ALMEIDA, JF. Exposure to community violence of Health Strategy agents of Family and repercussions on their working practices: a qualitative study [Dissertation]. São Paulo: "Faculdade de Medicina, Universidade de São Paulo"; 2015.In Brazil, the reflexes of community violence in the formation and development of the health care service actions, in the primary health care, present themselves as a reality to be better studied, as well as deserve more attention towards the repercussions suffered by the health care staffs. This paper aims at exploring qualitatively the representations of the community health workers and the manager of a Health Care Family Strategy facility concerning the community violence where they work, verifying the possibility of interference in this phenomenon in relation to the work they do. It was intended to investigate this interference in the bonds construction between the community health workers and the population attended by them. It was adopted the qualitative research methodology through social representation analysis, 12 open interviews with the community health workers and one interview with the health care facility manager had been made using a previously elaborated script with flexible questions, valuing the singularity of the interviewees' answers. It is highlighted as a research result the confirmation of the hypothesis that the community violence spoils the care integrality, in other words, the elaboration of determined strategies of promotion, prevention and recovery, related mainly to the approach about the drug abuse. It was evidenced that the actions regulation in the health care area are conditioned by the open restrictions or put implicitly by the social dynamics existents in the territory. Furthermore, the formation of this phenomenon helps to explain a part of the episodes, which involve the workplace violence pointed in threats, fear and concern of the community health workers. Moreover, the community violence and its social representations interfere in the production of the bonds stablished with the users -built with greater or shorter closeness, depending on the user and the strategies assembled by each worker. However, besides interfering, the violence and the representations are co-producers categories of bonds, in the broadest sense, as they approximate/bond the workers to determined experiences, which may influence them in their decisions and in the actions taken, consciously or not. In the social science's point of view was highlighted the centrality, which the worker acquires in the rationale of porous borders mediation, well designated from legal to formal and from the "world of crime". The presence of community violence in the primary health care presents itself as a reality in which the workers have been living with for many years. This issue has been discussed in the area of the public health and it needs to be recognized and approached in the federal, state and municipal levels aiming the construction of policies and strategies that assist the achi...

Evolução dos homicídios e indicadores de segurança pública no Município de São Paulo entre 1996 a 2008: um estudo ecológico de séries temporaisHomicide and public security indicator trends in the city of São Paulo between 1996 and 2008: a time-series ecological study

Throughout the first decade of the 2000s the homicide mortality rate (HMR) showed a significant reduction in the state and the city of São Paulo (MSP). The aim of this study is to describe the trend of HMR, socio-demographic indicators, and the investment in social and public security, and to analyze the correlation between HMR and independent variables in the MSP between 1996 and 2008. An exploratory time series ecological study was conducted. The following variables were included: HMR per 100,000 inhabitants, socio-demographic indicators, and investments in social and public security. The moving-averages for all variables were calculated and trends were analyzed through Simple Linear Regression models. Annual percentage changes, the average annual change and periodic percentage changes were calculated for all variables, and the associations between annual percentage changes were tested by Spearman’s correlation analysis. Correlations were found for the proportion of youth in the population (r = 0.69), unemployment rate (r = 0.60), State budget for education and culture (r = 0.87) and health and sanitation (r = 0.56), municipal (r = 0.68) and State (r = 0.53) budget for Public Security, firearms seized (r = 0.69) and the incarceration rate (r = 0.71). The results allow us to support the hypothesis that demographic changes, acceleration of the economy, in particular the fall in unemployment, investment in social policies and changes in public security policies act synergistically to reduce HMR in São Paulo. Complex models of analysis, incorporating the joint action of different potential explanatory variables, should be developed.

Este artigo aborda a história de um jovem morador de um bairro periférico de São Paulo sumariamente executado no contexto dos “Crimes de Maio” ocorridos em 2006. Utiliza-se do arcabouço conceitual da vulnerabilidade como forma de compreender os diferentes elementos envolvidos na sua vitimização. Esse conceito proporciona uma perspectiva ampla e dinâmica que considera a suscetibilidade a um determinado evento enquanto dependente não só de aspectos individuais, mas também relacionais e contextuais, evitando efeitos estigmatizantes. A análise desenvolvida enfatiza a incerteza social juvenil e a situação de liminaridade em relação ao “mundo do crime”; os processos de violência policial que recaem sobre determinadas parcelas da população, bem como a situação de impunidade. Tais elementos ocupam hoje uma posição central na conformação da vulnerabilidade de jovens à violência letal, o que torna necessária sua problematização para o desenvolvimento de ações de prevenção, inclusive no setor da saúde.

Resumo No contexto da atenção primária à saúde, a violência urbana é um desafio que tem impactado diretamente o setor por conta da localização geográfica dos equipamentos de saúde em áreas de vulnerabilidade e da maior interação dos trabalhadores com situações que colocam em perigo, implícita ou explicitamente, sua segurança. O artigo discute as implicações desse fenômeno no trabalho e na construção dos vínculos estabelecidos entre os agentes comunitários de saúde (ACS) com a população em um território. Foi utilizada a metodologia qualitativa e o referencial teórico das representações sociais para compreender como a execução das políticas de saúde se concretiza no cotidiano à luz das interações, dos conflitos e das decisões que permeiam os contatos com o público na produção do serviço. Como resultado, destacamos que a violência e as representações em torno desta interferem na produção de estratégias de promoção e prevenção e na produção dos vínculos, tornando os canais de negociações mais restritos. É fundamental que o processo de trabalho das equipes de saúde esteja fortalecido com discussões e articulação em rede na minimização dos riscos individuais sobre seus trabalhadores e como possibilidade de efetivação dos pressupostos da integralidade do cuidado e redução das iniquidades.

No abstract

Gross human rights violations more markedly occur in the population with the worst living conditions. Therefore, in a scenario in which inequality in attaining social and economic rights is directly superposed to the violation of civil rights, the violence cycle is intensified and perpetuated.

Background Adolescents in low-resource urban settings in Brazil are often exposed to high levels of trauma that can result in post-traumatic stress disorder (PTSD). However, preliminary evidence indicates that PTSD tends to be under-reported in Brazilian health services, despite the high prevalence of trauma. Additionally, little is known about the perceived applicability among clinicians of the new ICD-11 diagnosis of complex PTSD (CPTSD), despite its potential relevance for contexts of chronic trauma. The current study investigated local understandings of PTSD and CPTSD among health professionals working with adolescents in violent neighbourhoods of São Paulo city. Methods Semi-structured interviews were conducted with 58 health professionals working at both the primary care and specialized mental health levels in two areas of São Paulo city with high levels of community violence. Results Most participants knew about PTSD, but most did not know about CPTSD. There were mixed views concerning the commonality of PTSD among adolescents exposed to community violence. Many participants reported having no experience working with patients with the PTSD diagnosis. According to some, community violence was normalized by adolescents and health professionals, and did not result in PTSD. Others highlighted how they did not use psychiatric diagnoses in their practice, had critical perspectives towards psychiatric diagnoses and/or PTSD, or simply knew little about PTSD. Furthermore, many highlighted how the chronic nature of multiple traumas experienced by adolescents often resulted in complex clinical presentations characterised by many symptoms beyond PTSD. The diagnosis of CPTSD was considered appropriate to the context by many participants as it captured the complex traumatic histories and symptom presentations of adolescents exposed to community violence in Brazil. Conclusions These findings have important implications for the assessment and treatment of mental health among adolescents exposed to community violence in Brazil.