Ana Flávia Pires Lucas d’Oliveira

Violência e saúde: contribuições teóricas, metodológicas e éticas de estudos da violência contra a mulher

This article discusses theoretical, methodological, and ethical aspects pertaining to violence against women as both a form of gender violence and a public health issue. The text provides epistemological reflections based on daily research experience with qualitative and quantitative, population-based, and service-user studies that address both women and men. Violence is defined as a complex and sensitive theme of a medical and social nature in terms of its theoretical-methodological approach, pointing to interdisciplinarity as the reference for its construction as an object of health. The article discusses the difficulties in linking the various sciences, methodologies, and theoretical perspectives. It also highlights the special dynamic between visible and invisible violence, with implications for research design, particularly for demarcating the object of study, a relevant issue given the technological needs of health intervention. These specificities of violence raise further ethical issues for the production of knowledge, and there is a need for special care as part of methodological quality in the research. Research ethics is also responsible for the scientificity of the resulting data. Situations stemming from specific studies are used to illustrate the articles commentary.

Violência de gênero no campo da Saúde Coletiva: conquistas e desafios

This text deals with violence against women (VAW) as a scientific and practical object of Health. It is a theoretical and critical reflection related to historical processes that show convergences and distances between the approach of this violence as an issue and the health field particularities, creating contemporary conquests and challenges especially to Public Health. The text debates interdisciplinary aspects of this scientific object and some impacts to the knowledge production and to health actions. Considering the different scientific and practical cultures of Health and other fields that already deal with VAW, existing tensions between health perspective and violence as a socio-cultural phenomenon are showed, becoming critical when added the gender approach. Challenges are then created on dialogs between those fields in terms of: paradigms, scientific models and languages of each one; social intervention needs in every field; and the distinct relation between knowledge and social intervention presented in each field. On the other hand, the conquests related to human and social rights and the proposal of integral health are shown as convergences between these fields. To conclude, some possible answers to the challenges are considered.

Arte, saúde mental e atenção pública: traços de uma cultura de cuidado na história da cidade de São Paulo

By studying the inclusion of artistic and cultural activities in the care provided throughout the history of public mental healthcare in greater São Paulo, Brazil, we can better understand and characterize the practices adopted in the Psychosocial Care Centers in the city today. Experiments carried out between the 1920s and 1990s are investigated, based on bibliographic research. The contemporary data were obtained from research undertaken at 126 workshops at 21 Psychosocial Care Centers in the same city between April 2007 and April 2008. The findings indicate that the current trend in mental healthcare, whose clinical perspective spans the realms of art and mental health and has territorial ramifications, has maintained some of the features encountered in earlier mental healthcare experiments.By studying the inclusion of artistic and cultural activities in the care provided throughout the history of public mental healthcare in greater Sao Paulo, Brazil, we can better understand and characterize the practices adopted in the Psychosocial Care Centers in the city today. Experiments carried out between the 1920s and 1990s are investigated, based on bibliographic research. The contemporary data were obtained from research undertaken at 126 workshops at 21 Psychosocial Care Centers in the same city between April 2007 and April 2008. The findings indicate that the current trend in mental healthcare, whose clinical perspective spans the realms of art and mental health and has territorial ramifications, has maintained some of the features encountered in earlier mental healthcare experiments.

A continuidade das internações psiquiátricas de crianças e adolescentes no cenário da Reforma Psiquiátrica Brasileira

No cenario da Reforma Psiquiatrica Brasileira, uma politica de atencao em saude mental especifica para criancas e adolescentes esta em construcao. Porem, estudos indicam que ainda ocorre a internacao dessa populacao em instituicoes de carater asilar. Como resultado parcial de pesquisa, identificamos, durante um periodo de dois meses, quem sao as criancas e adolescentes internados em um servico que dispoe de leitos psiquiatricos, e os motivos dessas internacoes. Analisamos os prontuarios de 28 sujeitos a partir da abordagem da Hermeneutica Dialetica. Os resultados indicaram a continuidade das internacoes em um perfil similar ao de um momento anterior a Reforma Psiquiatrica, e que a principal razao para internacao gira em torno da agressividade/periculosidade. Conclui-se que, apesar da Reforma Psiquiatrica, internacoes psiquiatricas ainda acontecem em instituicoes de carater asilar.Within the Brazilian Psychiatric Reform scenario, a new policy for mental healthcare specifically for children and adolescents is under construction. However, studies have indicated that hospitalization in psychiatric institutions still occurs among this population. As a preliminary research result over a two-month period, we identified who are these children and adolescents in a hospital with psychiatric beds were and the reasons for their hospitalization. We analyzed the medical files of 28 subjects using a hermeneutic dialectic approach. The results indicated that hospitalization of cases with a profile similar to that of the time before the reform of psychiatric care was continuing and that the main reason for hospitalization related to aggressiveness and dangerousness. It was concluded that, despite the reform, psychiatric hospitalization in institutions of asylum nature is still occurring.

Disrespect and abuse in childbirth in Brazil: social activism, public policies and providers’ training

Abstract Brazil is a middle-income country with universal maternity care, mostly by doctors. The experience of normal birth often includes rigid routines, aggressive interventions, and abusive, disrespectful treatment. In Brazil, this has been referred to as dehumanised care and, more recently, as obstetric violence. Since the early 1990s, social movements (SM) have struggled to change practices, public policies and provider training. The aim of this paper is to describe and analyse the role of SM in promoting change in maternity care, and in provider training. In this integrative review using a gender-oriented approach, we searched the Scielo database and the Ministry of Health’s (MofH) publications and edicts for institutional and research papers on SM initiatives addressing disrespect and abuse in the last 25 years (1993–2018) in Brazil, and their impact on public policies and training programmes. We analyse these groups of interrelated initiatives: (1) political actions of SM resulting in changes in public policies and legislation; (2) events organised by SM for diffusion of information to the public; (3) MofH policies to humanise childbirth with participation of SM; and (4) initiatives to change providers’ training, including legal actions based on obstetric violence reports. To promote real change in maternity care, the progression of policies and enabling environment of laws, regulations, and broad dissemination of information, need to go hand in hand with changes in all health providers’ training – including a solid base in ethics, gender and human rights.

Revista de Saúde Pública in scientific publications on Violence and Health (1967-2015)

ABSTRACT This article retrieved the publications from the Revista de Saúde Pública journal (from 1967 to 2015) on violence and health, on the SciELO and PubMed bases, by searching for the terms “violence”, “suicide”, “aggression”, “bullying”, and “external causes”, registered in any part of the text. We found 130 articles (the first one published in 1974). We observed: increase of publications over time, with decrease in the last five years; similar production volume in lethal and non-lethal violence; later publication of the latter; few studies in qualitative research; mostly descriptive production; and visualization of the problem more by the acts than by contexts or motivations and aggressors. Social markers were little approached, appearing, from largest to smallest frequency, social class, gender, race/ethnicity, and generation. Human rights were little used and only recently used as analytical framework, connected more to gender than to social class. Although Revista de Saúde Pública has registered the theme in its publications, consolidating it as scientific production line, there is still great explanatory theoretical rarefaction and little intersectionality between violence, social inequalities, and human rights.

The continuity of psychiatric hospitalization of children and adolescents within the Brazilian Psychiatric Reform scenario

No cenario da Reforma Psiquiatrica Brasileira, uma politica de atencao em saude mental especifica para criancas e adolescentes esta em construcao. Porem, estudos indicam que ainda ocorre a internacao dessa populacao em instituicoes de carater asilar. Como resultado parcial de pesquisa, identificamos, durante um periodo de dois meses, quem sao as criancas e adolescentes internados em um servico que dispoe de leitos psiquiatricos, e os motivos dessas internacoes. Analisamos os prontuarios de 28 sujeitos a partir da abordagem da Hermeneutica Dialetica. Os resultados indicaram a continuidade das internacoes em um perfil similar ao de um momento anterior a Reforma Psiquiatrica, e que a principal razao para internacao gira em torno da agressividade/periculosidade. Conclui-se que, apesar da Reforma Psiquiatrica, internacoes psiquiatricas ainda acontecem em instituicoes de carater asilar.Within the Brazilian Psychiatric Reform scenario, a new policy for mental healthcare specifically for children and adolescents is under construction. However, studies have indicated that hospitalization in psychiatric institutions still occurs among this population. As a preliminary research result over a two-month period, we identified who are these children and adolescents in a hospital with psychiatric beds were and the reasons for their hospitalization. We analyzed the medical files of 28 subjects using a hermeneutic dialectic approach. The results indicated that hospitalization of cases with a profile similar to that of the time before the reform of psychiatric care was continuing and that the main reason for hospitalization related to aggressiveness and dangerousness. It was concluded that, despite the reform, psychiatric hospitalization in institutions of asylum nature is still occurring.

La continuidad de las internaciones psiquiátricas de niños y adolescentes en el escenario de la Reforma Psiquiátrica Brasileña

No cenario da Reforma Psiquiatrica Brasileira, uma politica de atencao em saude mental especifica para criancas e adolescentes esta em construcao. Porem, estudos indicam que ainda ocorre a internacao dessa populacao em instituicoes de carater asilar. Como resultado parcial de pesquisa, identificamos, durante um periodo de dois meses, quem sao as criancas e adolescentes internados em um servico que dispoe de leitos psiquiatricos, e os motivos dessas internacoes. Analisamos os prontuarios de 28 sujeitos a partir da abordagem da Hermeneutica Dialetica. Os resultados indicaram a continuidade das internacoes em um perfil similar ao de um momento anterior a Reforma Psiquiatrica, e que a principal razao para internacao gira em torno da agressividade/periculosidade. Conclui-se que, apesar da Reforma Psiquiatrica, internacoes psiquiatricas ainda acontecem em instituicoes de carater asilar.Within the Brazilian Psychiatric Reform scenario, a new policy for mental healthcare specifically for children and adolescents is under construction. However, studies have indicated that hospitalization in psychiatric institutions still occurs among this population. As a preliminary research result over a two-month period, we identified who are these children and adolescents in a hospital with psychiatric beds were and the reasons for their hospitalization. We analyzed the medical files of 28 subjects using a hermeneutic dialectic approach. The results indicated that hospitalization of cases with a profile similar to that of the time before the reform of psychiatric care was continuing and that the main reason for hospitalization related to aggressiveness and dangerousness. It was concluded that, despite the reform, psychiatric hospitalization in institutions of asylum nature is still occurring.