Reasons for consultation and healthcare strategies analyzed from a neighborhood dermatological assistance device. Qualitative research

Skin problems.Qualitative research.

Authors

DOI:

https://doi.org/10.31053/1853.0605.v78.n4.30831

Keywords:

qualitative research, primary health care, sanitary landfill, skin diseases, social epidemiology

Abstract

Aim of study: identify consultation reasons, experiences with seeking dermatological assistance and skin care strategies within neighbours from an urban deprived settlement in Buenos Aires province, Argentina. This setting lies onto a sanitary landfill with a high index of environmental contamination.

Materials  and  methods: a dermatological health care team from the main local hospital designed a dermatological assistance device (DAD), in cooperation with social leaders and institutions of the neighborhood. The DADs included walks around the neighborhood for attending those who could not get a consultation. The experiences were evaluated through a qualitative research strategy, developed from the theoretical framework of Sociocultural Epidemiology. Those who attended the DADs were interviewed. Ethnographic field notes were also recorded. Multiple accessibility barriers to the public health care system were identified and self care practices were also recognized.

Results: The most frequent consultations to the DADs were for "pimples", "stains'' and "lumps" on exposed areas of the skin. These lesions generated discomfort or pain, or even affected the interviewees aesthetically or emotionally. Most of them  were associated to extremely dry skin and a high sun exposure, in connection with the lack of shade in the neighbourhood. An initiative to plant trees  was promoted in order to prevent sun radiation-induced dermatoses. 

Conclusion: the reflective immersion of the dermatology team in the realm of the neighborhood daily life enabled the development of attention strategies grounded on the perceived needs of the population.

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Author Biographies

Maria Florencia Bertarini, Medica

Specialist in Dermatology and Family Medicine. Associate Physician Dermatology Service Hospital Italiano de Buenos Aires.

Gimena A. Castro Perez, Medica

Physician Specialist in Dermatology. Head of the Dermatology Service, Hospital Interzonal General de Agudos (H.I.G.A.) Eva Perón de San Martín, Province of Buenos Aires.

Luciano Martin Mantiñan, Antropologo

Degree in Social and Cultural Anthropology. Doctor in Social Anthropology. Member of the Humanities Research Laboratory (School of Humanities) Professor of the National University of San Martín, UNSAM.

Patricia Laura Alvarez, Licenciada en Enfermeria

Degree in Nursing. Adjunct professor at the National University of San Martín (UNSAM). Bachelor of Nursing Mental Health Service Hospital Interzonal de Agudos (HIGA) Eva Perón de San Martín.

Morena Diaz, Profesora en Ciencias Antropologicas

Professor of Middle and Higher Education in Anthropological Sciences. Junior Researcher in the Population Health Research Area of the Hospital Italiano de Buenos Aires.

Nahuel Braguinsky, Profesor en Ciencias Antropológicas

Professor of Middle and Higher Education in Anthropological Sciences. Qualitative Researcher. Italian Hospital of Buenos Aires

Natalia Pereiro, Licenciada en Sociología

Graduate in Sociology. Epidemiology Section of the Italian Hospital of Buenos Aires and Manager in the General Directorate of Community Health of the Ministry of Health of the Government of the City of Buenos Aires.

Jimena Vicens, Magíster en Epidemiología, Gestión y Políticas de Salud

Master in Epidemiology, Management and Health Policies. Researcher at the Italian Hospital of Buenos Aires.

Adriana Dawidowski, Doctora en Ciencias Sociales

Doctor in Social Sciences. Qualitative Researcher. Italian Hospital of Buenos Aires

Silvana Figar, Magíster en Epidemiología

Master in Epidemiology. Head of the Epidemiology Section of the Hospital Italiano de Buenos Aires. Coordinator of the Population Health area of the Research Department of the Hospital Italiano de Buenos Aires.

Luis Daniel Mazzuoccolo, Medico

Specialist in Dermatology. Head of the Dermatology Service of the Italian Hospital of Buenos Aires

References

Fleischer AB Jr, Herbert CR, Feldman SR, O’Brien F. Diagnosis of skin disease by nondermatologists. Am J Manag Care. 2000 Oct;6(10):1149–56.

Lowell BA, Froelich CW, Federman DG, Kirsner RS. Dermatology in primary care: Prevalence and patient disposition. J Am Acad Dermatol. 2001 Aug;45(2):250–5.

Porta N, San Juan J, Grasa MP, Simal E, Ara M, Querol MA e. I. [Diagnostic agreement between primary care physicians and dermatologists in the health area of a referral hospital]. Actas Dermosifiliogr. 2008 Apr;99(3):207–12.

Castillo-Arenas E, Garrido V, Serrano-Ortega S. Motivos dermatológicos de consulta en atención primaria. Análisis de la demanda derivada. Actas Dermo-Sifiliográficas. 2014;105(3):271–5.

To MJ, Brothers TD, Van Zoost C. Foot Conditions among Homeless Persons: A Systematic Review. Vol. 11, PLOS ONE. 2016. p. e0167463. doi: 10.1371/journal.pone.0167463.

Barazzetti DO, Barazzetti PHO, Cavalheiro BT, Ely JB, Nunes DH, Stamm AMN de F. Quality of life and clinical and demographic characteristics of patients with cutaneous squamous cell carcinoma submitted to tumor resection by double-bladed scalpel. An Bras Dermatol. 2019 Jul 29;94(3):304–12.

Fleitas A. Fleitas, A. G. (2015). Impacto de las condiciones socioeconómicas y ambientales con relación a la presencia de enfermedades dermatológicas en la población infantil en el barrio San Antonio Ypecurú (Vertedero Municipal). Revista sobre Estudios e Investigaciones del Saber Académico. 2015;5:73–7.

Vantarakis A, Paparrodopoulos S, Kokkinos P, Vantarakis G, Fragou K, Detorakis I. Impact on the Quality of Life When Living Close to a Municipal Wastewater Treatment Plant. J Environ Public Health. 2016 Jun 7;2016:8467023.

Fazzo L, Minichilli F, Santoro M, Ceccarini A, Della Seta M, Bianchi F. Hazardous waste and health impact: a systematic review of the scientific literature. Environ Health. 2017 Oct 11;16(1):107.

Minist Infraestruc y Serv Pub Prov BsAs. Registro público provincial de villas y asentamientos precarios (RPPVAP) [Internet]. [cited 2019 Jun]. Available from: http://www.mosp.gba.gov.ar/subsecretarias/reg_vilyasent.php

Polymorphisms in DNA repair genes XRCC1 and XRCC3, occupational exposure to arsenic and sunlight, and the risk of non-melanoma skin cancer in a European case-control study. Environ Res. 2014 Oct 1;134:382–9.

Surdu S, Fitzgerald EF, Bloom MS, Boscoe FP, Carpenter DO, Haase RF.. Occupational exposure to arsenic and risk of nonmelanoma skin cancer in a multinational European study. Int J Cancer. 2013 Nov;133(9):2182–91.

Eiroa SJR, Losada MTF, Faraldo MIR. Cáncer cutáneo por exposición ocupacional a agentes químicos. Vol. 60, Medicina y Seguridad del Trabajo. 2014. p. 420–33. doi: 10.4321/s0465-546x2014000200013

John SM, Trakatelli M, Gehring R, Finlay K, Fionda C, Wittlich M. CONSENSUS REPORT: Recognizing non-melanoma skin cancer, including actinic keratosis, as an occupational disease - A Call to Action. J Eur Acad Dermatol Venereol. 2016 Apr;30 Suppl 3:38–45.

Hersch-Martínez P. [Sociocultural epidemiology: an essential aproach]. Salud Publica Mex. 2013 Sep;55(5):512–8.

NIOSH skin notation (SK) profile: arsenic and inorganic arsenic containing compounds [CAS No. 7440-38-2] [Internet]. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health; 2017 Aug. Available from: https://www.cdc.gov/niosh/docs/2017-184/

Argentina. Guía de actuación y diagnóstico de enfermedades profesionales. Cáncer cutáneo ocupacional [Internet]. Superintendencia de Riesgos de Trabajo. Ministerio de Producción y trabajo 2019. Available from: https://www.argentina.gob.ar/sites/default/files/guia_de_actuacion_y_diagnostico_-_cancer_cutaneo.pdf

Gutberlet J, Baeder AM, Pontuschka NN, Felipone SMN, Dos Santos TLF. Participatory research revealing the work and occupational health hazards of cooperative recyclers in Brazil. Int J Environ Res Public Health. 2013 Sep 27;10(10):4607–27.

Curutchet G, Grinberg S, Gutiérrez RA. Degradación ambiental y periferia urbana: un estudio transdiciplinario sobre la contaminación en la región metropolitana de Buenos Aires. Vol. 15, Ambiente & Sociedade. 2012. p. 173–94. doi: 10.1590/s1414-753x2012000200010.

Barragán HL. Desarrollo, salud humana y amenazas ambientales: la crisis de la sustentabilidad. Editorial de la Universidad Nacional de La Plata; 2010. 523 p.

Megna M, Napolitano M, Costa C, Balato N, Patruno C. Waste exposure and skin diseases. G Ital Dermatol Venereol. 2017 Aug;152(4):379–82.

Di Pace M, Caride Bartrons H, Alsina MG, Barsky A, Calello TD, Crojethovich Martin A. Ecología Urbana. Universidad Nacional de General Sarmiento; 2012.

Rotger DV. Gestión de cuencas en la región Metropolitana de Buenos Aires. Historia y actualidad de un territorio en conflicto ambiental. El caso del Gran La Plata. Cuad urbano [Internet]. 2018 Jun 7;24(24). Available from: http://revistas.unne.edu.ar/index.php/crn/article/view/2919

Di Pace M, Barsky A. Agua y territorio. Fragmentación y complejidad de la gestión del recurso hídrico en la Región Metropolitana de Buenos Aires. Editorial Ciccus; 2012.

Porzionato N, Candal R, Curutchet G. “Evaluación del potencial de acidificación, liberación de metales y posibilidades de remediación de sedimentos del Rio Reconquista” [Doctorado en Ciencia y Tecnología Mención Química. ]. Universidad Nacional de San Martín; 2016.

CI Martínez Berré , VA Morris , JM Carou Maneiro y MR Simi. Morbilidad dermatológica en la unidad sanitaria “1o de mayo”, Lanús Este, Buenos Aires, agosto de 2009 a enero de 2010. Revista argentina de dermatología. 2010 Jun;91 (2).

Marbán L, de G LC, Ratto S, Agostini A. Contaminación con metales pesados en un suelo de la cuenca del río Reconquista. Ecol Austral. 1999 Sep;9:15–9.

Irby CE, Yentzer BA, Vallejos QM, Arcury TA, Quandt SA, Feldman SR. The prevalence and possible causes of contact dermatitis in farmworkers. Int J Dermatol. 2009 Nov;48(11):1166–70.

Cellini A, Offidani A. An epidemiological study on cutaneous diseases of agricultural workers authorized to use pesticides. Dermatology. 1994;189(2):129–32.

Hashmi, Hashmi, Imran, A. K. Adverse Health Effects of Pesticides Exposure in Agricultural and Industrial Workers of Developing Country [Internet]. Pesticides - The Impacts of Pesticides Exposure. 2011. doi: 10.5772/13835

Gómez SF, Rojas AM, Velandía J, Almeira JE. Revisión de documentación acerca de la contaminación por lixiviados generados en rellenos sanitarios en colombia. 1. 2016 Dec 1;(8):77–90.

Nader G. Modelización del transporte de metales en el río Reconquista (entre ex ruta 8 y Panamericana): etapas de conceptualización, formulación y calibración [Licenciatura en Análisis Ambiental]. Universidad Nacional de San Martín. ; 2009.

Menéndez EL. Intencionalidad, experiencia y función: la articulación de los saberes médicos. Revista de Antropología Social. 2005; (14):33–69.

Venturiello MP. Itinerario terapéutico de las personas con discapacidad y mediaciones en el cuidado de la salud: la mirada de los familiares. Physis. 2012;22(3):1063–83.

Kleinman A. Culture, Illness, and Care [Internet]. Vol. 88, Annals of Internal Medicine. 1978. p. 251. doi: 10.7326/0003-4819-88-2-251

Emerson RM, Fretz RI, Shaw LL. Writing Ethnographic Fieldnotes, Second Edition. University of Chicago Press; 2011. 320 p.

Kamal N. Writing ethnographic fieldnotes, by Emerson, Robert, Rachel Fretz and Linda Shaw [Internet]. Vol. 20, Social Anthropology. 2012. p. 337–8. doi: 10.1111/j.1469-8676.2012.00213_6.x

Achilli EL. Investigar en antropología social: los desafíos de transmitir un oficio. Centro de Estudios Antropológicos en Contextos Urbanos, Facultad de Humanidades y Artes, Universidad Nacional de Rosario; 2005. 98 p.

Bull RH. Society’s reactions to facial disfigurements. Dent Update. 1990 Jun;17(5):202, 204–5.

Pedraza DF, Costa GMC. Acessibilidade aos serviços públicos de saúde: a visão dos usuários da Estratégia Saúde da Família. Enfermería Global. 2014 Jan 5;13(1):267–91.

Moysés ST, Franco de Sá R. Local health promotion plans: intersetoralities created in the territory. Cien Saude Colet. 2014 Nov;19(11):4323–30.

Topete RO, Scholtès C, Hidalgo LG, Dubón CA, Carbajosa J, Pedroza GO. Dermatología comunitaria en Oaxaca: el modelo CECIPROC. Dermatol Rev Mex. noviembre-diciembre, 2013;57(6):421–7.

Estrada-Castañón R, G. C-L. Nuevos caminos en Dermatología comunitaria. Dermatol Rev Mex. 2016 May;60(3):199–201.

D’Angelo M, Cotti CL, Casas I. Teledermatología y Dermatología comunitaria: estrategias complementarias para mejorar la accesibilidad y calidad de la atención dermatológica. Dermatol Rev Mex. noviembre-diciembre 2013;57(6):446–53.

Universidade Federal do Rio Grande do Sul (Brasil), Toniol R. “O caminho é aqui”: um estudo antropológico da experiência do Caminho de Santiago de Compostela em uma associação de peregrinos do Rio Grande do Sul, Brasil. pasos. 2011;9(3):69–82.

Guber R. Prácticas Etnográficas. Ejercicios de reflexividad de antropólogas de campo. De Prácticas y discursos Universidad Nacional del Nordeste Centro de Estudios Sociales. 2014 [cited 2018 Mar]. Available from: http://revistas.unne.edu.ar/index.php/dpd/article/view/2814

Guber R. La etnografía: Método, campo y reflexividad. Siglo XXI Editores; 2019. 160 p.

Restrepo E. Etnografía: alcances, técnicas y éticas. 2018. Bogotá: Envión editores, 143 p.

Feltri AA, Arakaki J, Justo LF, Maglio F, Pichún FJ, Rosenberg MI. Salud reproductiva e interculturalidad. Salud Colect. 2006 Dec 4;2(3):299–316.

Published

2021-12-28

How to Cite

1.
Bertarini MF, Castro Perez GA, Mantiñan LM, Alvarez PL, Diaz M, Braguinsky N, Pereiro N, Vicens J, Dawidowski A, Figar S, Mazzuoccolo LD. Reasons for consultation and healthcare strategies analyzed from a neighborhood dermatological assistance device. Qualitative research: Skin problems.Qualitative research. Rev Fac Cien Med Univ Nac Cordoba [Internet]. 2021 Dec. 28 [cited 2024 Jun. 26];78(4):430-6. Available from: https://revistas.unc.edu.ar/index.php/med/article/view/30831

Issue

Section

Humanism and Medicine