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Infant death and interpretive violence in Northeast Brazil: taking bereaved Cearense mothers' narratives to heart
Nations, Marilyn K.;
Cadernos de Saúde Pública , 2008, DOI: 10.1590/S0102-311X2008001000005
Abstract: this study investigates bereaved mothers' ethnoetiologies of avoidable infant deaths in northeast brazil. it critically examines the anthropological debate concerning "selective maternal negligence" as a relevant explanation for high infant mortality, based on an analysis of preexisting data. from 2003 to 2006, 316 ethnographic interviews collected by the author from 1979 to 1989 in six communities in ceará state were retrieved. forty-five narratives of fatal illness and death of 56 children < 5 years of age were identified for in-depth analysis. despite their low income and schooling, grieving mothers constructed their own explanations for early death. the most common causes were infectious-contagious diseases (37.9%) and dehumanized care by the attending health professional (24.1%). no mother reported maternal carelessness, detachment, or negligence. if there is any "disregard" in the context of poverty, it is by the unjust economic, political, and social system and inhumane public health practice which violates their rights as citizens. to characterize a bereaved mother as "negligent", or worse, as accomplices in her child's death, is an act of interpretive violence, unfairly blaming and demoraling mother-caregivers in northeast brazil.
Múltiplos olhares sobre a mortalidade infantil no Ceará, Brasil
Sousa, José Roberto Pereira de;Nations, Marilyn;
Cadernos de Saúde Pública , 2011, DOI: 10.1590/S0102-311X2011000200007
Abstract: this qualitative study analyzes the perceptions of various social actors towards infant mortality and the program to reduce it in ceará state, northeast brazil. the study compares two municipalities (counties) that showed opposite infant mortality trends from 1993 to 1997, during which time ceará achieved international visibility for having reduced infant mortality statewide. a total of 48 semi-structured interviews with four groups of key informants health system managers, community health agents, mothers who had lost a child, and neighbor women with children in the same age bracket and content analysis revealed "multiple conflicting voices" on the issue. although the level of political determination to implement the interventions varied between the two municipalities, the differences in perceptions concerning infant death were more striking between the various groups of social actors, regardless of the municipality. the study revealed a kind of authoritarian educational practice that jeopardizes acceptance of the community health agents program. public policies are needed that give voice to the people closest to the experience of infant death.
"Prismas de percep??o": múltiplas leituras das campanhas em saúde no Nordeste brasileiro
Diógenes, Kátia Castelo Branco Machado;Nations, Marilyn;
Cadernos de Saúde Pública , 2011, DOI: 10.1590/S0102-311X2011001200018
Abstract: this anthropological study from february 2009 to november 2010 revealed the comprehension and cultural critique of three mass media health campaigns in northeast brazil. twenty-four ethnographic interviews were conducted, exploring the iconographic and semantic content of the campaigns in the dendê community in fortaleza, ceará state, brazil. the authors used content analysis; systems of signs, significance, and actions; and contextualized semantic interpretation. there is a gap between the elaboration and reception of messages. multiple interpretations occur (proximal reading, kaleidoscope of comprehension, and distant reading), depending on the reader's cognitive proximity to (or detachment from) the message. this "perceptual plasticity" arises from the creativity of popular imagination. health professionals who hear rather than dismiss the "recipient's" subjective voice, which re-signifies authoritative messages, can penetrate the perception of the recipient's "visual world". in the context of poverty, this re-framing is essential for people to comprehend and proactively defend their own health.
Stigma, deforming metaphors and patients' moral experience of multibacillary leprosy in Sobral, Ceará State, Brazil
Nations, Marilyn K.;Lira, Geison Vasconcelos;Catrib, Ana Maria Fontenelle;
Cadernos de Saúde Pública , 2009, DOI: 10.1590/S0102-311X2009000600004
Abstract: in response to the call for a new science of stigma, this anthropological study investigates the moral experience of patients diagnosed with severe multibacillary leprosy. from 2003 to 2006, fieldwork was conducted in the so-called "united-states-of-sobral", in ceará state, northeast brazil. sobral is highly endemic for leprosy, despite intensified eradication efforts and a 30% increase in primary care coverage since 1999. of 329 active leprosy cases at two public clinics, 279 multibacillary patients were identified and six information-rich cases selected for in-depth ethnographic analysis, utilizing illness narratives, key-informant interviews, home visits, participant-observation of clinical consultations and semi-structured interviews with physicians. a "contextualized semantic interpretation" revealed four leprosy metaphors: a repulsive rat's disease, a racist skin rash, a biblical curse and lethal leukemia. far from value-free pathology, the disease is imbued with moral significance. patients' multivocalic illness constructions contest physicians' disease discourse. "skin spot day" discriminates more than educates. patients' "non-compliance" with effective multi-drug therapy is due to demoralizing stigma more than a rejection of care. "social leprosy" in northeast brazil deforms patients' moral reputations and personal dignity.
Cuidado, "cavalo batizado" e crítica da conduta profissional pelo paciente-cidad?o hospitalizado no Nordeste brasileiro
Nations, Marilyn K.;Gomes, Annatália Meneses de Amorim;
Cadernos de Saúde Pública , 2007, DOI: 10.1590/S0102-311X2007000900018
Abstract: the current anthropological study focuses on the assessment by patients/citizens concerning the conduct of health professionals in a public general hospital in fortaleza, ceará state, brazil. from january to july 2005 we tracked 13 key informants during hospitalization and analyzed their narratives of the experience. according to our observations, patients develop definite opinions of the caregivers' gestures and expressions during the entire process. in the health professionals, patients appreciate the human ability to express affect, to talk, and to include them in clinical decisions, above and beyond the professionals' technical skills. patients criticize aloof, cold, and rude attitudes by health professionals, whom patients compare metaphorically to "human quadrupeds". they recommend an affective, empathetic, and ethical approach and clinical communications backed by straight talk, friendly conversation, and respect for daily customs related to life in northeast brazil. we contend that this legitimate and critical voice of the patient/citizen provides valuable clues for transforming professional conduct, rehabilitating patients' morale, and building a humane hospital within a context of social inequalities.
Cuidado e doen?a cr?nica: vis?o do cuidador familiar no Nordeste brasileiro
Pinto,Juliana Maria de Sousa; Nations,Marilyn Kay;
Ciência & Saúde Coletiva , 2012, DOI: 10.1590/S1413-81232012000200025
Abstract: the provision of care causes stress in everyday family dynamics leading to physical, mental and emotional complications in caregivers and spouses' loss of liberty and/or overwork. between march and november 2006, this anthropological research examined family caregiving in the context of chronic obstructive pulmonary disease (copd). by means of ethnographic interviews, illness narratives and participant observation, the scope was to describe family reorganization and coexistence with the disease and its evolution, caregiver perceptions about patient difficulties and limitations experienced and strategies employed to tackle their illness. six low-income family caregivers, living in poor, urban areas in the outskirts of the capital city, fortaleza, ceará, brazil, participated in the study. from the content analysis, two categories arose: "sharing suffering" and "attitudes and behavior perceived and experienced by caregivers." in-depth narratives revealed marked affection between patients and their family caregivers. despite poverty, structural violence, unemployment, social prejudice and low salaries endemic in the northeast of brazil, the caregivers find effective ways to cope with chronic illness besides creating strategies to diminish suffering caused by the illness.
Saber popular sobre dores nas costas em mulheres nordestinas
Arcanjo,Giselle Notini; Silva,Raimunda M. da; Nations,Marilyn K.;
Ciência & Saúde Coletiva , 2007, DOI: 10.1590/S1413-81232007000200015
Abstract: analyzing and understanding people's conceptions and actions regarding back pain is relevant since they can be part of the disease's explanation and cure. the nature of this study is qualitative with an anthropological focus. it was carried out from january to february, 2005 with nine women between 45 and 58 years of age with chronic back pains who participated in a health support group for menopausal women in a teaching institution in fortaleza, ceará. nine (9) in-depth ethnographic interviews were conducted with key informants exploring their problems, worries, coping strategies, their notion of quality of life and barriers to achieving this, especially as related to back pain. it was observed that back pain encompasses problems and solutions ranging from psychological, socioeconomic and political to educational aspects. despite informants' low educational levels, they present a holistic view of health and a rich coping and cure-seeking experience. because daily life activities can be considered as cultural risk, they need to be considered. it is, thus, necessary to consider the socio-cultural, economic, political and environmental context, in order to develop educational actions to promote health.
Narrative in the social health research: perspective and Method
Geison Vasconcelos Lira,Ana Maria Fontenelle Catrib,Marilyn Kay Nations
Revista Brasileira em Promo??o da Saúde , 2003,
Abstract: The narrative is a research technique that has been used in Medical Anthropology research as an access form to illness experience and its reconstruction. The illness experience, in fact, has been recognized by medical anthropology authors as indispensable to the establishment of a more empatic and ethic dialogue among health professional and patient and his/her social network. Thus, in the health research issues, valorization of illness experience means it’s necessary to eliciate narratives, both in the care and in the research. In this article, we linked the illness experience concept and structure to the narrative concept and structure, describing its contributions to research, the research types in what it can be used, the types of narratives in that the human experiences are translated, the procedures for its eliciation, as well as the techniques of analysis of data obtained in the fieldwork. In respect to these techniques, we describe here three: (1) the analysis of narratives proposed by Shütze; (2) the Thematic Content Analysis; and (3) the technique of the Collective Subject’s Speech.
Cronicidade e cuidados de saúde: o que a antropologia da saú- de tem a nos ensinar?
Geison Lira Vasconcelos,Marilyn K. Nations,Ana Maria Catrib Fontenelle
Texto & Contexto - Enfermagem , 2004,
Abstract: La ascensión de las enfermedades crónicas en el perfil de mortalidad de la población brasile a trajo implicaciones no sólo en la agenda nacional de la salud pública, también en la organización social de las prácticas de salud. En este artículo reflexionamos sobre cuestiones ontológicas, epistemológicas y metodológicas en la conformación de nuevos saberes en la salud para el enfrentamiento del impacto de las enfermedades crónicas en la realidad de la vida cotidiana. Inicialmente, discutimos la naturaleza ontológica de la enfermedad desde la antropología, donde la terminología es explicada, y de la sociología del conocimiento, enfocando la enfermedad como experiencia humana. Seguidamente, exploramos la epistemología de la relación fundacional sujeto-objeto sobre la aprehensión de la enfermedad por pacientes y cuidadores, destacando el concepto de Modelos Explicativos y su papel en la comprensión de la relación Profesional de la Salud-Paciente. Finalmente, en la metodología, sugerimos la narrativa como método para profundizar la cuestión de la cronicidad y del cuidado
Effects of asenapine on depressive symptoms in patients with bipolar I disorder experiencing acute manic or mixed episodes: a post hoc analysis of two 3-week clinical trials
Armin Szegedi, Jun Zhao, Arjen van Willigenburg, Kari R Nations, Mary Mackle, John Panagides
BMC Psychiatry , 2011, DOI: 10.1186/1471-244x-11-101
Abstract: In the original trials (A7501004 [NCT00159744], A7501005 [NCT00159796]), 977 patients were randomized to flexible-dose sublingual asenapine (10 mg twice daily on day 1; 5 or 10 mg twice daily thereafter), placebo, or oral olanzapine 5-20 mg once daily for 3 weeks. Three populations were defined using baseline depressive symptoms: (1) Montgomery-Asberg Depression Rating Scale (MADRS) total score ≥20 (n = 132); (2) Clinical Global Impression for Bipolar Disorder-Depression (CGI-BP-D) scale severity score ≥4 (n = 170); (3) diagnosis of mixed episodes (n = 302) by investigative site screening. For each population, asenapine and olanzapine were independently compared with placebo using least squares mean change from baseline on depressive symptom measures.Decreases in MADRS total score were statistically greater with asenapine versus placebo at days 7 and 21 in all populations; differences between olanzapine and placebo were not significant. Decreases in CGI-BP-D score were significantly greater with asenapine versus placebo at day 7 in all categories and day 21 in population 1; CGI-BP-D score reductions were significantly greater with olanzapine versus placebo at day 21 in population 1 and day 7 in populations 2 and 3.These post hoc analyses show that asenapine reduced depressive symptoms in bipolar I disorder patients experiencing acute manic or mixed episodes with clinically relevant depressive symptoms at baseline; olanzapine results appeared to be less consistent. Controlled studies of asenapine in patients with acute bipolar depression are necessary to confirm the generalizability of these findings.Bipolar disorder is a serious chronic medical condition that typically is cyclical, characterized by manic/hypomanic, depressed, or mixed states, and associated with a high risk for suicide [1,2]. Although manic episodes are considered the hallmark state of bipolar I disorder, patients spend up to 4 times more symptomatic time in depressed states [3], and it is depressio
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