Abstract Methodological reflexivity as an articulator center in qualitative research allows us to define and consolidate the epistemological, theoretical and ethical-political positioning of researchers. This paper reflects about contributions and challenges of ethnography as theoretical, methodological and scriptural tool to approach the understanding about mental healthcare at First Level of Care in Tabasco state, Mexico. This exercise is about decisions and dilemmas faced at field work arguing about ethical-political implications of working using ethnographic al designs and expressing a series of position in assumed through this researching. Finally, it shows the urgent need of ethical, cultural and emotional reflection in to the ethnographic al researching in mental health besides to draw attention to emotional challenges of working with vulnerable populations such as native people and mental ills.

Resumen La reflexividad metodológica como centro articulador de la investigación cualitativa permite definir y consolidar el posicionamiento epistemológico, teórico y ético-político de los investigadores. Este artículo reflexiona sobre los aportes y desafíos de la etnogra-fía como herramienta teórica metodológica y escritural para acercarse a la comprensión de la atención de la salud mental en el Primer Nivel de Atención, en el estado de Tabasco, México. El ejercicio presenta la toma de decisiones y dilemas hallados en el trabajo de campo; discute las implicaciones ético-políticas de trabajar con diseños etnográficos y expresa una serie de posicionamientos asumidos a lo largo de la investigación. Finalmente, plantea la urgencia de reflexionar ética, cultural y afectivamente en la investigación etnográfica en salud metal y llama la atención sobre los desafíos emocionales de trabajar con poblaciones en situación de vulnerabilidad, como los pueblos originarios y los enfermos mentales.

Abstract Purpose: This work estimates the availability and distribution of medical professionals in Mexico as a core resource of the health care team within the perspective of universal health as a right and with a care model based on APS-I as well as the training requirements which need to be addressed by higher education institutions. Methodological design: Information is processed from secondary, international, and national sources to assess the sufficiency, distribution, and challenges for training within the framework of a universal health policy. Results: The availability rate of medical professionals shows large gaps to reach similar values as in OECD countries and at the current rate, there is a shortage of these professionals. The training trend contributes to the difficulty of reaching the necessary sufficiency in addition to showing the exhaustion of a repeatedly questioned training model. Research limitations: It is necessary to analyze data about other health professionals to expand the scope of information regarding the needs of the health sector as a whole. Findings: The required number of university-trained medical professionals will hardly be obtained. Moreover, availability in the country is exacerbated in the states with the greatest deficiencies. Universities have the challenge of training medical professionals to be incorporated into a health care model based on APS-I.

Resumen Objetivo: este trabajo estima la necesidad de disponibilidad y de distribución de los profesionales de la medicina en México como recurso nuclear del equipo de salud en la perspectiva de la salud universal como derecho y el modelo de atención basado en la APS-I, así como los requerimientos de formación a los que deben atender las instituciones de educación superior. Diseño metodológico: se realiza el procesamiento de información de fuentes secundarias internacionales y nacionales para valorar la suficiencia, distribución y retos para la formación en el marco de una política de salud universal. Resultados: la tasa de disponibilidad de profesionales de la medicina muestra grandes brechas para alcanzar cifras similares a países de la OCDE, al ritmo actual se vislumbra carencia de esos profesionales. La tendencia de la formación contribuye a la dificultad de alcanzar la suficiencia necesaria, además de mostrar agotamiento de un modelo de formación reiteradamente cuestionado. Limitaciones de la investigación: se requiere analizar datos sobre otros profesionales de la salud para ampliar la información respecto a las necesidades del sector salud en su conjunto. Hallazgos: difícilmente se obtendrá la cantidad necesaria de profesionales médicos formados en las universidades. La falta de disponibilidad se agudiza en los estados con mayores carencias. Las universidades enfrentan el reto de formar profesionales de la medicina para incorporarse a un modelo de atención a la salud basado en la APS-I.

ABSTRACT The social representations resulting from the way of perceiving, interpreting and signifying social reality from the common sense, generate behaviors that directly influence the practice and application of dental care, under the influence of the current socioeconomic conditions of the country. Poverty levels increase rapidly, creating greater social inequalities, with a distribution of polarized economic benefi ts with a concentration of higher incomes in a few. With this, health- dental disease is determined by income levels, limiting access to health levels for the most disadvantaged social groups. The objective of this study is to know the social representations of health-dental disease and its relationship with care and access to dental services and the type of care that people with dental conditions access, and the characteristics of the dentistry practice of those who care for them. A qualitative study was carried out with professionals and patients from the private sector in an area of Mexico City. The results show characteristics of conception and practice infl uenced by the hegemonic medical model and decontextualization of the problems of dental care patients. It is concluded that the social representations of professionals and patients are built in the context of life where polarization and social exclusion prevail.

RESUMEN Las representaciones sociales producto de la forma de percibir, interpretar y significar la realidad social a partir del sentido común generan conductas que influyen directamente en la práctica y solicitud de la atención odontológica, bajo la influencia de las condiciones socioeconómicas actuales del país. Los niveles de pobreza se incrementan de manera acelerada, generando mayores desigualdades sociales, con distribución de beneficios económicos polarizados con concentración de los ingresos más altos en unos pocos. Con ello la salud-enfermedad es determinada por los niveles de ingreso, limitando el acceso a los servicios de salud para los grupos sociales más desfavorecidos. El objetivo de este estudio es conocer las representaciones sociales de salud-enfermedad odontológica y su relación con la atención y el acceso a servicios odontológicos y el tipo de atención al que acuden personas con padecimientos estomatológicos y las características de las prácticas odontológicas de quienes les atienden. Se realizó un estudio cualitativo con profesionales y pacientes del ámbito privado en una zona de la Ciudad de México. Los resultados muestran características de concepción y práctica influidas por el modelo médico hegemónico y de descontextualización de los problemas de atención odontológica de los pacientes. Se concluye que las representaciones sociales de profesionales y pacientes se construyen en el contexto de vida donde prevalece la polarización y exclusión social.

O objetivo deste estudo foi identificar a relação entre os fatores sociodemográficos com a autopercepção da saúde bucal (SPOH) em idosos. Realizou-se um estudo transversal exploratório de 150 idosos. Para avaliar a sua percepção da saúde bucal utilizou-se o Geriatric Oral Assesment Index (GOHAI) e também foram coletados dados sociodemográficos. Os dados foram analisados utilizando o teste T Student, a razão de chances (OR) de análise de regressão logística, o teste Chi Quadrado (p < 0.05) e análise de variância ANOVA. A média do índice de dentes cariados, perdidos ou obturados (CPO-D) dos participantes no estudo foi de 20.1 ± 5.8; 21.3% foram edêntulos e 69.3% eram portadores de prótese removível. O 62.7% dos participantes no estudo teve pobre autopercepção da saúde bucal (definida com uma suma de GOHAI < 44), a qual foi significativamente mais frequente nos homens (OR = 2.72, 95% Cl: 1.03-7.13, p < 0.05), com baixa renda (OR = 2.7, 95% Cl: 1.3 - 5.8, p < 0.01), e com menor escolaridade (OR = 2.26, 95% Cl: 1.1-4.6, p <0.05) do que entre a população em geral. Os resultados presentes sugerem que nos idosos a baixa renda e a menor escolaridade têm influência significativa na autopercepção da saúde bucal, independentemente da perda dentária.

The aim of this study was to identify the relationship between sociodemographic factors and self-perceived oral health (SPOH) among the elderly. A cross-sectional, exploratory examination of 150 elderly subjects whose ages ranged from 60-86 was conducted. These subjects used the Geriatric Oral Health Assessment Index (GOHAI) to assess their SPOH. In addition, sociodemographic data were collected from study participants. Data were analyzed using Student's t-test, the examination of odds ratio (OR) of logistic regression analysis, the chi-square test, and analysis of variance (ANOVA). The mean decayed, missing, and filled teeth (DMFT) index for the study participants was 20.1 ± 5.8; 21.3% of subjects were edentulous, and 69.3% of subjects wore removable dentures. 62.7% of study participants had poor SPOH (defined as GOHAI score <44). Poor SPOH was significantly more frequent among males (OR = 2.72, 95% CI: 1.03-7.13, p < 0.05), low-income individuals (OR = 2.7, 95% CI: 1.3 -5.8, p < 0.01), and subjects with less education (OR = 2.26, 95% CI: 1.1-4.6, p < 0.05) than among the overall subject population. The findings suggest that gender (male), low income and low educational levels have a significant influence on the self-perceived oral health status of elderly individuals, irrespective of tooth loss.

O objetivo deste estudo foi identificar a relação entre os fatores sociodemográficos com a autopercepção da saúde bucal (SPOH) em idosos. Realizou-se um estudo transversal exploratório de 150 idosos. Para avaliar a sua percepção da saúde bucal utilizou-se o Geriatric Oral Assesment Index (GOHAI) e também foram coletados dados sociodemográficos. Os dados foram analisados utilizando o teste T Student, a razão de chances (OR) de análise de regressão logística, o teste Chi Quadrado (p < 0.05) e análise de variância ANOVA. A média do índice de dentes cariados, perdidos ou obturados (CPO-D) dos participantes no estudo foi de 20.1 ± 5.8; 21.3% foram edêntulos e 69.3% eram portadores de prótese removível. O 62.7% dos participantes no estudo teve pobre autopercepção da saúde bucal (definida com uma suma de GOHAI < 44), a qual foi significativamente mais frequente nos homens (OR = 2.72, 95% Cl: 1.03-7.13, p < 0.05), com baixa renda (OR = 2.7, 95% Cl: 1.3 - 5.8, p < 0.01), e com menor escolaridade (OR = 2.26, 95% Cl: 1.1-4.6, p <0.05) do que entre a população em geral. Os resultados presentes sugerem que nos idosos a baixa renda e a menor escolaridade têm influência significativa na autopercepção da saúde bucal, independentemente da perda dentária.

The aim of this study was to identify the relationship between sociodemographic factors and self-perceived oral health (SPOH) among the elderly. A cross-sectional, exploratory examination of 150 elderly subjects whose ages ranged from 60-86 was conducted. These subjects used the Geriatric Oral Health Assessment Index (GOHAI) to assess their SPOH. In addition, sociodemographic data were collected from study participants. Data were analyzed using Student's t-test, the examination of odds ratio (OR) of logistic regression analysis, the chi-square test, and analysis of variance (ANOVA). The mean decayed, missing, and filled teeth (DMFT) index for the study participants was 20.1 ± 5.8; 21.3% of subjects were edentulous, and 69.3% of subjects wore removable dentures. 62.7% of study participants had poor SPOH (defined as GOHAI score <44). Poor SPOH was significantly more frequent among males (OR = 2.72, 95% CI: 1.03-7.13, p < 0.05), low-income individuals (OR = 2.7, 95% CI: 1.3 -5.8, p < 0.01), and subjects with less education (OR = 2.26, 95% CI: 1.1-4.6, p < 0.05) than among the overall subject population. The findings suggest that gender (male), low income and low educational levels have a significant influence on the self-perceived oral health status of elderly individuals, irrespective of tooth loss.

Abstract: The objective of this research was to understand from the collective health and social representations theory the content of the representations and symbolic relationships in a group of primary informal caregivers who care in everyday people with chronic renal failure (CRF). Participated an intentional sample of 21 informal caregivers of people with CRF in the Hemodialysis Unit of the General Hospital of Mexico. We used qualitative methodology with comprehensive-interpretative approach, which is a oriented mode in-depth understanding of social phenomena, such as informal health care. The data collection was through a focused interview and data were analyzed using content analysis assisted with the Atlas program ti.5. This program allowed the development of categories that facilitated the understanding of the data. We defined two types of social representation dimensions: a) Existing, this dimension belongs to the theory of social representations (information, field representation and attitudes about care) and b) Emerging, so called because this dimension emerged at the time of content analysis of the units of analysis (motivation, social support, needs, consequences and care practices). The results allowed to know the contents of social representations and to structure a social representation model of informal care about. It was concluded that embrace subjective of caregivers through social representations to make visible their rol like caregivers. Knowing this through their attitudes arroud of the care, motivattions, needs, consecuences and practices care. Which is extremely important because it makes visible to informal care as social problems in the field of health.

Resumen: El objetivo de esta investigación fue comprender desde la salud colectiva y la teoría de las representaciones sociales el contenido de las representaciones y sus relaciones simbólicas en un grupo de cuidadores primarios informales que cuidaban de personas con insuficiencia renal crónica (IRC). Participó una muestra intencional de 21 cuidadoras informales de personas con IRC de la Unidad de Hemodiálisis del Hospital General de México "Dr. Eduardo Liceaga". La metodología fue cualitativa con enfoque comprensivo interpretativo. La recolección de los datos se hizo a través de una entrevista focalizada/ semi-estructurada, y analizados con el programa Atlas ti.5. El cual permitió elaborar categorías que facilitaron la comprensión de los datos. Se definieron dos tipos de dimensiones de representación social: a) Existentes, definidas así por pertenecer a la teoría de las representaciones sociales (información, campo de representación y actitud acerca del cuidado); y b) Emergentes, que fueron aquellas que surgieron al momento del análisis de contenido de las unidades de análisis (motivación, apoyo social, necesidades, consecuencias y prácticas de cuidado). Los resultados permitieron conocer los contenidos de las representaciones sociales y estructurar un modelo de representación social acerca del cuidado informal. Se concluyó que adentrarse en la subjetividad de las cuidadoras a través de sus representaciones sociales "visibilizaba" su rol como cuidadoras. Conociendo esto por medio de sus actitudes alrededor del cuidado, sus motivaciones, necesidades, consecuencias y las prácticas de cuidado. Lo cual resulta de suma importancia ya que hace visible al cuidado informal como problemática social en el campo de la salud.

The subject of sexuality in academic and service institutions is perceived through predominantly biological conceptual perspectives, blurring the subjective component that is imbued in social and cultural processes. The meanings that medical staff construct around sexuality have implications in their professional development and practice. This work presents results from a qualitative study into the meaning of sexuality among medical interns from the Universidad Autónoma Metropolitana-Xochimilco. In-depth interviews were conducted with students during their community service. This group was selected because they had finished their studies and were performing an independent and autonomous professional practice. The results, which were analyzed based on Grounded Theory, revealed three dichotomies: biology vs. social construction, individual vs. professional and theoretical learning vs. experiences in the community. The most relevant aspect revealed was the antagonism found between a medical intern's biology-centered academic knowledge and the challenge posed by their patients' reproductive and sexual health needs. The interns recognize that they lack the necessary skills to face issues of sexuality in their professional practice.

El tema de la sexualidad en las instituciones académicas y de servicios se enmarca en perspectivas predominantemente biológicas, desdibujando la subjetividad inmersa en procesos sociales y culturales. Los significados construidos por el personal de salud en torno a la sexualidad impactan su formación y desempeño profesional. Se realizó una investigación cualitativa sobre el significado de la sexualidad en jóvenes pasantes de medicina de la Universidad Autónoma Metropolitana-Xochimilco, entrevistándolos porque sin ser titulados ejercen una práctica profesional autónoma e independiente como parte de su servicio social en comunidades rurales. Al analizar la información con base en la teoría fundamentada emergieron tres dicotomías: biológico-construcción-social; individuo-profesional y aprendizaje teórico-vivencias en la comunidad; estas evidencian el antagonismo del conocimiento adquirido durante su formación universitaria con énfasis biológico y los obstáculos para responder a las demandas de salud sexual y reproductiva de la población que atienden. Ellos se reconocen carentes de habilidades para enfrentar estos tópicos en su práctica profesional. Es relevante integrar la perspectiva subjetiva de este tema en los programas de las licenciaturas del área de la salud.

The subject of sexuality in academic and service institutions is perceived through predominantly biological conceptual perspectives, blurring the subjective component that is imbued in social and cultural processes. The meanings that medical staff construct around sexuality have implications in their professional development and practice. This work presents results from a qualitative study into the meaning of sexuality among medical interns from the Universidad Autónoma Metropolitana-Xochimilco. In-depth interviews were conducted with students during their community service. This group was selected because they had finished their studies and were performing an independent and autonomous professional practice. The results, which were analyzed based on Grounded Theory, revealed three dichotomies: biology vs. social construction, individual vs. professional and theoretical learning vs. experiences in the community. The most relevant aspect revealed was the antagonism found between a medical intern's biology-centered academic knowledge and the challenge posed by their patients' reproductive and sexual health needs. The interns recognize that they lack the necessary skills to face issues of sexuality in their professional practice.

El tema de la sexualidad en las instituciones académicas y de servicios se enmarca en perspectivas predominantemente biológicas, desdibujando la subjetividad inmersa en procesos sociales y culturales. Los significados construidos por el personal de salud en torno a la sexualidad impactan su formación y desempeño profesional. Se realizó una investigación cualitativa sobre el significado de la sexualidad en jóvenes pasantes de medicina de la Universidad Autónoma Metropolitana-Xochimilco, entrevistándolos porque sin ser titulados ejercen una práctica profesional autónoma e independiente como parte de su servicio social en comunidades rurales. Al analizar la información con base en la teoría fundamentada emergieron tres dicotomías: biológico-construcción-social; individuo-profesional y aprendizaje teórico-vivencias en la comunidad; estas evidencian el antagonismo del conocimiento adquirido durante su formación universitaria con énfasis biológico y los obstáculos para responder a las demandas de salud sexual y reproductiva de la población que atienden. Ellos se reconocen carentes de habilidades para enfrentar estos tópicos en su práctica profesional. Es relevante integrar la perspectiva subjetiva de este tema en los programas de las licenciaturas del área de la salud.

The discussion on the determinants is extremely prolific in the area of health. However, we still have to think about the way in which the determination is defined and understood as a category that allows to question reality, from an overall and complex view, and the extent that they can have their application in public health. This article discusses the concepts of causality, which is dominant in the positivist vision as well as determination and historicity, used by some alternative views on health. Some arguments are exposed on the ontological and epistemological approach to address the study of health-disease process, from considerations of phenomenology.

La discusión sobre los determinantes es muy prolífica en el campo de la salud, no obstante todavía hace falta reflexionar sobre la manera en que ésta es definida y entendida como una categoría que permite problematizar la realidad desde una mirada totalizadora y compleja y sobre los alcances que puede tener su aplicación en la salud colectiva. Este trabajo discute los conceptos de causalidad, que predomina en la visión positivista, y determinación utilizado por algunas visiones alternativas en el campo de la salud. Se exponen algunos argumentos en torno al tratamiento ontológico y epistemológico en el estudio del proceso salud-enfermedad a partir de algunos planteamientos de la fenomenología.

The discussion on the determinants is extremely prolific in the area of health. However, we still have to think about the way in which the determination is defined and understood as a category that allows to question reality, from an overall and complex view, and the extent that they can have their application in public health. This article discusses the concepts of causality, which is dominant in the positivist vision as well as determination and historicity, used by some alternative views on health. Some arguments are exposed on the ontological and epistemological approach to address the study of health-disease process, from considerations of phenomenology.

La discusión sobre los determinantes es muy prolífica en el campo de la salud, no obstante todavía hace falta reflexionar sobre la manera en que ésta es definida y entendida como una categoría que permite problematizar la realidad desde una mirada totalizadora y compleja y sobre los alcances que puede tener su aplicación en la salud colectiva. Este trabajo discute los conceptos de causalidad, que predomina en la visión positivista, y determinación utilizado por algunas visiones alternativas en el campo de la salud. Se exponen algunos argumentos en torno al tratamiento ontológico y epistemológico en el estudio del proceso salud-enfermedad a partir de algunos planteamientos de la fenomenología.