Determinación social de la obesidad, la diabetes y la hipertensión arterial desde las narrativas de mujeres de una comunidad indígena en el sur de Morelos, México.

OBJETIVO: comprender los procesos críticos (PC) de determinación social de la obesidad, la diabetes y la hipertensión (ODH) en una comunidad nahua de México. METODOLOGÍA: estudio cualitativo de registros de un taller de fotovoz, donde las participantes fotografiaron su entorno y analizaron las causas y posibles soluciones a la ODH. Para analizar los PC de la ODH utilizamos como método la investigación narrativa y, como referente teórico, la epidemiología crítica. RESULTADOS: la ODH se reproduce social e históricamente a través de PC destructivos vinculados con las relaciones de producción global y de género. Estas determinan modos de vida deteriorantes que limitan la atención a la salud, comprometen la salud mental, producen contaminación y diferenciación de uso de espacios, y reducen oportunidades para alimentarse nutritivamente y realizar actividad física. Todo ello se expresa como ODH y problemas de salud mental. Los PC protectores ante estas expresiones incluyen la atención estatal, las oportunidades de trabajo, y la promoción de dispositivos culturales y comunitarios. CONCLUSIONES: nuestros resultados aportan a la discusión global sobre cómo las condiciones históricas de vida son parte de la determinación social de la ODH. Comprender los PC y sus expresiones locales puede orientarnos hacia la descolonización de la forma de pensar y hacer promoción de la salud.

Inclusión social de persona con trastorno mental en situación de calle: una intervención comunitaria

Introducción: Experiencia de una comunidad de barrio capitalino (Asunción-Paraguay), movilizada por la grabación de un corto documental a cargo de estudiantes de cinematografía, que inician un proceso de participación para mejorar la calidad de vida de una persona con trastornos mentales y discapacidad psicosocial en situación de calle, logrando su inclusión social. Objetivo : Identificar los elementos claves que favorecieron la participación comunitaria, derivando en el proceso de reinserción social de una persona con trastorno mental y discapacidad psicosocial para contribuir con estrategias innovadoras de modelos de atención basados en la comunidad con enfoque de derechos humanos. Materiales y métodos: Estudio cualitativo de diseño narrativo, utilizando datos de la historia de una persona y la experiencia de una comunidad para describir, analizar e identificar elementos que se consideran claves para los resultados logrados. La experiencia comunitaria fue observada y registrada de cerca durante más de 4 años. Resultado: Participación comunitaria activa en torno a un objetivo colectivo impulsado por un proyecto cinematográfico logrando la reinserción social de una persona con trastorno mental o discapacidad psicosocial que se encontraba en situación de calle. Conclusión : El cine o arte generan un impacto emocional y sensibilizador que acompañados con estrategias sostenibles; facilitación, tecnología, recursos económicos, lugares de residencia o acogida, acompañamiento; permiten aprovechar y movilizar recursos comunitarios, con participación y enfoque de derechos humanos. El resultado en este caso es la inclusión social de una persona con trastornos mentales y discapacidad psicosocial, que se encontraba en el extremo de exclusión social: vida en calle por más de 20 años.

Introduction : Experience of a community from a neighborhood of the Capital City (Asunción-Paraguay), mobilized by the recording of a Short Documentary by cinematography students, who begin a process of participation to improve the quality of life of a person with mental disorders and psychosocial disabilities who are homeless, achieving their social inclusion. Objective : Identify the key elements that allowed community participation and the social reintegration process of a person with a mental disorder or psychosocial disability to contribute with innovative strategies of community-based care models with a human rights approach. Materials and Methods : A qualitative type study of narrative design, using data from a person's story and the experience of a community to describe, analyze and identify the key elements to the results achieved. The community experience was closely observed and recorded for more than 4 years. Results : active community participation around a collective objective driven by a film project, achieving the reintegration and social rehabilitation of a person with mental disorder who was in street situation. Conclusion : Cinema or art generates an emotional and sensitizing impact that, accompanied by sustainable strategies; facilitation, technology, economic resources, places of residence or reception, support; allows taking advantage of and mobilizing community resources, with participation and a human rights approach. The result in this case is the social inclusion of a person with mental disorders or psychosocial disabilities who was at the extreme of social exclusion; street life for more than 20 years.

Salud, complejidad y enfermedades no transmisibles

La ciencia y la producción del saber científico están cambiando, las partes no son el objetivo, es el todo y sus interrelaciones. La salud enfrenta nuevos retos que no pueden ser explicados por concepciones reduccionistas. Se reconoce el intento de agrupar variadas afecciones en las enfermedades no transmisibles que ocasionan las tres cuartas partes de las muertes en el mundo y en Cuba, constituyen uno de los grandes retos del desarrollo sostenible. Muchas de ellas, a pesar de su heterogeneidad y multicausalidad, comparten factores de riesgo -y protectores- comunes, que pueden ser revertidos con acciones integradas. Se comenta la frecuente comorbilidad de estas enfermedades con otras entidades, la polimorbilidad y el rol del envejecimiento en su aparición. Se resalta la presencia del estado inflamatorio crónico del endotelio y la disfunción de este órgano como posible vía final común de la patogenia, evolución y posterior expresión clínica de muchas de las conocidas como enfermedades no transmisibles, verdaderos síndromes sistémicos. Se dan un grupo de recomendaciones para mejorar su prevención y su control, con énfasis en la participación comunitaria, donde las ciencias sociales pueden aportar mucho para lograr mejores resultados, sin olvidar la susceptibilidad individual o de grupos a padecer determinadas enfermedades no transmisibles. Se considera que directivos, profesionales sanitarios, líderes formales e informales, personas, grupos y comunidades, deben capacitarse y actualizarse, en los conceptos y los enfoques de estas enfermedades para lograr el propósito de revertir sus efectos nocivos para la salud.

Science and the production of scientific knowledge are changing, the parts are not the objective, it is the whole and its interrelationships. Health faces new challenges that cannot be explained by reductionist conceptions. The attempt to group various conditions in non-communicable diseases that cause three quarters of deaths in the world and in Cuba is recognized as one of the great challenges of sustainable development. Many of them, despite their heterogeneity and multi-causality, share common risk -and protective- factors, which can be reversed with integrated actions. The frequent comorbidity of these diseases with other entities, polymorbidity, and the role of aging in their appearance are discussed. The presence of the chronic inflammatory state of the endothelium and the dysfunction of this organ are highlighted as a possible final common path of the pathogenesis, evolution and subsequent clinical expression of many of the so-called non-communicable diseases, true systemic syndromes. A group of recommendations are given to improve its prevention and control, with emphasis on the community participation of all, where the social sciences can contribute a lot to achieve better results, without forgetting individual or group susceptibility to suffering certain non-communicable diseases. It is considered that managers, health professionals, formal and informal leaders, people, groups and communities must be trained and updated in concepts and approaches to these diseases to achieve their purposes.

Círculos de la palabra con líderes vecinales: sistematización de la experiencia

Se realizó una sistematización de la experiencia de: "círculos de la palabra" con líderes barriales del municipio de Villamaría, Caldas, Colombia entre 2016 y 2019, con base en los lineamientos de los autores: Jara, Ghiso y Verger. La experiencia permitió identificar tres hitos: "conocernos, el acompañamiento y los sueños", "sujetos de conocimiento" y "la experiencia construida socialmente". Los círculos de la palabra se configuraron para dar a los líderes de las comunidades un espacio donde tener voz y promover la reflexión movilizadora, construir tejidos y crear redes sociales de apoyo para conseguir un buen vivir.

A systematization of the experience titled: "word circles" with neighborhood leaders in Villamaría - Caldas (Colombia) between 2016 and 2019, was conduc ted based on Jara, Ghiso, and Verger guidelines. This experience allowed to iden tify three milestones: "getting to know each other, accompaniment and dreams," "subjects of knowledge," and "experience socially constructed". The word circles were created to provide to community leaders a place where they may have a voice and to foster mobilizing reflection, to build social fabric, and creating support networks to achieve a good life.

[Evaluation of a community-based intervention to increase influenza vaccination coverage in pregnant women]. / Evaluación de una intervención comunitaria para incrementar la cobertura vacunal de la gripe en mujeres embarazadas.

OBJECTIVE: To know the impact of the educational intervention carried out on the professionals of a basic health area and their community participation group, which make up the intervention group (IG), and to analyze its repercussion on the vaccination coverage achieved for influenza in the risk group (pregnant and puerperal women) comparing it with its neighboring basic zone, which makes up the control group (CG), during the 2019/20 vaccination season. DESIGN: Quasi-experimental study of community intervention. SITE: Two basic health zones belonging to the Elche-Crevillente health department, Spain. PARTICIPANTS: Pregnant and postpartum women from 2 basic health areas and the community participation group. Health professionals directly related to the flu vaccination campaign. INTERVENTIONS: Training session for the IG prior to the 2019/20 flu campaign. MAIN MEASUREMENTS: Attitudes towards influenza vaccination in health professionals through the validated CAPSVA questionnaire and the vaccination coverage of pregnant and postpartum women through the Nominal Vaccine Registry and their acceptance of the vaccine in the midwife's office. RESULTS: The influenza vaccination coverage data recorded in Nominal Vaccine Registry for pregnant and puerperal women was 26.4% (n=207) in the IG and 19.7% (n=144) in the CG (p=0.001), with an incidence ratio of 1.34, thus achieving 34% more vaccination in the IG. Acceptance for vaccination in the midwife's office was also high, with 96.5% immunization in IG vs. 89.0% in CG, with a RR=1.09 (95% CI 1.01-1.62). CONCLUSIONS: Joint training strategies for professionals and community assets improve the results of vaccination coverage.

Implementation of Participatory Research in Vulnerable Context: Methodological Strategies and Challenges / Implementação de Pesquisa Participativa em Contexto de Vulnerabilização: Estratégias e Desafios Metodológicos / Implementación de la Investigación Participativa en un Contexto de Vulnerabilidad: Estrategias y Desafíos Metodológicos

Abstract Participatory methods contribute to scientific rigor by highlighting the contextual needs, especially of underrepresented populations, making them protagonists in the process of social change. This article aims to present the application of a participatory research method, called Community-Based Participatory Research (CBPR), in a context of social vulnerability in southern Brazil. It seeks to discuss the challenges and strengths of the method, which provides ecological validity for the development of public policies appropriate to the context, while empowering the participants. The research has been carried out since 2019 and, among the inherent challenges, has also faced the difficulties posed by the COVID-19 pandemic. Based on the application of this method in Brazil, the importance of involving participants throughout the research process has been identified, so that policies are developed to meet the needs of the community and are sustained by those most interested.

Resumo Métodos participativos contribuem para o rigor científico ao evidenciarem demandas do contexto, especialmente com populações sub-representadas, tornando-as protagonistas do processo de transformação social. Este estudo objetivou apresentar a aplicação de um método participativo de pesquisa, a Community-Based Participatory Research (CBPR), em um contexto de vulnerabilização social no sul do Brasil. Busca-se discutir os desafios e as potencialidades do método, que oferece recursos de validade ecológica para o desenvolvimento de políticas públicas próprias ao contexto, ao mesmo tempo em que empodera seus participantes. A pesquisa vem sendo realizada desde o ano de 2019 e, dentre os desafios inerentes, também enfrentou as dificuldades impostas pela pandemia de Covid-19. A partir da aplicação deste método em contexto brasileiro, identificou-se a relevância de se envolver os participantes ao longo do processo de pesquisa, a fim de que as ações desenvolvidas sejam desenvolvidas em coerência com as demandas trazidas pela comunidade, e mantidas por aqueles que são seus maiores interessados.

Resumen Los métodos participativos contribuyen al rigor científico al destacar las necesidades del contexto, especialmente de las poblaciones subrepresentadas, haciéndolas protagonistas del proceso de cambio social. Este artículo pretende presentar la aplicación de un método de investigación participativa, denominado Investigación Participativa Basada en la Comunidad (IBCB), en un contexto de vulnerabilidad social en el sur de Brasil. Busca discutir los desafíos y fortalezas del método, con validez ecológica para el desarrollo de políticas públicas, al tiempo que empodera a los participantes. La investigación empezó en 2019 y, entre los desafíos, también se ha enfrentado a las dificultades planteadas por la pandemia de Covid-19. A partir de la aplicación de este método en el contexto brasileño, se ha identificado la importancia de involucrar a los participantes en el proceso de investigación, para que se desarrollen políticas que respondan a las necesidades de la comunidad y sean mantenidas por los más interesados.

Stormfires in La Palma, Chile: Shared Meanings Emerging from a Post-disaster Community Intervention / Tormenta de fuego en la palma (chile): significados compartidos surgidos de una intervención comunitaria postdesastre

RESUMEN Los desastres socioambientales afectan desigualmente a las zonas rurales en comparación con las urbanas. Esta realidad hace que la movilización de recursos comunitarios sea esencial para afrontar estos eventos. El objetivo de este trabajo fue analizar la construcción de significados derivados del proceso de intervención comunitaria posterior a un desastre (incendio forestal) entre la comunidad La Palma y el equipo de la Fundación Tierra de Esperanza, planteando como pregunta de investigación ¿Qué significados compartidos surgen del proceso de intervención vivenciado por la comunidad de La Palma y el equipo interventor? El estudio tuvo un diseño fenomenológico, utilizando análisis interpretativo del discurso. Los resultados muestran la emergencia de categorías vinculadas a procesos identitarios, ruralidad, y el despliegue de procesos psicosociales durante la experiencia de intervención vinculados con el afrontamiento comunitario, apoyo social, rol clave de liderazgos femeninos y aprendizajes de la comunidad. Se discute cómo la toma de conciencia de esta comunidad rural incrementó su capacidad de agencia ante eventos en los que cuentan con escaso apoyo gubernamental.

ABSTRACT Socio-environmental disasters affect rural areas unequally, compared to urban areas. This reality makes the mobilization of community resources essential when facing these events. The objective of this study was to analyze the construction of meanings derived from the process of community intervention after a disaster (forest fires) between the La Palma community and the Tierra de Esperanza Foundation team, posing as a research question: What shared meanings emerge from the intervention process experienced by the La Palma community and the intervention team? The study had a phenomenological design, using interpretative discourse analysis. The results show the emergence of categories linked to identity processes, rurality, and the unfolding of psychosocial processes during the intervention experience, linked to community coping, social support, the key role of female leadership, and community learning. It is discussed how the awareness of this rural community increased its capacity for agency in the face of events with little government support.

The urgency of strengthening health information to support public perception and involvement in the COVID-19 vaccine.

OBJECTIVE: To identify the driving and inhibiting factors and to find a prototype of community involvement in the COVID-19 vaccine. METHOD: Data sources from PubMed database, Google Scholar, Web of Science, and ProQuest. The data were obtained based on searches using the keyword COVID-19 (n=11,.599), focusing on community acceptance (n=813), community involvement (n=86), and types of articles (n=46). Articles that meet the inclusion criteria are seven, and the data were analyzed with ATLAS Ti.9 software. RESULTS: Engagement and driving factors have the highest correlation (0.38). The drivers, perceptions of vulnerability, and inhibiting factors determine community involvement. The perception of exposure can be a supporting or inhibiting factor influenced by information reinforcement. CONCLUSIONS: Strengthening positive information can alter the sense of community vulnerability, making it a driving force for participation in the COVID-19 vaccine campaign. This finding is an appropriate strategy to expand the reach and resolve public doubts about accepting the vaccine.

Metodologias participativas em terapia ocupacional de natureza sociocomunitária: Reflexões desde uma orientação crítica epistemológica / Participatory methodologies in Occupational Therapy of sociocommunitarian nature: reflections from a critical epistemological orientation / Metodologías participativas en Terapia Ocupacional de naturaleza sociocomunitaria: reflexiones desde una orientación crítica epistemológica

Objetivo: Este manuscrito é uma breve reflexão sobre a utilização de metodologias participativas em terapia ocupacional, alinhada a uma orientação crítica epistemológica. Síntese dos elementos do estudo: metodologias desta natureza têm por objetivo a participação social de sujeitos e coletivos violados em seus direitos e epistemicamente excluídos. Conclusão: entendemos que estas podem ser utilizadas pelos terapeutas ocupacionais em diferentes cenários assistenciais, com destaque aos serviços de base territorial e comunitária, para subsidiar processos implicativos com comunidades que vivenciam privações nas esferas da vida cotidiana, em um horizonte ético-político de justiça e de garantia de direitos humanos e fundamentais.

Objective: This manuscript is a brief reflection on the use of participatory methodologies in occupational therapy, aligned with a critical epistemological orientation. Synthesis of the study's elements: Methodologies of this nature have as their objective the social participation of subjects and collectives violated in their rights and epistemically excluded. Conclusion: We understand that these can be used by occupational therapists in different care scenarios, with emphasis on territorial and community-based services, to support implicative processes with communities that experience deprivations in the spheres of daily life, in an ethical-political horizon of justice and the guarantee of human and fundamental rights.

Objetivo: Este manuscrito es uma breve reflexión sobre la utilización de metodologías participativas en terapia ocupacional, alineada a una orientación crítica epistemológica. Síntesis de los elementos del estudio: Metodologías de esta naturaleza tienen por objetivo la participación social de sujetos y colectivos violados en sus derechos y epistemicamente excluídos. Conclusión: Entendemos que éstas pueden ser utilizadas por los terapeutas ocupacionales en diferentes escenarios asistenciales, con énfasis en los servicios de base territorial y comunitaria, para apoyar procesos implicativos con comunidades que experimentan privaciones en las esferas de la vida cotidiana, en un horizonte ético-político de justicia y de garantía de los derechos humanos y fundamentales.

[Repercussions of COVID-19 in a participatory action-research process with adolescent Roma women]. / Repercusiones de la COVID-19 en un proceso de investigación-acción participativa con adolescentes gitanas.

The objective of this article is to describe the impact of the COVID-19 pandemic on the implementation of the RoMoMatter project, using a community-based participatory action research methodology, in Córdoba (Spain). Five academic researchers and 30 community members participated. Individual interviews, focus groups and field notes were used as data collection techniques. The interviews were audio-recorded with the consent of the participants and transcribed verbatim. The information collected was coded using Atlas Ti software. The efforts of adaptation to the new pandemic scenario made by the participants and the technical and emotional support role played by the adaptation team are highlighted. It is concluded that the main impact of the pandemic was evidenced in the participatory process of all the people involved, and in the format and number of activities.

Percepção de determinantes de saúde e doença em um território: relato de experiência / Perception of health and disease determinants in a territory: experience report / Percepción de los determinantes de la salud y enfermedad en un territorio: reporte de experiencia

O processo saúde-doença compreende amplas variáveis que envolvem o indivíduo e o meio em que vive. Diante da pandemia causada pelo novo coronavírus, da síndrome respiratória aguda grave e das necessidades de saúde da população no contexto do território, este estudo teve como objetivo conhecer a percepção de usuários do Sistema Único de Saúde (SUS) sobre os determinantes de saúde e doença, aliado à perspectiva do controle social e dos direitos e deveres dos usuários. Trata-se de um relato de experiência elaborado no contexto de atuação da equipe de residentes multiprofissionais em Atenção Básica/Saúde da Família e Comunidade da Prefeitura Municipal de Mossoró. Foram realizadas três etapas, constituídas por planejamento e pesquisa bibliográfica acerca do controle social e participação da comunidade no SUS; encontro com agentes comunitários de saúde para o (re)conhecimento ampliado do território; e encontro com membros da comunidade para discussão dos determinantes de saúde e doença no território. Os usuários participantes manifestaram uma visão ampliada do conceito de saúde, com menção a problemas ambientais e sociais que impactam as condições da saúde em sua comunidade. Pela experiência da ação, pode-se observar que a população sente a necessidade de momentos em que possa ser ouvida e, com os profissionais de saúde, debater os problemas e possíveis soluções para a comunidade, compreendendo sua corresponsabilização no processo de promoção da saúde nos âmbitos individual e coletivo, estabelecendo vínculos construtivos.

The health-disease process comprises broad variables that involve the individual and the environment in which they live. Given the pandemic caused by the new coronavirus, the severe acute respiratory syndrome, and the health needs of the population within a territory, this study sought to know the perception of Unified Health System (SUS) users about health and disease determinants, combined with the perspective of social control, and the rights and duties of users. This experience report was elaborated amidst a multidisciplinary team of residents in Primary Care/Family and Community Health of the Municipality of Mossoró. The research consisted of three stages: planning and bibliographical research about social control and community participation in the SUS; meeting with community health agents for a broader knowledge of the territory; and meeting with community members to discuss health and disease determinants in the territory. Participants expressed an expanded view of the concept of health, mentioning environmental and social issues that affect health conditions in their community. This experience showed that the population feels the need to be heard and discuss, together with health professionals, the problems and possible solutions for the community, understanding their co-responsibility in individual and collective health promotion actions, establishing constructive bonds.

El proceso salud-enfermedad tiene amplias variables que involucran al individuo y al medio en que se vive. Ante la pandemia provocada por el nuevo coronavirus, el síndrome respiratorio agudo severo y las necesidades de salud de la población en el contexto del territorio, este estudio tuvo como objetivo conocer la percepción de los usuarios del Sistema Único de Salud (SUS) sobre los determinantes de la salud y la enfermedad, combinados con la perspectiva del control social y los derechos y deberes de los usuarios. Este es un reporte de experiencia, elaborado en el contexto del trabajo del equipo multidisciplinario de residentes en Atención Básica/Salud Familiar y Comunitaria del Municipio de Mossoró (Brasil). Se realizaron tres momentos, consistentes en la planificación y búsqueda bibliográfica sobre control social y participación comunitaria en el SUS; encuentro con agentes comunitarios de salud para el (re)conocimiento ampliado del territorio; y reunión con miembros de la comunidad para discutir los determinantes de la salud y la enfermedad en el territorio. Los usuarios participantes expresaron una visión ampliada del concepto de salud, mencionando problemas ambientales y sociales que repercuten en las condiciones de salud de su comunidad. Se puede observar, a partir de la experiencia de la acción, que la población siente la necesidad de momentos en los que se pueda escucharla para, junto a los profesionales de la salud, discutir los problemas y posibles soluciones a la comunidad, que llevan en consideración su corresponsabilidad en la promoción de la salud a nivel individual y colectivo, y establecen vínculos constructivos.

Mirada ecológica en la construcción del proyecto de vida de jóvenes rurales / Ecological perspective of the construction of life projects by rural youth / Uma perspectiva ecológica na construção do projeto de vida dos jovens rurais

Resumen (analítico) El proyecto de vida de la juventud rural colombiana transita por dificultades en su planeación y desarrollo. Por ende, este estudio busca identificar los factores que interfieren en la construcción del proyecto de vida en jóvenes rurales, con una metodología de investigación cualitativa, enfoque etnometodológico y diseño transversal. Se emplearon como técnicas de recolección de información entrevistas semies tructuradas, grupos focales, observación y análisis documental. Participaron 117 adolescentes, ocho docentes y seis padres de familia. Los resultados facilitaron comprender los factores individuales y sociales que inciden en el proyecto de vida de la juventud rural desde el modelo ecológico, que aborda la relación del adolescente rural con las características de su contexto y específicamente desde el microsistema, mesosistema, exosistema y macrosistema.

Abstract (analytical) The life projects of Colombian young people in rural areas are facing difficulties in terms of planning and implementation. This study sought to identify the factors that affect rural young people's construction of life projects. This involved the use of a qualitative research methodology, ethnomethodological approach and cross-sectional design. Semi-structured interviews, focus groups, participant observation and documentary analysis were selected as data collection techniques. A total of 117 adolescents, 8 teachers and 6 parents participated. Using the ecological model, the results facilitated understanding of the individual and social factors that influence the life projects of rural youth. The study identified the importance of the relationship of rural adolescents with the characteristics of their context and specifically the microsystems, mesosystems, exosystems and macrosystems they inhabit.

Resumo (analítico) O projeto de vida da juventude rural colombiana está passando por dificuldades em seu planejamento e desenvolvimento, portanto, este estudo procura identificar os fatores que interferem na construção do projeto de vida na juventude rural, com uma metodologia de pesquisa qualitativa, abordagem etnometodológica e desenho transversal. Foram utilizadas entrevistas semiestruturadas, grupos de foco, observação e análise documental como técnicas de coleta de dados. Participaram um total de 117 adolescentes, 8 professores e 6 pais participaram. Os resultados facilitaram uma compreensão dos fatores individuais e sociais que influenciam o projeto de vida dos jovens rurais a partir do modelo ecológico, que aborda a relação dos adolescentes rurais com as características de seu contexto e especificamente do microssistema, mesossistema, exossistema e macrossistema.

Supporting community participation in a pandemic.

The invariable governmental approach to the impact of the COVID-19 pandemic has been to effect the White Knight stance of Don Quixote, defending the population from the "Virus Dragon" and dedicating its knight-errantry to the damsel Dulcinea. Though essential, new therapeutics, vaccines, physical distancing, rigorous hygiene standards and efficient health systems are not sufficient to counter the effects of the virus. Individual compliance to public health guidelines also matters, while remaining similarly insufficient to diminish the threat. Earthier, citizen-led, community participation strategies, however, lead to innovative, tailored solutions that better fulfil the needs of diverse neighbourhoods and assures greater virus resistance and increase in population health compared to a top-down, knightly approach or isolated individual efforts. The challenge of COVID-19 offers communities a moment to build more resilient, antifragile communities that not only survive the current crisis, but that thrive after it, and that are better equipped for the next challenge. This is not the time for the singular heroics of the White Knight, or the antics of Don Quixote, tilting at windmills. It is the time of Sancho Panza, which is to say of regular non-credentialed citizens, and their collective efforts, who up to now have largely been considered pawns in this contest. Asset-based community development (ABCD) rejects both the individual as an island and the institutional, knightly emphasis on assessing needs and deficits within communities. It favours identifying and mobilising available and latent assets within a community to forge closer connections among all people, the better to collectivise problem-solving efforts. Community-driven initiatives are assisted in this by localised not-for-profit agencies that practice subsidiarity.

Análisis del proceso técnico político de la ordenanza municipal para promoción de salud de Quillota

RESUMEN Para contribuir a la vida sana de la comunidad y en atención a las recomendaciones nacionales e internacionales para combatir la obesidad y sus consecuencias, en 2017 la Municipalidad de Quillota promulgó una Ordenanza de Promoción de Salud para favorecer entornos alimentarios saludables y para la práctica de actividad física. No está descrito en qué consiste y cuáles son las dificultades para establecer este tipo de normativas locales. El objetivo de este estudio fue analizar el proceso técnico y político que culminó en la generación de esta Ordenanza como ejemplo para el resto de los municipios del país. Con un diseño cualitativo, exploratorio y retrospectivo se recolectó información a través de entrevistas, grupos focales y diálogos participativos. Se realizó un mapeo de actores y el análisis de las lecciones aprendidas, considerando barreras y facilitadores. Los resultados muestran que la Ordenanza representó un desafío para la toma de decisiones que habilitaron su consolidación tanto en términos de gestión técnica como en los niveles de poder. Entre las lecciones aprendidas destaca la relevancia de un escenario político favorable, un equipo técnico competente y con liderazgo, y la fuerte articulación intersectorial; siendo clave la voluntad de las autoridades municipales y la negociación con sectores de oposición. La participación comunitaria activa fue un punto de compleja implementación.

ABSTRACT With the aim of improving the health of the community and given national and international recommendations to combat obesity and its consequences, in 2017, the Municipality of Quillota enacted a Health Promotion Ordinance to promote healthy food environments and physical activity practices. The ordinance is not specifically detailed, nor are the difficulties in establishing such local regulations described. Thus, this study intended to analyze the technical and political processes that generated this ordinance, which may serve as an example for other municipalities. The information collection was made through interviews, focus groups, and participatory dialogues, using a qualitative, exploratory, and retrospective design. Actors mapping and lessons learned analysis, considering barriers and facilitators found, was conducted. The results show that the ordinance consolidation presented a challenge to the decision-making management at the technical and empowerment levels. Lessons learned include favorable political scenarios, a competent technical team, and strong cross-sectoral articulation. Two key factors were the municipal authorities' resolution and negotiation with opposition sectors. Active community participation was a point of complex implementation.

Associations and community health workers: analysis and time trends over ten years of training-action.

OBJECTIVE: To analyse the profile of the persons and associations that participated in the course, quantify peer education activities and analyse their evolution. METHOD: A quantitative study using an analysis of the course records from 2009 to 2018 was designed for this purpose inside mihsalud program designed to promote health amongst persons in vulnerable situations in the city of Valencia (Spain). It offers a yearly training-action course of community health workers (CHW) that is attended by persons who have been proposed by associations. The associations were defined according to their population (immigrant, local or intercultural) and the CHWs according to gender, country of birth, year of course, association and continuity after training. Means and confidence intervals were calculated at 95% and a bivariate analysis was conducted in order to compare the activities that took place in 2009 to 2013 with those of 2014 to 2018. The time trends were analysed by applying linear regression models that included the different years studied as the dependent variable. RESULTS: 201 CHW of 31 nationalities were trained, 81.6% (95% confidence interval [95% CI]: 75.5-86.7] were women. Eighty-two associations participated, 51.2% (95% CI: 39.9-62.4] worked with culturally diverse populations. Participation by associations (p=.017) and CHWs (p=.377) increased in a statistically significant manner over the years. After the course, 35.3% (95% CI: 28.7-42.4] of the CHWs continued to collaborate voluntarily in the associations. CONCLUSIONS: The results of the CHW training-action course improve over time given that a significant increase in participation by associations and women can be seen, along with a greater number of activities completed during the training. One effect of this is that CHWs are contracted or carry out voluntary activities in the associations.

Abordajes comunitarios en salud mental en el primer nivel de atención: conceptos y prácticas desde una perspectiva integral / Community approaches in mental health at the first Level of care: concepts and practices from an integral Perspective

El objetivo de este trabajo fue realizar una aproximación conceptual y análisis de prácticas que permitan problematizar la inclusión de estrategias comunitarias en abordajes integrales de salud mental. Desde una perspectiva cualitativa, este escrito es producto de un proceso de articulación conceptual y sistematización derivado de un análisis reflexivo sobre prácticas de salud mental desarrolladas en el primer nivel de atención en la ciudad y provincia de Buenos Aires desde el año 2010. Se reconoce la fragilización de redes comunitarias como una problemática colectiva en salud mental, y se propone a la promoción en salud mental como estrategia central que permite, desde una perceptiva no normativa e integral, el desarrollo de acciones participativas y el fortalecimiento de lazos comunitarios solidarios como recursos colectivos para el cuidado de la salud mental. Se abordan ejes problemáticos relevados en la implementación de dichas prácticas y su relación con una vigente tensión entre los modelos biomédico e integral de atención. Se articulan reflexiones relacionadas a la pandemia por COVID-19, evidenciando una necesidad actual de profundizar el desarrollo de estrategias comunitarias en salud mental.

The objective of this work was to carry out a conceptual approach and analysis of practices that allow problematizing the inclusion of community strategies in comprehensive mental health approaches. From a qualitative perspective, this paper is the result of a process of conceptual articulation and systematization derived from a reflexive analysis of mental health practices developed in the first level of care in the City and Province of Buenos Aires since 2010. The fragilization of community networks is recognized as a collective mental health problem, and mental health promotion is proposed as a central strategy that allows, from a non-normative and comprehensive perspective, the development of participatory actions and the strengthening of supportive community bonds, as collective resources for mental health care. It addresses problematic axes revealed in the implementation of such practices and their relationship with a current tension between the biomedical and integral models of care. Reflections related to the COVID-19 pandemic are articulated, evidencing a current need to deepen the development of community strategies in mental health.

Estratégias de comunicação adotadas pela gestão do Sistema Único de Saúde durante a pandemia de Covid-19 - Brasil / Estrategias de comunicación adoptadas por la gestión del Sistema Brasileño de Salud durante la pandemia de Covid-19 - Brasil / Communication strategies adopted by the management of the Brazilian National Health System during the Covid-19 pandemic

Foi realizada caracterização e análise das principais estratégias de comunicação desenvolvidas pelos três níveis de gestão do Sistema Único de Saúde (SUS) para o enfrentamento de Covid-19 no Brasil. Consideraram-se websites, Twitter, Youtube, Instagram e Facebook, coletivas de imprensa, aplicativos e boletins epidemiológicos, totalizando 35 estratégias. Apesar da comunicação ser um dos eixos fundamentais em resposta à pandemia, parte significativa das estratégias não abordou adequadamente as temáticas de vigilância, assistência, promoção e educação em saúde. Observou-se predomínio do modelo de comunicação utilitarista, centralizador e funcional, com foco na transmissão de informações. O Estado tem o dever de promover uma comunicação comunitária e emancipatória, considerando a diversidade de sujeitos, o contexto local e o desenvolvimento de redes comunicativas, respeitando o direito humano e social à comunicação, à informação e à voz, segundo os princípios e diretrizes do SUS. (AU)

Se realizó una caracterización y análisis de las principales estrategias de comunicación desarrolladas por los tres niveles de gestión del Sistema Brasileño de Salud (SUS) para enfrentar la pandemia de Covid-19 en Brasil. Se consideraron páginas web, Twitter, YouTube, Instagram y Facebook, entrevistas colectivas de prensa, aplicaciones y boletines epidemiológicos, totalizando 35 estrategias. Aunque la comunicación es uno de los ejes fundamentales de respuesta a la pandemia, una parte significativa de las estrategias no abordó adecuadamente las temáticas de vigilancias, asistencia, promoción y educación en salud. Se observó el predominio del modelo de comunicación utilitarista, centralizador y funcional, enfocado en la transmisión de informaciones. El Estado tiene el deber de promover una comunicación comunitaria y emancipadora, considerando la diversidad de sujetos, el contexto local y el desarrollo de redes comunicativas, respetando el derecho humano y social a la comunicación, a la información y a la voz, según los principios y directrices del SUS. (AU)

The main communication strategies developed by the three levels of the Brazilian National Health System (SUS) for the management for coping with Covid-19 in Brazil were characterized and analyzed. The research encompassed Websites, Twitter, YouTube, Instagram and Facebook, press conferences, apps and epidemiological bulletins, totaling 35 strategies. Although communication is one of the key axes in response to the pandemic, a significant part of the strategies did not adequately address the topics of surveillance, care, promotion and health education. It was observed a predominance of the utilitarian, centralizing and functional communication model, focusing on the transmission of information. The State has a duty to promote community and emancipatory communication, considering the diversity of subjects, the local context and the development of communicative networks, respecting the human and social right to communication, information and voice, according to the principles and guidelines of the SUS. (AU)

Governança participativa e a expansão do conceito de saúde na experiência do community lab na itália / Participatory governance and the expansion of the health concept in the community lab experience in italy / Gobernanza participativa y la expansión del concepto de salud en la experiencia del community lab en italia

Este artigo estuda a metodologia do Community Lab (CL), um projeto de welfare participativo desenvolvido na região da Emilia Romana na Itália, que envolve movimentos sociais e comunitários e atores governamentais. Investigaremos duas experiências desse projeto, analisando os efeitos do processo participativo para os atores e para as políticas de saúde. A pesquisa qualitativa, de cunho etnográfico, combinou técnicas como diário de campo e entrevistas, com oficinas de escrita estruturadas em uma pesquisa-ação que envolveu participantes do CL. Destaca-se a flexibilidade metodológica, que responde mais às dinâmicas sócio-culturais e organizacionais dos territórios, do que às normativas institucionais, conciliando os efeitos na gestão, a democratização do processo decisório e a implementação das políticas públicas. O CL amplia as categorias de atores envolvidos e, com isso, as noções de saúde, fomentando a intersetorialidade e transformação dos aparatos estatais..

This article studies the methodology of the Community Lab (CL), a participatory welfare project developed in the Emilia Romana region in Italy, which involves social and community movements and government actors. We will investigate two experiences of this project, analyzing the effects of the participatory process for the actors and for health policies. The qualitative research, of an ethnographic nature, combined techniques such as field diaries and interviews, with writing workshops structured in an action research that involved CL participants. The methodological flexibility stands out, which responds more to the socio-cultural and organizational dynamics of the territories, than to the institutional regulations, reconciling the effects on management, the democratization of the decision-making process and the implementation of public policies. The CL expands the categories of actors involved and, with this, the notions of health, fostering the intersectoriality and transformation of state apparatus.

Este manuscrito apunta a La posibilidad de que una discusión debate integra lãs nociones de juventud, territorio y seguridad. Piensar que esas nociones y entrelazamientos se vuelven relevantes como medio de análisis y justificacion esperpassan y mantener El control como formas de juventuden Brasil. Los analizadores de três investigaciones, como los que atravesan este tema son usados: El primero discute un problema de seguridad em escuelas públicas del Estado; un segundo sobre adolescentes insertados sistema de justicia juvenil, pero también el estado de Río; y una final, com el análisis sobre la política de drogas en Brasil. Afirmando que La diversidad y multiplicidad de formas son jóvenes líneas, se trazan líneas de segregación que delimitan a algunas juventudes como más peligrosas, que se convierten em um mayor objetivo de control social. Así, La seguridad y El territorio se sostienen como líneas transversales a las temáticas de cada investigación y se delinean como racionalidades que concurren em la construcción de las políticas públicas para cierta juventud en Brasil.

Responsabilidad personal con la salud. Conocimientos y percepciones de diferentes actores sociales / Personal Responsibility with Health. Differents Social Actors Knowledges and Perceptions

RESUMEN Fundamento el proceso de actualización del modelo económico y social cubano refrenda la necesidad de asegurar el adecuado equilibrio entre las responsabilidades que competen al Estado y al Gobierno y las correspondientes a los individuos. Se ha producido un reposicionamiento del tema de la responsabilidad personal con la salud a nivel nacional, pero se desconoce la representación social de este término en diferentes actores sociales que intervienen en la gobernanza para la salud en el nivel comunitario y local. Objetivo: explorar los conocimientos y percepciones que poseen diferentes actores sociales de la comunidad sobre la responsabilidad personal con la salud. Método: se seleccionó una muestra de 385 sujetos del área de salud Andrés Ortiz del municipio Guanabacoa en La Habana mediante criterios probabilísticos y discrecionales, compuesta por profesionales y técnicos del sector de la salud, miembros de organizaciones no gubernamentales, de organizaciones políticas, del gobierno local y de la ciudadanía pertenecientes a tres consultorios de la atención primaria de salud. Se construyeron y validaron instrumentos para la recogida de datos. Se obtuvo la información mediante entrevistas semiestructuradas y encuestas. Se realizó análisis de contenido del discurso y análisis descriptivo de los datos utilizando frecuencias absolutas y relativas. Resultados: el 100 % de los profesionales y técnicos del sector de la salud, de los miembros del gobierno local, de las organizaciones políticas y de las organizaciones no gubernamentales poseía referencias previas sobre el término, pero solo el 45 % de la ciudadanía había escuchado acerca de él. Las fuentes del conocimiento previo sobre el término difirieron entre los actores sociales. La percepción de que la responsabilidad personal con la salud debe restringirse al autocuidado individual fue mayoritaria principalmente entre la ciudadanía (83,4 %), los representantes de las organizaciones no gubernamentales (78 %), los miembros del gobierno local y dirigentes del sector salud (62,5 %), los técnicos y profesionales de la salud (59 %) y en menor proporción los profesores de ese sector (50 %). El 100 % de los representantes de las organizaciones políticas percibieron que esta responsabilidad debía tener una visión individual. Conclusiones: existen divergencias en el campo representacional de la responsabilidad personal con la salud entre los diferentes actores sociales consultados. Predominó el entorno discursivo y representacional relacionado con una responsabilidad personal limitada a la salud individual.

ABSTRACT Background: the updating process of the Cuban economic and social model support the need to ensure the proper balance between the responsibilities that concern the State and the Government and those corresponding to individuals. There has been a repositioning of the issue of personal responsibility with health at the national level, but the social representation of this term in different social actors that intervene in health governance at the community level, community and local level, is unknown. Objective: to explore the knowledge and perceptions that different social actors in the community have on personal responsibility with health. Method: a sample of 385 subjects from the Andrés Ortiz health area of ​​the Guanabacoa municipality in Havana was selected using probabilistic and discretionary criteria, composed of professionals and technicians from the health sector, members of non-governmental organizations, political organizations, and the government local and citizens belonging to three clinics of primary health care. Instruments for data collection were built and validated. The information was obtained through semi-structured interviews and surveys. Discourse content analysis and descriptive data analysis were performed using absolute and relative frequencies. Results: the 100 % of professionals and technicians from the health sector, members of local government, political organizations and non-governmental organizations had previous references to the term, but only the 45 % of the public had heard about him. The sources of prior knowledge about the term differed among social actors. The perception that personal responsibility for health should be restricted to individual self-care was the majority mainly among citizens (83.4 %), representatives of non-governmental organizations (78 %), members of the local government and leaders of the health sector (62.5 %), technicians and health professionals (59 %) and, to a lesser proportion teachers in this sector (50 %). The 100 % of the representatives of the political organizations perceived that this responsibility should have an individual vision. Conclusions: there are differences of opinion in the representational field of personal responsibility with health among the different social actors consulted. The discursive and representational environment predominated, related to personal responsibility limited to individual health.

Integração ensino- trabalho- cidadania: vivência de alunos de graduação em fisioterapia / Integration among education, work and citizenship: experience of physical therapy graduate students / Integración enseñanza-trabajo-ciudadanía: experiencia de estudiantes de grado en fisioterapia

A Integração Ensino-Trabalho-Cidadania (IETC) é uma proposta de ensino de abordagem diversificada e que prevê interação entre as esferas prática e teórica, buscando ampliar a capacidade de resolução de problemas a partir de situações reais, e abordando a importância da cooperação e trabalho em equipe. Este estudo objetiva relatar a vivência de estudantes de fisioterapia durante o processo ensino aprendizagem por intermédio da IETC. Trata-se de um relato de experiência, elaborado no contexto das disciplinas Integração Ensino-Trabalho e Fisioterapia na Atenção Básica, ministradas no segundo período do curso de graduação em fisioterapia do Centro Universitário Serra dos Órgãos (Unifeso). A IETC foi implementada no ano de 2018 nos cursos do Centro de Ciências em Saúde, inicialmente objetivando potencializar e fortalecer a proposta da integração ensino e trabalho na comunidade do conjunto habitacional da Fazenda Ermitage, no município de Teresópolis, Rio de Janeiro. Nesse contexto, as atividades acadêmicas desenvolvidas têm como principal público-alvo os moradores, vítimas da tragédia natural de 2011. Os cenários de aprendizagem por meio da IETC constituíram-se espaços de cuidado, conhecimento e cidadania, incrementando a formação profissional dos estudantes. Especificamente, os alunos de fisioterapia vivenciaram abordagens educativas, ações assistenciais, individuais, coletivas, bem como diferentes práticas no campo técnico e de pesquisa. Assim, considera-se que a formação acadêmica com pensares e ações sociais promove uma perfeita interação entre discentes, docentes, gestores e a população, criando um cenário de prática humanitária e resolutiva.

Integration among Education, Work and Citizenship is a teaching proposal in the formation of future professionals, having a diversified approach between practice and theory and seeks to amplify the capacity of problem resolution starting from real situations by addressing the importance of cooperation and teamwork. This study aims at reporting the experience of physical therapy students during the teaching-learning process by IETC. This is an experience report, elaborated on the context of the subjects of Integration among Education, Work and Citizenship and Physical Therapy on Basic Attention, ministered on the 2nd term of the Physical Therapy undergraduation course at Centro Universitário Serra dos Órgãos (UNIFESO). The Integration among Education, Work and Citizenship was implemented in 2018 in the courses of the Sciences in Health Center from UNIFESO, first aiming at empower and strengthen the education and work integration, in the housing community at Fazenda Ermitage in the city of Teresópolis, state of Rio de Janeiro, Brazil. In that context, the academic activities performed had as main target assist the residents, victims of the natural disaster of 2011. The learning scenario through, constituted spaces of care, learning and citizenship, incrementing professional formation in the students. Specifically, the physical therapy students experienced over educational approach, individual and collective assistance actions and different practices in the technical and research field. The academic formation with thoughts and social actions promote a perfect interaction between students and teachers, managers and the population, thus creating a scenario of humanitarian and resolutive practice.

La Integración Enseñanza-Trabajo-Ciudadanía (IETC) es una propuesta de enseñanza que tiene un enfoque diversificado y que busca una interacción entre las esferas práctica y teórica con el propósito de expandir la capacidad de resolución de problemas desde situaciones reales, abordando la importancia de la cooperación y el trabajo en equipo. El estudio tiene como objetivo informar la experiencia de los estudiantes de fisioterapia durante el proceso de enseñanza-aprendizaje por medio de IETC. Este es un informe de experiencia, preparado en el contexto de las disciplinas Integración Enseñanza-Trabajo y Fisioterapia en Atención Primaria, impartidas en el segundo período del curso de grado en fisioterapia en Centro Universitário Serra dos Órgãos (UNIFESO). El IETC se implementó en 2018 en los cursos del Centro de Ciencias de la Salud, inicialmente con el objetivo de mejorar y fortalecer la propuesta para la integración de la educación y el trabajo en la comunidad del complejo de viviendas Fazenda Ermitage en municipio de Teresópolis (Rio de Janeiro, Brasil). Las actividades académicas se destinaban a los residentes en esta zona, víctimas del desastre natural de 2011. Los escenarios de aprendizaje mediante IETC constituyeron espacios de atención, conocimiento y ciudadanía, aumentando la educación profesional de los estudiantes. Específicamente, los estudiantes de fisioterapia experimentaron enfoques educativos, acciones de atención, individuales, colectivas, así como diferentes prácticas en el campo técnico y de investigación. La formación académica con pensamientos y acciones sociales promueve una interacción perfecta entre estudiantes, docentes, directivos y la población, así se crea un escenario de práctica humanitaria y decidida.