[Interweaving memories: the Fernandes Figueira Institute through a generational perspective]

Memories of care involving sick children and their mothers at the Fernandes Figueira Institute (Instituto Fernandes Figueira) are retrieved. The analysis using a generational perspective reveals the institute as a space of experiences and memories. Three sources of memories are analysed: (1) the research by Marismary Horsth De Seta with the generation that reached the institute in the 1940s; (2) the institute's 1973 activity report; (3) three interviews with workers admitted in the 1980s. It is concluded that care for children, and therefore interest in their mothers, is aligned with the global epidemiological transition, increasing the complexity of the profile of care given at the institute.

When disability and homoparenting meet: the adoption of children with disability by same sex couples

The present theoretical essay is based on six reports concerning same-sex couples and gay and lesbian people in order to interconnect homoparenting and the adoption of children with disabilities, through the lenses of human and social sciences in public health. The reports were interpreted in light of studies on same-sex adoption and the adoption of children with disabilities. Feminist approaches related to care and disability were also included in the interpretative perspective, operating as expressive webs of grammars of ableism. It was found that media approaches endorse the right to family formation and the adoption of children with disabilities by homoparental families, but with little critical depth on the category of disability and without highlighting support for the adoption of all adoptee profiles. Moreover, the intersections between homophobia and ableism increase discriminatory and oppressive logics, with the union of social groups considered to be "undesirable" representing a strategy of governmentality that reveals the complexity of grammars of ableism, applied to the sexual and reproductive rights of LGBTQIA+ adopters and to the fundamental rights of children and adolescents with disabilities who are available for adoption.

[Depression, anxiety, stress, and social support: a cross-sectional study with caregivers of visually impaired children in Rio de Janeiro, Brazil - Views-QoL Study]

We aimed to identify the reports of symptoms of depression, anxiety, and stress among caregivers of children without visual impairment, with low vision, and with blindness and their relationship with the degree of social, emotional, material, and affective support. This cross-sectional and multicenter study was conducted in the municipality of Rio de Janeiro, Brazil, from 2019 to 2020. A questionnaire was applied to obtain caregivers' sociodemographic and economic data. The Medical Outcomes Study Social Support Scale (MOS-SSS) and The Depression, Anxiety, and Stress Scale (DASS-21) were used. Tests were used for multiple comparisons of these scales. The prevalence ratio of symptoms of depression, anxiety, and stress was estimated. Of all caregivers (N = 355), more than 90% were women-mothers. Caregivers of children with visual impairment show the highest proportion of no schooling, incomplete elementary education, or lower average monthly income. Most caregivers of children with blindness reported symptoms of depression, anxiety, and stress (66.7%, 73.3%, and 80%, respectively) as did those of children with low vision. The evaluation of the relationship between MOS-SSS and DASS-21 results shows greater support and lower scores of reports of depression, anxiety, and stress for caregivers of children without disabilities or with less visual impairment. For caregivers of blind children, the highest prevalence of such reports was independent of the received support. Results indicate the need for a care policy with mechanisms to protect the mental health of caregivers of visually impaired children.

The sickle cell illness experience under the qualitative lens

This article aims to analyze the content of the qualitative production (2000-2023) on sickle cell disease to support the analytical category - the sickle cell disease experience. Methodologically, we conducted a qualitative, bibliographical study with a thematic content analysis anchored in the dialogue between the revised collection and the adopted theoretical-conceptual references. The thematic content analysis triggered eight interpretative dimensions: daily life and itineraries, care, reproductive decisions, stigma and its expressions, gender, participation, ethnicity, and religiosity. The sickle cell experience emerges and is related to exclusion, devaluation, ignorance, and invisibility, strongly allied to race components in nuances that distance it from the generic illness experience.

[The ethics of care and pediatric palliative care: a potential dialogue]

This article, in an essay format, seeks to establish a dialogue between the ethics of care and pediatric palliative care, taking into consideration the fact that moral perceptions are based on a network of relationships, while care is built on intersubjectivity. Four pillars that are referred to as movements are discussed: the ethics of care, as a feminist ethic, in a dialogue with pediatric palliative care, and communication and autonomy as tools of care based on their relational aspects. The conclusion drawn is that considering these aspects from a palliative standpoint can be a way to implement a moral commitment of care.

[Transgressions and concessions of care: resistance practices in long-term pediatric hospitalizations]

Long-term hospitalizations of children and adolescents with complex chronic health conditions imply many restrictions to common childhood experiences. Many of them are born, grow up, and even die in the hospital without ever having known their homes. The care experience of this group was triggered by a narrative investigation. Workers from a public pediatric hospital dedicated to the care of complex clinical profiles were invited to tell stories that marked their memory. The evocation of the affective dimension of care pointed to the tensioning of the established normative limits. Hospital rules were made more flexible to benefit children and adolescents. These situations, which are called transgressions and concessions in this study, were analyzed to discuss important aspects of the micro-relationships and culture of care. Resistance mechanisms stand out in an effort to overcome or repair an environment often considered dehumanizing.

Configurations of atypical parenting activism in disability and chronicity

Abstract This article aims to reflect on the configurations of atypical parenting in the field of disability and chronicity. The atypical emic category composes with these fields. Associative symbolicities are explored with an ethnography in social media and interviews with activists. We indicate ongoing processes in the anticapacitist struggle that dialogue with agendas of Politics as Care. We conclude that “atypical activist parenting” operates with meanings and learnings of living and being familiar with disability/chronicity/rarity in proximity to a son/daughter, not being restricted to biographical ruptures.

Configurations of atypical parenting activism in disability and chronicity

This article aims to reflect on the configurations of atypical parenting in the field of disability and chronicity. The atypical emic category composes with these fields. Associative symbolicities are explored with an ethnography in social media and interviews with activists. We indicate ongoing processes in the anticapacitist struggle that dialogue with agendas of Politics as Care. We conclude that "atypical activist parenting" operates with meanings and learnings of living and being familiar with disability/chronicity/rarity in proximity to a son/daughter, not being restricted to biographical ruptures.

Grammars of ableism: dialogues in the folds between disability, gender, childhood, and adolescence

Abstract In this theoretical essay, we assume ableism as a grammar that sustains several duplicities that hierarchize and discriminate reputed dissident corporalities. We maintain this argument based on the violation of rights to health and life of disabled people, travestis, trans and intersex people, and children and adolescents, in practices of surveillance and correction, which sustain health and education institutions, and Language as the central point of such enabling.

Grammars of ableism: dialogues in the folds between disability, gender, childhood, and adolescence

In this theoretical essay, we assume ableism as a grammar that sustains several duplicities that hierarchize and discriminate reputed dissident corporalities. We maintain this argument based on the violation of rights to health and life of disabled people, travestis, trans and intersex people, and children and adolescents, in practices of surveillance and correction, which sustain health and education institutions, and Language as the central point of such enabling.

[Narratives in the body: scars and tattoos from chronic, rare, and complex illnesses]

This essay explores the tattoos and scars that convey narratives on experiencing and living with chronic, rare, and complex illnesses. We view such marks as public expressions, when individuals bear witness to lives traversed by disability and frailty, whether as their own personal experience or in the role of caregivers. The body as witness and performative support is explored here in its aesthetic and political dimensions, in the expression of symbolic contents that gain visibility in the affirmation of neglected identities and agendas by persons who claim the recognition and valorization of their lives.

Stigmas of congenital Zika syndrome: family perspectives

This article uses a socio-anthropological framework to explore the stigmas around interactions with children born with congenital Zika syndrome caused by the Zika virus epidemic in two Brazilian municipalities. Semi-structured interviews were conducted with parents and other relatives. We reflected on the search for meaning when having a baby with unexpected body marks, the moral suffering, the societal ableism, the burden of care, and the need for support networks. We concluded that public policies, especially social policies (health, education, and social assistance), are essential for compensatory mechanisms, recognition, and social inclusion of these children and their families.

Performance and disability: ways to health reinvention

This essay aims to make a dialogue between disability studies in its postmodern aspect, with the Anthropology of Performance from two paths: 1) discussing bodily influence on the meanings attributed to the experience of disability; 2) discussing how performance, with emphasis on sport, places the body in the light of sociability, generating a tension between new body norms and the reproduction of current models on disability and health. We conclude that the performance of people with disabilities can contribute to a review or reinvention of the concept of health from the construction of new identities and empowerment projects. Thus, disability is separated from the biological function/dysfunction and brings it closer to the human being's action capacity in the world by the sociability established in sport.

[Interaction between humans and non-humans in a pediatric intensive care unit]

Technology is a central element for patients in intensive care. The article aimed to explore the interpretations of interactions between humans and non-humans in the production of care for children with complex chronic conditions in the intensive care unit (ICU). Secondarily, the study discussed the secret as one of the dimensions of interactions associated with the intensive care setting. This was an ethnographic study with participant observation and field diary records, in dialogue with Actor-Network Theory, to discuss the role of technology in social interactions in the context of complex care in a pediatric ICU. Children, families, and professionals attributed new meanings and functionalities to the technology during prolonged stay in the ICU, redefining its role and assuming it as an important mediator in the social interactions between life inside and outside the hospital. Technological incorporation reconfigured the limits of life and the physical and symbolic spaces involving the care and stretched the limits between the public and private spheres during hospitalization. The secret in this setting was traversed by the technological mediation that added new ingredients to the relations of sociability. This new order, linked to interaction between humans and non-humans, challenges health institutions and their staff to rethink their values, procedures, and way of interacting in order to improve the patient's care, where technological incorporation is a definitive and innovative reality in what could be called the digitization of life and care.

[Gifts and testimonies: sharing of experiences and memories among mothers of children with complex health conditions]

The American online journal Complex Child, written by and for mothers of complex children, has documented an important collection of personal experiences since 2008. We analyzed 126 editions of the journal, in which our approach was to search in the writings for positive (and thus counterhegemonic) meanings, based on an experience that has found little room in the social imaginary except for that of personal tragedy. Assuming the position of these mothers as politically and historically situated, we identified the dimension of testimonies. Marcel Mauss' theory of the gift, as well as the notion of social suffering in Veena Das, provide this study's theoretical framework, organized in essay format. After organizing and reading the collection in light of our references, we identified four niches for discussion. The maternal constructions of happiness appear to be grouped around the ideas of "gift" and "legacy". The notion of gift is associated with gains originating from the existence of (and care for) the complex child, while the idea of legacy refers mainly to a child or youngster who has passed away. Once the mother can see her child and the opportunities from caring for her child as gifts, she feels a practically imperious need to give back to the world.

Qualitative approaches in the Journal Ciência & Saúde Coletiva (1996-2020)

This study aims to analyze the qualitative papers published in the 25-year existence of the Journal Ciência & Saúde Coletiva (from 1996 to March 2020), taking into account themes, theoretical-conceptual anchors, methods, and techniques. This is a bibliographic study based on the principles of categorical analysis, dialoguing with the aspects of Social Sciences. We highlight the following outcomes. The collection spans over a variety of themes, and violence is the most recurrent topic. However, themes such as race/ethnicity are absent from the collection; 53% of the publications used Social Sciences references, and Bourdieu was the most cited author. Most papers (77%) show methodological information, under a predominantly Bardin's perspective. The collection with qualitative approaches is modest, with less than 10% of publications. We conclude, however, that the collection makes a significant contribution to Public Health because: (a) it establishes connections with different clinical areas; (b) it recognizes the voice of the actors, turning them into leading figures; (c) it collaborates with the epidemiological dimension to understand health contexts; (d) it subsidizes decision-making in health policies, planning and management; and (e) it unveils the symbolic dimensions of health-disease-care processes.

Hope and trust in times of Zika: the views of caregivers and healthcare workers at the forefront of the epidemic in Brazil

This article investigates how hope and trust played out for two groups at the forefront of the Zika epidemic: caregivers of children with congenital Zika syndrome and healthcare workers. We conducted 76 in-depth interviews with members of both groups to examine hope and trust in clinical settings, as well as trust in public institutions, in the health system and in the government of Brazil. During and after the Zika epidemic, hope and trust were important to manage uncertainty and risk, given the lack of scientific evidence about the neurological consequences of Zika virus infection. The capacity of healthcare workers and caregivers to trust and to co-create hope seems to have allowed relationships to develop that cushioned social impacts, reinforced adherence to therapeutics and enabled information flow. Hope facilitated parents to trust healthcare workers and interventions. Hope and trust appeared to be central in the establishment of support networks for caregivers. At the same time, mistrust in the government and state institutions may have allowed rumours and alternative explanations about Zika to spread. It may also have strengthened activism in mother's associations, which seemed to have both positive and negative implications for healthcare service delivery. The findings also point to distrust in international health actors and global health agenda, which can impact community engagement in future outbreak responses in Brazil and other countries in Latin America.

Zika epidemic and microcephaly in Brazil: Challenges for access to health care and promotion in three epidemic areas

Since 2015 Brazil has experienced the social repercussions of the Zika virus epidemic, thus raising a debate about: difficulties of diagnosis; healthcare access for children with Zika Congenital Syndrome (ZCS); the search for benefits by affected families; social and gender inequalities; and a discussion on reproductive rights, among others. The objective of this article is to analyse access to specialized health services for the care of children born with ZCS in three North-eastern states of Brazil. This is an exploratory cross-sectional study which analyses recorded cases of microcephaly at the municipal level between 2015 and 2017. Most of the cases of ZCS were concentrated on the Northeast coast. Rio Grande do Norte and Paraiba had the highest incidence of microcephaly in the study period. The states of Bahia, Paraiba and Rio Grande do Norte were selected for their high incidence of microcephaly due to the Zika Virus. Socio-territorial vulnerability was stratified using access to microcephaly diagnosis and treatment indicators. The specialized care network was mapped according to State Health Secretaries Protocols. A threshold radius of 100 km was stablished as the maximum distance from municipalities centroids to specialised health care for children with microcephaly. Prenatal coverage was satisfactory in most of the study area, although availability of ultrasound equipment was uneven within states and health regions. Western Bahia had the lowest coverage of ultrasound equipment and lacked health rehabilitation services. ZCS's specialized health services were spread out over large areas, some of which were outside the affected patients' home municipalities, so displacements were expensive and very time consuming, representing an extra burden for the affected families. This study is the first to address accessibility of children with microcephaly to specialised health care services and points to the urgent need to expand coverage of these services in Brazil, especially in the northeastern states, which are most affected by the epidemic.

["I forgot that I'm disabled": interactions and sociability of teenagers with physical disabilities that practice sports]

The article analyzes the meanings assigned by teenagers with disabilities to experiences participating in group sports. The qualitative study, based on comprehensive critical analysis, drew on semi-structured interviews with teens with physical disability. The results of the analysis pointed to three thematic lines: (1) the body, (2) sociability and group interactions, and (3) interactions outside the group. The sports setting features groups as a space for sociability, evoking autonomy, self-esteem, and performance. Reconfiguration of the body with disability approached the able-bodied ideal of the able body, which also shaped the challenges in interactions outside the group. In conclusion, the meanings legitimize hegemonic models of masculinity and femininity, and the able-bodied ideal was mobilized as a common system for relevance among teenagers with physical disability that practice sports.

[Navigating in rare oceans: notes from a family survey of children and adolescents living with rare diseases]

This article seeks to highlight the construction of social navigation in a hospital. Our focus is to reflect on scenes of application of a questionnaire on family costs of care/treatment of children with rare diseases. These processes are linked to the markers of gender, race, and generation of one of the authors. The interaction between researcher and subjects of field research is socially constructed according to the specific circumstances that demarcate the invitation to participate in the research, as well as data collection. It implies that his position as a researcher and the ethical perspective need to be well defined. The approach and ethics build this social navigation with the hospital and the subjects are permeated by difficulty and uncertainty, but also by surprises and learning. It was possible to observe remarkable characteristics of the institution, of their employees and the families, to evaluate the used methodological strategies.

[The need to act together in every way possible: inter-sector action in health and education for children living with the congenital Zika syndrome]

The experience with an intervention program conducted in an educational institution and targeted to families of children with congenital Zika syndrome, which includes multiple disabilities, revealed the challenges and strides with the entry of these families in the school system. This article aimed to explore the findings from a study conducted after the conclusion of an intervention program, using semi-open interviews with professional staff at the institution and the possible contributions towards establishing inter-sector relations aimed at school inclusion of children with disabilities. A change was seen, as a result of the program, in the relationship between the families and the professionals at the educational institution, whereby the families had room to voice their fears and discuss the school's role in the lives of their children with disabilities. The professionals thus came to see the families taking a more active stance. This experience can favor other services and municipalities that seek school inclusion for children and adolescents with disabilities, as well as their social inclusion and that of their families.

Analysis of the cost of care for children and adolescents with medical complex chronic conditions

This paper aimed to identify the use of technology and to analyze the cost of hospital care for children and adolescents with medical complex chronic conditions at a public federal hospital specialized in high-complexity pediatric care, and was performed concomitantly with a prospective cohort study conducted over a one-year period. It included 146 patients with complex medical chronic conditions and 37 non-chronic patients. The analysis showed that most patients had, on average, two hospitalizations a year and were diagnosed with diseases related to at least two organic systems. Catheters, drains and gastrostomy were the most common technologies used. Median direct costs of patients with medically complex chronic conditions were higher than those of non-chronic patients when comparing the use of technology. The study shows high hospitalization cost to these patients. Technology use and hospitalization care costs documentation yields more data to support decision-makers in the planning, managing, and financing of pediatric health policies.

Rare diseases and the associative dialogue: resignifications for moral experiences

This paper aims to discuss the experience of relatives of children and adolescents with rare diseases as a moral experience. Moral experience is characterized by suffering that is socially interpreted as a catastrophic event, mobilizing resources for signification and meaning that allow the reconstruction of identity, the appreciation of itineraries from a rare diagnosis, as well as the search for peers. Thus, the construction of relationships of recognition, alterity, and belonging is fundamental. From a symbolic interactionist perspective, the results show two significant cores: (1) shock as a surprise in the face of an unexpected diagnosis, leading to the search for peers and promotion of social recognition; (2) the cost involved with the course of a rare disease that implies a care work and the acquisition of associative capital as a possibility of strengthening and building the social capital of health care.

Trajectories and moral experiences of rare and chronic illness in biographies: a theoretical essay

Our subject is a dialogue with six literary works, understood in the publishing market as biographies that consider first and second person narratives on the relationship with situations of chronic, rare or complex disease. As a theoretical essay, we try to build an argument: these biographies are public forms of people's construction and presentation; they represent the possibility of assigning a place of visibility to moral experiences, of great public appeal, but which must be recognized in health care and training as political tools for reflection on practices. Thus, they become testimonies, providing less personal life histories and more biographical paths, with an interactionist dialogue among meanings, places, people, positions, stigma, right violations and discrimination.

When doing research with children means negotiating with adults: backstage of a survey of six-year-olds in schools

This paper aims to stir reflections on research with children by investigating aspects related to ethics, methods, play and contextualized activities. The possibility of recognizing adult authority as a mediator of interactive craftsmanship in the construction of the research environment also underlie the backstage and its craftsmanship. It builds on a survey of six-year-olds in schools that focused on the psychometric analysis of items in a test under construction. Returning to the memories of this environment, we discuss the importance of the leadership of children as research subjects. The foundation is anchored in the perspective of childhood sociology, discussing interactive craftsmanship. We conclude that it is possible to recognize this leadership in the engagement of negotiations with reference adults.

Social and economic impacts of congenital Zika syndrome in Brazil: Study protocol and rationale for a mixed-methods study

Global concern broke out in late 2015 as thousands of children in Brazil were born with microcephaly, which was quickly linked to congenital infection with Zika virus (ZIKV). ZIKV is now known to cause a wider spectrum of severe adverse outcomes-congenital Zika syndrome (CZS)-and also milder impairments. This study aimed to explore the social and economic impacts of CZS in Brazil. Data was collected through mixed methods across two settings: Recife City and Jaboatão dos Guararapes in Pernambuco State (the epicentre of the epidemic), and the city of Rio de Janeiro (where reports of ZIKV infection and CZS were less frequent). Data was collected May 2017-January 2018. Ethical standards were adhered to throughout the research. In-depth qualitative interviews were conducted with: mothers and other carers of children with CZS (approximately 30 per setting), pregnant women (10-12 per setting), men and women of child-bearing age (16-20 per setting), and health professionals (10-12 per setting). Thematic analysis was undertaken independently by researchers from at least two research settings, and these were shared for feedback. A case-control study was undertaken to quantitatively explore social and economic differences between caregivers of a child with CZS (cases) and caregivers with an unaffected child (controls). We aimed to recruit 100 cases and 100 controls per setting, from existing studies. The primary caregiver, usually the mother, was interviewed using a structured questionnaire to collect information on: depression, anxiety, stress, social support, family quality of life, health care and social service use, and costs incurred by families. Multivariable logistic regression analyses were used to compare outcomes for cases and controls. Costs incurred as a result of CZS were estimated from the perspective of the health system, families and society. Modelling was undertaken to estimate the total economic burden of CZS from those three perspectives.

Social and economic impacts of congenital Zika syndrome in Brazil: Study protocol and rationale for a mixed-methods study

Global concern broke out in late 2015 as thousands of children in Brazil were born with microcephaly, which was quickly linked to congenital infection with Zika virus (ZIKV). ZIKV is now known to cause a wider spectrum of severe adverse outcomes-congenital Zika syndrome (CZS)-and also milder impairments. This study aimed to explore the social and economic impacts of CZS in Brazil. Data was collected through mixed methods across two settings: Recife City and Jaboatão dos Guararapes in Pernambuco State (the epicentre of the epidemic), and the city of Rio de Janeiro (where reports of ZIKV infection and CZS were less frequent). Data was collected May 2017-January 2018. Ethical standards were adhered to throughout the research. In-depth qualitative interviews were conducted with: mothers and other carers of children with CZS (approximately 30 per setting), pregnant women (10-12 per setting), men and women of child-bearing age (16-20 per setting), and health professionals (10-12 per setting). Thematic analysis was undertaken independently by researchers from at least two research settings, and these were shared for feedback. A case-control study was undertaken to quantitatively explore social and economic differences between caregivers of a child with CZS (cases) and caregivers with an unaffected child (controls). We aimed to recruit 100 cases and 100 controls per setting, from existing studies. The primary caregiver, usually the mother, was interviewed using a structured questionnaire to collect information on: depression, anxiety, stress, social support, family quality of life, health care and social service use, and costs incurred by families. Multivariable logistic regression analyses were used to compare outcomes for cases and controls. Costs incurred as a result of CZS were estimated from the perspective of the health system, families and society. Modelling was undertaken to estimate the total economic burden of CZS from those three perspectives.

[Complex care, high cost, and loss of income: frequent issues for families of children and adolescents with rare health conditions]

Estimates point to more than seven thousand rare diseases already identified, representing 6 to 10% of all diseases. In Brazil, a rare disease is defined as one that affects up to 65 persons per 100,000. The quantification of costs for the families of patients with such conditions and their impact on income provides information capable of supporting public policies for these youngsters. The study aimed to estimate the cost and loss of earnings, viewed from the perspective of families of children and adolescents with cystic fibrosis, mucopolysaccharidosis, and osteogenesis imperfecta. The study included 99 families of patients treated at a national referral hospital for rare diseases in Rio de Janeiro, based on the principal caregiver's report. The descriptive data analysis showed that the median direct nonmedical cost for families was BRL 2,156.56 (USD 570) for cystic fibrosis, BRL 1,060.00 (USD 280) for mucopolysaccharidosis, and BRL 1,908.00 (USD 505) for osteogenesis imperfecta. Loss of earnings exceeded 100% for all three diseases. A total of 54% of families fail to receive any social benefits. The estimate of coping costs indicated that 69% of the families had incurred loans and that 22.5% had sold household assets to cope with the treatment costs. Catastrophic expenditures were observed in families dealing with the three diseases. The results unveil costs that are rarely estimated, and not only in the field of rare diseases. The findings point to a major burden on the families' income. It is important to incorporate such studies in the discussion of financing, the incorporation of new technologies, and the supply of health services.

[Dilemmas in regulating access to specialized care for children with complex chronic health conditions]

The scope of this article was to analyze the access of children with complex chronic health conditions to specialized care, identifying their strengths and weaknesses from the perspective of speech therapists. The selection of research subjects was made considering the participation in a virtual group whose dynamics signaled the difficulty of members, municipal civil servants, in the conduct of referring patients to health services. Face-to-face interviews were conducted with 14 speech therapists from this group who work with children. The study of the difficulties faced by the interviewees made it possible to identify that care via the Regulation System is an aggravating factor in difficulties of access. In this respect, the problems mentioned were grouped into three topics: (1) Waiting time for making appointments; (2) Distance from the care centers; and (3) Misconceptions in the referral process. In addition, the work of the Expanded Family Health and Primary Care Service was identified as a relevant factor in facilitating children's access to specialized care services in partnership with regulation. The conclusion drawn is that the presence of mediators in health care benefits the population with difficulty of access to services, including children with complex chronic health conditions.

Making decisions on health care for children / adolescents with complex chronic conditions: a review of the literature

The profile of pediatric care has gone through changes in Brazil and in the world. This process becomes more visible in surveys that deal with hospital admission or specialized outpatient care data. This fact leads us to the idea that it is in such spaces that these children and subjects who care for them are more visible and negotiate decisions. We aim to perform a state of the art literature review on decision making discussions and definitions, analyzing the current research in light of the theoretical Mol perspectives on the actors' logics of chronic diseases care; And the perspective of care goods exchanges in the dialogue between Martins and Moreira, triggering the Theory of Gift. The synthesis of the literature shows that decision making may be understood as a care planning process in which family, patients and health professionals are involved, and is linked to the family-centered care model. In terms of difficulties, we point out the prevalence of a dynamic that favors a criticizable choice because of the risks of inequality, such as the lack of discussion on the options and the actuation of the family mostly in times of difficult decisions.

Physiotherapy for New Actors: Disputes and Innovations in Care for Chronically Ill Children

Based on interviews with physiotherapists, we explored the arguments produced by them about their actions and the relationships of a change that has been taking place in the profile of illness in children, where an increased prevalence of complex chronic conditions has been observed. Structured in a qualitative approach, data were generated based on two provocative affirmations that generated arguments by the professionals. Data analysis revealed statements that can be referred to as results of power struggles over the performance in this new field of knowledge. Physiotherapists seek to affirm themselves through their knowledge and by approaching other professional categories, especially Medicine, in order to feel recognized and valued. However, we see that these professionals use a simpler discourse with family and caregivers, creating a bond of trust and identification with them, which facilitates their care and access to children. We point out the need for the hospital environment to be recognized as a place for the action of other categories, besides Medicine and Nursing, and the valuation in pediatric physiotherapy.

Guidelines for child health: language development on focus

Language disorders impact on child overall development. Policy directives for the child guide on ways to follow up child development for greater efficiency and effectiveness. The aim of this paper was to identify the policies positions of the proposals on the attention to language problems in the child health field. From a documental research, national and international guidelines were reviewed in order to identify actors, objectives, contexts, motivations, arguments, justifications and proposals regarding the follow of child development and child language. We performed a critical analysis in order to explain these positions and place on discussion the arguments that support them. The results point out to consensual aspects that place the problems of child development as vulnerabilities producers. Language problems cross the boundaries of political, scientific and social matters. These issues are challenges to interdisciplinary and intersectoral work and guide the need to promote the most effective responses of public policy for people requiring language support. The link of this discussion with the concepts of life cycle and human development for achieving full citizenship requires further deepening.

Zika, protagonismo feminino e cuidado: ensaiando zonas de contato

Neste ensaio iluminamos temas lançados ao debate pós-epidemia de Zika Vírus (ZIKAV) na vida de mulheres e crianças. Analisamos 23 artigos, publicados entre 2016 e 2017, selecionados em periódicos brasileiros, no campo das Ciências Sociais e Humanas em Saúde. Há um discurso mestiço de reivindicação por direitos – grandes narrativas de apelo social e explicação pelas forças sociais de um Estado negligente – associado a pequenas narrativas de cuidado de um filho com deficiência. Provisoriamente, concluímos que a zona de contato se dá pelo movimento de resgate das pequenas narrativas na tradução das iniquidades produzidas pelo Estado na vida das pessoas comuns.

The experience of illness of women with endometriosis: narratives about institutional violence

This paper conjures up the centrality of the relational category of gender to shed a light on women's life narratives with a chronic disease named endometriosis. It aims to discuss the meaning of the illness experience of women with endometriosis in the interface with institutional violence. Based on Bertaux reference, in the Narratives of Life method, twenty women participated in this research. They were invited from two virtual spaces of discussion and gatherings about living with endometriosis. Interviews were conducted in person in the States of Rio de Janeiro, São Paulo and Minas Gerais circuit. Authors sustained the theoretical approach and addressed the experience of chronic illness as a sociocultural phenomenon, metaphorical readings of the problem and criticism of institutional violence. The results identify situations of gender/institutional violence perpetrated in various women care settings. They are expressed through the trivialization of women's discourses; user-physician tensions, where the supposed lay knowledge appears as an insult to official biomedical knowledge and, mainly, the difficult access to services, leading women to a care pilgrimage and to submit themselves to care types not necessarily based on best practices.

Complex chronic conditions in children and adolescents: hospitalizations in Brazil, 2013

This article aims to estimate the extent of hospitalizations for complex chronic conditions in Brazil. Data from the Hospital Information System for 2013 were compiled according to the International Classification of Diseases 10th Revision. Hospitalization rates were estimated according to region, sex, age and disease chapter, taking into account the 2012 population as a reference, as well the percentage of highly complex procedures and mortality rates. Public hospitals treated 190,000 inpatients in 2013. The rate was highest among the population in the South of Brazil, those who were male and children under the age of one. The rate was lowest among the population in the North, females and children aged between 10 and 14years. The mean duration of hospitalization was six days, the percentage of highly complex procedures was 13.5% and the mortality rate was 1.3%. The three most common causes for hospitalizations were diseases of the respiratory system, neoplasms and diseases of the nervous system. The incidence of complex chronic conditions is 331 inwards per 100,000 children and adolescents in Brazil, with an estimate of 240,000 children and adolescents hospitalized. This panorama points to the problem as an emergent public health issue in Brazil.

Lines of male care geared to sexual health, reproduction and paternity

The article seeks to propose principles for male care geared to sexual health, reproduction and paternity, as well as present a blueprint for the involvement of men in prenatal care. The proposal of the authors was submitted to a consensus building process with invited experts. The main results presented include: (a) the principles of lines of male care geared to sexual health, reproduction and paternity; and (b) a blueprint for the involvement of men in prenatal care. The conclusion drawn is that the cultural preconceptions of how males should lead their lives, including their social relations and roles as fathers interfere in health care actions and touch on three main points: (a) the idea of man as a collaborator in the promotion of the health of his partner while pregnant and/or his offspring; (b) the idea of paternity being strongly linked to being the financial provider;

Crianças e Adolescentes com Condições Crônicas Falam Sobre Saúde

Este artigo apresenta os resultados de uma pesquisa realizada com crianças e adolescentes com condições crônicas complexas internados em um hospital de referência localizado no município do Rio de Janeiro. O objetivo do estudo foi investigar os sentidos atribuídos por estas crianças e adolescentes à ideia de saúde. Como metodologia foi utilizada a perspectiva etnográfica. A observação participante e diferentes abordagens lúdicas foram utilizadas de modo a possibilitar a expressão das crianças e dos adolescentes garantindo, assim, o protagonismo deles como sujeitos da pesquisa.Ao longo do estudo ressaltou-se nas crianças sobretudo a capacidade normativa destas, capacidade a que se refere à Georges Canguilhem (1978) em sua obra “ O Normal e o Patológico” que encontramos presente em todas as circunstâncias do adoecimento como modos de lidar com as difíceis situações de sofrimento inerentes às condições crônicas.

[Guidelines for a line of care for children and adolescents with complex chronic health conditions]

The definition of complex chronic health condition (CCHC) is important for identifying children and adolescents occupying pediatric beds in Brazilian hospitals, where they live out their childhood, requiring complex care by multidisciplinary teams in network format both in-hospital and in home care. The current article addresses guidelines for a line of care for children and adolescents with CCHCs. An expert panel validated 13 guidelines organized in three dimensions. Using the consensus conference technique, experts from different specialties validated the guidelines. We concluded that the process requires planning, professional training, and the production of an inter-sector research agenda involving other definitions, reviewing norms and conventions as to what is expected. Expectations include the ideal professional composition and profile for comprehensive care of these children and adolescents with CCHCs and safeguards for their rights, with access to a wide variety of social equipment, including but not limited to the health sector.

Fatherhood and parenting as health issues facing the rearrangements of gender

In this theoretical essay we aim to discuss paternity as a health issue in the context of contemporary gender roles by considering two lines of argument: (a) paternity, parenting and rearrangements of gender roles; and (b) paternity and parenting as a mutual relationship based on care. In our discussion, we highlight the inclusion of men in the health system from the point of view of paternity. At present this appears to be operating in an instrumental manner, with the mother-infant dyad still a major concern and men not being viewed as individuals with rights to health. Thus, we seek to question the system itself, in relation to its perceptions of the current state of paternity, by taking into consideration recent discussions about gender and sexuality as well as and new family arrangements that may challenge beliefs about the roles of families, fathers and mothers, which have impacts on care. Among other aspects, we conclude that we need to reinvent ourselves because we were not raised under the aegis of diversity and we were also not trained as professionals with a basis in the current problematic divisions that exist between father/mother and sex/gender, among many other previous certainties, all of which does not always help us to promote actions in the area of health.

Quando a participação de crianças e jovens com deficiência não se resume à atividade: um estudo bibliográfico

Resumo O artigo analisa a abordagem da participação de crianças e adolescentes no campo dos estudos sobre deficiência (Disability Studies). Metodologicamente, conjuga uma revisão bibliográfica a uma análise de conteúdo temática com intuito de analisar quais dimensões da participação são exploradas na literatura. Como resultados, destacam-se quatro temáticas: Esporte, Qualidade de vida/Bem estar, Mensuração da participação e Escola. Conclui-se que há um foco na participação como execução de atividades em um contexto sendo escassas as discussões mais ampliadas sobre o domínio contemplando-o como um valor humano, relacionado à sociabilidade e bases de apoio, gerenciamento de autonomia e níveis de dependência.

["Are men coming to the clinic now?!" Healthcare strategies for men]

This is a qualitative study from the perspective of dialectical hermeneutics on healthcare strategies for men in the view of health professionals. The authors drew on 18 semi-structured interviews addressing male sexuality, men's healthcare, participation in prenatal care, and fatherhood. Three thematic lines were established, based on an understanding of the interviews as a whole, independently of both the specific themes mentioned above and the region. The themes provide structure for and are structured by ideas that traverse the various interviews. Themes of male sexuality associated with healthcare and fatherhood further evoke the private dimension, referred to the home's geographic boundaries. These ideas people the cultural repertoire on maleness; the novelty lies in unlinking sexuality from sexual relations and sexual health from transmission and contagion in the interpretation of our material.

[Children with tuberculosis: situations and interactions in family health care]

This qualitative study analyzed meanings associated with tuberculosis (TB) in children. Interviews were conducted with lay caregivers and health professionals in six health situations in a vulnerable territory. Data collection was followed by thematic content analysis and interpretation in consultation with the literature concerning the concepts of stigma, childhood illness, and preservation of the façade. The results showed that the discussion on the meanings of TB in children involves relativity of the core family concept and valuation of their network of relationships. The complexity of TB in children requires an expanded understanding of their health situation and interactions among the surrounding relationships. The health professional's role in identifying and managing possibilities for care and diagnostic and therapeutic difficulties is an important tool for health promotion in children.

O protagonismo de jovens com doença renal crônica e a dádiva na construção da atenção à saúde

Resumo Esta pesquisa discute o adoecimento crônico na juventude no contexto das trocas sociais baseadas na teoria da dádiva. O objetivo é analisar os signi ficados de ser jovem com doença renal crônica no universo das trocas sociais de bens de cuidado. De natureza qualitativa, a pesquisa foi realizada em um serviço de saúde especializado no atendimento aos jovens com doença renal crônica na cidade do Rio de Janeiro. Participaram do estudo 11 usuários com idades entre 12 e 20 anos e quatro profissionais de saúde envolvidos no cuidado a esse grupo. Como referencial teórico-metodológico nos guiamos pela Sociologia Compreensiva de Schütz, que permite explorar as relações sociais a partir da experiência do sujeito. Os resultados apontam para a impor tância da troca simbólica entre o jovem e o serviço na constituição e vivência plena da juventude, e a relevância da perspectiva do jovem na construção do cuidado e da prática profissional dos cuidadores. A partir desse estudo, ficou evidente a importância de refletirmos sobre a ampliação do protagonismo juvenil desses jovens e, estimulados pelo serviço de saúde, tentarmos reconhecer esse grupo como potencial agente de sua própria saúde, bem como de outros sujeitos que compartilham o universo da doença crônica.