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This review addresses the impact of the COVID-19 pandemic on workers' mental health, in particular, teleworking conditions. Our analysis is based on documents from several international organizations and specialized scientific publications. The retrieved information reveals that the pandemic has had a significant effect on the mental health of frontline workers and employees who had to migrate to a virtual environment without prior warning. However, a positive aspect is reflected in the development of several remote mental health care devices implemented to protect vulnerable population, frontline workers, and the general population. Finally, this paper underscores the importance of developing public policies for protecting workers' mental health.

This paper presents a synchronic analysis of the diseases during the emergence of COVID-19, the management and impact of the lockdown, and how the media narrated these events in working-class neighborhoods of the metropolitan areas of Buenos Aires and Gran Resistencia from March to November 2020. We resorted to quantitative methods on secondary sources to describe poverty and syndemics and conducted week-by-week ethnographic and media research on 38 neighborhoods with water shortages and critical overcrowding. As a result, COVID-19 syndemically emerged with dengue, measles, and tuberculosis, and the preventive measures exacerbated institutional and gender violence, the Werther effect, and the neglect of other illnesses. Ethnography revealed syndemics with noncommunicable diseases and the influence of structural violence on health. The media analysis shows interest in the districts associated with the fear of contagion, but they disappear from the media agenda once dispelled.

The COVID-19 pandemic induced changes in the dynamics of the life of women in the perinatal phase who, due to the health crisis, restructured social care and coexistence practices. The scope of this paper was to assess the experiences of high-risk perinatal pregnancy risk among COVID-19 positive women through social interaction. The work was conducted in a hospital of tertiary perinatal care. Qualitative methodology was used, whereby questionnaires and interviews were conducted via zoom with 14 COVID-19 positive women in the perinatal phase. Critical-interpretative discourse analysis was applied based on the concept of social interaction and complex thinking. Three types of social interaction were developed to assess the results: a) Initial social interaction: experiences when becoming aware of being COVID-19 positive; b) Acquired social interaction: experiences of care prior to COVID-19; c) Enduring social interaction: experience required in the face of COVID-19. The result of experience leads to new forms of social interaction after notification ranging from care to resilience. The conclusion drawn is that the experience of COVID-19 of women in the perinatal period remodeled their ways of coexistence and care within the institutional, family, and personal spheres.

The paper analyzes, from a qualitative perspective, how the COVID-19 pandemic has significantly reduced medical care for chronic patients at the three levels of the Mexico City health sector due to community mitigation strategies, the perceived risk of infection of health personnel and patients, the focus on pandemic care, and how these processes are articulated with the previous underfunding conditions of the public health system. Thus, we adopted the Grounded Theory approach based on the description and analysis of the experiences of 42 doctors interviewed at the three care levels. The pandemic iatrogenesis concept is proposed to address the interrelation between the material and symbolic organization of the dominant model of medical care and specific structural and cultural dimensions of massive and systemic neglect since the arrival of the pandemic. We point out some strategies and possibilities to avoid similar future settings based on this theoretical proposal and the experiences of the doctors interviewed.

This paper seeks to understand why interpersonal aggressions that lead to homicides in young people can be tolerated, claimed or acclaimed in the contexts of sociability in which they occur. The methodology developed was qualitative, namely it sought to document and analyze the meanings and experiences of the actors from their perspectives. The field work was carried out with young men from popular sectors that inhabit six municipalities in the Buenos Aires suburbs between 2014 and 2017. Among the results, we argue that empowerment of lethal aggressions is linked to a reduction in youth sociability in peer groups with strong territorial inks. This reduction is expressed as a consequence of the weakness of family, work and institutional ties in shaping the social experience of young people. In peer groups, responses to insults can be valued not only as a way of intervening in conflicts, but also as a source of belonging and social recognition. We conclude that these reduced sociabilities express socio-political inequalities that contribute to homicide being an exceptional event with recurrent spaces for interaction.

This paper aims to understand the meanings of food and nutrition policies for beneficiary mothers and for technicians designing and implementing said policies. The Grounded Theory method was employed. The data collection techniques adopted were the semi-structured interview and the focus group. The participants were beneficiaries of food and nutrition programs, with a minimum two-year experience, and technicians with five-year experience in designing or implementing these policies and programs. Food and nutrition policies are conceived and managed under a market logic, which has required an institutional framework that adopted this commercial model to provide public services, which is implemented in the scheme of outsourcing third parties, especially private companies, who implement these policies to achieve financial profitability. The market is imposed as the benchmark for the State's actions, and, therefore, the State's action is limited the oversight of outsourced actions, and food policies become devices for the diversion of public resources to the private sector.

The scope of this paper was to identify what kind and which type of modern industrialized foods that overweight and obese adolescents consume and the perception they have of them. The study was of the qualitative-quantitative, descriptive and interpretative type and was conducted with adolescent students from four high schools in the municipality of Abalá, Yucatán, Mexico. It consisted of three stages, the first of which involved recording anthropometric measurements of 292 high school students to obtain their Body Mass Index. In the second stage, 58 students who were overweight and obese were randomly selected and a food consumption frequency questionnaire was applied. In the third stage, four focus groups were held to ascertain the perception with respect to food consumption. A high intake of modern industrialized foods was observed at breakfast, school break and dinner, though traditional dishes are still consumed at mealtimes. The conclusion drawn is that there is a transculturation of food among adolescents.

This paper aimed to explain why more women died in the earthquake of September 19, 2017, in Mexico City. We adopted a mixed quantitative-qualitative method, with epidemiological and statistical data and a hemerographic review about the influence of gender on earthquake-derived mortality. In the quantitative part, the results show that the difference in deaths among women compared to those among men cannot be attributed to population distribution or randomization issues. In the qualitative part, the results show that many data are evidencing that gender is an essential social determinant that can explain why more women die than men after an earthquake. Therefore, we recommend that these data be considered responsibly to improve future prevention and intervention actions.

The aim of this paper is to describe the main systems of hierarchization in the Mexican medical field (and those of other similar Latin American countries). Drawing on Bourdieu's genetic structuralism, our hypothesis is that the structure of the medical field is closely correlated with the schemes of perception and appreciation of the medical field's agents. These schemes are rooted in hierarchical classifications by which work is organized and the main agents' prestige is allocated. Empirical data include focus groups, interviews and observations in hospitals, as well as images, memes and other graphic displays found in Facebook and other public internet locations. The analysis sought to identify the main systems of hierarchization that structure both the academic training and the professional practice of physicians. Four systems of hierarchization are identified: professional, by subfields, by specialties, and by division of labor. These systems of hierarchization, reciprocally entangled with one another, are part of the complex structure of positions within the medical field, as well of the agents' schemes of perception and appreciation which are embodied under the form of habitus.

This paper aims to analyze the regulatory structure of nursing in Mexico through its legislation and perspectives of participant stakeholders. A case study was undertaken using qualitative and quantitative data sources, as well as from the review of official documents. The analysis included data from the sources according to the four realms proposed by the Moran & Wood (1993) model. The more advanced realm was the market entry since the state regulates entry through a license of practice. The regulation of competition is weak, showing very reduced areas of autonomous practice. The labor market is offering a wide variety of entry options with clear signs of deterioration. The dominant payment mechanism is salary, showing a structure that incorporates a component that does not impact on pensions at the end of the labor cycle. The regulation of nursing is a component of its professionalization, and as such, it is understood as a multidimensional consolidating process, particularly realms related to the regulation of competition, market structure, and payment mechanisms, in which nursing representatives should play a more active role in the future.

The present paper analyzes, in the context of a settlements' relocation, the participation and tactics developed by the Barrio Nuevo inhabitants and doctors of a Health Centre in La Plata (Argentina), to face the crisis that is taking place in the country from the application of austerity policies. Our assumption is that community participation and in health issues (understood in a holistic sense) makes it possible to identify and intervene in social conditions, such as the right to the city, to produce changes in the health situation of the territory. For this, we will investigate the crisis, the current public policies and the modes of participation. Specifically, we will develop the experience of a Health Situation Analysis (ASIS) held in the territory and we will analyze the relationship between the right to health and the right to the city.The methodology used is ethnography. We carried out participant observations, in-depth interviews, a health workshop and participated in the ASIS.We conclude that there is a dialectical relationship between the right to the city and to health and this is a collective construction. All community participation strengthens health interventions. This is essential in crisis contexts to fight for violated rights.

The scope of this paper was to analyze the trends, impact on life expectancy and effect of the main associated socioeconomic factors with the death rate by homicide in Colombia between 2000 and 2014 at the state level, by gender and age groups. Standardized mortality rates and years of life lost among those under 85 years of age were calculated and multivariate regression analysis was performed using negative binomial fixed effects regression models with panel data to analyze the associated socioeconomic factors with the incidence of homicide. The reduction of the death rate by homicide in Colombia was corroborated, which was generalized at state level, though it did not occur homogenously. A higher mortality risk was found among males, particularly between 15 and 49 years of age. Economic growth and inequality were negatively associated with death rates by homicide; unemployment was positively associated; and poverty had no effect on the mortality rate. Investigating the main associated factors with homicidal violence is complex, but is indispensable due to its impact on economic and social development, given that it mainly affects the population of productive age, with broad public health consequences and at a high cost to healthcare services.

BDSM sexual practices related to sadomasochism, domination and submission, represent a vast range of possibilities in terms of paraphernalia, associated emotions, uses and applications that are as diverse as the human beings who practice it. Taking this into account, we conducted a study to understand the practices related to BDSM, under the perspective of its own practitioners. For this, a qualitative methodology was used, with an emergent and projected type of design. We covered 8 in-depth interviews on men and women from Venezuela and the data was analyzed through the constant comparison method in order to generate grounded theory, this paper comes up as part of a larger study. Among the most outstanding findings were the importance of limits, some as irrefutable an others that are meant to break, and the importance of the physical and mental health conditions in the practice.

The scope of this paper is to review the available scientific literature about the effects on health of occupational exposure to Legionella spp. A systematic review of the scientific literature retrieved from the MEDLINE (via PubMed), ISI-Web of Science (Institute for Scientific Information), Cochrane Library, LILCAS and SCOPUS databases through February 2015 was conducted. The key words used were ««Legionnaires' Disease» «Legionellosis» «Occupational Exposure» «Occupational Diseases». Two hundred and twenty-two references were retrieved of which, after applying inclusion/exclusion criteria, 13 complete articles were selected. Of these, 9 describe pneumonia, 4 list Pontiac Fever, 1 reveals legionellosis and 3 result in death. The main causative agent of disease in workers exposed was Legionella pneumophila serogroup 1. Legionella spp infection is closely related to professions where there is nebulization with water, mainly among workers subjected to long exposure or even re-exposure. Outbreaks occurs seasonally, especially in the hottest months.

In the context of social and demographic studies of sexual and reproductive health, this paper discusses the situation of young people in Argentina, emphasizing the problems revolving around Sexually Transmitted Diseases (STDs) and the compliance with sexual rights. This work aims to study the calendars and characteristics of the onset of sexual life in young Argentinean people and to describe the current situation of knowledge, practices, and access related to sexual life. Based on data from the National Survey on Sexual and Reproductive Health ( 2013) we worked with the universe of young people between 15 and 29 years of age (n = 2,084 women, n = 1,872 men, without weighting) and analyzed the differences in the calendars of the onset of sexual life, as well as the knowledge and prevention of STDs by gender sex, age groups, household income and geographical regions.A national scenario was found featuring marked tendencies in the calendars of first sexual intercourse by gender sex, as well as in the knowledge about STDs. However, the analysis by region and household income in each gendersex showed high heterogeneities, which would indicate certain limitations in the access to sexual education and the effective compliance of people's rights, as well as an increased risk to contracting STDs in specific social groups.

This paper aims to analyze the process of medicalization in current societies, starting from the description of the way in which medicine gradually appropriated various aspects of everyday life that were once part of the life cycle of people. At the theoretical level, we are based on authors such as Descola and Latour, who problematize the dichotomy between Nature and Culture, and propose the need to think from a superior episteme. Methodologically, this theoretical proposal enables an analysis of the medicalization that can illuminate what is hidden in the discourse and biomedical practices: the sociocultural, political and economic processes that are part of these "objects" of Medicine. From this perspective, the presentation of them as scientific facts, objectively isolatable and manipulable by medical science, is in crisis. Thus, our analysis, based on the concept of "quasi-objects" or "hybrids", problematizes such objectification, while providing critical tools to reflect on the medicalization of life in today's societies.

Food security and the vulnerability among indigenous and peasant populations has become a topic of interest to public health all around the world, leading to the investigation about measurement, classification and factors that determine it. This systematic review aims to describe the situation of food security in indigenous and peasant communities, and the methods used for evaluation. The literature search was performed on the Pub Med (5), ScienceDirect (221) and Scopus (377) databases searching for publications between 2004 and 2015, a total of 603 items were located with the search engines. At the end of the screening process and after adding the items found in the gray literature, 25 papers were obtained to write the review. In the 11 years evaluated between 2004 and 2015, scientific activity around the theme was poor with just 4.54% of the publications on this subject, but for 2011 the percentage increased to 13 publications, 63%. Various factors that influence the development of food insecurity are climate change, the diversity of agriculture, globalization and market westernization.

This paper seeks to analyze the factors associated with the use of dental health services (UDHS) by adults in the city of Corrientes, Argentina. A cross-sectional study was conducted. Information concerning the study variables was collected via a home survey. The sample size was established with a 95% confidence interval level (381 individuals). A simple random sampling design was used, which was complemented with a non-probability quota sampling. The data was analyzed using SPSS version 21.0 and Epidat version 3.1 softwares. Socio-economic level, dental health coverage, perception of oral health care, perception of oral health, knowledge about oral health, and oral hygiene habits were significantly associated with the UDHS over the last twelve months. These same factors, excluding dental health coverage and knowledge about oral health, were associated with the UDHS for routine dental check-ups. Measures should be implemented to increase the UDHS for prevention purposes in men and women of all socio-economic levels, particularly in less-privileged individuals.

The scope of this paper was to ascertain the meaning of the term "nursing" among teaching nurses at Spanish universities. The research was qualitative, and the strategy used was analytical induction. Sampling was theoretical and focused on the selection of extreme cases and the data collection technique was in-depth interviews. The analysis was carried out using the specific Grounded Theory technique. Strategies were established to ensure credibility, portability, confirmability and auditability. Based on the analysis of the data, three categories were identified that responded to the planned objective: it is a "human activity linked to motherhood," a "vocation to help others that some people have" and an "activity that takes care of the needs of others respecting their identity." It can be concluded that in Spanish universities a model of nurse is being transmitted where the proper role of care is inherent to the feminine gender and the vocation of service to others that some people have. This is the reason why the Spanish Royal Academy (RAE) only identifies the role of technical assistance to medicine as a professional element of nursing.

The aim of this paper is twofold. First, it aims to investigate the increased interest in health as an important dimension of the foreign policy and diplomatic concerns together with the emergence of a new framework for regional health integration and regional health diplomacy. Second, it seeks to understand the role and practices of new regional blocs in the field of health and whether they are conducting to the emergence of new strategies for addressing health regional policies in South America. The regional policy process relates to health as a right. Thus, some practices and processes in social policy are setting new standards for political and social cohesion in the construction of new regionalism. Health crosses national, regional, and global agendas in a multi-directional fashion, rather than via one-way, top-down policy transfer. A special feature of Unasur is upholding regional health sovereignty despite the unique fact that member countries retain national autonomy. Unasur has projected foreign policy that promotes social values in ways that seem innovative. Experience as Unasur shows that regional organisms can become a game changer in global diplomacy and an influential actor in the international agenda. Resumen El objetivo de este artículo es doble. En primer lugar,investigar el creciente interés en la salud como una dimensión importante de la política exterior, en sintonía con el surgimiento de un nuevo marcopara la integración regional y la diplomacia en salud. En segundo lugar, comprender el papel y las prácticas de los nuevos bloques regionales en el campo de la salud y si estasconducena la emergencia de nuevas estrategias para abordar las políticas sanitarias regionales en América del Sur. Los nuevos procesos de integración regional se refieren a la salud como un derecho. Así, algunas prácticas y procesos de la política regional están estableciendo nuevos patrones de cohesión política y social en el avancede un nuevo regionalismo. La salud en este proceso de formulación e implementación de la política regional,atraviesa las agendas nacionales, regionales y globales de forma multidireccional. Un valor agregado de Unasur es su propuesta de avanzar es pos de una mayor soberanía regional en salud, a pesar del hecho de que los países miembros mantienen su autonomía nacional. En este sentido, Unasur ha proyectado una política exterior que promueve principios y valores a partir de un enfoque innovador. El caso de Unasur muestra que los organismos regionales tienen el potencial para cambiar las reglas (y el resultado) del juego en la diplomacia global y convertirse en actores influyentes en la agenda internacional.

Since the TRIPS Agreement (Agreement on Trade-Related Aspects of Intellectual Property Rights) came into effect, Brazil, like other developing countries, has become more assertive in multilateral negotiations and begun to argue that the present international system of intellectual property should be better adapted to its needs and interests. In doing so, the country has emphasized that intellectual property is not a subject exclusively associated with trade, but also with public health and human rights. This paper discusses the activity of the Brazilian government in multilateral negotiations that involve public health, innovation and intellectual property. The conclusion from looking at Brazil's diplomatic activity in this area is that Brazil has been a protagonist in this debate, seeking solutions that mitigate the adverse effect of the present international intellectual property system on access to drugs, and other medical technologies, in the developing countries.

This paper examines the development of a treatment - a fixed-dose combination of artesunate and mefloquine - in Brazil, from three points of view: in terms of access to medication; to record and report successes; and to look at the lessons learned. This product development took place in the ambit of a public-private partnership. Semi-structured interviews were held with key actors involved in the different phases of the development, and documents were analyzed. Two important points of reference orienting the design of the study and analysis were: a logical model for access to medication; and evaluation of programs. It is concluded that there were several successes over the course of the project, but insufficient attention was given in the project's architecture to planning of adoption of the product: irregularities in demand caused difficulties in planning and production, and adoption of the product was irregular in the Americas. It is concluded that the project can be considered to have been successful: the product was created, and the aims were met - strengthening of institutional and individual capacities and alliances, and advocacy. However, there were weaknesses in the process, which need to be mitigated in future projects of the same type.

Health has become a priority issue on the agenda in relation to Brazilian international technical cooperation in the last decade. This applies to Mozambique which is a strategic partner of Brazil's when one takes into consideration the volume of projects that have been undertaken between the two countries and the available resources on offer. There has been a shift in the foreign policy paradigm which has resulted in a new Brazilian foreign policy posture that promotes bilateral agreements and international cooperation. On conducting a retrospective and current analysis it is clear that there are, however, major obstacles and challenges for bilateral agreements and technical international cooperation that require in-depth study and which need to be dealt with in the area of health. This paper seeks to identify and analyze these obstacles with a view to providing proposals for ways forward. It takes the approach of using the methodology of reviewing specialized journals on this topic as well as using qualitative research from the main actors and institutions involved in bilateral cooperation.

This paper examines how the Union of South American Nations (Unasur) concerned itself with ensuring democracy and participation in the construction of health policies. It aims to explain the meaning of health democracy, and its importance for making the right to health effective. The concern is that the decision on these politics of the bloc should be in harmony with the interests of their citizens, so as to identify ethical activity of the States in international relations. An analysis was made of the documents of constitution, and resolutions on health policy, of this bloc, and statements were found with objectives and principles about democracy and citizen participation; but no institutionalization of mechanisms that might make participative democracy in health operational was found.

This paper aims to conduct a conceptual analysis of the relationship between scientific and technical progress and social equality, or the reduction of inequalities. We examine this relationship by drawing on three theoretical perspectives: 1) ethical economics, championed by classical economic thinkers and centered on utilitarian self-interest, 2) Mainstream theories of economic development espousing the endogenous link between labor productivity growth and technical progress, 3) the critique of theories of economic development that emerged in the second half of the twentieth century, including Celso Furtado's critique of the theory of underdevelopment, emphasizing the prevalence of egalitarian tendencies, and ecological economics, which suggest alternative paths to those set by "classical" theories of development. The fundamental antinomy posed by the title of this article, characterized by an intrinsic contradiction between technical progress and social equality, strictly presupposes the ethical economics perspective, dominated by the social relations that constitute the "social order".

The paper analyzes formulations in the area of international health at the time of the International Conference on Primary Health Care, held in Alma Ata, Kazakhstan, in 1978. It is set within the context of the broader debate on development and international cooperation throughout the 1970s. Three sets of concepts and prescriptive formulations were examined namely: the New International Economic Order (NIEO), the Dag Hammarskjöld Report (DHR) and the Basic Human Needs Approach (BHN). They were compared with the proposals in documents from the World Health Organization and in the statements from Halfdan Mahler, its director. As a whole, this set of formulations and proposals share a broad spectrum of terms and notions, as well as much of the expectations for change and tensions that existed in the classic period of development during the later years of the post-war era.

Understanding that conditions of health are dependent on more general nationwide factors relating to the level of development means admitting that 'sectorization' of health service is something that tends to limit the formation of knowledge. It also points to the importance of investigating the relationship between health and development, including issues about the processes that feed the persistence of the polarization between modernization and exclusion which has been a history of Brazil's contemporary development. This paper, based on a review of the literature, aims to look more deeply at the structural conditioning factors of the relationship between health and development, and their reproduction in the formation of contemporary knowledge, based on a dialog with the ideas of Celso Furtado. It concludes that a 'virtuous' articulation between health and development calls for policies that are able to reconcile the antagonistic factors represented by the interests of capitalism, and the interests of social wellbeing, in a harmonious co-existence. In Furtado's conception, this would be possible, if the process of social homogenization is correlated with an efficient production system that has a degree of technological autonomy.

The high unemployment rates observed in the United States during the recent economic crisis, that moreover vary between ethnic groups, make it relevant to inquire into how this problem is linked to the mental health of employed and unemployed persons. Therefore, in this paper the relationship between unemployment and mental health among Mexican immigrants, Mexicans born in the US, and other Hispanics in comparison with non-Hispanic native whites and Afro-Americans in the US is analyzed. To achieve this objective prevalence, prevalence ratios and odds ratios for the population between 18 and 65 years of age in the labor force was calculated using data from the 1999 and 2009 National Health Interview Surveys. It was seen that in times of crisis the prevalence of Non-Specific Psychological Disorders (NSPD) in the labor force increased in all ethnic groups. The prevalence ratios indicate that the unemployed face a higher risk of suffering from NSPD than the employed, especially for the non-Mexican Hispanics. Mexican immigrants, in contrast, show the lowest risks.

During the 1980s, 1990s and early 2000s,various intercultural health proposals and actions emerged in most Latin American countries. These initiatives aimed to integrate biomedicine with traditional medicine based on 'parallel' relationships, as opposed relationships based on exclusion, subordination and hegemony. These initiatives had two basic objectives:1) to contribute to the cultural rehabilitation of ethnic groups that made effective use of traditional medicine; and 2) to improve the quality of relationships between health professionals and indigenous patients. This paper analyzes the reasons for the limited impact and, in some cases, failure of such intercultural health initiatives.

The scope of this paper is to characterize the main barriers faced by the Colombian population when they attempt to gain access to health services. It is an observational, descriptive and exploratory study using both quantitative and qualitative techniques. It was based on the records of Petitions, Complaints, Claims and Suggestions sent to the National Department of Health of Colombia between January 2102 and June 2013. In-depth interviews were conducted with users of health services, as well as officials of the Health Promoting Companies and Outlets for Right to Health of the Health Department of Bogotá. The study is based on domains proposed by Frenk et al for effective access to health services. Users of this study found limitations starting at admission and search for care due to communication failures in accessing health services. For ongoing care services, they encountered barriers resulting from the need for authorizations, lack of availability of specialist medical appointments, surgical procedures and drug delivery. Based on the findings, the conclusion reached is that the barriers perceived by users generate negative perceptions and harmful consequences both for them and for their families.

The scope of this paper is to analyze and compare the evolution of deaths from violent causes among adolescents and young adults in the cities of Cordoba (Argentina) and Porto Alegre (Brazil). It also seeks to establish if the results are consistent with those reported in previous national and local research. Based on official data, specific mortality rates (by sex, age and cause) are calculated for the 1990-92 and 2008-10 periods. In general, violent causes play a significant part in the total number of deaths especially among young men and as they get older. In line with the reality of the country, in Córdoba both non-traffic-related and also traffic-related deaths are most frequent. On the other hand, in Porto Alegre (where the level of deaths from violent causes is higher), homicides and traffic accidents are the most common cause of death. Beyond the actions taken so far, it is necessary to redouble efforts to counter the problem in question, both in the recording of information for decision-making and in regard to the decisions when they are put into practice.

This paper addresses the proposition that even though there appears to be unanimity on the biomedical diagnosis of obesity, it is insufficient or not precise enough, since it is necessary to know more about the consequences of different lifestyles in ways of eating and the impact of lifestyles on the health of the population. Therefore, the paper reflects on how the biomedical ideation of obesity contributes to make body weight and food into what from a rather reductionist and controversial approach is defined as a "social problem." Lastly, the standardization of international strategies against obesity is considered, linked to its classification as a global epidemic, in order to reflect on the effects of dealing with a limited view of culture and food. The ideas articulated in this work are part of the theoretical problematization phase of the topic, prior to the implementation of the research project entitled a socio-anthropological approach to childhood obesity in three case studies: Spain, Mexico and Cuba.

This article addresses some questions regarding the exclusion of the subjectivity derived from the ideals of objectivity and neutrality that characterize the modern scientific parade gm. Several consequences of this exclusion with respect to health care and illness are considered. Five problem areas are discussed, emphasizing the contributions of qualitative inquiry for the recovery of the importance of the individual. These include health and disease as subjective experiences, the gap between the experts' perspective and that of the layman, as well as disagreements among health professionals and common people, both in the preventive and in the curative fields. They also include the omission of the patients' voice when dealing with their illness and the sterilization of subjective creativity to establish new avenues to health care. The paper concludes by pointing out that, despite the challenges involved, certain currents of qualitative research whose foundations are located in the most advanced area of current epistemological, ethical and aesthetic reflection, can help to open new routes towards richer alternatives for health care and illness in Latin American societies.

This paper analyzes the palliative care of terminal patients, examining the tensions between the humanization of care and the progressive medicalization at the end-of-life situation. The research upon which the article is based adopts a qualitative methodological approach derived from interviews with professionals and patients and ethnographic observations in a palliative care unit in the City of Buenos Aires, Argentina. The article describes the configuration of personalized and comprehensive health care based on the core values of more humanized end-of-life care promoted by palliative care supporters. Similarly, the paper analyzes how these practices are assisted by progress in the medicalization process in which the dimension of care is considered less an unprofessional area of medical practice than an area of care in which specific technical skills and know-how are employed. The articles explores how instead of being divergent, the logic of care and medicalization work in a complementary fashion.

This paper discusses the methodological problems in the scientific research on HIV/AIDS in Bolivia, both in the areas of epidemiology and social sciences. Studies associated with this research served as the basis for the implementation of health programs run by The Global Fund, The Pan-American Health Organization, International Cooperation, Non-Governmental Organizations and the Bolivian Ministry of Health and Sports. An analysis of the methodological contradictions and weaknesses was made by reviewing the bibliography of the studies and by conducting qualitative methodological research, that was focused on the quality of health care available to people living with HIV/AIDS in public hospitals and health centers, and looked at how programs targeted at this sector of the population are designed and delivered. In this manner, it was possible to observe the shortcomings of the methodological design in the epidemiological and social science studies which serve as the basis for the implementation of these health programs.

Created in 1986, the Spanish National Health System adopted Primary Health Care (PHC) as one of its building blocks. Since the beginning, the Spanish PHC model has been the subject of both praise and criticism. Nowadays, a crisis in public policy funding--including health funding policies--is resurrecting old debates and raising new ones. This paper analyzes the data available about the degree of acceptance of PHC from the perspective of Spanish citizens as well as data about the debate produced in the last five years by politicians, patients and health workers. At the end of the paper the authors seek to draw some conclusions based on the commonly acknowledged strengths and weakness of the PHC model, which decision-makers ought to take into consideration in order to avoid mistakes caused by improvised decisions elicited by the requirements of the moment.

Homicides occur the world over, but they are not homogeneously distributed by geographical areas (continents, countries, regions), either over long or short periods of time, or in social groups, namely age, gender, social class or ethnicity. Why are there more homicides in some countries than in others? Why do killings increase in some countries, while they decrease in others? There are two fundamental schools of thought for social explanations of crime and violence: those attributing its origins to poverty and inequality and those blaming institutionalization or social norms. To discuss these theories, this paper analyzes and compares the changes in Colombia, Venezuela and Brazil in the first decade of the twenty-first century, where the homicide rate has decreased, increased and remained the same, respectively. Using the measurement of six variables (poverty, inequality, unemployment, national wealth, human development and the rule of law) and the technique of trajectory analysis, the results revealed that institutionalization is more to blame for the change than poverty and inequality. The text concludes that poverty and inequality affect crime and homicides, although not directly, but mediated by the institutions instead.

The medicalization of life and its implications for the production of subjectivities are phenomena that have been highlighted by the human sciences in the study of health and disease. Nevertheless, the analysis of its local expressions has been insufficiently covered. The scope of this paper is to explore this field by an ethnographical study of the medicalization process of child malnutrition in a primary healthcare center of the city of Buenos Aires. We will describe analytically the singularities involved in the body perception and the alimentary context by health professionals and their patients. We emphasize that the criteria of perception and moral values that encourage social positions of health professionals and recipients of their actions precluded the institutionalization of a medical vision. We conclude that the process analyzed highlights the need to exceed the medicalization approaches dealing exclusively from the angle of imposition. The social history of the groups involved and ways of establishing relationships in local settings, are essential to understand the peculiarities of these processes.

This paper explores some ethical dilemmas faced while doing fieldwork. Ethical norms are not enough to appraise the relationship between researchers and participants; a reflexivity practice is needed to understand the dilemmas aroused during this process. Here four issues faced during fieldwork are presented. The academic social time usually defines the schedule of fieldwork; hence, the researcher may decide to follow the academic schedule or to arrange a different schedule with informants. Researchers usually decide which part of their identity will be disclosed for introducing themselves to the informants; but may also decide to hide who really he/she is. Researchers may cope with the dilemma to disclose their private life to informants during the fieldwork. Researchers also may decide to behave according to academic cultural norms of reciprocity or according to the cultural norms of participants. Finally, a reflexivity movement should be developed in Iberoamerica to define an agenda on ethical issues and to develop decolonizing strategies to debate these ethical dilemmas.

This paper presents the rationale for the choice of participants in qualitative research in contrast with that of probability sampling principles in epidemiological research. For a better understanding of the differences, concepts of nomothetic and ideographic generalizability, as well as those of transferability and reflexivity, are proposed, Fundamentals of the main types of sampling commonly used in qualitative research, and the meaning of the concept of saturation are mentioned. Finally, some reflections on the controversies that have arisen in recent years on various paradigmatic perspectives from which to conduct qualitative research, their possibilities of combination with epidemiological research, and some implications for the study of health issues are presented.

The scope of this paper was to identify the role of gender for women as workers, through the perception and discourse of health service providers at the 'Health Centers for Indigenous Women' ("Casas de Salud de las Mujeres Indígenas") in Ometepec, Guerrero and Matías Romero, Oaxaca, Mexico. It is a qualitative study, based on a secondary analysis of the interviews conducted as part of the "Rescatando la experiencia de la Casa de la Mujer Indígena: sistematización y evaluación del proceso" project. A strong sense of the value of work and a strong commitment towards the community were identified. Guilt appears as the result of tension between work outside the home and the responsibilities as mothers and wives. The possibility of helping other women is a source of gratification that dissipates these conflicts; prestige and recognition are added to the benefits of their role. The labor experience of female workers in the "Casas de Salud de las Mujeres Indígenas" of Matías Romero, Oaxaca and Ometepec, Guerrero, described in this paper, reveals that it has very specific characteristics, which are difficult to replicate in other regions of the country. In future studies it is necessary to consider the different contexts of vulnerability.

The scope of this paper is to discuss how so-called "new professionalism" can help in how the education of physicians is conducted, by taking into account the effects of globalization both on the situation of health and on the needs of health professionals with particular emphasis on European Union countries, which are engaged in a profound process of reform in university education. To achieve this, first we present the basic concepts of "new professionalism" and the key strategies of current medical education, which is to train physicians capable of dealing with ethical, scientific and professional challenges that are arising at the beginning of this century. The interdependence of reforms in the undergraduate, graduate and ongoing training areas is then emphasized. The challenges and difficulties to be faced when switching to different stages of medical education are then outlined. It was concluded that, notwithstanding recent reforms in medical education, their great complexity and the still limited availability of contrasting assessments of their results, there are strong synergies between the principles and values of the "new professionalism" and the objectives of the reforms.

This paper is part of the "Southern cone countries multicentric study of primary healthcare: healthcare models, health system integration and intersectoral relations in urban contexts in Argentina, Brazil, Paraguay and Uruguay". Its scope is to contextualize, describe and analyze the current state of the PHC strategy in Argentina and its potential for transforming the fragmented and segmented health system. The data-gathering methodology was review of the literature, study of documents, interviews with key informants and workshop discussions with stakeholders of the system. The dimensions of the data analysis were: (1) stewardship capability; (2) PHC financing; (3) provision, human resources and comprehensiveness; (4) integration and continuity. The transversal analytical categories in all the dimensions were the segmentation and fragmentation of governance and the health system. For this reason, the dynamics and actions of the social actors involved in the healthcare system and their position in relation to PHC were analyzed. The paper contains a theoretical introduction on the scope of current definitions of PHC and the description of the social, economic, political and epidemiological context of healthcare policies in Argentina. PHC based on the proposed dimensions is then analyzed.

This paper presents an overview of Primary Health Care (PHC) in Paraguay, as part of a multicentric study, seeking to identify the possibilities of PHC as a factor for reorganizing the health system. The methodology adopts the comprehensive PHC concept, and takes into consideration the system's segmentation, formed by the public sector of the Ministry of Health and Welfare, Social Security, a not-for-profit private sector, a private for-profit sector and a mixed sector. The study analyzes 5 dimensions: stewardship, financing, resources, integration/continuity, intersectorality/participation, through reviewing data from the literature and official documents, and key informant interviews (experts, decision-makers, professionals and civil society). Advances in health policy legislation since the 1990, with gratuity for all age groups, have been observed. Public spending on health is among the lowest in Latin America. PHC is provided through different vertical programs, with poor coordination and articulation, though a recent political shift prioritizes the progressive implementation of Family Health teams. In conclusion, PHC can contribute to improve health, equity and participation.

The Mexican health system is comprised of the Department of Health, state labor social security and the private sector. It is undergoing a reform process initiated in 1995 to achieve universal coverage and separate the regulation, financing and service functions; a reform that after fifteen years is incomplete and problematic. The scope of this paper is to assess the problems that underlie the successive reforms. Special emphasis is given to the last reform stage with the introduction of the "Insurance of the People" aimed at the population without labor social security. In the analysis, health reform is seen as part of the Reform of the State in the context of neoliberal reorganization of society. Unlike other Latin American countries, this process did not include a new Constitution. The study is based on official documents and a systematic review of the process of the implementation of the System of Social Health Protection and its impact on coverage and access to health services. The analysis concludes that it is unlikely that universal population coverage will be accomplished much less universal access to services. However, reforms are leading to the commodification of the health system even in the context of a weak private sector.

This paper studies the smallpox vaccination in Argentina since 1870, when these discussions were initiated until the 1910s, when they were extended to the rest of the country. We analyze immunization practices implemented prior to the compulsory vaccination law, passed in 1886 for the Capital and in 1904 for the rest of the country. Such a move found resistance from different sectors. Its approval depended on the consequences of modernization and urbanization, the weight of hygienists in the political arena, and its extension depended on a different administrative conception, incorporating new areas and sectors to the national scenario.

This paper aims to present a portion of a study aimed to evaluate the effects and impact of the educative component of the Growth and Development Monitoring Program in four Health Institutions in Medellín, Colombia, regarding the meanings that the significant adults (SA) and health team members (HTM) have about the Program and its outcomes. It was done a qualitative evaluative research under a multiple case study. There were found important differences in the meanings of the Program and its outcomes among the stakeholders reflecting differences in interests, priorities, and needs. For the HTM, the Program's axis is the child and the education process is guided to change SA behaviors. In contrast, the SA considers itself a part of the Program axis, as a subject, because his raising role is related to his own development and well being as well as the child's. 'Raising' is a socio - historic, cultural and ontological category that should be at center of any early childhood care program. It is very important to understand the meanings of the Program and its outcomes for the stakeholders in order to make better planning, implementation and evaluation of childhood care programs.

The purpose of this paper is to analyze the process of institutionalizing tuberculosis research and teaching in the Faculty of Medical Sciences of the State University of Cordoba. The province of Cordoba, especially the capital and the northwestern region, was considered an area suitable for climatic cure. This caused an important flow of migration of infected people and at the same time an increasing interest of the argentine physicians in studying this disease. The analysis of the different actors that participated in the creation process of teaching institutions in this area will be studied with basis on Bourdieu's concept of 'field'. From this perspective, this paper approaches the stages of the disease, the development of teaching institutions, and the tensions and disagreements that were involved in their constitution.