Generalized Resistance Deficits in inmates with hypertension: missing resources that limit health / Déficits de Resistencia Generalizados en reclusos con hipertensión: recursos faltantes que limitan la salud / Déficits Generalizados de Resistência em pessoas presas com hipertensão: recursos ausentes que limitam a saúde

ABSTRACT Objective: to understand the Generalized Resistance Deficits of people deprived of liberty with hypertension in a Brazilian prison unit. Method: qualitative research, anchored in Salutogenesis, carried out with 38 people with hypertension from a Brazilian prison unit, from February to July 2022, with a semi-structured interview with open-ended questions, whose analysis was thematic, explaining the limitations to health in prison. Results: 13 Generalized Resistance Deficits were reported, mostly related to the prison environment and, to a lesser extent, to the social group and the individual, respectively. Living in prison for people with hypertension implies living with a high number of Generalized Resistance Deficits, accentuating the movement towards the disease pole. Final considerations: knowing Generalized Resistance Deficits allows directing health promotion to support the use of available Generalized Resistance Resources and contributes to the expansion of intersectoral policies.

RESUMEN Objetivo: comprender los Déficits de Resistencia Generalizados de personas privadas de libertad con hipertensión arterial sistémica en una unidad penitenciaria brasileña. Método: investigación cualitativa, anclada en la Salutogénesis, realizada con 38 personas con hipertensión arterial sistémica de una unidad penitenciaria brasileña, de febrero a julio de 2022, con entrevista semiestructurada con preguntas abiertas, cuyo análisis fue temático, explicando las limitaciones a la salud en prisión. Resultados: se reportaron 13 Déficits de Resistencia Generalizados, en su mayoría relacionados con el ambiente penitenciario y, en menor medida, con el grupo social y el individuo, respectivamente. Vivir en prisión para personas con hipertensión arterial sistémica implica vivir con un elevado número de Déficits de Resistencia Generalizados, acentuando el movimiento hacia el polo de la enfermedad. Consideraciones finales: conocer los Déficits de Resistencia Generalizada permite orientar la promoción de la salud para apoyar el uso de los Recursos de Resistencia Generalizada disponibles y contribuye a la ampliación de políticas intersectoriales.

RESUMO Objetivo: apreender os Déficits Generalizados de Resistência de pessoas privadas de liberdade com hipertensão arterial sistêmica de uma unidade prisional brasileira. Método: pesquisa qualitativa, ancorada na Salutogênese, realizada com 38 pessoas com hipertensão arterial sistêmica de uma unidade prisional brasileira, de fevereiro a julho de 2022, com entrevista semiestruturada de questões abertas, cuja análise foi temática, explicitando os limitantes à saúde na prisão. Resultados: foram relatados 13 Déficits Generalizados de Resistência, relacionando-se em maioria ao ambiente prisional e, em menor proporção, ao grupo social e ao indivíduo, respectivamente. O viver na prisão para pessoas com hipertensão arterial sistêmica implica conviver com elevado número de Déficits Generalizados de Resistência, acentuando o movimento em direção ao polo doença. Considerações finais: conhecer os Déficits Generalizados de Resistência permite direcionar a promoção da saúde para apoiar o uso dos Recursos Generalizados de Resistência disponíveis e contribui com a ampliação de políticas intersetoriais.

Association Between Sense of Coherence and Tobacco Use Among Brazilian Adolescent Students.

Background: Investigating tobacco use and associated factors is essential to set priorities and health promotion strategies among adolescents. Several studies examined the relationship between this behavior and the psychosocial salutogenic construct Sense of Coherence (SOC), but the evidence is limited to adolescents in high-income countries. This study aimed to analyze the association between tobacco use and SOC among Brazilian adolescent students. Methods: A cross-sectional school-based survey was conducted in 2018. Dependent variables were categorical binary (Yes/No): (1) Smoking experimentation (at least one puff in a lifetime); (2) Current smoking (at least one cigarette smoked in the last 30 days); (3) Daily cigarette smoking; and (4) Experimentation with hookah and/or other tobacco products (at least once in a lifetime). Independent variable SOC was assessed with the SOC-13 item scale. Independent-samples t-Test and Logistic regression were used in the statistical analyses. Potential confounders were identified using a Directed Acyclic Graph. Results: Participants were 3034 adolescents aged 13-19. The mean SOC scores were higher among adolescents who answered no to each of the dependent variables than among those who answered yes (p < .05). In the regression analysis, those with higher SOC scores were less likely to report smoking experimentation, current use, daily use, and experimentation with hookah and/or other tobacco products, than those with lower SOC scores. The associations remained after controlling for sociodemographic and/or social-environmental factors. Conclusion: An inverse relationship between SOC and tobacco use was observed among Brazilian adolescent students.

[Sense of coherence in type 2 diabetes mellitus debutants: case-control study]. / Sentido de coherencia en debutantes de diabetes mellitus 2: estudio tipo casos-controles.

Background: The pathogenic model guides the study of risk factors for the disease; the salutogenic model guides the study of health assets, focused on problem solving, the ability of people to use their available resources and perceive their lives as coherent, structured and understandable. Its central element is the sense of coherence (SOC). The relationship of SOC with different phases of diabetes has been demonstrated, but not in diabetic debutants. Objective: To evaluate the magnitude of the association of SOC between type 2 diabetes mellitus (T2DM) debutants and absentees in people detected in the PREVENIMSS module. Material and methods: case-control design. Cases were T2DM debutants with fasting plasma glucose ≥ 126 mg/dL; controls, people with plasma glucose < 100 mg/dL. Sample size was estimated for independent groups (101 cases and 202 controls) in which the SOC-29 questionnaire was administered; socio-demographic data was recorded and their file was reviewed. Reliability of SOC-29 was analyzed; univariate analysis, chi-squared and binary logistic regression were used to estimate association and odds ratio (OR). Results: T2DM debutants were 5 times more likely to achieve a low SOC score than patients without T2DM (p = 0.002; OR: 5.31, 95% confidence interval: 1.81-15.53). Conclusions: High sense of coherence is an asset for the health of T2DM debutants; it is proposed to incorporate this topic into the DIABETIMSS program.

Introducción: el modelo patogénico orienta a estudiar factores de riesgo para la enfermedad; el modelo salutogénico orienta a estudiar activos para la salud y está centrado en la resolución de problemas, la capacidad de las personas para usar sus recursos disponibles y percibir su vida como coherente, estructurada y comprensible. Su elemento central es el sentido de coherencia (SOC). Está demostrada la relación del SOC con diferentes fases de la diabetes, pero no con el debut diabético. Objetivo: evaluar la magnitud de la asociación del SOC entre debutante y ausente de diabetes mellitus tipo 2 (DMT2) en personas detectadas en el módulo PREVENIMSS. Material y métodos: diseño de casos y controles. Los casos fueron personas debutantes de DMT2 con glucemia plasmática en ayuno ≥ 126 mg/dL; los controles, personas con glucemia plasmática < 100 mg/dL. Se estimó tamaño de muestra para grupos independientes (101 casos y 202 controles) en los que se aplicó cuestionario SOC-29; se registraron datos sociodemográficos y se revisó su expediente. Se analizó la confiabilidad del SOC-29; se empleó análisis univariado, chi cuadrado y regresión logística binaria para estimar asociación y razón de momios (RM). Resultados: los pacientes debutantes de DMT2 tenían 5 veces más probabilidad de alcanzar una puntuación de SOC baja que los pacientes sin DMT2 (p = 0.002; RM 5.31, intervalo de confianza del 95% 1.81-15.53). Conclusiones: el sentido de coherencia alto es un activo para la salud del debutante de DMT2; se propone incorporar este tema al programa DIABETIMSS.

Doença crônica e saúde das pessoas privadas de liberdade à luz da teoria salutogênica: estudo de métodos mistos / Chronic disease and health of people deprived of liberty in light of the salutogenic theory: a mixed methods study

Resumo: Introdução: As pessoas privadas de liberdade sofrem mudanças em seus hábitos e costumes que podem influenciar em suas vidas e saúde, possuindo direitos a cuidados equivalentes aos da comunidade. Objetivo: Apreender a situação de saúde das pessoas privadas de liberdade de um complexo penitenciário brasileiro. Método: Trata-se de uma pesquisa de métodos mistos, com abordagens qualitativa e quantitativas, com pessoas privadas de liberdade do complexo penitenciário, composto de quatro unidades penais, entre abril de 2021 a julho de 2022. Foram três etapas: na primeira, os participantes pertenciam às quatro unidades penais e, na segunda e terceira etapas, apenas uma unidade. Os instrumentos utilizados foram: questionário semiestruturado e senso de coerência; instrumento de dados clínicos e perguntas abertas, de consulta de enfermagem; de literacia em saúde e de conhecimento em hipertensão arterial. A pesquisa obedeceu aos critérios éticos vigentes no Brasil. A análise estatística foi realizada no ambiente R 4.1.1, por meio de análise descritiva e testes de associação (p<0,05). O referencial teórico que sustentou as análises foi a Teoria Salutogênica. Resultados: Na primeira etapa participaram 326 pessoas privadas de liberdade, 90,8% do sexo masculino, 53,4% jovens, com idade entre 18 e 29 anos, 43,3% solteiros, 55,8% com escolaridade inferior a nove anos, 61,3% realizavam alguma atividade na unidade penal, 63,2% eram fumantes ou ex-fumantes, 28,2% ingeriam bebida alcoólica e 60,4% usuários ou ex-usuários de drogas ilícitas, 71,2% praticavam atividades físicas, 86,1% avaliaram positivamente o estado de saúde e 52,5% relatou alguma doença crônica. As doenças que prevaleceram foram: as respiratórias, gastrointestinais, psíquicas, cardiovasculares e osteomusculares. Em relação ao senso de coerência, prevaleceu o moderado (65,9%), associado com a idade (p-valor: 0,011) e realização de atividades na unidade penal (p-valor: 0,005), e o fraco foi prevalente em pessoas com transtornos mentais (p-valor: 0,001) e doenças infectocontagiosas (p-valor: 0,018). Na segunda e terceira etapas, participaram da intervenção 38 homens; destes, 73,3% com idade entre 30 e 44 anos, 46,7% casados, 56,7% pais de 1 a 3 filhos, 73,3 % com escolaridade inferior a 12 anos de estudo, 46,7% com renda familiar prévia a privação de liberdade entre 1 a 2 salários mínimos, 63,3% a hipertensão foi diagnosticada nas unidades penais. As intervenções de enfermagem repercutiram na literacia em saúde e no conhecimento em da doença; contudo, o senso de coerência não apresentou mudanças. As categorias da análise qualitativa foram: saúde, bem-estar e qualidade de vida na prisão; recursos generalizados de resistência e ausência de recursos; (Des)esperanças com a vida e o futuro e (Des)cuidados com a saúde. Considerações finais: Ações de intervenções de enfermagem fortaleceram literacia em saúde e o conhecimento da doença. O impacto social relaciona-se ao referencial teórico salutogênico, que permitiu uma nova perspectiva de cuidado às pessoas privadas de liberdade, contribuindo para a formulação de políticas de saúde, e nas condições de vida e saúde delas. A pesquisa possui potencial para replicabilidade devido ao caminho metodológico percorrido e os resultados encontrados, que refletem a realidade local, necessitando de novas pesquisas em outras regiões brasileiras.

Abstract: Introduction: People deprived of liberty suffer changes in habits that influence their lives and health, having the same care rights that the community has. Objective: Apprehending the health situation of people deprived of liberty in the city of Foz do Iguaçu - Paraná. Method: This research has mixed methods with qualitative and quantitative approaches, carried out between April 2021 and July 2022, with people deprived of liberty who reside in a penitentiary complex composed of four penal units. The research was divided into three stages: on the first, the participants belonged to four penal units and, in the second and third stages, they corresponded to only one unit. The instruments used were: semi-structured questionnaire and sense of coherence; nursing consultation clinical data instrument and subjective questions; health literacy and knowledge on arterial hypertension. The research complied with the ethical criteria force in Brazil. Statistical analysis was performed in the R 4.1.1 sector through descriptive analysis and association tests (p<0.05). The theoretical literature that supported the analyzes was based on the Salutogenic Theory. Results: 326 people deprived of their liberty participated in the first stage, 90.8% male, 53.4% young people aged between 18 and 29 years, 43.3% single, 55.8% with less than nine years of schooling, 61.3% participated in some activity in the penal unit, 63.2% smokers or former smokers, 28.2% drank alcohol and 60.4% were users or former users of illicit drugs. Furthermore, 71.2% of the participants practiced physical activities and 86.1% positively evaluated their health status, but 52.5% reported some chronic illness. Reports of diseases prevailed: respiratory, gastrointestinal, psychic, cardiovascular and musculoskeletal. Regarding the sense of coherence, moderate (65.9%) associated with age (p-value: 0.011) and with carrying out activities in the penal unit prevailed (p-value: 0.005); weak was prevalent in people with mental disorders (pvalue: 0.001) and infectious diseases (p-value: 0.018). In the second and third stages, 38 men participated in the intervention, among them 73.3% aged between 30 and 44 years, 46.7% married, 56.7% were fathers up to three children, 73.3% had less education than 12 years of study, 46.7% had family income prior to deprivation of liberty of one or two minimum wages, 63.3% with hypertension diagnosed in penal units. Nursing interventions had repercussions on health literacy and knowledge of the disease; however, the sense of coherence did not change. The qualitative analysis categories were: health, well-being and quality of life in prison; generalized resources of resistance and lack of resources; (Dis)hope for life and the future and (Dis)care for health. Final considerations: Nursing intervention actions strengthened health literacy and knowledge of the disease. The social impact is related to the salutogenic theoretical framework, which allowed a new perspective of care for people deprived of liberty, contributing to the formulation of health policies and the life and health conditions of the participants. The research has the potential for replicability due to the methodological path followed and the results found, as it reflects the local reality, requiring, however, further research in other Brazilian regions.

Modelo sinérgico de salud: una integración de la salutogénesis y el modelo de activos para la salud.

Se propone un "modelo sinérgico" para avanzar en la integración de elementos clave de la salutogénesis y el modelo de activos para la salud, utilizando como marco para esta articulación la teoría bioecológica de Bronfenbrenner. El sentido de coherencia es clave para facilitar la transformación de recursos potenciales en activos disponibles, produciendo un desarrollo positivo de la salud. El modelo sinérgico puede aportar a la contextualización de las ideas en políticas y prácticas de salud pública, fortaleciendo la dimensión salud-bienestar y contribuyendo al desarrollo de modelos de salud más integrados y colectivos.

Salutogénesis, sanación y curación

Introducció n: En salud aún prevalece, a escala mundial, el modelo patogénico, el cual acentúa la etiopatogenia de la enfermedad, la curación o rehabilitación. Progresivamente se viene introduciendo el modelo de salutogénesis, que preconiza la importancia de la prevención primaria, el bienestar y la sanidad. El objetivo del artículo consiste en argumentar los nexos entre salutogénesis, curación y sanación, como categorías conectadas a la condición saludable de los sujetos, tomándose como fuente de sustentación el criterio de profesionales de la salud y la consulta de fuentes bibliográficas acreditadas acerca de la temática. Material y métodos: Se emplearon métodos y técnicas teóricos, empíricos y estadísticos. La sistematización teórica permitió caracterizar y relacionar los procesos de salutogénesis, curación y sanación. Se aplicó un cuestionario en línea a profesionales vinculados con el sector de la salud para indagar acerca de las categorías de sanación y curación, de los que se obtuvo respuesta de 35 especialistas. Los datos fueron procesados mediante la estadística descriptiva. Resultados: La exploración develó algunas diferencias y semejanzas entre los procesos curativo y sanador; destacándose el carácter más restringido del primero; en tanto la metodología más versátil y creativa, el carácter transformador y los efectos más duraderos del segundo. Se advierte que el nivel de dominio relativo a ambos procesos no es suficientemente extendido ni notorio, como se requeriría para una labor asistencial más efectiva.

Introduction: In health, the pathogenic model still prevails worldwide, which emphasizes the etiopathogenesis of the disease, cure or rehabilitation. The salutogenesis model has been progressively introduced, which advocates the importance of primary prevention, well-being and health. The objective of the article is to argue the links between salutogenesis, healing and curing, as categories connected to the healthy condition of the subjects, taking as a source of support the criteria of health professionals and the consultation of accredited bibliographic sources on the subject. Material and method: Theoretical, empirical and statistical methods and techniques were used. The theoretical systematization allowed to characterize and relate the processes of salutogenesis, healing and curing. An online questionnaire was applied to professionals linked to the health sector to inquire about the categories of healing and curing, from which responses were obtained from 35 specialists. The data was processed using descriptive statistics. Results: The exploration revealed some differences and similarities between the curative and healing processes; highlighting the more restricted character of the first; as the most versatile and creative methodology, the transformative character and the most lasting effects of the latter. It is noted that the level of mastery related to both processes is not sufficiently widespread or notorious, as would be required for a more effective care work.

Stories of Hope and Health: Wisdom From Older Mexican-American Women Who Broke Free From the Entangled Web of Love and Violence.

This interpretive qualitative study explores the lived experience of intimate partner violence (IPV) among 12 older Mexican-American women aged 55-85 with past experiences of IPV to understand how it shaped their lives. Sociocultural factors that influenced the IPV experience and sustained health amidst adversity were explored. Denzin's interpretive interactionism along with Antonovsky's salutogenic theory guided this study. These women survived IPV and discovered ways to foster health and thrive in later years. They all vowed to break the cycle of violence for future generations. Their wisdom offers hope and has implications for healthcare professionals, future research, and advocacy efforts.

Resources for health maintenance in persons deprived of liberty with arterial hypertension: a salutogenic approach / Recursos para el mantenimiento de la salud en prisioneros con hipertensión arterial: un enfoque saludgénico / Recursos para manutenção da saúde em pessoas presas com hipertensão arterial: uma abordagem salutogênica

ABSTRACT Objective: to know the generalized resistance resources of people deprived of liberty with systemic arterial hypertension in a triple border region. Method: a qualitative study based on the theoretical framework of Salutogenesis, in which 38 people deprived of liberty in Foz do Iguaçu, Paraná, Brazil, participated from February to July 2022. Guiding questions were used in the interviews which were submitted to thematic content analysis. Results: 12 generalized resistance resources emerged in the reports of people deprived of liberty with systemic arterial hypertension: health team; access to medications; work; lifestyle habits: food, physical activity and restriction of access to drugs/cigarettes/alcoholic beverages; stress/anxiety control; reading and games; religiosity; family; self-care; cellmates; and employees. Conclusion: people deprived of liberty with systemic arterial hypertension have generalized resistance resources to manage their life and health, which are related to personal care, the social group and the environment. It is noteworthy that once they are identified, the generalized resistance resources can be used by health professionals to manage SAH, other chronic diseases and aid in health promotion.

RESUMEN Objetivo: conocer los recursos generalizados de resistencia de las personas privadas de libertad con hipertensión arterial sistémica en una región de la triple frontera. Método: investigación cualitativa basada en el referencial teórico de la Salutogénesis, en la que participaron 38 personas privadas de libertad de Foz do Iguazú, Paraná, Brasil, de febrero a julio de 2022. Se utilizaron preguntas orientadoras en las entrevistas, que fueron sometidas al análisis de contenido en la modalidad temática. Resultados: 12 recursos generalizados de resistencia surgieron en los relatos de detenidos con hipertensión arterial sistémica: equipo de salud; acceso a medicamentos; trabajar; hábitos de vida: alimentación, actividad física y restricción de acceso a drogas/cigarrillos/bebidas alcohólicas; control del estrés/ansiedad; lectura y juegos; religiosidad; familia; cuidados personales; compañeros de cubículo y empleados. Conclusión: las personas privadas de libertad con hipertensión arterial sistémica poseen recursos generalizados de resistencia para el manejo de su vida y salud, los cuales están relacionados con el cuidado personal, el grupo social y el medio ambiente. Se destaca que, una vez identificados, los recursos generalizados de resistencia pueden ser utilizados por los profesionales de la salud en el manejo de la HAS, otras enfermedades crónicas y promoción de la salud.

RESUMO Objetivo: conhecer os recursos generalizados de resistência das pessoas privadas de liberdade com hipertensão arterial sistêmica de uma região de tríplice fronteira. Método: pesquisa qualitativa pautada no referencial teórico da Salutogênese, da qual participaram 38 pessoas privadas de Liberdade de Foz do Iguaçu, Paraná, Brasil, no período de fevereiro a julho de 2022. Utilizou-se de questões norteadoras nas entrevistas, as quais foram submetidas a análise de conteúdo na modalidade temática. Resultados: emergiram 12 recursos generalizados de resistência nos relatos das pessoas presas com hipertensão arterial sistêmica: equipe de saúde; acesso às medicações; trabalho; hábitos de vida: alimentação, atividade física e restrição ao acesso a drogas/cigarro/bebida alcóolica; controle do estresse/ansiedade; leitura e jogos; religiosidade; família; autocuidado; companheiros de cubículo e funcionários. Conclusão: as pessoas privadas de liberdade com hipertensão arterial sistêmica apresentam recursos generalizados de resistência para manejar sua vida e saúde, os quais se relacionam ao cuidado pessoal, ao grupo social e ao ambiente. Destaca-se que, uma vez identificados, os recursos generalizados de resistência podem ser utilizados pelos profissionais de saúde no gerenciamento da HAS, outras doenças crônicas e promoção da saúde.

[Mapping strategy for health and wellbeing community assets in the city of Buenos Aires]. / Estrategia de mapeo de activos comunitarios para la salud y el bienestar en la ciudad de Buenos Aires.

Introduction: implementing an asset model in large urban territories is a great challenge. The objective was to develop and evaluate community asset (CA) mapping strategies in a large city. Methods: mixed technique, in phases. At first, community resources (CR) were collected through interviews with key informants, search of information sources and field surveys with university students and community volunteers in some pilot neighborhoods. In the second phase, a mass communication campaign was carried out to disseminate the collaborative virtual map. Assets were validated according to eligibility criteria. Campaign evaluation was carried out through indicators of visualization, interaction and participation. In a third phase, community work in the field was reinforced in different neighborhoods. Results: 1144 CR and CA were identified, all of them validated, classified and grouped into five categories. A month after launching the communication campaign "#MeHaceBienMiBarrio," it had been broadcast in the main media in the country. In just two weeks, 120,383 people had been reached with the news on Facebook, and 9,213 had interacted. By then, the map had more than 23,000 views and 87 new community assets were received. The participation rate fell as diffusion decreased. Discussion: The first stage was positive in terms of dissemination and interaction with the map. Field work is essential to sustain and enhance results.

Introducción: Implementar un modelo de activos en amplios territorios urbanos es un gran desafío. El objetivo fue desarrollar y evaluar estrategias de mapeo de recursos y activos en una gran ciudad. Métodos: técnica mixta, en fases. En la primera, se relevaron recursos con entrevistas a informantes clave, búsqueda en fuentes de información y relevamiento en terreno con alumnos universitarios y voluntarios de la comunidad en algunos barrios piloto. En la segunda fase se realizó una campaña de comunicación masiva para difundir el mapa virtual colaborativo. Se validaron los activos según criterios de elegibilidad. La evaluación de la campaña se realizó mediante indicadores de visualización, interacción y participación. En una tercera fase se reforzará el trabajo comunitario en terreno en distintos barrios. Resultados: se identificaron 1144 recursos y activos, todos ellos validados, clasificados y agrupados en cinco categorías. Al mes de iniciada la campaña de comunicación "#MeHaceBienMiBarrio", se había difundido en los principales medios de comunicación del país. En sólo dos semanas, 120.383 personas habían sido alcanzadas con la noticia en Facebook, y 9.213 habían interactuado. Para entonces, el mapa tenía más de 23.000 visitas y se recibieron 87 nuevos activos de la comunidad. La tasa de participación bajó al bajar la difusión. Discusión: la primera etapa fue positiva en difusión e interacción con el mapa. Es fundamental el trabajo en terreno para sostener y potenciar los resultados.

Sentido Comunitario de la Coherencia en asentamientos informales: aprendizajes y reflexiones desde Medellín (Colombia) / Community Sense of Coherence in slums: learnings and reflections from Medellín (Colombia) / Sentido comunitário da coerência em assentamentos informais: aprendizagens e reflexão desde Medellín (Colômbia)

Resumen Introducción: el modelo de urbanización ha provocado un aumento de las inequidades sociales, transgrediendo los principios éticos de la justicia social y espacial. La Organización Mundial de la Salud ha identificado la urbanización como uno de los principales desafíos de salud pública del siglo XXI. Objetivo: comprender el sentido de la coherencia comunitario generado a través de los activos comunitarios para la salud en el asentamiento informal El Faro al nororiente de la ciudad de Medellín. Materiales y métodos: se realizó una investigación bajo una metodología de estudio de caso de alcance interpretativo, y un análisis narrativo de construcción de la explicación a partir de siete entrevistas semiestructuradas, dos talleres de fotovoz y un mapeo de activos comunitarios para la salud desarrollado entre 26 habitantes de Medellín. Resultados: desde el modelo salutogénico se reconoció el empoderamiento de la comunidad, porque les ha permitido enfrentar las resistencias del contexto, creando prácticas positivas y saludables. Estas prácticas han movilizado sus activos comunitarios, permitiendo el desarrollo de un importante Sentido Comunitario de la Coherencia, con el cual la comunidad enfrenta los desafíos de la vida y construye experiencias coherentes. Conclusiones: los habitantes han buscado encontrar soluciones que respondan a la situación de pobreza, en un proceso de abajo hacia arriba que ha buscado crear espacios significativos, un mayor sentido de pertenencia y una percepción de seguridad de habitar este territorio. Finalmente, cuanto mejor se conoce el entorno, mejor se conocen las comunidades entre sí y se preserva mejor la salud comunitaria y el bienestar social.

Abstract Introduction: The urbanization model has caused an increase in social inequities, transgressing the ethical principles of social and spatial justice. The World Health Organization has identified urbanization as one of the major public health challenges of the 21st century. Objective: To understand the Sense of Community Coherence generated through community assets for health in the informal settlement El Faro in the northeast of the city of Medellin. Materials and methods: This research was conducted under a case study methodology with an interpretive scope, and a narrative analysis of construction of the explanation from seven semi-structured interviews, two photo-voice workshops and a mapping of community assets for health developed between 26 inhabitants of Medellin. Results: From the salutogenic model, the empowerment of the community was recognized because it has allowed them to face the resistance of the context creating positive and healthy practices. These practices have mobilized their community assets, allowing the development of an important Community Sense of Coherence with which the community faces the challenges of life and builds coherent experiences. Conclusions: The inhabitants have sought to find solutions that respond to the situation of poverty in a bottom-up process that has search to create significant spaces, a greater sense of belonging and a perception of security in inhabiting this territory. Finally, the better the environment is known, the better the communities know each other and the better the community health and social well-being are preserved.

Resumo Introdução: o modelo de urbanização tem provocado um aumento das inequidades sociais, transgredindo os princípios éticos da justiça social e espacial. A Organização Mundial da Saúde já identificou a urbanização como um dos principais desafios da saúde pública do século XXI. Objetivo: compreender o sentido da coerência comunitária gerada a través dos ativos comunitários para a saúde no assentamento informal O Faro ao nordeste da cidade de Medellín. Materiais e métodos: realizou-se uma pesquisa baixo uma metodologia de estudo de caso de alcance interpretativo, e uma análise narrativa de construção da explicação a partir de sete entrevistas semi-estruturadas, das oficinas de foto voz e um mapeio de ativos comunitários para a saúde desenvolvendo entre 26 habitantes de Medellín. Resultados: desde o modelo salutogênico se reconheceu o empoderamento da comunidade, porque lhes permitiu enfrentar as resistências do contexto, criando práticas positivas e saudáveis. Estas práticas tem mobilizado seus ativos comunitários, permitindo o desenvolvimento de um importante Sentido Comunitário da Coerência, com o qual a comunidade enfrenta os desafios da vida e constrói experiencias coerentes. Conclusões: os habitantes procuraram encontrar soluções que respondam à situação de pobreza, em um processo de abaixo para arriba que tem buscado criar espaços significativos, um maior sentido de pertinência e uma percepção de segurança de habitar este território. Finalmente, quanto melhor se conhece o entorno, melhor se conhecem as comunidades entre si e se preserva melhor a saúde comunitária e o bem-estar social.

Salutogenesis, nutritional status and eating behaviour: a systematic review.

OBJECTIVE: To assess the relationship between the sense of coherence (SOC), eating behaviour and nutritional status. DESIGN: It is a systematic review. SETTING: The following databases were searched: MEDLINE/PubMed, Science Direct/Elsevier, LILACS/Bireme, SciELO and Google Scholar, using the indexed terms 'salutogenesis', 'sense of coherence', 'nutritional status', 'nutrition', 'eating behavior' and 'healthy eating'. The indexed terms were used in Portuguese and English according to the database searched. The data were extracted in a standardised way and the quality of the studies was assessed using the Newcastle-Ottawa Scale. PARTICIPANTS: Observational studies were included, with no limitations on the date of publication or language. RESULTS: After reading the titles and abstracts of 1855 articles, 107 full texts were retrieved, of which 27 were included. Of these, twenty-five were cross-sectional and two were longitudinal. The average score for Newcastle-Ottawa studies was 6 and most studies were rated as moderate and low quality. The cumulative sample size of all included studies was 28 981 adults and the elderly, aged between 18 and 81 years. The studies were carried out in fifteen different countries. Fifteen articles assessed eating behaviour/habit and twelve assessed nutritional status. Studies have shown that SOC has a positive relationship with an appropriate eating behaviour/habit. On the other hand, the relationship between SOC and nutritional status was controversial among studies. The heterogeneity of the data resulting from the use of different methods of evaluation of the outcomes of interest (nutritional status and eating behaviour) made it impossible to perform a meta-analysis. CONCLUSION: SOC was positively associated with adequate eating behaviour. However, it was not possible to establish a relationship between SOC and nutritional status.

Grassroots innovation practices for social transformation of the health and well-being in a self-built settlement in Medellín-Colombia.

Grassroots innovation generates possibilities for the informal and collective production of the territory that the city itself denies, from bottom-up solutions for sustainable development and consumption, which respond to the local situation, interests, and values of the communities involved. This paper aims to identify how grassroots innovation practices take place and are shaped in 'El Faro', a self-built settlement at the urban border of the city of Medellín; and how these have allowed the social transformation of health and well-being. This was done from a qualitative approach with an interpretative scope, under the case study methodology. 'El Faro' is a space built by its inhabitants, in a process that they have called "dignity and resistance", becoming the promoter of what we identify as four 'grassroots innovation practices' developed around three main issues: community water management, artistic training and the creation of community public spaces. This process has allowed them, from the capacity of agency, to understand their poverty situation and face it, modifying the conditions that reproduce it and responding to unsatisfied basic needs, based on innovative solutions that guarantee conditions of life with dignity and well-being. Likewise, it generates mechanisms that reduce inequality because the community becomes the main driving agent for the construction of the city and the transformation of the health-disease process, through its community assets.

Effectiveness of tailored intervention with a salutogenic approach to improve adherence in adults with hypertension: a non-randomized trial.

AIMS: Hypertension (HTN) is a chronic long-term, slowly progressing disease. For HTN control, management, and prevention of associated complications, adequate adherence to treatment is required. It has been proposed that tailored interventions to individual needs are required to address the phenomenon of adherence to treatment. However, studies evaluating the effects of tailored interventions to improve adherence are still scarce. The aim of this study is to evaluate the effectiveness of a tailored intervention using a salutogenic approach, to improve adherence in patients with HTN. METHODS AND RESULTS: A non-randomized trial design was used in this study. Adult patients with HTN were allocated in two groups: tailored intervention (n = 75) and standard care (n = 78). The content of the tailored intervention was based on personal resources and elaboration of an action plan with objectives in agreement with the patients. Patient outcomes (treatment adherence, blood pressure) were assessed both at the beginning of the study and at the 4-week follow-up for the intervention group and the standard care group. The Treatment Adherence Questionnaire for Patients with Hypertension was used to measure adherence. The results of this study showed that the total score and each dimension of the adherence questionnaire (medications, diet, physical activity, weight control, stimulation, and stress relief) increased significantly in the experimental group compared with the control group (P < 0.05). For the group assigned to tailored intervention, the delta score of the total adherence score increased in the final evaluation to 9.4 (95% CI = 8.60-10.28). CONCLUSION: A tailored intervention with a salutogenic approach appears to be effective for improving adherence in patients with HTN. Randomized controlled trials are required to confirm the effect of tailored interventions in this type of population.

Bases teóricas para promoção da saúde e resistência camponesa: um novo horizonte metodológico / Theoretical bases for peasant health promotion and resistance: a new methodological horizon

RESUMO O agronegócio vem historicamente promovendo a submissão da produção, economia e vida das famílias camponesas, gerando graves danos sanitários a essa parcela da população brasileira. No entanto, a resistência do campesinato perante esse secular processo evidencia que a organização das famílias e comunidades camponesas e o resgate participativo dos conhecimentos agroecológicos locais podem fundamentar estratégias de promoção da saúde que busquem mudanças concretas nesse contexto sanitário vulnerável. O objetivo deste trabalho foi apresentar pilares que fundamentaram o processo capitalista de submissão camponesa no Brasil e abordagens teórico-prático-epistemológicas que permitem sua superação. Para isso, foram apresentados tanto referenciais para pesquisas e ações que subsidiem famílias e comunidades camponesas em um processo social de autorreconhecimento, autovalorização e utilização dos seus conhecimentos e suas práticas para uma transição agroecológica emancipatória, quanto a experiência ampliada de promoção da saúde desenvolvida por meio desses referenciais em Lavras-MG. A estrutura metodológica participativa apresentada permitiu o desenvolvimento, nesse município, dos passos iniciais e fundamentais de um processo social de organização camponesa em torno de seu modo de vida e economia, tendo a agroecologia como fator determinante para a saúde e para a construção de um contexto mais justo, favorável e promissor.

ABSTRACT Agribusiness has historically promoted the submission of production, economy, and life of peasant families, causing serious health damage to this portion of the Brazilian population. However, the peasantry's resistance to this secular process shows that the organization of families and communities and the participatory rescue of local agroecological knowledge can support health promotion strategies that seek concrete changes in this vulnerable health context. The objective of this work is to present bases that founded the capitalist process of peasant submission in Brazil and also theoretical-practical-epistemological approaches that allow its overcoming. For this, references for research and actions that subsidize peasant families and communities in a social process of self-recognition, self-valorization, and use of their knowledge and practices for an emancipatory agroecological transition are presented, as well as the health promotion expanded experience developed through these references in Lavras-MG, Brazil. The participatory methodological structure presented allowed the development of the initial and fundamental steps of a social process of peasant organization around their way of life and economy, with agroecology as a determining factor for health and for the construction of a fairer, more favorable, and more promising context.

Efectos en adultos mayores de su participación en un proyecto comunitario basado en activos para la salud / Effects on older adults of their participation in a community project based on health assets

Introducción: el envejecimiento poblacional y el incremento de las enfermedades crónicas no transmisibles están generando un gran impacto en los sistemas de salud a nivel mundial. Articular el sistema de salud con los recursos comunitarios es fundamental para poder coordinar la atención sociosanitaria, descomplejizar la atención de los adultos mayores y promover el envejecimiento activo. Nuestro objetivo fue analizar la relación entre la participación de adultos mayores en un proyecto de mapeo de activos para la salud y los efectos percibidos en esta experiencia. Métodos: la intervención consistió en un taller de seis encuentros semanales donde se aprendió a reconocer activos para la salud. Estos fueron volcados en un mapa virtual de acceso libre y gratuito para ser compartido con toda la sociedad. En el taller también se reforzó la importancia de la relación entre los participantes para mejorar los apoyos sociales. Utilizamos un diseño cualitativo de tipo interactivo con una estructura interconectada y flexible de los componentes de la investigación. Se observaron las interacciones y diálogos que se produjeron entre moderadoras-participantes y participantes entre sí, y se incluyeron los registros del cuaderno de campo de las moderadoras. Al finalizar el último encuentro, y cumplidos tres meses, se realizaron entrevistas en profundidad a quienes asistieron, al menos, a la mitad de los encuentros. Se utilizó una guía con preguntas abiertas, para conocer la perspectiva de los participantes acerca de eventuales cambios percibidos a partir de la experiencia vivida en el taller. Los datos se categorizaron y, posteriormente, se triangularon para garantizar la validez del análisis. Resultados: se identificaron las siguientes categorías que sitúan las experiencias de los participantes en relación con su paso por el proyecto: la generación de vínculos entre pares, los vínculos con las moderadoras, la dinámica de taller, la sustentabilidad del proyecto y la resignificación del barrio. Conclusión: es factible generar cambios positivos en la salud de los adultos mayores, potenciar los espacios de socialización y contribuir satisfactoriamente en la resignificación de los barrios a través del mapeo de activos para la salud. (AU)

Introduction: population ageing and the increase in chronic non-communicable diseases are having a major impact on health systems worldwide. Linking the health system with community resources is essential in order to coordinate social and health care, decomplexify the care of older adults and promote active ageing. Our objective was to analyse the relationship between the participation of older adults in a health asset mapping project and the perceived effects of this experience. Methods: the intervention consisted of a workshop of six weekly meetings where participants learned to recognise health assets from the perspective of each participant. These were then uploaded onto a virtual map that could be accessed free of charge and shared with the whole of society. The workshop also reinforced the importance of the relationship between participants to improve social support.We used an interactive qualitative design with an interconnected and flexible structure between the research components. The interactions and dialogues that took place between moderators-participants and participants with each other were observed, and the field notebook records of the moderators were included. At the end of the last meeting, and after three months, in-depth interviews were conducted with those who attended at least half of the meetings. A guide with open-ended questions was used to find out the participants perspective on possible changes perceived as a result of the workshop experience. The data were categorised and then triangulated to ensure the validity of the analysis. Results: the following categories were identified that situate the participants experiences in relation to their time in the project: the generation of links between peers, the links with the moderators, the workshop dynamics, the sustainability of the project and the re-signification of the neighbourhood. Conclusion: it is feasible to generate positive changes in the health of older adults, to strengthen the spaces for socialisation and to successfully contribute to the resignification of the neighbourhoods through the mapping of assets for health. (AU)

Social determinants of health and community assets: Their importance for context analysis / Determinantes sociales de la salud y activos comunitarios: importancia para el análisis de contexto

ABSTRACT Public health, from alternative perspectives on the approach to positive health, seeks to overcome the deficit in recognizing the resources possessed by people and their communities as proposed in the Salutogenesis assets model. Therefore, this paper aims to establish the relationship between the Social Determinants of Health (SDH) and community assets. A two-stage sequential transformative mixed methods design, quantitative and qualitative, was used. Family files, mapping techniques, interviews, and participant observation were used as instruments. Older adults, women, and leaders have a history that creates opportunities based on education, work, and potential, developed individually or by coexistence between the same families and in the neighborhood. The SDH and community assets converge in the understanding of the territory as a social, historical, and eco-environmental space. There, the macro-policies are reflected, sometimes isolated from people's perceived, conceived, and lived spaces. In the construction of a healthy life, the main elements are people and their relationships. It is in this context that their talents, skills, and abilities are discovered. The results show a bilateral relationship between community assets and the SDH to understand the health-disease process. While the determinants focus on external conditions, risk, and vulnerability, depending on the disease, the assets do so in a positive health perspective that strengthens the resources of people and their communities. In this sense, they complement each other.

RESUMEN La salud pública, desde miradas alternativas con acercamiento a la salud positiva, busca superar el déficit para reconocer los recursos que tienen las personas y sus comunidades, a partir de la Salutogénesis - Modelo de activos. Así, pues, el escrito establece la relación de los determinantes sociales de la salud (DSS) y los activos comunitarios. Se utilizó un diseño mixto transformativo recurrente con dos fases: cuantitativa y cualitativa. Como instrumentos, las fichas familiares, técnicas cartográficas, la entrevista y la observación participante. Los adultos mayores, mujeres y líderes poseen una historia que crea oportunidades basadas en la educación, el trabajo y sus potencialidades, desarrolladas individualmente o por la convivencia entre las mismas familias y el barrio. Los DSS y los activos comunitarios convergen en la comprensión del territorio, como un espacio social, histórico y ecoambiental. Allí, se reflejan las macro políticas, en ocasiones aisladas de los espacios percibidos, concebidos y vividos de las personas. En la construcción de una vida sana, los principales elementos son las personas y sus relaciones; en ese contexto, se descubren sus talentos, las habilidades y las capacidades. Los resultados evidenciaron relación bilateral entre los activos comunitarios y los DSS, para comprender el proceso salud-enfermedad; mientras los determinantes se centran en condiciones externas, de riesgo y de vulnerabilidad en función de la enfermedad, los activos lo hacen en una mirada de salud positiva, que fortalece los recursos de las personas y sus comunidades. En este sentido, se complementan de manera recíproca.

[Community health assets mapping in a slum in Medellin (Colombia)]. / Mapeo de activos comunitario para la salud en un asentamiento informal de Medellín (Colombia).

OBJECTIVE: To describe how the community from El Faro neighborhood identifies its community assets, uses them to face life's challenges through the capacity of collective agency; and by generating community development processes, applying the salutogenic theory that considers people as active subjects, with the capacity to conserve and generate health and well-being, through the use of their own resources called health assets. METHODS: A map of community assets was made in 2018 in el Faro neighborhood, an informal settlement of Medellín, Colombia, following the phases recommended by other authors and from a qualitative, participatory approach that delves into the health situation of the community. RESULTS: In this process were identified 12 individual community assets, 12 collective, 13 institutional and 10 in the environment. The main community asset among the 47 described was community participation, from the agency capacity, mainly of its leaders who participating in their own organizations encourage development, identity construction and well-being. CONCLUSION: Asset mapping has served to identify intangible assets for the community and, in turn, this recognition has been useful in strengthening the agency's capacity for community development. This is a territory transformed by community reflection processes allowing to understand situations of exclusion and poverty, seeking to create a more livable place and developing a community capacity to solve their own problems, through solidarity and community support.

'A synergy model of health': an integration of salutogenesis and the health assets model.

This article proposes to advance the connections between salutogenic theory and assets models for health improvement. There is a need to integrate their use in public health and health promotion so that their respective potentials can be fully developed. This requires their synergies to be made more explicit so that a more coherent approach can be taken to their utilization. A mechanism is therefore needed that helps to raise awareness of them and their value as a resource together. Bronfenbrenner's bioecological theory provides one framework that can support better integration of salutogenesis with the applied nature of assets-based models. This paper proposes a new 'synergy model for health' that integrates key concepts associated with salutogenic theory-generalized and specific resistance resources (GRRs/SRRs) and generalized and specific resistance deficits and the sense of coherence (SOC). In doing so, it highlights those GRRs and SRRs which are assets that, either individually or collectively, help to develop a stronger SOC. Higher levels of SOC can then support the transformations of potential resources into available assets (that people can understand, manage and make sense of), capable of producing positive health development. The proposed 'Synergy model of health' aims to contribute to a deeper theoretical understanding of health and development through the integration of the key elements of both salutogenesis and assets models. This can facilitate a better contextualization of the ideas into public health policy and practice by making the salutogenic theory more action-oriented and the assets model more theoretical.

Salutogenesis in oral health research in preschool children: A scoping review.

BACKGROUND: Oral health research in children has focused both on identifying the risk factors for dental caries and on the impact the disease has on children's life. AIM: Identifying studies that used the salutogenic theory to investigate positive aspects to promote a healthy condition in preschool children. DESIGN: A literature scoping review was conducted to answer the question: 'What has been produced in scientific literature about children's oral health with a salutogenic theoretical reference?' The checklist preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) was applied. The research was conducted on the databases PubMed, Scopus, and Web of Science with no language, design, country or date restrictions. Three independent reviewers selected the studies to be included in the research, extracted data, and assessed the studies' contribution to the review. RESULTS: Among the 38 studies retained, 10 were included, those were published between 2009 and 2018: five in Brazil, two in the United States of America, and one in Canada, China and India, respectively. All articles were published in English language. Nine studies investigated the relation between the parents'/caretakers' sense of coherence and aspects related to the children's oral health condition. One study investigated health factors among the parents of caries-free children. CONCLUSION: Salutogenic orientation must be included in oral health research, so that salutary and risk factors may coexist, contributing to a new perspective for oral health promotion among children.

Saúde bucal na infância: um modelo orientado para a gênese da saúde / Oral health in childhood: a model oriented towards the genesis of health

Nas últimas décadas do século XX e início do século XXI, a prevalência de cárie dentária apresentou redução na maioria dos países desenvolvidos. Apesar disso, a cárie permanece como a doença crônica mais frequente na infância, com distribuição desigual entre os países e populações. O esforço da comunidade científica se concentrou, até o momento, em desenvolver pesquisas focadas na etiopatogenia e nos fatores de risco à cárie. Poucos estudos buscaram analisar os fatores positivos, considerados como ativos em saúde que contribuem para a saúde bucal na infância. Este ensaio teórico teve por objetivo propor um modelo teórico-conceitual, incorporando as abordagens da patogênese e salutogênese, com orientação para a gênese da saúde. A metodologia foi estruturada por meio de revisões de literatura que subsidiaram a elaboração do modelo proposto.

In the last decades of the 20th century and the beginning of the 21st century, the prevalence of dental caries decreased in most developed countries. Despite this, caries remains the most frequent chronic disease in childhood, with uneven distribution among countries and populations. So far, the scientific community's efforts have been focused on developing research regarding the etiopathogenesis and risk factors for caries. Few studies have sought to analyze the positive factors, considered to be active in health that contribute to oral health in childhood. This theoretical essay aims to propose a theoretical-conceptual model, incorporating approaches to pathogenesis and salutogenesis, with guidance for the genesis of health. The methodology was structured through literature reviews that support the development of the proposed model.