In an effort to bridge the gap between public health practice and academia, the Health Resources and Services Administration–funded Tennessee Public Health Training Center (LIFEPATH) has supported establishment of an academic health department (AHD) involving the East Tennessee State University College of Public Health (COPH) and the Sullivan County Regional Health Department (SCRHD). The SCRHD identified a need to increase internal capacity to conduct ongoing community health assessment and community-centered practice. Similarly, the COPH recognized the need to expand evidence-based practice implementation and evaluation opportunities for public health students. Personnel from the SCRHD, LIFEPATH, and the COPH developed a formal AHD agreement during the summer of 2012 and launched the program the subsequent fall semester. One aspect of the COPH/SCRHD/LIFEPATH model that addresses financial barriers experienced by other AHDs is the competitive awarding of the coordinator position to a doctor of public health student from the COPH, demonstrating investment in the model by the college. The doctor of public health student gains leadership experience through project management, coordination of the local health council, and day-to-day facilitation of undergraduate and master's student interns. The SCRHD benefits from the formal academic background of graduate-level interns dedicated to working in the community. This AHD framework offers an opportunity for doctoral-level students to develop practical leadership skills in a health department while enhancing the capacity of the SCRHD and the COPH to serve their community and stakeholders.

Policy-makers, research funders, and practitioners acknowledge the need for theories about the uptake of scientific evidence into policy and programs to reduce population-wide risk factors for the major avoidable chronic non-communicable diseases. Models of evidence-informed practice in public health settings have not been developed through systematic scientific inquiry. This study explores and develops a realistic account of evidence-informed tobacco control practice in Ontario public health agencies. In-depth, intensive, semi-structured qualitative interviews were conducted with twelve local public health agency senior executives and other key tobacco control staff in three diverse public health agencies in Ontario, Canada. Interviews explored aspects of tobacco control related decision-making and practice, as well as supports from regional, provincial, and national levels that might enhance tobacco control practice. Interview data were supplemented by field notes and other documentation provided by interviewees, as well as unobtrusive sources. A grounded theory approach to the analysis of textual data identified six major and many subcategories and dimensions implicated in evidence-informed tobacco control practice in local public health agencies. The major category structure includes: information and evidence, interpretation and decision-making, organizational aspects, organizational environment, practice integration, and time. An overall model and five sub-models were developed describing the relations among core category and sub-category factors. Propositions were developed a priori based on an extensive review of the literature. Potentially relevant social theories and concepts were also identified based on a selective review of the literature, including critical realist and other perspectives pertaining to agency-structure issues. Theories and propositions were reviewed, which resulted in a minor modification to the subcategory structure of one branch. Public health agency tobacco control case descriptions were developed based on a final category structure, including six branches, 27 sub-branches, and 98 twigs, and verified (subject to some adjustments) through a member check. Working knowledge is seen to be complex and socially constructed, incorporating aspects of social cognitive and planned behavior theories and Aristotelian intellectual virtues. Realist social theory offers insights into potential change processes. Contributions of the study of theory, practice and methods are discussed, as are strengths and limitations, and areas of needed future research.

Policy-makers, research funders, and practitioners acknowledge the need for theories about the uptake of scientific evidence into policy and programs to reduce population-wide risk factors for the major avoidable chronic non-communicable diseases. Models of evidence-informed practice in public health settings have not been developed through systematic scientific inquiry. This study explores and develops a realistic account of evidence-informed tobacco control practice in Ontario public health agencies. In-depth, intensive, semi-structured qualitative interviews were conducted with twelve local public health agency senior executives and other key tobacco control staff in three diverse public health agencies in Ontario, Canada. Interviews explored aspects of tobacco control related decision-making and practice, as well as supports from regional, provincial, and national levels that might enhance tobacco control practice. Interview data were supplemented by field notes and other documentation provided by interviewees, as well as unobtrusive sources. A grounded theory approach to the analysis of textual data identified six major and many subcategories and dimensions implicated in evidence-informed tobacco control practice in local public health agencies. The major category structure includes: information and evidence, interpretation and decision-making, organizational aspects, organizational environment, practice integration, and time. An overall model and five sub-models were developed describing the relations among core category and sub-category factors. Propositions were developed a priori based on an extensive review of the literature. Potentially relevant social theories and concepts were also identified based on a selective review of the literature, including critical realist and other perspectives pertaining to agency-structure issues. Theories and propositions were reviewed, which resulted in a minor modification to the subcategory structure of one branch. Public health agency tobacco control case descriptions were developed based on a final category structure, including six branches, 27 sub-branches, and 98 twigs, and verified (subject to some adjustments) through a member check. Working knowledge is seen to be complex and socially constructed, incorporating aspects of social cognitive and planned behavior theories and Aristotelian intellectual virtues. Realist social theory offers insights into potential change processes. Contributions of the study of theory, practice and methods are discussed, as are strengths and limitations, and areas of needed future research.

Recent public health scholarship finds that health outcomes are explained by the social and individual determinants of health rather than the individual-level determinants alone. The individualistic perspective has dominated the 20th century institutionalization of public health in the United States where the public health system has tended to focus largely, if not exclusively, on individual factors. This persistent orientation lies in contrast to another set of perspectives that have also persisted, focused on social causes, which are currently dominant in contemporary public health academic literature and in major, international health organizations. Whether the orientation within the United States is due to a prevailing paradigm among public health officials or is the result of new ideas about health causation being dampened under organizational weight is unknown. Despite public health being central to decreasing morbidity and mortality in the 20th century, significant gaps remain in researchers' understanding of what influences practice in the American public health system. My dissertation research investigates the broad outlines of the determinants of health as understood by state public health administrators. I study how the understanding of the determinants of health affects the practice of public health through analyzing how the ideas of state public health administrators interact with the organizational dynamics of the public health organizations they lead. This mixed-methods dissertation uses survey research and in-depth interviews and quantitative and qualitative analysis. I find that state public health officials' professionalization, length of tenure, level of education, and gender affect the perspective of health causation to which they adhere. I also find that the state public health officials with a social health frame more commonly report they are situated in organizations that are learning environments. Both organizational and ideational factors influence public health practice. The interview data expand this finding to paint a complex picture of organizational and ideational factors influencing one another as well as resulting practices. This research reveals that state public health officials often have strong health frames that are only able to shape the edges of their practice due to the political and organizational dynamics interacting with state public health departments. / Ph. D.

Submitted by Jadson Francisco de Jesus SILVA (jadson@uefs.br) on 2018-07-20T21:40:33Z No. of bitstreams: 1 DISSERTA??O VER?NICA GAMBOA cd.pdf: 3654035 bytes, checksum: bb1f7c26524d7edc5944ae2c6c8482b4 (MD5) / Made available in DSpace on 2018-07-20T21:40:33Z (GMT). No. of bitstreams: 1 DISSERTA??O VER?NICA GAMBOA cd.pdf: 3654035 bytes, checksum: bb1f7c26524d7edc5944ae2c6c8482b4 (MD5) Previous issue date: 2018-03-01 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Integrative Review Study, with a qualitative approach, based on a critical analytical perspective, aiming to understand the meanings of Health Promotion in the context of PHC in Brazil and in other countries of the world; to analyze the practices of Health Promotion in the context of PHC in Brazil and in other countries of the world and to discuss the concreteness between the areas of action established in the International Conferences on Health Promotion on Health Promotion practices in the context of Primary Care in Brazil and in the world. For the production of the empirical data, we cover the six (6) steps performed in the Integrative Review, delimiting the corpus of the study to 18 articles with peer review conditions published between January 2016 and July 2017 in different countries of Asia, Europe and America. As a method of analysis, we adopt Hermeneutics-dialectics. The results are organized in four empirical categories: Characterization of the corpus of the study: a reality to be achieved; Meanings of Health Promotion in the context of PHC: confluences and dissonances between theory and practice; Health Promotion in the context of PHC: contradictions, fragilities and challenges in the health work process; confrontations between the areas of action of the International Conferences on Health Promotion on practices in the context of PHC. We understand that Health promotion implies a 'new' and 'polysemic' practice that still generates theoretical and philosophical tensions, which has been associated with concepts such as lifestyles-healthy habits-health behaviors, empowerment, social participation, autonomy, intersectoriality, however there is a conflict, even reinforced by several authors, related to the conceptual misconception about health education, and more worrying about its differential character as approaches and practices to primary prevention. In the work process of Health Promotion, the purpose was to 'improve people's quality of life' as well as 'generate empowerment in users'; as the instruments were considered the theoretical models as fundamentals of practice, as well as the combination of strategies, practical guides and various educational materials; activities were related to health education, the use of online technologies, health advisory services and counseling; the agents were identified under the figure of collective agents, such as nurses and doctors with different training areas, health visitors, psychologists, social workers, as well as other professionals from the health service and the community itself; as for the interpersonal relationship, it was possible to see the strengthening of the links between users and health teams with a certain potentiality in the practice of Health Promotion. The evaluation emerged as a topic that presents weaknesses in the practice of Health Promotion and which represents a challenge to be conquered. In the confrontation of the areas of action of Health Promotion with its practice evidenced in the corpus of the study. In relation to the development of healthy policies was reinforced the importance of support for decision makers and joint responsibility of the State, health services with their professionals and community. The creation of favorable environments was invisible, even when it is considered relevant, since it could be of ?little importance? given to them in the practice and actions of Health Promotion. Community empowerment had a direct relation with the processes of empowerment and social participation, emphasizing the intersectoriality as key in this process. The development of personal skills was the area most studied in the articles analyzed, focusing on health education activities and once again the emergence of prevention as a conflicting concept in the understanding and practice of Health Promotion; finally, the reorientation of health services was visible when considering the paradigm shift and the strengthening of professional training in Health Promotion. We consider that Health Promotion contributes from its innovative, differentiated approach and with a positive approach to health services and specifically PHC. The protagonism of the professional with a profile in Health Promotion is significant in the development of strategies and corresponding actions with the areas of action, as well as to dispel conflicts by the conceptual misconceptions of Health Promotion in relation to the concepts of health education and prevention. / Estudo de Revis?o Integrativa, com abordagem qualitativa, fundamentado na perspectiva cr?tico anal?tica, com os objetivos de compreender os sentidos e significados da Promo??o da Sa?de no contexto da APS no Brasil e em outros pa?ses do mundo; analisar as pr?ticas de Promo??o da Sa?de no contexto da APS no Brasil e em outros pa?ses do mundo e discutir a concretude entre as ?reas de a??o estabelecidas nas Confer?ncias Internacionais de Promo??o da Sa?de sobre as pr?ticas de Promo??o da Sa?de no contexto da Aten??o Prim?ria no Brasil e no mundo. Para a produ??o de dados emp?ricos percorremos as seis (6) etapas realizadas na Revis?o Integrativa delimitando-se o corpus do estudo a 18 artigos com condi??o de peer review, publicados entre janeiro de 2016 e julho de 2017, em diversos pa?ses da ?sia, Europa e Am?rica. Como m?todo de an?lise adotamos a Hermen?utica-dial?tica. Os resultados encontram-se organizados em quatro categorias emp?ricas: Caracteriza??o do corpus do estudo: uma realidade a ser conquistada; Sentidos e Significados da Promo??o da Sa?de no contexto da APS: conflu?ncias e disson?ncias entre teoria e pr?tica; Promo??o da Sa?de no contexto da APS: contradi??es, fragilidades e desafios no processo de trabalho em sa?de; confrontos entre as ?reas de a??o das Confer?ncias Internacionais da Promo??o da Sa?de sobre as pr?ticas no contexto da APS. Compreendemos que a Promo??o da Sa?de implica uma pr?tica ?nova? e ?poliss?mica? que ainda gera tens?es te?ricas e filos?ficas, a qual esteve associada a conceitos como estilos de vida-h?bitos saud?veis-comportamentos em sa?de, empoderamento, participa??o social, autonomia, intersetorialidade, abordagem populacional, por?m, existe um conflito, refor?ado por diversos autores, diante do equ?voco conceitual em rela??o ? educa??o em sa?de e, mais preocupante pelo seu car?ter diferenciado enquanto a abordagens e pr?ticas, ? preven??o prim?ria. No processo de trabalho da Promo??o da Sa?de, foi destacada como finalidade ?melhorar a qualidade de vida das pessoas? assim como ?gerar empoderamento nos usu?rios?; como os instrumentos foram considerados os modelos te?ricos como fundamentos da pr?tica, assim como a combina??o de estrat?gias, as guias pr?ticas e diversos materiais educativos; j? as atividades estiveram relacionadas ? educa??o em sa?de, o uso de tecnologias online, as assessorias e os aconselhamentos em sa?de; os agentes constitu?ram-se nas figuras de agentes coletivos, como as enfermeiras e os m?dicos com diferentes ?rea de forma??o, os visitadores sanit?rios, os psic?logos, os assistentes sociais, assim como outros profissionais do servi?o de sa?de e a pr?pria comunidade; quanto a rela??o interpessoal, foi vis?vel o fortalecimento dos v?nculos entre usu?rios e as equipes de sa?de com certa potencialidade ? pr?tica de Promo??o da Sa?de. A avalia??o surgiu como um tema que apresenta fragilidades na pr?tica da Promo??o da Sa?de e que representa um desafio a ser conquistado. No confronto das ?reas de a??o da Promo??o da Sa?de com a sua pr?tica evidenciada no corpus do estudo, em rela??o ao desenvolvimento de pol?ticas saud?veis foi refor?ada a import?ncia do apoio aos respons?veis ?s decis?es e responsabiliza??o conjunta do Estado, dos servi?os de sa?de com seus profissionais e da comunidade. A cria??o de ambientes favor?veis ficou invis?vel, apesar da sua relev?ncia, uma vez que poderia estar associada ? ?pouca import?ncia? dada a eles na pr?tica e nas a??es de Promo??o da Sa?de. O fortalecimento comunit?rio teve rela??o direta com os processos de empoderamento e de participa??o social, ressaltando a intersetorialidade como chave nesse processo. O desenvolvimento de habilidades pessoais foi a ?rea mais trabalhada nos estudos analisados, focando em atividades de educa??o em sa?de e surgindo mais uma vez a preven??o como um conceito conflituante na compreens?o e na pr?tica da Promo??o da Sa?de; finalmente, a reorienta??o dos servi?os de sa?de foi vis?vel a necessidade de mudan?a de paradigmas e o fortalecimento da forma??o profissional em Promo??o da Sa?de. Consideramos que a Promo??o da Sa?de vem contribuir desde a sua abordagem inovadora, diferenciada e com um enfoque positivo aos servi?os de sa?de e especificamente de APS. O protagonismo do profissional com perfil em Promo??o da Sa?de ? significante no desenvolvimento de estrat?gias e a??es correspondentes com as ?reas de a??o, assim como para dissipar os conflitos pelos equ?vocos conceituais da Promo??o da Sa?de em rela??o aos conceitos de educa??o em sa?de e de preven??o principalmente.

Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / Source: Masters Abstracts International, Volume: 46-05, page: 2673. Adviser: Linda Lloyd. Includes bibliographical references.

O objeto deste estudo são as práticas que favorecem a participação social, realizadas por enfermeiros na Atenção Básica, em Unidade de Saúde da Família (USF). As práticas dos enfermeiros na Atenção Básica têm sido orientadas pelas diretrizes das políticas públicas de saúde, por isso devem adotar a concepção do processo-saúde doença sancionada no Sistema de Saúde brasileiro, a de que esse processo tem determinantes e condicionantes associados às formas de vida dos indivíduos e grupos sociais. Portanto, as práticas devem ser planejadas para responder necessidades de saúde ampliadas. Contudo, os protocolos que orientam práticas de enfermeiros privilegiam o enfoque da clínica médica, limitando o objeto dessas práticas a agravos e doenças. A literatura registra a descrição de práticas preponderantemente ancoradas nos saberes da clínica médica, centradas em agravos, doenças, processos característicos de determinadas fases da vida; ou seja, práticas que respondem principalmente necessidades de preservação da vida. Defende-se que a inclusão da participação social como uma das finalidades das práticas de saúde permite respostas a necessidades de saúde ampliadas, considerando-se que essa participação está nas raízes das necessidades de saúde, na medida em que possibilita o aprimoramento das condições de reprodução social. Referencial teórico: necessidades de saúde são reconhecidas como necessidades de reprodução social, portanto, determinadas pela inserção social dos indivíduos e grupos sociais, e se conformarão de forma distinta nas diferentes classes sociais. Portanto, necessidades de saúde não são respondidas apenas em serviços de saúde. Para respondê-las é necessário que se considere as necessidades de reprodução social - originadas nas formas de trabalhar e de viver, que estão na base dos processos saúde-doença; a necessidade da presença do Estado, que garante direitos para viabilizar respostas a necessidades de reprodução social e as necessidades de participação social, que possibilitam colocar em jogo necessidades acima de interesses, possibilitando o aprimoramento das necessidades de reprodução social. Participação neste estudo é compreendida como processos de lutas sociais voltadas para a transformação de condições da realidade social, de carência econômica e/ou opressão sociopolítica e cultural. Objetivo geral: apreender características das práticas operacionalizadas por enfermeiros, na AB, que tenham como uma das finalidades o estímulo à participação social de usuários do serviço e de grupos sociais. Objetivos específicos: identificar as práticas realizadas por enfermeiros de uma USF; identificar e analisar as práticas realizadas por enfermeiros que favorecem mobilização e participação social; analisar as práticas que efetivam a participação social, realizadas por enfermeiros. Finalidade: subsidiar as práticas de saúde na AB, com ênfase nas do enfermeiro, para que sejam operacionalizadas como respostas a necessidades de saúde ampliadas. Procedimentos metodológicos: estudo qualitativo, do tipo estudo de caso, realizado em uma USF da Supervisão de Saúde do Butantã com todos os enfermeiros que atuavam na Estratégia de Saúde da Família. Primeiro foram realizadas entrevistas e depois observação participante de práticas que favoreciam a participação social. Necessidades de saúde e participação social foram as categorias analíticas. O projeto foi aprovado por Comitês de Ética em Pesquisa e respeitou os preceitos éticos recomendados. Resultados: Foram identificadas, nos processos de trabalho de enfermeiras da USF, práticas pautadas na concepção dos determinantes sociais do processo saúde-doença; portanto, práticas ampliadas, tanto voltadas a atendimento individual ao usuário quanto ao coletivo, a grupos sociais. Essas práticas incorporavam a associação entre condições de reprodução social e processos saúde-doença; ou seja, respondiam a necessidades de saúde ampliadas, para além daquelas concretizadas no corpo bio-psíquico. Ao construir com os sujeitos do cuidado a compreensão desse nexo, essas práticas possibilitavam a mobilização, inerente à participação social, com vistas ao aprimoramento das condições de trabalho e vida e, consequentemente, de saúde. Portanto, os espaços de respostas a necessidades de saúde ampliadas não eram restritos ao cuidado individual e os de mobilização para a participação social não eram restritos, nem exclusivos do Conselho Gestor. Essas práticas participativas estavam incorporadas nos processos de trabalho das enfermeiras da USF; portanto, legitimadas pela gerente da USF, também enfermeira, em sintonia com características de gestão democrática dessa USF. Considerações finais: para que as práticas de saúde respondam a necessidades de saúde, a participação social deve ser incorporada às finalidades dos processos de trabalho de todos os trabalhadores de saúde. Acredita-se que essa é a forma de garantir que as necessidades de saúde dos moradores sejam reconhecidas e possam ser tomadas como objeto, não só dos processos de trabalho da USF, mas também dos processos de participação social, uma vez que essa participação possibilita a modificação da realidade concreta dos grupos sociais, pela via do aprimoramento das condições de reprodução social que estão, por sua vez, nas raízes das necessidades de saúde. No entanto, esse processo deve ser reconhecido pelos trabalhadores, a começar pela gerência dos serviços, para não serem esporádicos, eventuais. / The objects of the present study are the practices that favor social participation, performed by primary health care nurses working in Family Health Units (FHU). Primary health nurses practices have been guided by public health policies, and should, therefore, adopt the concept of the health-diseases process as sanctioned by the national health system, which states that there are determining and conditioning factors associated with the life styles of individuals and social groups. For this reason, nurses must plan their practices aiming to meet broader health needs. However, the protocols guiding nurses practices focus mainly on clinical medicine, thus limiting the objects of these practices to illness and disease. Literature records the description of practices based predominantly on clinical medicine knowledge, centered on illness, disease, and processes characteristic of specific life phases; i.e., practices that meet mainly the needs for the preservation of life. It is believed that including social participation as one of the goals of health care would allow achieving responses for the broader health needs, since that participation stands in the roots of health needs, as it permits to enhance the conditions of social reproduction. Theoretical framework: health needs are recognized as the needs of social reproduction, hence, they are determined by the social insertion of individuals and social groups, and will emerge in different ways in the different social classes. Therefore, health needs are not met exclusively at health services. In order to meet health needs, it is necessary to consider the needs of social reproduction which originate in the different ways of working and living, and stand at the basis of health-diseases processes; the need for the presence of the State, which assures the rights to meeting the needs of social reproduction and of social participation, which permit to attend to needs before interests, thus allowing an enhancement of the social reproduction needs. Participating in this study is understood as the processes of social battles aimed at transforming the conditions of social reality, economic needs and/or sociopolitical and cultural oppression. Overall objective: to identify the characteristics of the practices conducted by primary health care nurses, which aim to encourage the social participations of patients and social groups. Specific objectives: to identify the practices conducted by the nurses of a FHU; identify and analyze the nurses practices that benefit mobilization and social participation; analyze the nurses practices that make social participation effective. Purpose: to support primary health care practices, focused on nurses practices, so they are conducted as responded to broader health needs. Methodological procedures: qualitative case study, performed with all nurses working with Family Health Strategy at the FHU of the Butantã Health Division. First, interviews were conducted. After, were made the participant observation of practices that favor social participation. Health needs and social participation were the analytical categories. The project was approved by Research Ethics Committees and complied with all ethical principles. Results: It was identified, in the FHU nurses working processes, practices based on the concept of the social determinants of the health-disease process; hence, broader practices, aiming at the health care to individuals as well as to social groups. Those practices incorporated the association between the conditions of social reproduction and health-disease processes; in other words, they answered broader health needs, beyond those of the bio-psyche-body. By achieving an understanding of that nexus with the subjects of care, those practices allowed for mobilization, inherent to social participation, with a view to improving ones work, life, and, thus, health conditions. Therefore, the spaces for answering broader health needs were not restricted to individual care, and those of mobilization for social participation were not restricted nor exclusive of the Administration Committee. These participative practices were incorporated in the working processes of FHU nurses; however, legitimated by the FHU manager, who was also a nurse, in harmony with the characteristics of the democratic administration of the referred FHU. Final remarks: in order for health practices to meet health needs, social participation must be incorporated to the purposes of the working processes of all health care workers. This is the way of assuring that the health needs of the local population will be recognized and made the object not only of the work at the FHU, but also of processes of social participation, as the latter allows making a change in the concrete reality of the social groups, by improving the conditions of social reproduction, which, on their hand, stand within the roots of the health needs. Nevertheless, workers, particularly and firstly the management, must acknowledge that process, so it does not become periodic, sporadic.

<p>Men’s violence against women is a universal issue affecting health, human rights and gender-equality. In pregnancy, violence is a risk for both the mother and her unborn child.</p><p>The overall aims were: to determine the prevalence of such violence in a Swedish pregnant population, to investigate pregnant women’s attitudes to questioning about exposure to violence, and to evaluate experience gained by antenatal care midwives having routinely questioned pregnant women regarding violence.</p><p>All women registered for antenatal care in Uppsala, Sweden, during 6 months were assessed regarding acts of violence. The Abuse Assessment Screen (AAS) was used twice during pregnancy and again after delivery when the women were asked an open-ended written question regarding attitudes to questioning about violence. Midwives’ experiences regarding routine assessment were evaluated in focus group discussions.</p><p>The AAS questions were answered by 93% (1,038) of those eligible. Physical abuse by a partner or relative during or shortly after pregnancy was reported by 1.3%, and by 2.8% when the year preceding pregnancy was included. Lifetime sexual abuse was reported by 8.1%. Repeated questioning increased the abuse detection rate. Abused women reported more previous ill-health, and women physically abused during pregnancy more pregnancy terminations than did non-abused women. Abuse assessment was found entirely acceptable by 80%, both acceptable and unacceptable/disagreeable by 5% and solely unacceptable/ disagreeable by 3%, while 12% were neural. Abused and non-abused women did not differ regarding disinclination to answer the abuse questions. According to the midwives the delicacy of the subject and the male partners’ presence were the most prominent remaining obstacles to routine determination of violence. </p><p>Routines are required to make questioning about violence an integral part of antenatal care. This would necessitate a private appointment for the woman, knowledge among care providers about the nature of men’s violence, and awareness of referral options.</p>

Men’s violence against women is a universal issue affecting health, human rights and gender-equality. In pregnancy, violence is a risk for both the mother and her unborn child. The overall aims were: to determine the prevalence of such violence in a Swedish pregnant population, to investigate pregnant women’s attitudes to questioning about exposure to violence, and to evaluate experience gained by antenatal care midwives having routinely questioned pregnant women regarding violence. All women registered for antenatal care in Uppsala, Sweden, during 6 months were assessed regarding acts of violence. The Abuse Assessment Screen (AAS) was used twice during pregnancy and again after delivery when the women were asked an open-ended written question regarding attitudes to questioning about violence. Midwives’ experiences regarding routine assessment were evaluated in focus group discussions. The AAS questions were answered by 93% (1,038) of those eligible. Physical abuse by a partner or relative during or shortly after pregnancy was reported by 1.3%, and by 2.8% when the year preceding pregnancy was included. Lifetime sexual abuse was reported by 8.1%. Repeated questioning increased the abuse detection rate. Abused women reported more previous ill-health, and women physically abused during pregnancy more pregnancy terminations than did non-abused women. Abuse assessment was found entirely acceptable by 80%, both acceptable and unacceptable/disagreeable by 5% and solely unacceptable/ disagreeable by 3%, while 12% were neural. Abused and non-abused women did not differ regarding disinclination to answer the abuse questions. According to the midwives the delicacy of the subject and the male partners’ presence were the most prominent remaining obstacles to routine determination of violence. Routines are required to make questioning about violence an integral part of antenatal care. This would necessitate a private appointment for the woman, knowledge among care providers about the nature of men’s violence, and awareness of referral options.

O objeto deste estudo são as práticas que favorecem a participação social, realizadas por enfermeiros na Atenção Básica, em Unidade de Saúde da Família (USF). As práticas dos enfermeiros na Atenção Básica têm sido orientadas pelas diretrizes das políticas públicas de saúde, por isso devem adotar a concepção do processo-saúde doença sancionada no Sistema de Saúde brasileiro, a de que esse processo tem determinantes e condicionantes associados às formas de vida dos indivíduos e grupos sociais. Portanto, as práticas devem ser planejadas para responder necessidades de saúde ampliadas. Contudo, os protocolos que orientam práticas de enfermeiros privilegiam o enfoque da clínica médica, limitando o objeto dessas práticas a agravos e doenças. A literatura registra a descrição de práticas preponderantemente ancoradas nos saberes da clínica médica, centradas em agravos, doenças, processos característicos de determinadas fases da vida; ou seja, práticas que respondem principalmente necessidades de preservação da vida. Defende-se que a inclusão da participação social como uma das finalidades das práticas de saúde permite respostas a necessidades de saúde ampliadas, considerando-se que essa participação está nas raízes das necessidades de saúde, na medida em que possibilita o aprimoramento das condições de reprodução social. Referencial teórico: necessidades de saúde são reconhecidas como necessidades de reprodução social, portanto, determinadas pela inserção social dos indivíduos e grupos sociais, e se conformarão de forma distinta nas diferentes classes sociais. Portanto, necessidades de saúde não são respondidas apenas em serviços de saúde. Para respondê-las é necessário que se considere as necessidades de reprodução social - originadas nas formas de trabalhar e de viver, que estão na base dos processos saúde-doença; a necessidade da presença do Estado, que garante direitos para viabilizar respostas a necessidades de reprodução social e as necessidades de participação social, que possibilitam colocar em jogo necessidades acima de interesses, possibilitando o aprimoramento das necessidades de reprodução social. Participação neste estudo é compreendida como processos de lutas sociais voltadas para a transformação de condições da realidade social, de carência econômica e/ou opressão sociopolítica e cultural. Objetivo geral: apreender características das práticas operacionalizadas por enfermeiros, na AB, que tenham como uma das finalidades o estímulo à participação social de usuários do serviço e de grupos sociais. Objetivos específicos: identificar as práticas realizadas por enfermeiros de uma USF; identificar e analisar as práticas realizadas por enfermeiros que favorecem mobilização e participação social; analisar as práticas que efetivam a participação social, realizadas por enfermeiros. Finalidade: subsidiar as práticas de saúde na AB, com ênfase nas do enfermeiro, para que sejam operacionalizadas como respostas a necessidades de saúde ampliadas. Procedimentos metodológicos: estudo qualitativo, do tipo estudo de caso, realizado em uma USF da Supervisão de Saúde do Butantã com todos os enfermeiros que atuavam na Estratégia de Saúde da Família. Primeiro foram realizadas entrevistas e depois observação participante de práticas que favoreciam a participação social. Necessidades de saúde e participação social foram as categorias analíticas. O projeto foi aprovado por Comitês de Ética em Pesquisa e respeitou os preceitos éticos recomendados. Resultados: Foram identificadas, nos processos de trabalho de enfermeiras da USF, práticas pautadas na concepção dos determinantes sociais do processo saúde-doença; portanto, práticas ampliadas, tanto voltadas a atendimento individual ao usuário quanto ao coletivo, a grupos sociais. Essas práticas incorporavam a associação entre condições de reprodução social e processos saúde-doença; ou seja, respondiam a necessidades de saúde ampliadas, para além daquelas concretizadas no corpo bio-psíquico. Ao construir com os sujeitos do cuidado a compreensão desse nexo, essas práticas possibilitavam a mobilização, inerente à participação social, com vistas ao aprimoramento das condições de trabalho e vida e, consequentemente, de saúde. Portanto, os espaços de respostas a necessidades de saúde ampliadas não eram restritos ao cuidado individual e os de mobilização para a participação social não eram restritos, nem exclusivos do Conselho Gestor. Essas práticas participativas estavam incorporadas nos processos de trabalho das enfermeiras da USF; portanto, legitimadas pela gerente da USF, também enfermeira, em sintonia com características de gestão democrática dessa USF. Considerações finais: para que as práticas de saúde respondam a necessidades de saúde, a participação social deve ser incorporada às finalidades dos processos de trabalho de todos os trabalhadores de saúde. Acredita-se que essa é a forma de garantir que as necessidades de saúde dos moradores sejam reconhecidas e possam ser tomadas como objeto, não só dos processos de trabalho da USF, mas também dos processos de participação social, uma vez que essa participação possibilita a modificação da realidade concreta dos grupos sociais, pela via do aprimoramento das condições de reprodução social que estão, por sua vez, nas raízes das necessidades de saúde. No entanto, esse processo deve ser reconhecido pelos trabalhadores, a começar pela gerência dos serviços, para não serem esporádicos, eventuais. / The objects of the present study are the practices that favor social participation, performed by primary health care nurses working in Family Health Units (FHU). Primary health nurses practices have been guided by public health policies, and should, therefore, adopt the concept of the health-diseases process as sanctioned by the national health system, which states that there are determining and conditioning factors associated with the life styles of individuals and social groups. For this reason, nurses must plan their practices aiming to meet broader health needs. However, the protocols guiding nurses practices focus mainly on clinical medicine, thus limiting the objects of these practices to illness and disease. Literature records the description of practices based predominantly on clinical medicine knowledge, centered on illness, disease, and processes characteristic of specific life phases; i.e., practices that meet mainly the needs for the preservation of life. It is believed that including social participation as one of the goals of health care would allow achieving responses for the broader health needs, since that participation stands in the roots of health needs, as it permits to enhance the conditions of social reproduction. Theoretical framework: health needs are recognized as the needs of social reproduction, hence, they are determined by the social insertion of individuals and social groups, and will emerge in different ways in the different social classes. Therefore, health needs are not met exclusively at health services. In order to meet health needs, it is necessary to consider the needs of social reproduction which originate in the different ways of working and living, and stand at the basis of health-diseases processes; the need for the presence of the State, which assures the rights to meeting the needs of social reproduction and of social participation, which permit to attend to needs before interests, thus allowing an enhancement of the social reproduction needs. Participating in this study is understood as the processes of social battles aimed at transforming the conditions of social reality, economic needs and/or sociopolitical and cultural oppression. Overall objective: to identify the characteristics of the practices conducted by primary health care nurses, which aim to encourage the social participations of patients and social groups. Specific objectives: to identify the practices conducted by the nurses of a FHU; identify and analyze the nurses practices that benefit mobilization and social participation; analyze the nurses practices that make social participation effective. Purpose: to support primary health care practices, focused on nurses practices, so they are conducted as responded to broader health needs. Methodological procedures: qualitative case study, performed with all nurses working with Family Health Strategy at the FHU of the Butantã Health Division. First, interviews were conducted. After, were made the participant observation of practices that favor social participation. Health needs and social participation were the analytical categories. The project was approved by Research Ethics Committees and complied with all ethical principles. Results: It was identified, in the FHU nurses working processes, practices based on the concept of the social determinants of the health-disease process; hence, broader practices, aiming at the health care to individuals as well as to social groups. Those practices incorporated the association between the conditions of social reproduction and health-disease processes; in other words, they answered broader health needs, beyond those of the bio-psyche-body. By achieving an understanding of that nexus with the subjects of care, those practices allowed for mobilization, inherent to social participation, with a view to improving ones work, life, and, thus, health conditions. Therefore, the spaces for answering broader health needs were not restricted to individual care, and those of mobilization for social participation were not restricted nor exclusive of the Administration Committee. These participative practices were incorporated in the working processes of FHU nurses; however, legitimated by the FHU manager, who was also a nurse, in harmony with the characteristics of the democratic administration of the referred FHU. Final remarks: in order for health practices to meet health needs, social participation must be incorporated to the purposes of the working processes of all health care workers. This is the way of assuring that the health needs of the local population will be recognized and made the object not only of the work at the FHU, but also of processes of social participation, as the latter allows making a change in the concrete reality of the social groups, by improving the conditions of social reproduction, which, on their hand, stand within the roots of the health needs. Nevertheless, workers, particularly and firstly the management, must acknowledge that process, so it does not become periodic, sporadic.