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2.
Trials ; 23(1): 263, 2022 Apr 05.
Article in English | MEDLINE | ID: covidwho-1779666

ABSTRACT

BACKGROUND: Antiretroviral therapy (ART) has led to dramatic improvements in survival for people living with HIV, but is unable to cure infection, or induce viral control off therapy. Designing intervention trials with novel agents with the potential to confer a period of HIV remission without ART remains a key scientific and community goal. We detail the rationale, design, and outcomes of a randomised, placebo-controlled trial of two HIV-specific long-acting broadly neutralising antibodies (bNAbs): 3BNC117-LS and 10-1074-LS, which target CD4 binding site and V3 loop respectively, on post-treatment viral control. METHODS: RIO is a randomised, placebo-controlled, double-blinded prospective phase II study. Eligible individuals will have started ART within 3 months of primary HIV infection and have viral sequences that appear to be sensitive to both bNAbs. It will randomise 72 eligible participants 1:1 to the following arms via a two-stage design. In Stage 1, arm A participants are given dual long-acting (LS-variants) bNAbs infusions, followed by intensively monitored Analytical Treatment Interruption (ATI) (n = 36); in arm B, participants receive placebo infusions followed by ATI. The primary endpoint will be time to viral rebound within 36 weeks after ATI. Upon viral rebound, the participant and researcher are unblinded. Participants in arm A recommence ART and complete the study. Participants in arm B are invited to restart ART and enroll into Stage 2 where they will receive open-label LS bNAbs, followed by a second ATI 24 weeks after. Secondary and exploratory endpoints include adverse events, time to undetectable viraemia after restarting ART, immunological markers, HIV proviral DNA, serum bNAb concentrations in blood, bNAb resistance at viral rebound, and quality of life measures. DISCUSSION: The two-stage design was determined in collaboration with community involvement. This design allows all participants the option to receive bNAbs. It also tests the hypothesis that bNAbs may drive sustained HIV control beyond the duration of detectable bNAb concentrations. Community representatives were involved at all stages. This included the two-stage design, discussion on the criteria to restart ART, frequency of monitoring visits off ART, and reducing the risk of onward transmission to HIV-negative partners. It also included responding to the challenges of COVID-19. TRIAL REGISTRATION: The protocol is registered on Clinical. TRIALS: gov and EudraCT and has approval from UK Ethics and MHRA.


Subject(s)
COVID-19 , HIV Infections , HIV-1 , Broadly Neutralizing Antibodies , Clinical Trials, Phase II as Topic , Community Participation , HIV Antibodies , HIV Infections/diagnosis , HIV Infections/drug therapy , Humans , Prospective Studies , Quality of Life , Randomized Controlled Trials as Topic , SARS-CoV-2 , Treatment Outcome
3.
Front Public Health ; 9: 713159, 2021.
Article in English | MEDLINE | ID: covidwho-1775828

ABSTRACT

Objectives: Digital technologies in public health are primarily used in medical settings and mostly on an individual and passive way of use. There are research gaps on digital media facilitating participation, empowerment, community engagement, and participatory research in community settings. This scoping review aims to map existing literature on digital formats that enable participation in the field of health promotion and prevention in community settings. Design: The databases Medline, EMBASE, and PsycINFO were used to identify studies published from 2010 up to date (date of literature search) onward that used digital formats in all or in the main sequences of the process to enable high levels of participation in health promotion and prevention activities in community settings. Results: This review identified nine out of 11 included studies relevant to the research question. We found five studies that applied qualitative participatory research, two studies on peer support and one study each on empowerment and crowdsourcing. The digital technologies used varied widely and included social media platforms, bulletin boards, online forum webpages, and customized web providers and programs. Most studies mentioned anonymity, flexibility, and convenience as benefits of digital interventions. Some papers reported limitations such as difficulties by interpreting written-only data or the possibility of selection bias due to the digital divide. Conclusion: This scoping review identified only few studies relevant to our objective, indicating an existing gap in research on this topic. Digital formats were found to be particularly suitable for purposes where anonymity and flexibility are beneficial, such as for online peer exchange and peer support programs.


Subject(s)
Community Participation , Health Promotion , Internet , Humans , Public Health
4.
Front Public Health ; 10: 797290, 2022.
Article in English | MEDLINE | ID: covidwho-1775998

ABSTRACT

Background: The growing ethical requirement to engage communities with health research has yielded diversification in approaches and targeted audiences. Conventional approaches like community "town-hall meetings," laboratory open-days and focus group discussions, have evolved into new methods and audiences such as community drama and school engagement with health research (SEHR) involving learning interactions between researchers and school students. While engagement practices are diversifying, evaluations of these initiatives are rare in Low- and Middle-Income Countries (LMIC). This article focuses on the use of Participatory Video (PV) to explore the influence of the KEMRI-Wellcome Trust Research Programme's (KWTRP) School Engagement Programme (SEP) on the views and understandings of science and research among Kenyan state secondary school students. Methods: Twelve male and twelve female students from four coeducational schools were provided with film-making kits (1 per school), and a one-day PV training workshop. They prepared 22 short films over 8 weeks depicting their experiences and views of research and engagement and conveying their career aspirations. Schools were selected based on prior SEP participation; two schools having experienced different engagement approaches, and the others with no prior school engagement. Study data comprised footage and participant observation notes. Results: PV provided an opportunity to simultaneously engage and evaluate to inform practice. Through student-led filmmaking, PV stimulated conversations with students about research and engagement, enabling them to share their views in a way they felt was appropriate. These interactions offered an understanding of student gains from engagement, the depth of interaction required to address perceptions held about research and the potential unintended consequences of engagement. PV also provided insights into the context and complexity of life in which engagement is situated. Understanding this context is important because of its potential influence on participation in engagement activities. We draw on these insights to make two recommendations for school engagement practice. First is that PV can provide an enjoyable and insightful means of combining engagement with evaluation. Second, given that time for SEHR is competed for against other important curricular and extracurricular activities, SEHR practitioners must ensure that activities are as beneficial and enjoyable as possible to students.


Subject(s)
Biomedical Research , Communications Media , Community Participation , Female , Humans , Kenya , Male , Schools , Students
5.
JMIR Mhealth Uhealth ; 10(3): e30872, 2022 03 09.
Article in English | MEDLINE | ID: covidwho-1770891

ABSTRACT

The COVID-19 pandemic has overwhelmed health care systems worldwide, particularly in underresourced communities of color with a high prevalence of pre-existing health conditions. Many state governments and health care entities responded by increasing their capacity for telemedicine and disease tracking and creating mobile apps for dissemination of medical information. Our experiences with state-sponsored apps suggest that because many of these eHealth tools did not include community participation, they inadvertently contributed to widening digital health disparities. We propose that, as eHealth tools continue to expand as a form of health care, more attention needs to be given to their equitable distribution, accessibility, and usage. In this viewpoint collaboratively written by a minority-serving community-based organization and an eHealth academic research team, we present our experience participating in a community advisory board working on the dissemination of the COVID Alert NY mobile app to illustrate the importance of public participation in app development. We also provide practical recommendations on how to involve community representatives in the app development process. We propose that transparency and community involvement in the process of app development ultimately increases buy-in, trust, and usage of digital technology in communities where they are needed most.


Subject(s)
COVID-19 , Mobile Applications , Telemedicine , COVID-19/epidemiology , Community Participation , Humans , Pandemics , SARS-CoV-2
6.
Am J Public Health ; 112(4): 598-600, 2022 04.
Article in English | MEDLINE | ID: covidwho-1760048
8.
PLoS One ; 17(3): e0260574, 2022.
Article in English | MEDLINE | ID: covidwho-1753182

ABSTRACT

INTRODUCTION: The COVID-19 Community Research Partnership is a population-based longitudinal syndromic and sero-surveillance study. The study includes over 17,000 participants from six healthcare systems in North Carolina who submitted over 49,000 serology results. The purpose of this study is to use these serology data to estimate the cumulative proportion of the North Carolina population that has either been infected with SARS-CoV-2 or developed a measurable humoral response to vaccination. METHODS: Adult community residents were invited to participate in the study between April 2020 and February 2021. Demographic information was collected and daily symptom screen was completed using a secure, HIPAA-compliant, online portal. A portion of participants were mailed kits containing a lateral flow assay to be used in-home to test for presence of anti-SARS-CoV-2 IgM or IgG antibodies. The cumulative proportion of participants who tested positive at least once during the study was estimated. A standard Cox proportional hazards model was constructed to illustrate the probability of seroconversion over time up to December 20, 2020 (before vaccines available). A separate analysis was performed to describe the influence of vaccines through February 15, 2021. RESULTS: 17,688 participants contributed at least one serology result. 68.7% of the population were female, and 72.2% were between 18 and 59 years of age. The average number of serology results submitted per participant was 3.0 (±1.9). By December 20, 2020, the overall probability of seropositivity in the CCRP population was 32.6%. By February 15, 2021 the probability among healthcare workers and non-healthcare workers was 83% and 49%, respectively. An inflection upward in the probability of seropositivity was demonstrated around the end of December, suggesting an influence of vaccinations, especially for healthcare workers. Among healthcare workers, those in the oldest age category (60+ years) were 38% less likely to have seroconverted by February 15, 2021. CONCLUSIONS: Results of this study suggest more North Carolina residents may have been infected with SARS-CoV-2 than the number of documented cases as determined by positive RNA or antigen tests. The influence of vaccinations on seropositivity among North Carolina residents is also demonstrated. Additional research is needed to fully characterize the impact of seropositivity on immunity and the ultimate course of the pandemic.


Subject(s)
Antibodies, Viral/analysis , COVID-19/epidemiology , Health Personnel/statistics & numerical data , SARS-CoV-2/immunology , Adult , Age Factors , Community Participation , Female , Humans , Longitudinal Studies , Male , Middle Aged , North Carolina/epidemiology , Seroconversion , Young Adult
9.
Int J Environ Res Public Health ; 19(6)2022 03 14.
Article in English | MEDLINE | ID: covidwho-1742455

ABSTRACT

The COVID-19 pandemic and resultant lockdowns have brought unprecedented challenges for Maternal, Sexual and Reproductive Health (MSRH) services. Components of MSRH services adversely affected include antenatal, postnatal, and newborn care; provision of family planning and post-abortion care services; sexual and gender-based violence care and prevention; and care and treatment for sexually transmitted infections including HIV. Resuscitating, remodeling or inventing interventions to restore or maintain these essential services at the community level, as a gateway to higher care, is critical to mitigating short and long-term effects of the COVID-19 pandemic on essential MSRH. We propose a possible framework for community involvement and propose integrating key information, education, and communication of MSRH messages within COVID-19 messages.


Subject(s)
COVID-19 , HIV Infections , COVID-19/epidemiology , Communicable Disease Control , Community Participation , Female , HIV Infections/prevention & control , Humans , Infant, Newborn , Pandemics/prevention & control , Pregnancy , Reproductive Health
10.
Acta Trop ; 227: 106269, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1729465

ABSTRACT

Monte Verde, a peri­urban squatter community near San Pedro Sula, virtually eliminated Aedes aegypti production in all known larval habitats: wells; water storage containers including pilas (open concrete water tanks used for laundry), 200-liter drums, 1000-liter plastic "cisterns," buckets; and objects collecting rainwater. The project began in 2016 when Monte Verde was overrun with dengue, Zika, and chikungunya. During more than a year of experimentation, Monte Verde residents crafted an effective, sustainable, and environmentally friendly toolkit that was inexpensive but required full community participation. Biological control with copepods, turtles, and tilapia was at the core of the toolkit, along with a mix of other methods such as getting rid of unnecessary containers, scrubbing them to remove Ae. aegypti eggs, and covering them to exclude mosquitoes or rainwater. Environmentally friendly larvicides also had a limited but crucial role. Key design features: (1) toolkit components known to be nearly 100% effective at preventing Ae. aegypti production when fitted to appropriate larval habitats; (2) using Ae. aegypti larval habitats as a resource by transforming them into "egg sinks" to drive Ae. aegypti population decline; (3) dedicated community volunteers who worked with their neighbors, targeting 100% coverage of all known Ae. aegypti larval habitats with an appropriate control method; (4) monthly monitoring in which the volunteers visited every house to assess progress and improve coverage as an ongoing learning experience for both volunteers and residents. Taking pupae as an indicator of Ae. aegypti production, from September 2018 to the end of the record in December 2021 (except for a brief lapse during COVID lockdown in 2020), the monthly count of pupae fluctuated between zero and 0.6% of the 22,984 pupae counted in the baseline survey at the beginning of the project. Adult Ae. aegypti declined to low numbers but did not disappear completely. There were no recognizable cases of dengue, Zika, or chikungunya after June 2018, though the study design based on a single site did not provide a basis for rigorous confirmation that Monte Verde's Ae. aegypti control program was responsible. Nonetheless, Monte Verde's success at eliminating Ae. aegypti production can serve as a model for extending this approach to other communities. Key ingredients for success were outside stimulation and facilitation to foster shared community awareness and commitment regarding the problem and its solution, enduring commitment of local leadership, compatibility of the toolkit with the local community, overcoming social obstacles, rapid results with "success breeding success," and building resilience.


Subject(s)
Aedes , COVID-19 , Copepoda , Dengue , Tilapia , Turtles , Zika Virus Infection , Zika Virus , Aedes/physiology , Animals , Communicable Disease Control , Community Participation , Dengue/epidemiology , Dengue/prevention & control , Honduras , Humans , Larva , Mosquito Control/methods , SARS-CoV-2
11.
Health Promot Int ; 36(Supplement_1): i24-i38, 2021 Dec 13.
Article in English | MEDLINE | ID: covidwho-1722432

ABSTRACT

Community engagement is crucial for controlling disease outbreak and mitigating natural and industrial disasters. The COVID-19 pandemic has reconfirmed the need to elevate community engagement to build equity, trust and sustained action in future health promotion preparedness strategies. Using the health promotion strategy of strengthening community action enhances the opportunity for better outcomes. There is, therefore, a need to improve our understanding of community engagement practices during crises, scale-up good community engagement initiatives, and improve and sustain people-centered approaches to emergency responses. This paper presents five case studies from the United States, Singapore, Sierra Leone, Kenya and South Africa that demonstrate the potential strengths that can be nurtured to build resilience in local communities to help mitigate the impact of disasters and emergencies. The case studies highlight the importance of co-developing relevant education and communication strategies, amplifying the role of community leaders, empowering community members to achieve shared goals, assessing and adapting to changing contexts, pre-planning and readiness for future emergencies and acknowledgement of historic context.


Subject(s)
COVID-19 , Pandemics , Community Participation , Health Promotion , Humans , SARS-CoV-2 , United States
12.
Glob Health Promot ; 28(4): 104-108, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1673858

ABSTRACT

The pandemic has exposed the vulnerability of our civilization and reinforced the importance of living in harmony with nature, not rampaging it in a conquering mode. South and South-East Asia have a vital role to play in achieving the global goal of 'Health for All' as the regions have a significantly large share of global income and multidimensional poor compared to other regions. Clearly, the progress in health and development outcomes of these regions cannot be achieved without addressing social determinants of health and ensuring active public participation. These regions must collectively address the social determinants of health following a realistic health promotion model. It is indeed a favourable time to look beyond the so-called predominantly reductionist biomedical model of health care to a more holistic model of health, that places humans and the environment at the centre, and emphasizes the importance of promoting health and wellbeing.


Subject(s)
Health Promotion , Income , Asia, Southeastern/epidemiology , Community Participation , Far East , Humans
13.
Public Health Rep ; 137(2): 226-233, 2022.
Article in English | MEDLINE | ID: covidwho-1643027

ABSTRACT

For more than 30 years, the network of Centers for Disease Control and Prevention (CDC)-funded Prevention Research Centers (PRCs) has worked with local communities and partners to implement and evaluate public health interventions and policies for the prevention of disease and promotion of health. The COVID-19 pandemic tested the PRC network's ability to rapidly respond to multiple, simultaneous public health crises. On April 28, 2020, to assess the network's engagement with activities undertaken in response to the early phase of the pandemic, PRC network leadership distributed an online survey to the directors of 34 currently or formerly funded PRCs, asking them to report their PRCs' engagement with predetermined activities across 9 topical areas and provide case studies exemplifying that engagement. We received responses from 24 PRCs, all of which reported engagement with at least 1 of the 9 topical areas (mean, 5). The topical areas with which the greatest number of PRCs reported engagement were support of frontline agencies (21 of 24, 88%) and support of activities related to health care (21 of 24, 88%). The mean number of activities with which PRCs reported engagement was 11. The PRCs provided more than 90 case studies exemplifying their work. The results of the survey indicated that the PRCs mobilized their personnel and resources to support the COVID-19 response in less than 6 weeks. We posit that the speed of this response was due, in part, to the broad and diverse expertise of PRC personnel and long-standing partnerships between PRCs and the communities in which they work.


Subject(s)
COVID-19/prevention & control , Community Participation , Health Services Research/organization & administration , Preventive Health Services/organization & administration , Public Health , Centers for Disease Control and Prevention, U.S. , Health Services Research/statistics & numerical data , Humans , Intersectoral Collaboration , Organizational Case Studies , Preventive Health Services/statistics & numerical data , Surveys and Questionnaires , United States
16.
Public Health Rep ; 137(2): 352-361, 2022.
Article in English | MEDLINE | ID: covidwho-1622163

ABSTRACT

OBJECTIVES: This study was conducted to assess an intervention that was created by a community-academic partnership to address COVID-19 health inequities. We evaluated a community-engaged bidirectional pandemic crisis and emergency risk communication (CERC) framework with immigrant and refugee populations during the COVID-19 pandemic. METHODS: A 17-year community-engaged research partnership adopted a CERC framework in March 2020 to address COVID-19 prevention, testing, and socioeconomic impacts with immigrant and refugee groups in southeast Minnesota. The partnership used bidirectional communication between communication leaders and their social networks to refine messages, leverage resources, and advise policy makers. We conducted a mixed-methods evaluation for intervention acceptability, feasibility, reach, adaptation, and sustainability through multisource data, including email communications, work group notes, semistructured interviews, and focus groups. RESULTS: The intervention reached at least 39 000 people in 9 months. It was implemented as intended and perceived efficacy was high. Frequent communication between community and academic partners allowed the team to respond rapidly to concerns and facilitated connection of community members to resources. Framework implementation also led to systems and policy changes to meet the needs of immigrant and refugee populations. CONCLUSIONS: Community-engaged CERC is feasible and sustainable and can reduce COVID-19 disparities through shared creation and dissemination of public health messages, enhanced connection to existing resources, and incorporation of community perspectives in regional pandemic mitigation policies.


Subject(s)
COVID-19/ethnology , Community Participation/methods , Community-Based Participatory Research/organization & administration , Emigrants and Immigrants , Health Communication/methods , Program Evaluation , Refugees , Humans , Minnesota , SARS-CoV-2
17.
Am J Public Health ; 112(1): 116-123, 2022 01.
Article in English | MEDLINE | ID: covidwho-1591384

ABSTRACT

Arguing for the importance of robust public participation and meaningful Tribal consultation to address the cumulative impacts of federal projects, we bridge interdisciplinary perspectives across law, public health, and Indigenous studies. We focus on openings in existing federal law to involve Tribes and publics more meaningfully in resource management planning, while recognizing the limits of this involvement when only the federal government dictates the terms of participation and analysis. We first discuss challenges and opportunities for addressing cumulative impacts and environmental justice through 2 US federal statutes: the National Environmental Policy Act and the National Historic Preservation Act. Focusing on a major federal planning process involving fracking in the Greater Chaco region of northwestern New Mexico, we examine how the Department of the Interior attempted Tribal consultation during the COVID-19 pandemic. We also highlight local efforts to monitor Diné health and well-being. For Diné people, human health is inseparable from the health of the land. But in applying the primary legal tools for analyzing the effects of extraction across the Greater Chaco region, federal agencies fragment categories of impact that Diné people view holistically. (Am J Public Health. 2022;112(1):116-123. https://doi.org/10.2105/AJPH.2021.306562).


Subject(s)
Community Participation , Decision Making , Environmental Policy/legislation & jurisprudence , Hydraulic Fracking/legislation & jurisprudence , Federal Government , Government Regulation , Humans , New Mexico/ethnology , Public Health
18.
PLoS One ; 16(12): e0261733, 2021.
Article in English | MEDLINE | ID: covidwho-1581733

ABSTRACT

The Covid-19 pandemic has highlighted the importance of citizens' behaviors in the containment of the virus. Individuals might change their intention to adhere to public health prescriptions depending on various personal characteristics, including their own emotional status, which has been recognized to be a crucial psychological factor in orienting people's adherence to public health recommendation during emergency settings. In particular, it is crucial to support citizens' alliance with authorities and feeling of trust: public engagement is a concept that refers to the general involvement of citizens into public affairs which is generally considered an effective approach to enhance citizens' understanding of their crucial role in public affairs. However, so far there is no agreement on the metrics and indexes that should be used to measures public engagement during a health crisis. The aim of this paper is to validate a psychometric scale (PHEs-E), which intends to measure the readiness of individuals to adhere to the prescribed behavioral change to contain the emergency. Data were collected throughout the pandemic in Italy: in particular, five independent samples were recruited starting from March 2020 to March 2021. Results showed that the proposed measure has good psychometric characteristics. A general linear model was computed to assess the differences of public engagement across the different data points and among citizens with different sociodemographic characteristics. Correlations with other psychological constructs (i.e. Anxiety, Depression and Self-Efficacy) were also tested, showing that more engaged citizens have a lower level of anxiety and depression, and a higher self-efficacy. This study's findings indicate that individuals' characteristics may differentiate citizens' motivation to engage in public health behavioral recommendation to prevent the COVID-19 contagion. However the scale could be useful to perform a psychological monitoring of psychological readiness to engage in public health strategies to face critical events and settings.


Subject(s)
COVID-19/psychology , Psychometrics/methods , Stakeholder Participation/psychology , Adult , Aged , COVID-19/prevention & control , Community Participation , Cross-Sectional Studies , Emergencies , Female , Guideline Adherence/trends , Humans , Italy/epidemiology , Male , Middle Aged , Models, Theoretical , Pandemics/prevention & control , Patient Compliance/psychology , Public Health/trends , SARS-CoV-2/pathogenicity
19.
Asia Pac J Public Health ; 33(8): 951-952, 2021 11.
Article in English | MEDLINE | ID: covidwho-1575076

ABSTRACT

Although coronavirus vaccine roll-out is beginning, standard public health practices will, for most people, remain their first line of protection for some time. Three principles guiding the pandemic control process, namely community participation, promotion of equity, and cultural sensitivity, can help people adhere to public health advice. These three principles can enhance intervention effectiveness, decreasing the rate of infection and protecting human rights, promoting social harmony and preventing unrest.


Subject(s)
COVID-19 , Pandemics , COVID-19 Vaccines , Community Participation , Humans , Pandemics/prevention & control , Public Health , SARS-CoV-2
20.
rev. colomb. cienc. soc ; 12(2): 778-804, 2021.
Article in Spanish | WHO COVID, LILACS (Americas) | ID: covidwho-1573042

ABSTRACT

El objetivo de este trabajo fue realizar una aproximación conceptual y análisis de prácticas que permitan problematizar la inclusión de estrategias comunitarias en abordajes integrales de salud mental. Desde una perspectiva cualitativa, este escrito es producto de un proceso de articulación conceptual y sistematización derivado de un análisis reflexivo sobre prácticas de salud mental desarrolladas en el primer nivel de atención en la ciudad y provincia de Buenos Aires desde el año 2010. Se reconoce la fragilización de redes comunitarias como una problemática colectiva en salud mental, y se propone a la promoción en salud mental como estrategia central que permite, desde una perceptiva no normativa e integral, el desarrollo de acciones participativas y el fortalecimiento de lazos comunitarios solidarios como recursos colectivos para el cuidado de la salud mental. Se abordan ejes problemáticos relevados en la implementación de dichas prácticas y su relación con una vigente tensión entre los modelos biomédico e integral de atención. Se articulan reflexiones relacionadas a la pandemia por COVID-19, evidenciando una necesidad actual de profundizar el desarrollo de estrategias comunitarias en salud mental.


The objective of this work was to carry out a conceptual approach and analysis of practices that allow problematizing the inclusion of community strategies in comprehensive mental health approaches. From a qualitative perspective, this paper is the result of a process of conceptual articulation and systematization derived from a reflexive analysis of mental health practices developed in the first level of care in the City and Province of Buenos Aires since 2010. The fragilization of community networks is recognized as a collective mental health problem, and mental health promotion is proposed as a central strategy that allows, from a non-normative and comprehensive perspective, the development of participatory actions and the strengthening of supportive community bonds, as collective resources for mental health care. It addresses problematic axes revealed in the implementation of such practices and their relationship with a current tension between the biomedical and integral models of care. Reflections related to the COVID-19 pandemic are articulated, evidencing a current need to deepen the development of community strategies in mental health.


Subject(s)
Humans , Patients/psychology , Psychology, Social , Community Participation/methods , Patient Care
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