Las nociones de juventud y relaciones intergeneracionales en los enfoques de promoción de la salud / As noções de juventude e relações intergeracionais nas abordagens da promoção da saúde / The notions of youthand intergenerational relationships in health promotion approaches

RESUMEN La promoción de la salud ha originado un debate fructífero y polémico en la reflexión sobre las prácticas sanitarias. Este trabajo contribuye con aportes a ese debate indagando el papel de los jóvenes en estas prácticas, el valor de sus experiencias, y los problemas que enfrentan. Con base en una investigación de carácter teórico, se identificó el alcance de la noción de juventud y sus implicancias en torno a la promoción de la salud, así como las formas que asume la relación adulto - joven para el desarrollo de esas experiencias. Se reconoce el carácter plural de las juventudes, tanto en lo que refiere a la singularidad de las trayectorias como a la diversidad cultural y la vulnerabilidad en que se encuentran. Se analiza la visión hegemónica afirmada sobre discursos que restringen la autonomía de las personas jóvenes y quitan potencia a los propios cuidados.

RESUMO A promoção da saúde deu origem a um debate frutífero e controverso em torno da reflexão sobre as práticas de saúde. Esse trabalho é uma contribuição para esse debate e apresenta perguntas sobre o papel dos jovens nessas práticas, o valor de suas experiências e os problemas que enfrentam. A partir de uma investigação teórica, identificou-se o escopo da noção de juventude e suas implicações na promoção da saúde, bem como as formas que a relação adulto-jovem assume para o desenvolvimento dessas experiências. Se reconhece o caráter plural da juventude, tanto em termos da singularidade das trajetórias quanto da diversidade cultural e a vulnerabilidade em que convivem. E analisada a visão hegemônica afirmada em discursos que restringem a autonomia dos jovens e minimizam a importância dos cuidados próprios.

ABSTRACT Health promotion has given rise to a controversial discussion on health practices. This article contributes by investigating the role of young people in these practices, the value of their experiences, and the problems they face. Based on a theoretical research, the scope of the notion of youth and its implications regarding health promotion were identified, as well as the forms that the adult - young relationship assumes for the development of these experiences.The plural nature of youth is recognized, both in terms of the uniqueness of the trajectories as well as the cultural diversity and vulnerability in which they are found. The hegemonic visión affirmed on discourses that restrict the autonomy of young people and remove power from their own care is analyzed.

Can open-defecation free (ODF) communities be sustained? A cross-sectional study in rural Ghana.

Community-led total sanitation (CLTS) is a widely used approach to reduce open defecation in rural areas of low-income countries. Following CLTS programs, communities are designated as open defecation free (ODF) when household-level toilet coverage reaches the threshold specified by national guidelines (e.g., 80% in Ghana). However, because sanitation conditions are rarely monitored after communities are declared ODF, the ability of CLTS to generate lasting reductions in open defecation is poorly understood. In this study, we examined the extent to which levels of toilet ownership and use were sustained in 109 communities in rural Northern Ghana up to two and a half years after they had obtained ODF status. We found that the majority of communities (75%) did not meet Ghana's ODF requirements. Over a third of households had either never owned (16%) or no longer owned (24%) a functional toilet, and 25% reported practicing open defecation regularly. Toilet pit and superstructure collapse were the primary causes of reversion to open defecation. Multivariate regression analysis indicated that communities had higher toilet coverage when they were located further from major roads, were not located on rocky soil, reported having a system of fines to punish open defecation, and when less time had elapsed since ODF status achievement. Households were more likely to own a functional toilet if they were larger, wealthier, had a male household head who had not completed primary education, had no children under the age of five, and benefitted from the national Livelihood Empowerment Against Poverty (LEAP) program. Wealthier households were also more likely to use a toilet for defecation and to rebuild their toilet when it collapsed. Our findings suggest that interventions that address toilet collapse and the difficulty of rebuilding, particularly among the poorest and most vulnerable households, will improve the longevity of CLTS-driven sanitation improvements in rural Ghana.

When More is More: Do Non-Restricted Goals Benefit Employers and the Environment Too?

Prior research on goal self-concordance (GSC) and goal attainment (GA) has studied these dimensions as transversal sections through a person’s life domains. Blending the recent developments in self-determination theory and pro-environmental behavior literature, the current study introduced the concept of non-restricted goals and explored whether work climate (WCQ) and environmental identity (EID) impact GA and, through it, in-role job performance (IRB), organizational citizenship behaviors (OCB) and wellbeing, as well as organizational citizenship behaviors for the environment (OCBE). It also explored GSC along with basic psychological needs’ satisfaction (BPNS) and GA, as explanatory mechanisms. The study relied on data collected at two different moments in time, with a retained sample of 201 employees from different organizations. Results confirmed that WCQ and EID are relevant antecedents for IRB, OCB and wellbeing, as well as OCBE. Except for the direct relationship between EID and OCB/OCBE, most of these impacts were indirect, through BPNS, GSC or GA. The current study did not find a significant relationship between GSC and GA, adding to the line of mixed results regarding their relationship. The findings inform pro-environmental interventions in the workplace, as well as human resource management practices that foster employee wellbeing, work-life balance, and job performance. (AU)

Depressive Symptoms Moderate the Relationship Among Physical Capacity, Balance Self-Efficacy, and Participation in People After Stroke.

OBJECTIVE: It was previously found that balance self-efficacy mediated the relationship between physical capacity and participation after stroke. The effect of other factors that influence participation, such as depression, on this relationship has not been explored. This study examined the effect of symptoms of depression on the mediated relationship between physical capacity and participation by balance self-efficacy in individuals after stroke. METHODS: In this cross-sectional study, 282 persons with chronic stroke (>6 months) were classified as having either low or high Geriatric Depression Scale scores. This study used a multiple group structural equation model to test moderated mediation by comparing a constrained model (indicating no effect of depression on the mediation) and an unconstrained model (indicating an effect of depression on the mediation). The models were compared using a chi-squared difference test. RESULTS: The chi-squared difference test suggested that the unconstrained model was a better fit, indicating that depressive symptoms moderated the mediated relationship between physical capacity and participation (χ2(3, N = 282) = 9.0). In the Low Depression group, a significant indirect effect indicated that balance self-efficacy did mediate the relationship between physical capacity and participation. There was no significant indirect effect in the High Depression group. CONCLUSION: The results suggest the relationship between physical capacity and participation appears to be mediated by balance self-efficacy in individuals after stroke with low reports of depressive symptoms, but in those with high reports of depressive symptoms, physical capacity and balance self-efficacy are unrelated to participation. IMPACT: Targeting balance self-efficacy to improve post-stroke participation may be beneficial only for individuals with low reports of depression. In individuals after stroke with high reports of depression, treatment should include and emphasize the treatment of those depressive symptoms. Additional work further examining these complex relationships is warranted.

The impact of community led alternative rite of passage on eradication of female genital mutilation/cutting in Kajiado County, Kenya: A quasi-experimental study.

INTRODUCTION: In Kenya, Female Genital Mutilation/Cutting (FGM/C) is highly prevalent in specific communities such as the Maasai and Somali. With the intention of curtailing FMG/C prevalence in Maasai community, Amref Health Africa, designed and implemented a novel intervention-community-led alternative rite of passage (CLARP) in Kajiado County in Kenya since 2009. The study: a) determined the impact of the CLARP model on FGM/C, child early and forced marriages (CEFM), teenage pregnancies (TP) and years of schooling among girls and b) explored the attitude, perception and practices of community stakeholders towards FGM/C. METHODS: We utilised a mixed methods approach. A difference-in-difference approach was used to quantify the average impact of the model with Kajiado as the intervention County and Mandera, Marsabit and Wajir as control counties. The approach relied on secondary data analysis of the Kenya Demographic and Health Survey (KDHS) 2003, 2008-2009 and 2014. A qualitative approach involving focus group discussions, in-depth interviews and key informant interviews were conducted with various respondents and community stakeholders to document experiences, attitude and practices towards FGM/C. RESULTS: The CLARP has contributed to: 1) decline in FGM/C prevalence, CEFM rates and TP rates among girls by 24.2% (p<0.10), 4.9% (p<0.01) and 6.3% (p<0.01) respectively. 2) increase in girls schooling years by 2.5 years (p<0.05). Perceived CLARP benefits to girls included: reduction in teenage marriages and childbirth; increased school retention and completion; teenage pregnancies reduction and decline in FGM/C prevalence. Community stakeholders in Kajiado believe that CLARP has been embraced in the community because of its impacts in the lives of its beneficiaries and their families. CONCLUSION: This study demonstrated that CLARP has been positively received by the Maasai community and has played a significant role in attenuating FGM/C, CEFM and TP in Kajiado, while contributing to increasing girls' schooling years. CLARP is replicable as it is currently being implemented in Tanzania. We recommend scaling it up for adoption by stakeholders implementing in other counties that practice FGM/C as a rite of passage in Kenya and across other sub Saharan Africa countries.

Understanding how communities respond to COVID-19: experiences from the Orthodox Jewish communities of Antwerp city.

BACKGROUND: The importance of community involvement in the response against disease outbreaks has been well established. However, we lack insights into local communities' experiences in coping with the current COVID-19 pandemic. This study explored both the impact of, and response to, COVID-19 within the Orthodox Jewish communities of Antwerp (Belgium) during the first lockdown period (March 2020 - May 2020). METHODS: We conducted an explorative qualitative study using a participatory approach. First, we performed a community mapping to identify relevant stakeholders. Through the active involvement of a community advisory board and based on qualitative interviews with key-informants and community members, we elicited lived experiences, attitudes, and perceptions towards COVID-19. Interviews were conducted both face-to-face and using online web conferencing technology. Data were analyzed inductively according to the principles of thematic analysis. RESULTS: Government-issued outbreak control measures presented context-specific challenges to the Orthodox Jewish communities in Antwerp. They related mainly to the remote organization of religious life, and practicing physical distancing in socially and culturally strongly connected communities. Existing community resources were rapidly mobilized to adapt to the outbreak and to self-organize response initiatives within communities. The active involvement of community and religious leaders in risk communication proved to be of great importance to facilitate the coverage and uptake of pandemic control measures while protecting essential community values and traditions. Creating bottom-up and community-adapted communication strategies, including addressing language barriers and involving Rabbis in the dissemination of prevention messages, fostered a feeling of trust in government's response measures. However, unmet information and prevention needs were also identified, such as the need for inclusive communication by public authorities and the need to mitigate the negative effects of stigmatization. CONCLUSION: The experiences of Orthodox Jewish communities in Antwerp demonstrate a valuable example of a feasible community-centered approach to health emergencies. Increasing the engagement of communities in local decision-making and governance structures remains a key strategy to respond to unmet information and prevention needs.

Adolescent, caregiver and community experiences with a gender transformative, social emotional learning intervention.

BACKGROUND: Inequitable gender norms, beliefs and behaviors, are shaped by learning experiences during key developmental stages in an individual's life course, and can have negative impacts on health and well-being outcomes. Very early adolescence represents one stage when formative learning experiences about gender inequity can have the potential to support or hinder more equitable gender norms, beliefs and behaviors. The aim of this qualitative study was to evaluate the effect of a gender transformative, social emotional learning intervention for very young adolescents (VYAs) that included experiential learning with peers, parents/caregivers and community members. METHODS: This study examined the effects of an intervention designed to provide social emotional learning opportunities for adolescents ages 10-11 in Dar es Salaam, Tanzania. The qualitative sample included 279 participants. Qualitative methods included 102 in-depth interviews with VYAs, 22 focus groups with 117 VYAs, 60 in-depth interviews with parents/caregivers and 54 participant observations. A grounded theory approach was used to identify emergent themes. RESULTS: Participants reported growth in targeted areas of social emotional mindsets and skills, including a shift in gender norms, beliefs and behaviors. VYAs reported that experiential learning in mixed gender teams provided opportunities to actively practice and reflect on gender norms, beliefs and behaviors. VYAs also reported active practice of social emotional mindsets and skills with peers, parents/caregivers and the community. Parents/caregivers reported changes in VYAs' social emotional mindsets and skills within the home, with the community and with siblings and peers. Both adolescents and parent/caregivers reported positive change towards more equitable gender norms, beliefs and behaviors through participation in experiential learning activities and reflective discussions. CONCLUSIONS: These findings suggest that an intervention providing social and emotional experiential learning opportunities during the developmental window of very young adolescence can be effective in transforming gender norms, beliefs and behaviors. Involvement of peers, parents/caregivers and community members was effective at supporting learning social emotional mindsets and skills in VYAs. Findings encourage local and global adolescent programming to include gender transformative content paired with social emotional experiential learning with peers, family and the community and can stimulate positive change in gender norms, beliefs and behaviors to promote gender equity.

What do you mean by engagement? - evaluating the use of community engagement in the design and implementation of chronic disease-based interventions for Indigenous populations - scoping review.

BACKGROUND: Indigenous populations have remained strong and resilient in maintaining their unique culture and values, despite centuries of colonial oppression. Unfortunately, a consequential result of facing years of adversity has led Indigenous populations to experience a disproportionate level of poorer health outcomes compared to non-Indigenous populations. Specifically, the rate of Indigenous chronic disease prevalence has significantly increased in the last decade. Many of the unique issues Indigenous populations experience are deeply rooted in their colonial history and the intergenerational traumas that has subsequently impacted their physical, mental, emotional and spiritual well-being. With this, to better improve Indigenous health outcomes, understanding the local context of their challenges is key. Studies have begun to use modes of community engagement to initiate Indigenous partnerships and design chronic disease-based interventions. However, with the lack of a methodological guideline regarding the appropriate level of community engagement to be used, there is concern that many interventions will continue to fall short in meeting community needs. OBJECTIVE: The objective of this study was to investigate the how various community engagement strategies have been used to design and/or implement interventions for Indigenous populations with chronic disease. METHODS: A scoping review guided by the methods outlined by Arksey and O'Malley was conducted. A comprehensive search was completed by two reviewers in five electronic databases using keywords related to community engagement, Indigenous health and chronic disease. Studies were reviewed using a descriptive-analytical narrative method and data was categorized into thematic groups reflective of the main findings. RESULTS: We identified 23 articles that met the criteria for this scoping review. The majority of the studies included the use a participatory research model and the procurement of study approval. However, despite the claimed use of participatory research methods, only 6 studies had involved community members to identify the area of priority and only five had utilized Indigenous interview styles to promote meaningful feedback. Adapting for the local cultural context and the inclusion of community outreach were identified as the key themes from this review. CONCLUSION: Many studies have begun to adopt community engagement strategies to better meet the needs of Indigenous Peoples. With the lack of a clear guideline to approach Indigenous-based participatory research, we recommend that researchers focus on 1) building partnerships, 2) obtaining study approval and 3) adapting interventions to the local context.

Using the 4Ms framework to teach geriatric competencies in a community clinical experience.

BACKGROUND: As the population of older adults in the US steadily increases and becomes more diverse, there is an urgent need to integrate geriatric competencies into baccalaureate nursing education. PURPOSE: To integrate the Institute for Healthcare Improvement 4 Ms Framework into an existing baccalaureate nursing community clinical experience to build geriatric and interprofessional competencies and promote positive health outcomes. METHODS: As part of the Geriatric Workforce Enhancement Program, 15 students worked with bilingual social workers and community health workers in an affordable housing urban highrise, assessed building residents and implemented personalized plans of care using the 4Ms framework (what matters to the individual, medications, mentation, and mobility). RESULTS: Students demonstrated competence conducting cognition and depression screening, medication review, and functional and fall risk assessments. Student self-rated achievement of learning objectives ranged from 4.3 to 4.8 (1-5 scale). A retrospective pretest-posttest survey suggested learning about the importance of interprofessional teamwork, and integration of person-centered values when providing care to older adults in the community. Students reflected on barriers to health for older adults in low socioeconomic states and the importance of improving care across the continuum. CONCLUSION: The 4Ms framework provided a valuable construct to guide the community experience and teach geriatric evidence-based practice to nursing students.

Homeostasis Revisited: Patterns of Stability and Rebalancing in Older Adults' Social Lives.

OBJECTIVES: To examine patterns of change in later-life social connectedness: (a) the extent and direction of changes in different aspects of social connectedness, including size, density, and composition of social networks, network turnover, and three types of community involvement and (b) the sequential nature of these changes over time. METHOD: We use three waves of nationally representative data from the National Social Life, Health, and Aging Project, collected from 2005/2006 to 2015/2016. Respondents were between the ages of 67 and 95 at follow-up. Types of changes in their social connectedness between the two successive 5-year periods are compared to discern over-time change patterns. RESULTS: Analyses reveal stability or growth in the sizes of most older adults' social networks, their access to non-kin ties, network expansiveness, as well as several forms of community involvement. Most older adults experienced turnover within their networks, but losses and additions usually offset each other, resulting in generally stable network size and structural features. Moreover, when older adults reported decreases (increases) in a given form of social connectedness during the first half of the study period, these changes were typically followed by countervailing increases (decreases) over the subsequent 5-year period. This general pattern holds for both network and community connectedness. DISCUSSION: There is an overwhelming tendency toward either maintaining or rebalancing previous structures and levels of both personal network connectedness and community involvement. This results in overall homeostasis. We close by discussing the need for a unifying theoretical framework that can explain these patterns.

Outside the norm: Mental health, school adjustment and community engagement in non-binary youth.

Aims: The aim of this study was to explore the role of self-reported non-binary gender identity in mental health problems, school adjustment, and wish to exert influence on municipal issues in a community sample of adolescents. Methods: In a cross-sectional design, data were collected through an anonymous survey in Uppsala County, Sweden, among 8385 students (response rate 58.2%) in grades 7, 9, and 11, aged 13-17 years. The Strengths and Difficulties Questionnaire (SDQ) self-report was used to assess mental health problems. Gender identity was measured with one item and youth were categorized into those who identified as male or female (i.e. binary youth), and those who did or could not identify with either gender (i.e. non-binary youth). Logistic regressions and qualitative content analysis were used to analyse data. Results: Youth with non-binary gender identity (n = 137; 1.6%) had higher odds of having mental problems according to the SDQ total score (OR=3.05; 1.77-5.25). The association between non-binary gender identity and mental health problems remained significant after adjusting for confounders. Additionally, compared to their binary peers, the non-binary youth reported more truancy (36.5% vs 49.6%), more often failed a subject (21.5% vs 36.5%), and were more interested in exerting influence on municipal issues such as sociopolitical development, education, municipal services, and drug and alcohol policies (25.3% vs 38.0%). Conclusions: Youth with non-binary gender identity constitute a vulnerable population regarding mental health problems and school adjustment. The willingness to exert influence on municipal issues suggests a possible pathway to engagement.

Concept analysis of nursing activism.

Nursing history is firmly rooted in social and political activism; however, both the word activism and its defined actions have been minimized in modern nursing practice. This paper seeks to define activism, its uses, and importance to the nursing discipline. A concept analysis using the Walker and Avant (2019) method was conducted. Literature sources were identified through a search of PubMed, CINAHL, and PsycINFO along with hand searches of reference lists. Nursing activism is a concept that extends from within the discipline's ethical responsibilities and social contract with humanity. Activism differs from advocacy or engagement as it requires the expenditure of energy including personal, social, and/or political capital. Nursing activism is a necessary response to health inequities, social accountability, and advancement of the nursing profession.

Fear of Falling, Community Participation, and Quality of Life Among Community-Dwelling People Who Use Wheelchairs Full Time.

OBJECTIVES: To examine the differences in community participation and quality of life (QOL) among individuals who use wheelchairs full time with and without fear of falling (FOF). DESIGN: Cross-sectional study design. SETTING: University research laboratory. PARTICIPANTS: Individuals (N=85) who use a manual or power wheelchair full time who are living with various health conditions and have a history of at least 1 fall in the past 12 months (age, 45.4±15.8y; disability duration, 21.5±13.6y) were included. Forty-six (54%) were manual wheelchair users. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: To quantify FOF, participants responded (yes/no) to the question: "Are you worried or concerned that you might fall?" Community participation and QOL were indexed by the Community Participation Indicator (CPI) and the World Health Organization Quality of Life-Brief version (WHOQOL-BREF), respectively. A multivariate analysis of variance (MANOVA) was performed to examine the differences in CPI and WHOQOL-BREF scores among wheelchair users who reported FOF and no FOF. RESULTS: A total of 54 participants (63.5%) reported that they were worried or concerned about falling. The MANOVA revealed significant differences in overall CPI (F2,82=4.714; P=.012; Wilks' λ=0.897) and WHOQOL-BREF (F4,63=3.32; P=.016; Wilks' λ=.826) scores. Participants who reported FOF demonstrated significantly lower CPI and WHOQOL-BREF scores compared with those who did not report FOF. CONCLUSIONS: FOF and associated activity curtailment are prevalent and may be a factor influencing full time wheelchair users' community participation and QOL. Prospective research is needed to better understand how FOF influences community participation and QOL among individuals who use wheelchairs full time. Findings would support the development of interventions, specifically for individuals who use wheelchairs full time, to reduce FOF and improve community participation and QOL.

Developing community mobility and driving with youth on the autism spectrum: A psychosocial perspective.

BACKGROUND: Youth on the autism spectrum face particular challenges with community mobility and driving, contributing to reduced community participation. Skill development may be uniquely shaped by complex interactions between autistic traits, psychosocial influences and community environments. Research to guide occupational therapy practice is sparse. OBJECTIVE: This short report explores the complex interplay between psychosocial and environmental influences on community mobility development, to stimulate further occupational therapy research and provide considerations for practice. METHOD: Because of the lack of autism specific research, we firstly discuss psychosocial and environmental influences impacting non-autistic youth, then draw on current research to identify challenges for youth on the spectrum. Finally, we propose considerations for practice and research. CONCLUSION: Psychosocial considerations for developing community mobility and driving include social communication, safety, navigating unpredictable community environments, emotional regulation and motivation for community participation. Future research should explore how to develop foundational community mobility skills; communication and social skills; and autistic needs for inclusive design. Supporting normative community mobility skills during adolescence may underpin transition to independence in adulthood. SIGNIFICANCE: Broadening the focus of community mobility and driving research to understand environmental and psychosocial contexts of community environments, is necessary to provide guidance for occupational therapists supporting youth on the spectrum with independent community participation.

Oficinas de atividades, dinâmicas e projetos em Terapia Ocupacional Social como estratégia para a promoção de espaços públicos / Workshops of activities, dynamics, and projects in Social Occupational Therapy as a strategy to foster public spaces / Talleres de actividades, dinámicas y proyectos en Terapia Ocupacional Social como estrategia para la promoción de espacios públicos

Objetiva-se refletir à luz da teoria de Hannah Arendt sobre oficinas de atividades, dinâmicas e projetos, em Terapia Ocupacional Social, como estratégia na promoção de espaços públicos. Baseia-se na análise de uma experiência de ensino, pesquisa e extensão universitária, durante a qual se realizou objetivação participante das oficinas realizadas semanalmente com jovens pobres, ao longo de um ano. Partindo dos registros em diário de campo e de entrevistas com participantes, realizou-se uma leitura das oficinas como possível fomento à oferta de espaços para a convivência, no exercício da igualdade e da tessitura da sociabilidade diante da pluralidade; da visibilidade de sujeitos em vulnerabilidade social e suas demandas; de liberdade para participação na tomada de decisões e aprendizados acerca da vida coletiva e da cidadania, podendo auxiliar na promoção de espaços públicos para múltiplas vivências sociais. (AU)

The objective is to reflect upon Hannah Arendt's theory on workshops of activities, dynamics, and projects in social occupational therapy as a strategy to foster public spaces. Based on the analysis of a teaching, research, and university extension experience during which the participants of weekly workshops held with poor young people for one year were objectified. Based on field notes and interviews with participants, the workshops were analyzed as a potential promotion of living spaces to practice equality and sociability's interconnection regarding its plurality, visibility of socially vulnerable subjects and their demands, freedom to participate in decision-making processes and learnings regarding collective life and citizenship, being able to help foster public spaces in multiple social experiences. (AU)

El objetivo es reflexionar a la luz de la teoría de Hanna Arendt sobre Talleres de Actividades Dinámicas y proyectos en Terapia Ocupacional Social, como estrategia en la promoción de espacios públicos. Se basa en el análisis de una experiencia de enseñanza, investigación y extensión universitaria, durante la cual se realizó objetivación participante de los Talleres realizados semanalmente con jóvenes pobres en el transcurso de un año. Partiendo de los registros en diario de campo y de entrevistas con participantes, se realizó una lectura de los Talleres como posible fomento a la oferta de espacio para la convivencia, en el ejercicio de la igualdad y de la trama de la sociabilidad ante la pluralidad, de la visibilidad de sujetos en vulnerabilidad social y sus demandas; de libertad para la participación en la toma de decisiones y aprendizajes sobre la vida colectiva de la ciudadanía, pudiendo auxiliar en la promoción de espacios públicos para múltiples vivencias sociales. (AU)

Práticas de cuidado extramuros nos Centros de Atenção Psicossocial Álcool e outras Drogas: a ocupação cidadã / Extramural care practices developed outside Alcohol and drugs Psychosocial Care Centers: citizen occupation / Prácticas de cuidado extramuros en los Centros de Atención Psicosocial Alcohol y Drogas: la ocupación ciudadana

Este artigo tem por objetivo investigar as práticas extramuros realizadas pelos profissionais que atuam nos Centros de Atenção Psicossocial Álcool e outras Drogas (CAPSad) do Distrito Federal (DF). Trata-se de uma pesquisa de abordagem qualitativa de caráter exploratório e descritivo. A coleta de dados ocorreu por meio de entrevista semiestruturada e questionário sociodemográfico e ocupacional com 48 profissionais que atuam nos sete CAPSad do DF. Adotou-se a análise de conteúdo de Bardin e de forma complementar o software NVivo. Constatou-se que os profissionais realizaram práticas extramuros inovadoras e exitosas, como: "Loja de rua", "Jardim comunitário", "Clube de corrida", atividades esportivas, de geração de renda, participações políticas, de arte, lazer e cultura. No entanto, ainda são escassas as ações de cuidado extramuros de forma sistemática, sendo a maioria temporária. É imprescindível que trabalhadores sejam capacitados e tenham condições para atuar extramuros. (AU)

This article investigates the extramural practices developed by health professionals working in Alcohol and Drugs Psychosocial Care Centers (CAPSad) in the Federal District, Brazil. We conducted a qualitative exploratory descriptive study with data collected using semi-structured interviews and sociodemographic and occupational questionnaires administered to 48 professionals working in seven CAPSad located in the Federal District. We adopted the content analysis method proposed by Bardin and NVivo. The findings show that the professionals developed innovative and successful extramural practices, including: "street shops", "community gardens", "running clubs", sports, income generating activities, and political participation through art, leisure and culture. However, systematic extramural care actions remain scarce and tend to be temporary. It is vital that health worker are trained and have the conditions necessary to develop extramural activities. (AU)

El objetivo de este artículo es investigar las prácticas extramuros realizadas por los profesionales que actúan en los Centros de Atención Psicosocial alcohol y otras drogas (CAPSad) del Distrito Federal (DF). Se trata de una investigación de abordaje cualitativo de carácter exploratorio y descriptivo. La colecta de datos se realizó por medio de entrevista semiestructurada y cuestionario sociodemográfico y ocupacional con 48 profesionales que actúan en los siete CAPSad del DF. Se adoptó el análisis de contenido de Bardin y de forma complementaria el software NVivo. Se constató que los profesionales realizaron prácticas extramuros innovadoras y exitosas, como: "Tienda de calle", "Jardín comunitario", "Club de carreras", actividades deportivas, de generación de renta, participaciones políticas de arte, ocio y cultura. Sin embargo, todavía son escasas las acciones de cuidado extramuros de forma sistemática, siendo la mayoría temporales. Es imprescindible que los trabajadores sean capacitados y tengan condiciones para actuar extramuros. (AU)

Quem é o "cidadão de bem"? / ¿Quién es el "ciudadano de bien"? / Qui est le "bon citoyen"? / Who is the "good citizen"?

Resumo A figura do chamado "cidadão de bem" constitui um tipo de estratégia discursiva ideológica e expressa uma patologia social da cidadania brasileira. O objetivo deste ensaio é submeter essa figura a uma análise crítica de seus pressupostos discursivos, históricos, morais e políticos. Para tanto, recorremos ao modelo de crítica imanente da ideologia proposto por Rahel Jaeggi. Identificamos contradições e problemas decorrentes do uso retórico da figura do "cidadão de bem" relacionadas: ao apelo punitivista e por armas de fogo para civis; às representações ideológicas de gênero, raça e classe; à função social da mídia; e ao neoconservadorismo político. A contradição fundamental do "cidadão de bem" não é em relação à figura do "bandido" ou "vagabundo", mas ao próprio ideal de universalização da cidadania. Enquanto expressão da ideologia, o "cidadão de bem" se revela um verdadeiro anticidadão e, portanto, um risco para a democracia.

Resumen La figura del llamado "ciudadano de bien" constituye un tipo de estrategia discursiva ideológica y expresa una patología social de la ciudadanía en Brasil. El objetivo de este ensayo es analizar críticamente los presupuestos discursivos, históricos, morales y políticos de esta figura. Para ello, se utiliza el modelo de crítica inmanente de la ideología propuesto por Rahel Jaeggi. Se identificaron contradicciones y problemas derivados del uso retórico de la figura del "ciudadano de bien" relacionadas a: la demanda punitivista y por armas de fuego para civiles; las representaciones ideológicas de género, raza y clase; la función social de los medios de comunicación; y el neoconservadurismo político. La contradicción fundamental del "ciudadano de bien" no es en relación a la figura del "bandido" o del "vagabundo", sino al propio ideal de universalización de la ciudadanía. Mientras una expresión de la ideología, el "ciudadano de bien" se revela un verdadero anticiudadano y, por lo tanto, un riesgo para la democracia.

Résumé L'expression « bon citoyen ¼ constitue une stratégie discursive idéologique et traduit une pathologie sociale de la citoyenneté brésilienne. Cet essai vise à soumettre cette figure à une analyse critique de ses aspects discursifs, historiques, moraux et politiques. Pour ce faire, nous recourrons au modèle de critique immanente de l'idéologie proposée par Rahel Jaeggi. Nous avons identifié les contradictions et les problèmes découlant de l'utilisation rhétorique de la figure du « bon citoyen ¼ en rapport avec : l'appel à la punition et aux armes à feu pour les civils ; les représentations idéologiques du genre, de la race et de la classe ; la fonction sociale des médias ; et le néoconservatisme politique. La contradiction fondamentale du « bon citoyen ¼ n'est pas liée à la figure du « bandit ¼ ou du « clochard ¼, mais à l'idéal même de la citoyenneté universelle. En tant qu'expression d'une idéologie, le « bon citoyen ¼ se révèle être un véritable anti-citoyen et, par conséquent, un risque pour la démocratie.

Abstract The figure of the so-called "good citizen" constitutes a type of ideological discursive strategy and expresses a social pathology of Brazilian citizenship. The aim of this essay is to subject this figure to a critical analysis of its discursive, historical, moral and political assumptions. For this, we resort to the model of immanent critique of ideology proposed by Rahel Jaeggi. We identified contradictions and problems arising from the rhetorical use of the figure of "good citizen" related to: the punitive and firearms appeal to civilians; the ideological representations of gender, race and class; the social function of the media; and political neoconservatism. The fundamental contradiction of the "good citizen" is not in relation to the figure of "bandit" or "bum," but to the very ideal of universalization of citizenship. As an expression of ideology, the "good citizen" proved to be a real anti-citizen and, therefore, a risk for democracy.

Inclusión social de las personas con discapacidad: estudio piloto en el contexto laboral del papel mediador de la autodeterminación entre el conflicto de rol y la inclusión social / Social Inclusion of People with Disability: Pilot Study in the Workplace of the Mediating Role of Self-Determination between Role Conflict and Social Inclusion

En este estudio se pretende conocer la calidad de vida que tienen los trabajadores con discapacidad respecto a la inclusión social, así como si los problemas existentes en el trabajo (conflicto de rol) consideran que son determinantes en dicha inclusión. Además, proponemos un modelo donde se plantea que la autodeterminación tiene un efecto mediador entre el conflicto de rol y la inclusión social. El trabajo se ha realizado con un total de 51 trabajadores con discapacidad pertenecientes a un Centro Especial de Empleo que prestan un servicio de limpieza en la Administración Pública. Los resultados indican que los trabajadores valoran la inclusión social y que el conflicto de rol puede afectar a su inclusión social. Además, los hallazgos respaldan el modelo propuesto, ofreciendo una orientación para conseguir la inclusión social del colectivo con discapacidad. Al final planteamos las implicaciones prácticas del presente trabajo y, también, se debate en torno al relevante papel que desempeña el trabajo en la inclusión social

This study aims to know the perception that workers with disability have regarding social inclusion, as well as whether the problems at work (role conflict) consider them to be determinants in such inclusion. In addition, we propose a mediation model that states that self-determination has effect between role conflict and social inclusion. The work has been carried out with a total of 51 workers with disability from a Special Employment Center that they perform a cleaning job in the Public Administration. The results indicate that workers value social inclusion and that role conflict can affect their social integration. In addition, the findings support the proposed model, offering guidance to achieve social inclusion of the group with disability. In the end we propose the practical implications of this work and, also, we discuss the relevant role that work plays in social inclusion

A multilevel mixed effects analysis of informal carers health in Australia: the role of community participation, social support and trust at small area level.

BACKGROUND: Informal carers suffer from worse health outcomes than non-carers due to their caregiving role. Yet, in a society carers health is as important as that of their care recipients. This study investigated the self-assessed mental and general health outcomes of informal carers in Australia. It evaluated the influence of carers' personal social capital- a logically linked sequence of their social behaviour such as community participation, social support and trust in others- on their health outcomes. The study estimated the magnitude of small area level variation at Statistical Area Level 1 (SA1) along with individual level variation in carers' health outcomes. METHODS: The study used a multilevel mixed effects cross-sectional design using data from the Household Income and Labour Dynamics of Australia survey, wave 14. It included Australians aged 15 years and older that were surveyed in the year 2014. The sample consisted of 12,767 individuals and 5004 SA1s. The outcome measures included- mental health, general health and physical functioning, domains of the Short Form 36 Questionnaire, a widely used multi-dimensional measure of health-related quality of life. RESULTS: Informal carers suffered from poor mental (Beta = - 0.587, p = 0.003) and general health (Beta = - 0.670, p = 0.001) outcomes compared to non-carers in Australia. These health outcomes exhibited significant variation acrossSA1s in Australia, with 12-13% variation in general and mental health. However, within small local areas, differences at the individual level, accounted for most of the variation in outcomes. Moreover, levels of community participation, personal social connection and trust, as perceived by individuals in the communities, had a positive influence on both mental and general health of carers and non-carers, and were more beneficial for carers compared to non-carers. CONCLUSION: It seems that the positive influence of social capital for carers helps them in coping with the negative impact of their caregiving duty on health outcomes. Findings suggested that some targeted community support programs for carers to build on their personal social cohesion and trust in their community could help in improving their poor health profiles. Moreover, improved informal carers' health may help the health system in better managing their resources.