Health needs and masculinities: primary health care services for men

Estudam-se relações entre masculinidades e cuidado em saúde, abordando o reconhecimento de necessidades por homens usuários de atenção primária e respostas dos serviços. É parte de pesquisa realizada em quatro estados brasileiros, com oito serviços amostrados por conveniência. Triangulou-se observação etnográfica com entrevistas semi-estruturadas com 182 usuários de 15 a 65 anos e com 72 profissionais. A análise temática dos registros etnográficos e das entrevistas foi baseada nos referenciais de gênero e em estudos do trabalho em saúde. Os resultados apontam como a medicalização das necessidades de saúde marca usuários, profissionais e serviços, ocultando questões vinculadas à masculinidade. Permitem caracterizar a atenção primária como voltada para as mulheres, reproduzindo no funcionamento dos serviços e nos desempenhos profissionais as desigualdades de gênero, em que para as mulheres há a disciplina do cuidado e para os homens, impropriedades para assistir e cuidar.This study deals with the relations between masculinities and health care, approaching the recognition of health needs among male users of primary health care and the responses by the services. The study is part of a larger research project in four Brazilian States, with a convenience sample of eight health services. Ethnographic observation was compared with semi-structured interviews with 182 health care users from 15 to 65 years of age and 72 health professionals. Thematic analysis of the ethnographic records and interviews was based on gender references and studies on health work. The findings show how medicalization of health needs affects users, professionals, and services, disguising issues related to masculinity. Primary care focuses mainly on women, thereby reproducing gender inequalities in health services operations and professional performance, with women receiving disciplined care and men receiving insufficient attention and care

Are We Asking Too Much of the Health Sector? Exploring the Readiness of Brazilian Primary Healthcare to Respond to Domestic Violence Against Women

BACKGROUND: There is growing recognition of the health sector's potential role in addressing domestic violence (DV) against women. Although Brazil has a comprehensive policy framework on violence against women (VAW), implementation has been slow and incomplete in primary healthcare (PHC), and little is known about the implementation challenges. This paper aims to assess the readiness of two PHC clinics in urban Brazil to integrate an intervention to strengthen their DV response. METHODS: We conducted 20 semi-structured interviews with health managers and health providers; a document analysis of VAW and DV policies from São Paulo and Brazil; and 2 structured facility observations. Data were analysed using thematic analysis. RESULTS: Findings from our readiness assessment revealed gaps in both current policy and practice needing to be addressed, particularly with regards to governance and leadership, health service organisation and health workforce. DV received less political recognition, being perceived as a lower priority compared to other health issues. Lack of clear guidance from the central and municipal levels emerged as a crucial factor that weakened DV policy implementation both by providers and managers. Furthermore, responses to DV lost visibility, as they were diluted within generic violence responses. The organizational structure of the PHC system in São Paulo, which prioritised the number of consultations and household visits as the main performance indicators, was an additional difficulty in legitimising healthcare providers' time to address DV. Individual-level challenges reported by providers included lack of time and knowledge of how to respond, as well as fears of dealing with DV. CONCLUSION: Assessing readiness is critical because it helps to evaluate what services and infrastructure are already in place, also identifying obstacles that may hinder adaptation and integration of an intervention to strengthen the response to DV before implementation

A violência contra mulheres: demandas espontâneas e busca ativa em unidade básica de saúde

Acolher demandas e assistir mulheres que sofrem violência é parte dos direitos em saúde, embora a assistência não esteja estruturada e ocorra pouca detecção de casos. Buscou-se um diagnóstico de situação em serviços, avaliando-se a emergência de demandas referidas à violência por parte das usuárias de uma unidade básica da rede pública, contrastando-se a demanda espontânea com a busca ativa de casos. Realizou-se um primeiro estudo por técnicas de observação participante, seguida de estudo de prontuário, com 142 mulheres sendo acompanhadas; num segundo estudo, em uma amostra de 322 usuárias, aplicou-se entrevista. Em atividades grupais observou-se relatos espontâneos e nos prontuários médicos registros de demandas espontâneas; o mesmo não ocorreu em consultas individuais. A entrevista detectou uma prevalência de casos muito maior. Então, a possibilidade de detecção de casos, seu acolhimento e algumas respostas do serviço, requer especificidade de abordagem e cuidados próprios para que a violência contra mulheres possa emergir como parte da demanda usual na saúde

Genome sequencing reveals fine scale diversification and reticulation history during speciation in Sus

Background Elucidating the process of speciation requires an in-depth understanding of the evolutionary history of the species in question. Studies that rely upon a limited number of genetic loci do not always reveal actual evolutionary history, and often confuse inferences related to phylogeny and speciation. Whole-genome data, however, can overcome this issue by providing a nearly unbiased window into the patterns and processes of speciation. In order to reveal the complexity of the speciation process, we sequenced and analyzed the genomes of 10 wild pigs, representing morphologically or geographically well-defined species and subspecies of the genus Sus from insular and mainland Southeast Asia, and one African common warthog. Results Our data highlight the importance of past cyclical climatic fluctuations in facilitating the dispersal and isolation of populations, thus leading to the diversification of suids in one of the most species-rich regions of the world. Moreover, admixture analyses revealed extensive, intra- and inter-specific gene-flow that explains previous conflicting results obtained from a limited number of loci. We show that these multiple episodes of gene-flow resulted from both natural and human-mediated dispersal. Conclusions Our results demonstrate the importance of past climatic fluctuations and human mediated translocations in driving and complicating the process of speciation in island Southeast Asia. This case study demonstrates that genomics is a powerful tool to decipher the evolutionary history of a genus, and reveals the complexity of the process of speciation

Investigação em sistemas e serviços de saúde: novos problemas e objetos, abordagens e estratégias

O artigo discute as tendências atuais das políticas e da organização dos sistemas e serviços de saúde, identificando os problemas que estão a exigir o desenvolvimento de investigações cujos resultados venham a subsidiar a formulação e implementação de propostas de mudança na formação de pessoal e nas práticas de saúde. Identifica áreas temáticas e discute os novos objetos de investigação que estão sendo constituidos, destacando a problemática dos sujeitos políticos em saúde, a redefinição do papel do Estado e a questão dos mercados em saúde, assim como a preocupação com o impacto das políticas, programas e serviços de saúde no contexto do ajuste estrutural das economias latinoamericanas e brasileira, em particular. Analisando as tendências atuais da produção científica no campo dos sistemas e serviços de saúde, aponta o crescimento do interesse pela pesquisa avaliativa e discute as estratégias de articulação entre as instituições de ensino-pesquisa e os serviços, notadamente o estabelecimento de "parcerias" para o desenvolvimento de atividades de cooperação técnica, o que vem colocando novos desafios e oportunidades para a consolidação de núcleos de investigação e da própria Rede de investigações em sistemas e serviços de saúde.The article discusses the present trends of the policies and health system organizations and services. It identifies the problems that at the moment demand the development of investigations with results that may support the formulation and implementation of proposal of changes in the personnel qualification and health practices. The paper also identifies the thematic areas and discusses the new objects of investigation being constituted highlighting the predicament of the political subjects in health, the redefinition of the role of the state and the issues of the health markets another concern is the impact of the policies, programs and health services in the context of economic structural adjustment of Latin America and in special Brazil. Having analyzed the present trends of scientific production in the field of health systems and services it points to the growing interest for the evaluative research. Next it discusses the articulation strategies among the teaching research institutions and the services, notably the establishment of partnerships for the development of activities of technical cooperation. Such strategies have placed new challenges and opportunities for the consolidation of not only the investigation nuclei but also the very Investigation Net system and services