Determination or determinants? A debate based on the Theory on the Social Production of Health

Rocha, Patrícia Rodrigues da; David, Helena Maria Scherlowski Leal

doi:10.1590/s0080-623420150000100017

Cited by 42 publications

(29 citation statements)

References 3 publications

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“…Furthermore, it is possible that EE includes components that may act as factors of protection or that in isolation it may be insufficient to predict the occurrence of relapses and should be understood as a multi-factorial phenomenon. Among the factors that may influence relapses, social determinants of health can be highlighted as their impact may influence psychological states triggering the disorder (22) . Cultural questions, as well as social determinants of health, such as socio-economic and educational factors, strongly influence the home environment and family relationships, as indicators of tolerance levels between the family member and the patient (22)(23) .…”

Section: Discussionmentioning

confidence: 99%

“…Among the factors that may influence relapses, social determinants of health can be highlighted as their impact may influence psychological states triggering the disorder (22) . Cultural questions, as well as social determinants of health, such as socio-economic and educational factors, strongly influence the home environment and family relationships, as indicators of tolerance levels between the family member and the patient (22)(23) . Understanding of these aspects is essential to evaluate how different contexts influence levels of expressed emotion and prognosis of the disease (23) .…”

Section: Discussionmentioning

confidence: 99%

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Emoção expressa de familiares e recaídas psiquiátricas de pacientes com diagnóstico de esquizofrenia

Zanetti

Vedana

Gherardi‐Donato

et al. 2018

Rev. esc. enferm. USP

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Objective: Assess the relationship between psychiatric relapses of patients with a diagnosis of schizophrenia, the levels of expressed emotion among their relatives and related factors. Method: Prospective study carried out at a mental health outpatient clinic and two Psychosocial Care Centers, with patients and relatives responding to the Family Questionnaire -Brazilian Portuguese Version, a form containing socio-demographic and clinical variables and a structured script to assess relapses. A logistic regression model was used for the analysis. Results: A total of 89 dyads participated in the study. Of the patients investigated, 31% presented relapses and, among the relatives, 68% presented elevated levels of expressed emotion. The relationship between expressed emotion and the relapses was not significant. The logistic regression analysis demonstrated that when there were a higher number of hospital admissions in the two years preceding the study, the chance of the patient relapsing in the 24-month period is 1.34. Conclusion: Expressed emotion was insufficient to predict relapses. Thus, a relapse should be understood as a multifactorial phenomenon. These results provide support for interventions and investigations on the multiple factors involved in the evolution of schizophrenia patients in follow-up at community-based health services. DESCRIPTORS INTRODUCTIONThe concept of Expressed Emotion (EE) has long been used to investigate the family environment of patients with mental disorders. EE reflects the extent to which family members close to a patient express critical, hostile and emotionally over-involved attitudes or warmth when talking about the patient (1) . The main components of EE are critical comments (CC), which are related to negative judgment of patient conduct; hostility (H), related to the negative concept of the patient as a person; and emotional overinvolvement (EOI), which refers to feelings or attitudes, to despair, to self-sacrifice and to overprotection of the patient on the part of the family members. It is worth highlighting that hostility overlaps with critical comments. The family may be classified as having high EE if the family member that spends most of the time with the patient presents one or more of these components (2)(3) . Studies show that EE is a strong predictor of psychiatric relapses in schizophrenic patients, in different social and cultural contexts (4)(5) . A meta-analysis identified 27 articles reporting EE and psychiatric relapses in schizophrenia patients. These studies confirmed that EE is a good predictor of schizophrenia relapses, especially in patients in the most chronic phase of the disease (6) . Recent prospective studies have shown that patients with schizophrenia living with families with high levels of EE have higher chances of suffering relapses when compared to those that live in family settings with low EE (7)(8) .Relapses are defined by the exacerbation of symptoms related to the diagnosis of schizophrenia in patients with a stable condition (7)...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Emoção expressa de familiares e recaídas psiquiátricas de pacientes com diagnóstico de esquizofrenia

Zanetti

Vedana

Gherardi‐Donato

et al. 2018

Rev. esc. enferm. USP

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“…Por otra parte, el hecho de que los casos presentaran un nivel socioeconómico bajo y una mala calidad de la vivienda en mayor proporción que los controles, sugiere una determinación social del riesgo y la pobreza estructural (33), en la que variables como el nivel medio de ingresos no reflejan la capacidad real de respuesta del grupo ni sirven como controles de la variable de confusión, mientras que el nivel educativo y la calidad de la vivienda pueden ser factores asociados a dicha determinación (34). En este sentido, la adopción del grupo doméstico en lugar del caso individual como unidad de análisis (aunque el apareamiento casos-control fue individual), implica la perspectiva de la exposición doméstica, la 'construcción' del concepto de riesgo y su manejo social.…”

Section: Discussionunclassified

Factores de riesgo en escenarios emergentes de leishmaniasis visceral urbana, Misiones, Argentina

et al. 2016

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Introducción. La leishmaniasis visceral es una enfermedad desatendida de alta letalidad que requiere profundizar los estudios locales para un diseño de estrategias de control efectivo. En América se verificó la urbanización de su transmisión, teniendo como reservorio principal al perro doméstico, donde condiciones socio-económicas, representaciones y prácticas de grupos domésticos (GD) jugarían un rol estratégico poco conocido para su endemicidad. Objetivo. Analizar representaciones y prácticas de prevención y afrontamiento de leishmaniasis visceral en humanos (LVh) y caninos (LVc) y factores socio-económicos de riesgo.Materiales y métodos. Estudio transversal de casos y controles. Caso: GD, con al menos un integrante con antecedentes de LVh notificado por Ministerio de Salud Pública. Control: GD sin integrantes con antecedentes de LVh. A partir de información primaria, se caracterizó demográfica y socialmente la población, la calidad de su vivienda y se construyó un ranking de conocimientos y actitudes frente a la LV, se describieron prácticas asociadas a riesgo y presencia de LVc.Resultados. Mala calidad de la vivienda (p≤0,001), personas del GD fuera vivienda después 18 hs (razón de momios, RM=4,5; IC 95%: 1,69-12,18), la reproducción sin control racial de perros (RM=15,7; IC 95%: 3,91-63,2) y con LVc en el domicilio (RM=120,3; IC 95%: 18,51-728,3) se asocian positivamente o incrementan el riesgo de contraer LVh.Conclusión. Se observa una determinación social de riesgo asociada a pobreza estructural, que aumentan la probabilidad de contacto humano-vector por mala calidad de vivienda y hacinamiento. El factor de riesgo más importante para la LVh fue la tenencia de perros con LVc en el domicilio.

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“…In the Collective Health perspective, health care social practice is aimed to emancipate the people assisted, whose needs are much wider than individual's illness cure or rehabilitation. In Collective Health the labour process is oriented to transform the epidemiologic profiles of the population grounded on the understanding of health‐illness process as socially determined, instrumentalized by Critical Epidemiology (as opposed to traditional Epidemiology). Coherently, the objective of Collective Health practices is to provide knowledge to the population as an instrument to social participation in public policy development and implementation…”

Section: Discussionmentioning

confidence: 99%

Implementation of evidence‐based health care using action research: An emancipatory approach

Cordeiro

Soares

2016

Int J of Nursing Practice

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The aim of the study is to discuss the emancipatory approach to action research as an appropriate methodology for workers' meaningful implementation of evidence-based health care. Implementation of evidence-based health care using action research is well supported by the literature. There are various approaches to action research, and they are coherent with the objectives and methods elected to develop the investigation. It is not clear which approach of action research is responsible for meaningful worker engagement in changing praxis. This is a discussion paper based on our experiences and supported by literature on collective health. Health care is defined as a social praxis, dependent upon the capitalist mode of production in which health workers engage themselves in a labour process that has negative (as alienation) as well as positive (as creativity) meanings. Emancipatory changes of social praxis through implementation of evidence-based health care require that participants understand the positive and negative meanings of their work and engage health workers in a conscious and intentional collaborative educational process. Implementation of evidence-based health care through emancipatory action research is capable of overcoming alienation and changing social practice through a participatory meaningful process of knowledge translation.

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Determination or determinants? A debate based on the Theory on the Social Production of Health

Cited by 42 publications

References 3 publications

Emoção expressa de familiares e recaídas psiquiátricas de pacientes com diagnóstico de esquizofrenia

Emoção expressa de familiares e recaídas psiquiátricas de pacientes com diagnóstico de esquizofrenia

Factores de riesgo en escenarios emergentes de leishmaniasis visceral urbana, Misiones, Argentina

Implementation of evidence‐based health care using action research: An emancipatory approach

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