Health literacy, a more complex concept than knowledge, is a required capacity to obtain, understand, integrate and act on health information [1], in order to enhance individual and community health, which is defined by different levels, according to the autonomy and personal capacitation in decision making [2]. Medium levels of Health literacy in an adolescent population were found in a study conducted in 2013/2014, being higher in sexual and reproductive health and lower in substance use. It was also noticed that the higher levels of health literacy were in the area adolescents refer to have receipt more health information. The health literacy competence with higher scores was communication skills, and the lower scores were in the capacity to analyze factors that influence health. Higher levels were also found in younger teenagers, but in a higher school level, confirming the importance of health education in these age and development stage. Adolescents seek more information in health professionals and parents, being friends more valued as a source information in older adolescents, which enhance the importance of peer education mainly in older adolescents [3]. As a set of competences based on knowledge, health literacy should be developed through education interventions, encompassing the cultural and social context of individuals, since the society, culture and education system where the individual is inserted can define the way the development and enforcement of the health literacy competences [4]. The valued sources of information should be taken into account, as well as needs of information in some topics referred by adolescents in an efficient health education. Schizophrenia is a serious and chronic mental illness which has a profound effect on the health and well-being related with the well-known nature of psychotic symptoms. The exercise has the potential to improve the life of people with schizophrenia improving physical health and alleviating psychiatric symptoms. However, most people with schizophrenia remains sedentary and lack of access to exercise programs are barriers to achieve health benefits. The aim of this study is to evaluate the effect of exercise on I) the type of intervention in mental health, II) in salivary levels of alpha-amylase and cortisol and serum levels of S100B and BDNF, and on III) the quality of life and selfperception of the physical domain of people with schizophrenia. The sample consisted of 31 females in long-term institutions in the Casa de Saúde Rainha Santa Isabel, with age between 25 and 63, and with diagnosis of schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Physical fitness was assessed by the six-minute walk distance test (6MWD). Biological variables were determined by ELISA (Enzyme-Linked Immunosorbent Assay). Psychological variables were assessed using SF-36, PSPP-SCV, RSES and SWLS tests. Walking exercise has a positive impact on physical fitness (6MWD -p = 0.001) and physical components of the psychological test...
Introdução: As intervenções nutricionais são configuradas, historicamente, por distribuição de alimentos e ampliação de conhecimento, permanecendo nas práticas atuais. Para ampliar o campo criou-se, em 2012, o Marco de Referência de Educação Alimentar e Nutricional. Objetivo: Analisar a produção científica brasileira sobre avaliação de intervenções de Educação Alimentar e Nutricional antes da criação do marco. Metodologia: Pesquisa sistemática com inclusão de artigos publicados entre 2000-2012. Após leitura crítica, foram feitas divisão e seleção dos estudos, classificando-os por região, contexto e cenário. Resultados: Selecionaram-se 28 artigos, divididos em três categorias: características institucionais e do estudo; contexto da intervenção e atores sociais envolvidos; e estruturação e base teórica. Verificou-se que os nutricionistas, assim como o tema da nutrição, estão mais presentes no contexto da saúde. No ambiente escolar, no território e no ambiente de trabalho, a promoção da saúde é abordada por equipes multiprofissionais. Os objetivos e as avaliações das intervenções relacionam-se, predominantemente, com indicadores numéricos, mas os estudos do território se aproximam dos referenciais do marco ao se apropriarem de indicadores qualitativos. Observou-se descrição sucinta das bases teórico-metodológicas, limitando a reprodução dos estudos. Considerações: Aponta-se a necessidade de realizar mais estudos de intervenção e de aperfeiçoá-los mediante a utilização do marco como referência.
This study compared nutritional education groups regarding their theoretical and practical dimensions, within primary health care, between São Paulo and Bogotá. A descriptive study was conducted in stages:identification of the professionals; characterization of educational groups; identification of social representations about nutritional education; and comparison of the linkage between theory and practice in the groups, per city. Through interviews with 54 nutritionists 17 central ideas were identified, which were classified into thematic axes that related to the groups. In both contexts, the importance of participant empowerment was highlighted, with similarities in the profile of actions, but with differentiation of the mediators" autonomy. It was found that the theory/practice of the groups was in transition from the traditional to a more humanistic approach. However, this was at a slow speed, compared with healthcare policies and needs.
: The study analyzed the social representations of primary health care professionals on evaluative processes of groups that work with food and nutrition, and described the educational strategies used in this care. This was a qualitative study from 2012 to 2014 in the city of São Paulo, Brazil, in which 48 interviews were analyzed. In the analysis of the interviews, for classification of the educational strategies in learning categories and contents, Bogdan & Biklen and Zabala were used, respectively. The evaluative processes used the collective subject discourse technique, based on Jodelet's social representations. Three learning contents were found in the educational strategies and four social representations of the evaluative processes which combined to reveal the presence of a conflict by a practice directed by the work process to quantitative and individual evaluative criteria and a health-promoting practice that used inclusive approaches and participant evaluation. In this practice, the study implicitly identified the presence of autonomy in health. The study revealed the need to acknowledge and systematize group planning as an educational tool that qualifies and empowers comprehensive care.
RESUMO O objetivo deste estudo foi apresentar um panorama do planejamento de grupos operativos realizados com usuários de serviços de saúde. Realizou-se uma revisão na base de dados Scientific Electronic Library Online (SciELO). Nos 12 estudos analisados, a teoria de grupo operativo teve como base cinco autores diferentes. Os grupos pretenderam prevenir doenças/agravos e tratar doenças, porém o processo destacou a promoção da saúde associada à educação em saúde e à educação alimentar e nutricional. A observação foi o método de avaliação mais aplicado, entretanto, poucos estudos usaram indicadores de avaliação. O panorama construído poderá auxiliar profissionais no momento de planejar e desenvolver seus grupos.PALAVRAS-CHAVE Revisão. Planejamento em saúde. Promoção da saúde. Processos grupais. ABSTRACT The objective of this study was to present a panorama of the planning of operative groups carried out with health services users. A review was conducted in the Scientific Electronic Library Online (SciELO) database. In the 12 studies analyzed, the operative group theory was based on five different authors. The group aimed to prevent diseases/grievances and treat diseases, but the process highlighted the promotion of health associated with health education and food and nutrition education. The most common method of used evaluation was observation, however, few studies used evaluation indicators. The built panorama can help professionals in 950 IntroduçãoO grupo, como modalidade de cuidado coletivo à população, tem se tornado frequente nos serviços de saúde, devido ao seu reconhecimento enquanto prática de educação em saúde. O cuidado em grupo envolve, a partir de relações interpessoais, a constituição de subjetividade e do psiquismo, a elaboração do conhecimento e a aprendizagem em saúde (AFONSO; COUTINHO, 2010;FERREIRA NETO; KIND, 2010).Uma teoria de grupo legitimada na área da saúde é o Grupo Operativo (GO), que foi elaborada por Pichon-Rivière, psiquiatra e psicanalista, na década de 1940 (MENEZES; AVELINO, 2016). O objetivo do GO é promover um processo de aprendizagem para os participantes, o qual é compreendido como uma leitura crítica da realidade, uma atitude investigadora, uma abertura para as dúvidas e para as novas inquietações. Este processo coloca em evidência a possibilidade de uma nova elaboração de conhecimento, de integração e de questionamentos acerca de si e dos outros (AFONSO;COUTINHO, 2010).Desse modo, o GO na área da saúde visa não apenas conceber as condições de saúde/ doença por meio da transmissão de conhecimento -abordagem utilizada por muitos profissionais da saúde (MELO, 2013;VINCHA ET AL., 2014) -, mas também transformar o conhecimento em atitude, a partir das necessidades e da realidade dos participantes. Esta transformação ocorre por meio do vínculo, da comunicação e do protagonismo de todos. Por isso, significados, sentimentos, relações, expectativas e experiên-cias individuais são implicados na ação (AFONSO; COUTINHO, 2010;PICHON-RIVIÈRE, 2009).O GO, como processo de aprendizagem, po...
Background: Educational interventions designed to promote healthy eating are essential in primary health care. Nevertheless, given the nutrition controversies about what is healthy, the contradictions created by the media, and the situation of users with complex needs, the prioritization of the themes to be addressed in the services has scarcely been described in the planning process. This study aimed to identify the process of implementing the themes discussed by health professionals in nutrition education groups in two primary health care models. Methods: Our study followed a qualitative comparative approach. It included the systematic observation of nutrition education group meetings to identify the key messages addressed and semi-structured interviews with health professionals in São Paulo, Brazil, and in Bogotá, Colombia. We used thematic networks to classify the messages and the collective subject discourse technique to organize the information obtained from interviews. We observed 28 nutrition education groups in São Paulo, and 13 in Bogotá, and conducted 27 interviews with nutritionists in each city. Results: The messages identified were grouped into four global themes: feeding habits, life cycle, disease, and "being a multiplier". The process of implementing the themes, understood as identification, selection, consultation, and application of themes, is intermediated by social representations of the health professionals about service requirements, training and professional performance, and the relationship with users. Two notions shape these representations: Control, although the time and the physical space dedicated to health services are restricted to the disease in São Paulo, in Bogotá only limited health promotion is provided; and specificity, which is portrayed as therapeutic support within a more educational model in São Paulo and as health promotion training courses within a prescriptive model in Bogotá. Conclusions: Understanding the process of implementing the themes discussed in nutrition education groups can reveal mechanisms that support the approach to themes on healthy eating, including communicative and educational adaptations of health professionals. This study contributes to the discussion about educational models in health care and their effects on the qualifications of health professionals within the service, especially those included in the context of low-and middle-income settings.
À professora Ana Maria Cervato-Mancuso, orientadora da produção desta tese e de uma trajetória acadêmica permeada de acolhimento, de confiança, de estímulo e de aprendizado. Ana, obrigada pela convivência, com ela me fortaleci enquanto pesquisadora, professora, nutricionista e pessoa. A minha busca por uma educação transformadora continuará ativa, pois tenho você no meu 'mundo interno'. Aos professores membos da banca, Cláudia Maria Bógus, Patrícia Constante Jaime, Maria Fernanda Petroli Frutuoso e Silvia do Amaral Rigon pela leitura cuidadosa e pelas apreciações na pré-avaliação desta tese, que promovem seu aprimoramento. Agradeço, em especial à professora Cláudia por me acompanhar no desenvolvimento da pesquisa, desde a qualificação e por me permitir vivenciar momentos enriquecedores em sala de aula. Às nutricionistas Viviane Laudelino Vieira e Samantha Caesar de Andrade por todo o acolhimento, o apoio e o incentivo oferecidos no campo de pesquisa. Como também aos estudantes e demais profissionais do Centro de Saúde Escola Geraldo de Paula Souza. O apoio de vocês fez com que a pesquisa se concretizasse. Aos participantes dos grupos educativos pelo aceite e pela confiança depositada no trabalho. Gratidão pelo compartilhamento de experiências e conhecimentos, produtor de frutos saborosos. Aos colegas pós-graduandos do grupo de pesquisa 'Segurança Alimentar e Nutricional: formação e atuação profissional'. Em especial à Débora Aparecida Santiago, pela parceria e por despertar em mim o interesse pela comunicação em saúde e à Bruna Zillesg Borges dos Santos pela disposição, pelas contribuições e pela amizade. A travessia compartilhada pela vida acadêmica tornou-a mais encantadora. Às graduandas, Amanda de Faria, Natália Walter, Greice Lúcia Silva e Cristiani Marton pela participação, pela cooperação e pela dedicação para com a pesquisa. Vocês serão excelentes nutricionistas. Às colegas Leila Maria Pellegrinelli e Elizete Aparecida Leite de Campos, pela inspiração e pela fascinação ao mundo dos grupos que vocês me cederam. À Renata Pisani de Almeida pela disponibilidade e pela ajuda na revisão da tese. À CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior) pelo fomento para a realização do doutorado, que permitiu a minha dedicação permanente na busca de produzir uma pesquisa de qualidade. À FAPESP (Fundação de Amparo à Pesquisa do Estado de São Paulo) pelo apoio financeiro ao projeto de pesquisa do qual este estudo faz parte, o que viabilizou a realização dos grupos educativos. Reconhecendo que uma tese é também construída pelo suporte e pelo encorajamento de grupos sociais, famílias e amigos, agradeço: Ao meu companheiro de vida, Francisco César Dalmo, pelo amor, pelo carinho, pelo amparo e pela compreensão, que foram tão necessários para a concretização deste trabalho. Aos meus pais, Tânia e Wilson, exemplos de dedicação, força, sabedoria e amor. Obrigada por sempre me incentivaram a buscar o melhor de mim. Aos meus irmãos, Thais e Wilson Victor, mesmo na distância, vocês estavam sempre comigo neste c...
Objective This study aimed to understand the role of health professionals in educational groups that have food and nutrition as their theme. Methods Qualitative research was conducted in the city of São Paulo, with professionals from the Family Health Strategy. Interviews were conducted to understand the professionals’ perceptions of the roles played in groups. These were analyzed using the Discourse of the Collective Subject technique. The groups’ observations on the performance of the professionals in their mediations were analyzed, based on the following items: meeting organization, communication, support, participation, confirmation of messages, and encouragement to ask questions. Results Twenty-two professionals from different backgrounds were interviewed, and 23 groups of different configurations were observed. The speeches showed that the professionals recognize themselves as organizers, mediators, and evaluators of the groups. Under the topic of organization, teamwork was highlighted. In mediation, there was an assumption of different types of performance that are inserted in conceptions of banking education and dialogical education. In the theme of evaluation, conflict and contradiction arose, pointing out the complexity of approaching a group theme when professionals seek a more horizontal posture with users. Observation of the groups revealed a duality between discourse and professional practice, which is surrounded by contradictions inserted into academic formation and the work process of the teams. Conclusion It was possible to understand the complexity of the practice of professionals when approaching the theme in groups, evidencing the need for spaces of care and for permanent education, especially when regarding professionals who use problematic and active approaches.
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