Contribuições para pensar a participação comunitária em saúde/saúde mental a partir da perspectiva de redes

Desde la declaración de Alma-Ata, en 1978, múltiples experiencias han incluido en sus prácticas en salud/salud mental dispositivos basados en la participación comunitaria. En ellas se han reproducido sentidos globales y abstractos que artificialmente homogeneizan las características comunitarias y participativas, reproduciendo modelos normativos que dieron origen a la Atención Primaria de Salud (APS). El objetivo de este artículo es revisar algunos de los principales aportes de la teoría de redes que, desde una perspectiva compleja, permitan redimensionar la participación comunitaria en salud. Se indagan las lógicas en que son entendidas la comunidad y la participación comunitaria en un estudio de caso. Se concluye que considerar a la población como actor potencial y generar canales efectivos de participación sigue siendo un gran desafío.Since the declaration of Alma-Ata (1978), multiple experiences have included devices based on community participation in their practices in health/mental health. Abstract and global senses that artificially homogenized community and participatory characteristics have been reproduced, reproducing models that gave rise to the Primary Health Care (PHC). This paper aims to review some of the main contributions of the networks theory that, from a complex perspective, resize the community participation in health. In a case study, the logics in which community and community participation are understood are enquired. It is concluded that to consider the population as a potential role player and to generate effective channels of participation remain a great challenge.Desde a declaração de Alma-Ata, em 1978, múltiplas experiências incluíram em suas práticas de saúde/saúde mental dispositivos baseados na participação comunitária. Nelas reproduziram-se sentidos globais e abstratos que homogeneízam artificialmente as características comunitárias e participativas, reproduzindo modelos normativos que deram origem à Atenção Primária à Saúde (APS). O objetivo deste artigo é revisar algumas das principais contribuições da teoria de redes que, desde uma perspectiva complexa, permitam redimensionar a participação comunitária em saúde. Indagam-se as lógicas que entendem a comunidade e a participação comunitária em um estudo de caso. Conclui-se que considerar a população como ator potencial e gerar canais efetivos de participação continua a ser um grande desafio.Fil: Bang, Claudia Lia. Universidad de Buenos Aires. Facultad de Psicología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Stolkiner, Alicia Ines. Universidad de Buenos Aires. Facultad de Psicología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Conceptualizing mental health into practice: considerations from the latin american social medicine/collective health percepctive

Este trabajo tiene como objetivo discutir las posibilidades de una definición de salud mental desde la perspectiva de la medicina social/salud colectiva latinoamericanas, señalándose algunas líneas de articulación entre dicho pensamiento y la salud mental. Para ello se realiza una historización de dicho movimiento y se analizan las facetas de su conceptualización del proceso salud-enfermedad-cuidado, enfatizando en ello la complejidad, la perspectiva de derechos y la referencia a la vida, en contraste con la tendencia a la objetivación/medicalización. Finalmente, se ligan estas conceptualizaciones con los debates actuales del campo de la Salud Mental.The aim of this work is to discuss about the possibilities of a mental health definition from the perspective of the Latin American social medicine/collective health movement. Some relations between that movement and the mental health are pointed out. A historical analysis of that movement is presented. The conceptualizations of the health-sickness-care process are considered, emphasizing the complexity, rights perspective and the reference to life, in contrast with the objetivation/medicalization trend. Finally, these ideas are linked with the current debates on the Mental Health field.Fil: Stolkiner, Alicia Ines. Universidad de Buenos Aires. Facultad de Psicología; Argentina. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; ArgentinaFil: Ardila Gómez, Sara Elena. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Psicología; Argentin

Neighborhood living with psychiatric patients and its impact on community attitudes: study in the Province of Buenos Aires, Argentina. 2012-2013

Objetivo: Analizar las transformaciones producidas en la comunidad de vecinos al tener entre sus miembros a personas externadas de hospitales psiquiátricos. Métodos: Estudio observacional analítico en el que se compararon zonas de vecinos de casas de convivencia en las que habitan personas externadas de un hospital psiquiátrico y zonas equivalentes pero sin casas de convivencia. Se elaboró y aplicó un cuestionario a 236 personas (grupo de estudio n=117; grupo control n=119), que indagaba por características del barrio, actitudes frente a poblaciones específicas e ideas frente a la enfermedad mental y su tratamiento. También se analizó una sub-muestra de vecinos (n=9) con otro cuestionario que exploraba por la convivencia barrial con las personas externadas y sus efectos. El análisis de los datos fue cuantitativo (SPSS 18.0) y cualitativo. Resultados: Se destaca la asociación estadísticamente significativa entre ser vecino y el grado de aceptación hacia personas con "enfermedad mental", y entre el grado de cohesión social y la aceptación de la "enfermedad mental". Conclusiones: La convivencia barrial con personas externadas tendría efectos en la salud mental de la comunidad, entendida ésta en términos psicosociales. Indexada en: Latindex Catálogo, Latindex Directorio.Objective: To analyze the effects on the neighbors’ attitudes related with the community living with people discharged from a psychiatric hospital. Methodology: Observational analytical study where two groups were compared: one composed by neighbors of group homes for discharged patients from a psychiatric hospital (study group, n = 117) and the other composed by an equivalent area but without group homes nearby (control group, n = 119). A questionnaire was administered to both groups and it explored: neighborhood features, attitudes toward certain groups, attitudes toward mental illness and its treatment. A sub-sample of the study group (n = 9) was re-contacted and a new questionnaire was administered with the purpose to analyzed in depth the community life with the group home tenants and its effects on the neighborhood and the neighbors. Data was analyzed quantitatively (SPSS 18.0) and qualitatively. Results: It was found a statistically significant difference between the study and the control group regarding acceptance toward people with mental illness. Also, and association between the level of social cohesion and the acceptance toward people with mental illness, was found. Conclusions: Community life with people discharged form psychiatric hospital would have an effect on the neighbors’ attitudes, which could be seen as a dimension of the community mental health.Fil: Ardila Gómez, Sara Elena. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; Argentina. Universidad de Buenos Aires. Facultad de Psicología; ArgentinaFil: Fernández, Marina. Universidad de Buenos Aires. Facultad de Psicología; ArgentinaFil: Hartfiel, María Isabel. Universidad Nacional Arturo Jauretche; ArgentinaFil: Guadalupe, Ares Lavalle. Universidad de Buenos Aires. Facultad de Psicología; Argentina. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; ArgentinaFil: Borelli, Mariana. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; ArgentinaFil: Canales, Valeria. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; ArgentinaFil: Stolkiner, Alicia Ines. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; Argentin

Human rights and the right to health in Latin America: the Two Faces of One Powerful Idea

During the past decade the discussion of human rights has reappeared in the field of health, replacing the technocratic approaches of the previous period which had centered on cost-effectiveness. The focus on rights in public policies, with its emphasis on international norms for social rights, has influenced primary health care (PHC) strategy and fostered the return of PHC to its original role as guarantor of the right to health.3 As human rights became increasingly global, they once again occupied a central place in World Health Organization (WHO) documents and in government attitudes. The revival of human rights discourse occurred at a time when neoliberalism was being discredited intellectually. It coincided with the appearance of governments critical of the hegemonic model of the 1990s, the restructuring of geopolitical alliances, and a crisis of world capitalism affecting its central core. Various trends have co-existed within this process; the attempt to establish more just societies runs parallel to the search for a new way to legitimize power, given the loss of consensus over the neoliberal model. This dual aspect of the inclusion of human rights in the political arena demands a careful analysis of the various discourses and the proposals with which they are associated

Women living with HIV/AIDS and mental health: legislation, rigths and dignity in care at the argentinian public health system

Este artículo analiza el marco jurídico nacional e internacional relativo a la problemática de la inclusión de prácticas en salud mental como parte de la atención integral de mujeres que viven con VIH/Sida que han sido madres recientemente en el sistema público de salud. Se busca establecer en qué medida la legislación vigente conforma un marco que posibilita la implementación de estas prácticas y promueve la dignidad en la atención. Se realizó un análisis documental cuyo corpus fue la legislación vigente relativa a la temática abordada. En las conclusiones se destaca que la atención en salud mental está poco explicitada en la legislación específica de VIH/Sida, que hace énfasis en el abordaje biomédico. Además, la legislación se orienta fundamentalmente a los objetivos de la prevención de la transmisión vertical, relegando las necesidades de las mujeres y poniendo en cuestionamiento la dignidad en la atención de las mismas.This article discusses the national and international legal framework associated with the issue of the likelihood of including mental health practices in the Argentinean public health system, as part of the comprehensive care of women with HIV/AIDS who have recently become mothers. It aims to establish the extent with which legislation in force comprises a framework allowing for implementation of these practices and promoting dignity in female care. A documentary analysis of the legislation in force on the approached issue was performed. Conclusions highlight that mental health care is scarcely stated in the specific HIV/AIDS legislation, which mainly emphasizes the biomedical approach. In addition, the legislation is mainly oriented towards the objectives of vertical transmission prevention, postponing needs and questioning dignity in female care.Fil: Obiols, María Julieta. Universidad de Buenos Aires. Facultad de Psicología. Instituto de Investigaciones; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Stolkiner, Alicia Ines. Universidad de Buenos Aires. Facultad de Psicología. Instituto de Investigaciones; Argentin

Local implementation of the primary health care in Argentina: case study in Lanús municipality, Buenos Aires province

Se presentan resultados en Argentina de la segunda etapa de un estudio multicéntrico sobre Atención Primaria en Salud, realizado por la Universidad Nacional de Lanús y por la Red de Investigación en Sistemas y Servicios de Salud del Cono Sur, financiado por el International Development Research Center (Canadá). Se indagó sobre la traducción en servicios, prácticas y procesos de los abordajes y modelos de la Atención Primaria en Salud. Eso es un estudio de caso que aplicó el cuestionario de Evaluación Rápida de Atención Primaria en Salud (Barbara Starfield; adaptación y validación por Almeida/Macinko) a usuarios y profesionales de centros de salud del Municipio de Lanús. Se entrevistó a gestores y fueron realizados talleres participativos. Los resultados señalan que el índice global de desempeño de la Atención Primaria en Salud en el municipio fue satisfactorio, con puntuaciones altas en las dimensiones ‘vínculo con profesionales’ y ‘formación profesional’, y bajas en ‘acceso’ y ‘orientación a la comunidad’Results of the second phase of a multicenter study on Primary Health Care are here presented, which were implemented by the National University of Lanús and by the Network of Research on Health Systems and Services of the Southern Cone, financed by the International Development Research Center (Canada). The objective of this phase was to describe the translation of Primary Health Care models into practices, services, and processes. It is a case study that applied the survey of Primary Health Care Fast Evaluation (Barbara Starfield, adaptation by Almeida/Macinko) to users and staff of health centers at Lanús municipality. Primary Health Care managers were interviewed, and participatory workshops were organized. Results indicate that the global index of performance of the Primary Health Care in the municipality was satisfactory with high scores on the dimensions ‘professional link’ and ‘professional training’, and low on ‘access’ and on ‘community guidance’Fil: Ardila Gómez, Sara Elena. Universidad de Buenos Aires. Facultad de Psicología; Argentina. Universidad Nacional de Lanús; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: De Paepe, Pierre. Instituto de Medicina Tropical; BélgicaFil: Luciani Conde, Leandro Nestor. Universidad de Buenos Aires. Facultad de Psicología; Argentina. Universidad Nacional de Lanús; ArgentinaFil: Stolkiner, Alicia Ines. Universidad de Buenos Aires. Facultad de Psicología; Argentina. Universidad Nacional de Lanús; Argentin

Social Perceptions About Community Life with People with Mental Illness: Study of a Discharge Program in Buenos Aires Province, Argentina

Effects of living near people with mental illness in community settings have been researched as part of psychiatric reform evaluation. However, these studies have been carried out mostly in industrialized countries, where social contexts differ from those in which psychiatric reform is now being implemented. To analyze the effects of community life with people with mental illness in the neighborhoods in which they live, in Buenos Aires, Argentina. A questionnaire was administered to randomly-selected neighbors of group homes of a discharge program and an equivalent control area (n = 236). Data was analyzed both quantitatively and qualitatively. Significant differences were found between being a neighbor and having a high degree of acceptance toward people with mental illness. In addition, significant associations were found between neighbors having a high-perceived social cohesion and having a high level of acceptance toward the mentally ill. Living near people with mental illness is associated with better acceptance toward them; these results are congruent with those results found in other cultural contexts.Fil: Ardila Gómez, Sara Elena. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Psicología. Área de Salud Pública y Salud Mental; Argentina. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; ArgentinaFil: Guadalupe, Ares Lavalle. Universidad de Buenos Aires. Facultad de Psicología. Área de Salud Pública y Salud Mental; Argentina. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; ArgentinaFil: Fernández, Marina. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; ArgentinaFil: Hartfiel, María Isabel. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; ArgentinaFil: Borelli, Mariana. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; Argentina. Programa de Rehabilitación y Externación Asistida; ArgentinaFil: Canales, Valeria. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; ArgentinaFil: Stolkiner, Alicia Ines. Universidad Nacional de Lanus. Departamento de Salud Comunitaria; Argentin