and tobacco were above 50%, against 6% for marijuana and cocaine; with 57.7% of participants reporting tobacco use, 84.7% alcohol, 2.6% marijuana and 1% cocaine. Marijuana and cocaine use was overestimated, while alcohol use was underestimated. The perception of tobacco use was correct. The study findings are useful to sensitize university authorities and put prevention policies in practice.Con el objetivo de estimar la diferencia entre las normas percibidas sobre el uso de drogas por los pares y el uso real de drogas entre estudiantes universitarios se efectuó un estudio cuantitativo transversal, basado en una encuesta de 196 estudiantes de enfermería de Lima. Se utilizó un cuestionario que midió la percepción del uso de drogas y el propio uso. La información fue analizada con estadística descriptiva; fue considerando un valor mayor, menor o igual a 10% para establecer la diferencia. Las normas percibidas para alcohol y tabaco fueron mayores de 50%, mientras que para marihuana y cocaína fue de 6%. El 57,7% informó haber usado tabaco, 84,7% alcohol, 2,6% marihuana y 1% cocaína; se encontró que existe sobreestimación sobre el uso de marihuana y cocaína, subestimación para el alcohol, y percepción exacta para el uso de tabaco. Los resultados serán de utilidad para sensibilizar a las autoridades universitarias e para implementar políticas o programas de prevención.Com o objetivo de estimar a diferença entre as normas percebidas sobre o uso de drogas por estudantes universitários, foi realizado estudo quantitativo transversal, baseado em censo com 196 estudantes de enfermagem de Lima, Peru. Utilizou-se questionário com a finalidade de medir a percepção do uso de drogas e do próprio uso, analisando-se a informação com estatística descritiva, considerando valor maior, menor ou igual a 10 pontos para estabelecer a diferença. As normas percebidas para o álcool e tabaco foram maiores que 50%, enquanto que para maconha e cocaína foi de 6%; 57,7% referiram ter usado tabaco, 84,7% álcool, 2,6% maconha e 1% cocaína. Existe superestimação do uso de maconha e cocaína, subestimação para o uso de álcool e percepção exata para o uso de tabaco. Os resultados são úteis para sensibilizar as autoridades universitárias e implementar políticas de prevenção

Exploring disability from the perspective of adults living with HIV/AIDS: Development of a conceptual framework

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Normas percibidas por estudiantes peruanos acerca de sus pares y el uso de drogas

O objetivo deste estudo foi avaliar a diferença entre as normas percebidas pelos estudantes universitários, com idade entre 18 e 24 anos, sobre o uso de drogas pelos seus pares e o uso de drogas relatado pelos próprios estudantes em cursos da área da saúde. Foi usado o método transversal, baseado em censo realizado através de questionário, preenchido pelos próprios estudantes, sem identificação. O número de participantes foi de 306 (82%). Como resultados obteve-se: a proporção de estudantes que utilizou drogas no último ano foi de 51,3% para o tabaco, 90,8% para o álcool, 5,9% para a maconha e 0,7% para a cocaína. Diferença entre as normas percebidas e o uso de drogas foi observada para o tabaco (70% vs 51,3%), maconha (10% vs 5.9%) e cocaína (8,3% vs 0,7%). Conclui-se que os estudantes universitários apresentaram estimativa aumentada sobre o consumo de tabaco, maconha e cocaína entre seus pares.El objetivo de este estudio fue estimar la diferencia entre las normas percibidas sobre el uso de drogas por sus pares y el uso real de drogas entre universitarios, entre 18 y 24 años, de las áreas de salud. Se trata de un estudio transversal, basado en un censo y en un cuestionario anónimo y autoaplicado. Participaron 306 estudiantes (82%). La proporción del consumo, en el último año, fue de 51,3% para el tabaco, 90,8% para el alcohol, 5,9% para la marihuana y 0,7% para la cocaína. Se observó una diferencia entre la norma percibida de consumo y la proporción de uso real informado para el tabaco (70% vs. 51.3%), marihuana (10% vs. 5.9%) y cocaína (8.3% vs. 0.7%). Se concluye que los universitarios sobrestiman el consumo de tabaco, marihuana y cocaína de sus pares.Objective: to evaluate the difference between perceived norms about drug use among peer and actual drug use as reported by the same university students. The students were between 18 and 24 years old and attended health courses. Method: cross-sectional study based on a survey, using an anonymous questionnaire filled out by the students. RESULTS: There were 306 participants. Senior students used drugs as follows: 51.3% used tobacco, 90.8% used alcohol, 5.9% used marijuana, and 0.7% used cocaine. Differences were observed between perceived norms and actual drug use for tobacco (70% vs. 51.3%), marijuana (10% vs. 5.9%) and cocaine (8.3% vs. 0.7%). CONCLUSIONS: university students presented an overestimated rate for the use of tobacco, marijuana and cocaine among their peers