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BACKGROUND: Functional capacity is recognized as a central factor for health in old age and not all studies that seek to clarify the role of social relationships in functional capacity are conclusive. The subject has only been studied in a limited way in Latin America, a region that is aging prematurely, with evidence primarily from developed countries, which have experienced a more gradual aging of their population. This longitudinal study aimed to determine how aspects of social relationships impact the functionality of older Chileans. METHODOLOGY: We conducted a cohort study of 2,265 people aged 60 years or older who lived in the community and resided in Greater Santiago, Chile. Five aspects of social relationships were considered at baseline (participation in groups, clubs, or organizations; number of people in the household; participation in recreational activities; perception of material support, help or advice, and marital status), from which a cluster analysis by conglomerate was performed and used as the exposure of interest. Functional limitation (FL) was the dependent variable, classified as a limitation in at least 1 basic activity of daily living or 1 instrumental activity or 2 advanced activities. The control variables considered were: sex, age, educational level, multimorbidity, depression and years of follow-up. Survival analyses using a Cox proportional hazard regression and multilevel logistic regressions (person level and follow-up wave level) were performed. RESULTS: The identified clusters were four: "without social participation and does not live alone"; "without a partner and without social participation"; "no perception of support and no social participation"; "with participation, partner and perception of support". Social relationship clusters predicted FL incidence and FL reporting during follow-up. Being in the clusters "without social participation and does not live alone" and "without partner and without social participation" were risk factors for incident FL and report of FL during follow-up, compared to being in the reference cluster "with participation, partner and perception of support. CONCLUSIONS: In summary, our study showed that participating in social organizations, not living alone and having a partner are protective factors for presenting and developing functional limitation in old age for community-living Chileans in an urban area.

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BACKGROUND: There is limited research on social factors related to falls among older adults. This study assessed the association between falls during the past year with social participation, children's support, relationship with children, and social frailty. METHODS: Participants were 17,687 community-dwelling older adults from the 2015 Survey on Health, Well-being, and Aging (SABE) in Colombia. Covariates included sociodemographic characteristics, environmental barriers, psychotropic intake, vision problems, memory loss, multimorbidity, and fear of falling. RESULTS: In multivariate logistic regression analyses, being socially frail (vs. no-frail) was associated with higher odds of falls (odds ratio [OR]=1.20; 95% confidence interval [CI] 1.10-1.32). Participating in groups (OR=1.07; 95% CI 1.03-1.11), helping others (OR=1.04; 95% CI 1.02-1.06), or volunteering (OR=1.09; 95% CI 1.01-1.17) were also associated with higher odds of falls. These findings were partly explained because most group participants reside in cities where they are more exposed to environmental barriers. In contrast, receiving help, affection, and company from children (OR=0.95; 95% CI 0.93-0.97) was associated with lower fall odds than not receiving it. Moreover, having a good relationship with children was associated with lower odds of falls (OR=0.75; 95% CI, 0.66-0.85) compared to an unsatisfactory relationship. CONCLUSION: Support from children and having a good relationship with them were associated with fewer falls; however, social frailty and participation in social groups were associated with more falls.

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Resumo Esta revisão narrativa tem por objetivo analisar a literatura no âmbito da Saúde Coletiva no intento de reconhecer o que se tem discutido em Educação Popular em Saúde (EPS) entre 2019 e 2022. Após busca, 59 artigos foram selecionados, analisados criticamente e separados em seis categorias-síntese: as práticas de educação popular como promotoras de uma visão participativa da saúde; educação popular e a valorização dos saberes e práticas da cultura popular local; a educação popular em saúde como estratégia de apoio à reconstrução social ante aos retrocessos nas políticas públicas; a importância da articulação nacional em educação popular como resposta à sua desvalorização; a educação popular como projeto libertador pensando a formação democrática e luta contra violências institucionais e estruturais; educação popular no processo de formação universitária em saúde. Pôde-se obter importantes resultados que elucidam a importância da EPS no contexto do Sistema Único de Saúde e na formação acadêmica de profissionais da saúde, favorecendo o respeito aos saberes ancestrais e a horizontalidade do cuidado. Ainda, reafirma-se a necessidade de articulação nacional e dialogada com os movimentos populares para o avanço de uma agenda emancipadora e dignificante da saúde no Brasil.

Abstract This narrative review aims to analyze the literature on Collective Health to recognize what has been discussed in Popular Health Education (PHE) from 2019 to 2022. Fifty-nine articles were selected, critically analyzed, and separated into six summary categories: popular education practices as promoters of a participatory vision of health; popular education and the valorization of local popular culture knowledge and practices; popular health education as a strategy to support social reconstruction in the face of setbacks in public policies; the importance of national articulation in popular education as a response to its devaluation; popular education as a liberating project thinking about the democratic formation and the fight against institutional and structural violence; popular education in the university health training process. We achieved significant results that elucidate the importance of PHE within the Unified Health System and the academic education of health professionals, fostering respect for ancestral knowledge and care horizontality. We also reaffirm the need for national articulation and dialogue with grassroots movements to advance Brazil's emancipatory and dignifying health agenda.

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Resumo O artigo discute questões sobre o futuro da humanidade ante as ameaças que rondam a saúde das populações, cujo impacto vem se exacerbando no curso das desigualdades em todas as partes do mundo, pari passu o desenvolvimento global no modelo hegemonizado a partir do século passado. A pandemia de COVID-19 foi tomada como um caso que bem ilustra essa dessintonia entre desenvolvimento e desigualdades. Formulam-se perguntas a serem postas em debate sobre a construção do futuro da sociedade mundial, com base na acepção sobre o caráter evolucional da vida no planeta vis-à-vis os males que acometem grandes contingentes populacionais e representam poderosos riscos para esse processo evolutivo. São indagações que apontam para a discussão em torno da participação social na definição e no controle das políticas públicas, em contrapartida à hegemonia dos interesses privados na formulação e execução dessas políticas, tanto nos cenários de cada país como no contexto internacional.

Abstract This article discusses questions concerning the future of humanity in the face of threats to the health of populations, whose impact has been exacerbated in the course of inequalities in all parts of the world, pari passu with global development in the hegemonized model since last century. The COVID-19 pandemic is a good example that illustrates this dissonance between development and inequalities. Questions were formulated to be debated about the construction of the future of world society, based on the understanding of the evolutionary character of life on the planet vis-à-vis the evils that affect large contingents of the population and represent powerful risks for this evolutionary process. These questions call attention to the discussion around social participation in the definition and control of public policies, as opposed to the hegemony of private interests in the formulation and execution of these policies, both in the scenarios of each country and in the international context.

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Objective: To examine the correlation between the Brazilian Active Aging Index (AAI-Brazil) and the Human Development Index (HDI) at both national and regional levels. Methods: Based on the original AAI developed by the United Nations Economic Commission for Europe in response to the World Health Organization's program to promote more active and healthy aging, we calculated the total and domain-specific (AAI-independence, AAIemployment, AAI-capacity, and AAI-participation) scores of the AAI-Brazil for Brazil and its regions. Data were obtained from the Brazilian Longitudinal Study of Aging (ELSI-Brazil) and analyzed in relation to the overall HDI and its indicators (HDI-education, HDI-income, and HDI-longevity) using linear regression. Statistical significance was set at p < 0.05. Results: The overall AAI-Brazil score was 34%, with domain-specific scores of 57% for independence, 39% for employment, 14% for capacity 14%, and 9% participation. The CentralWest region had the highest score (36%), followed by the South and Southeast (both 35%). The North and Northeast regions had the lowest overall scores (34% and 32%, respectively), as well as the lowest scores across all domains. A positive and significant relationship was found between the AAI-Brazil and total HDI (p = 0.029), HDI-education (p = 0.011), and HDI-income (p = 0.035); as well as between AAI-capacity and total HDI (p = 0.004), HDIeducation (p = 0.016), HDI-income (p = 0.008), and HDI-longevity (p = 0.003). Conclusion: Regions with higher AAI-Brazil scores were associated with higher HDI levels. This finding suggests that human development disparities affect the healthy and active aging of the Brazilian population. (AU)

Objetivos: Relacionar o Índice de Envelhecimento Ativo no Brasil (IEABrasil) total e por módulos, do país e das suas regiões com o Índice de Desenvolvimento Humano (IDH). Metodologia: A partir do Active Ageing Index que foi desenvolvido pela Comissão Econômica das Nações Unidas para a Europa em resposta ao programa da Organização Mundial da Saúde que visa estimular um envelhecimento mais ativo e saudável, foi calculado o IEABrasil total e por módulos (Independência, Emprego, Capacidade e Participação) para o país e cada região. Foram utilizados os dados do Estudo Longitudinal da Saúde dos Idosos do Brasil, e relacionados com o IDH (total, educação, renda e longevidade), através da Regressão Linear, assumindo p<0,05 como estatisticamente significativo. Resultados: Obteve-se IEABrasil total 34%, IEA-Independência 57%, IEA-Emprego 39%, IEA-Capacidade 14% e IEA-Participação 9%. A Região Centro-Oeste pontuou 36%, seguida pelas Regiões Sul e Sudeste, ambas com 35%, e as Regiões Norte e Nordeste ficaram com 34% e 32%, respectivamente. As Regiões Norte e Nordeste também apresentaram piores índices em todos os módulos. Na análise do IEABrasil de cada região com o IDH correspondentes, identificamos relação positiva e significativa entre IEABrasil e IDH total (p=0,029), IDH educação (p=0,011) e IDH renda (p=0,035); IEA-Capacidade com IDH total (p=0,004), IDH educação (p=0,016), IDH renda (p=0,008) e IDH longevidade (p=0,003). Conclusão: As regiões com índices mais elevados de IEABrasil apresentaram maiores níveis de IDH. Os resultados do IEABrasil sugeriram que as desigualdades de desenvolvimento humano afetam o envelhecimento ativo dos brasileiros. (AU)

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OBJECTIVE: To analyze the influences of the institutions in the operation of the Local Health councils. DESIGN: qualitative, descriptive and exploratory study. STUDY SETTING: 02 Primary Health Care services of a municipality in the inland of the state of São Paulo, Brazil. PARTICIPANTS: twenty-four members of the Local Health Councils and 4 key informants. METHODS: Supported by the theoretical methodological framework of Institutional Analysis. Data were produced through 28 semi-structured interviews, observation and participation in the activities of the councils and recording in the research diary. Data were organized and analyzed by the process of transcription, transposition and reconstitution. RESULTS: The institutions act in the territories represented by social actors who occupy positions and functions within the Primary Health Care services, evidencing the perpetuation of hierarchization with valorization of the speeches of professionals and managers to the detriment of patients and predominance of bureaucratized meetings. The social actors reproduce the ideals of the collective to which they belong in these spaces. CONCLUSIONS: The health management teams do not recognize the different forces that act in the health territory, however, these forces interfere in the activities performed and in health care. The groups act both in formal spaces through official representatives who meet and discuss issues in collegiate meetings and in informal spaces, and constitute forces in dispute in the health territory.

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Resumo A consulta pública (CP) da Anvisa é o mecanismo de participação social mais usado na regulamentação, consolidada com base em movimentos antagônicos: democratização da tomada de decisão e contrarreforma do Estado. Diante do conceito de participação social como várias ações relacionadas à decisão pública com valorização da diversidade e como exercício da cidadania, o artigo discute a possibilidade de as CPs configurarem um processo de regulamentação democrático ao considerar saberes populares e evidências coloquiais, além de promover a criação de evidências híbridas em um modelo moderado de evidências. Apesar dos diferentes interesses, as CPs abrem oportunidades para deliberação democrática da sociedade na busca do entendimento, onde se espera que o Estado escolha a melhor decisão e a justifique. Dessa forma, delimita-se o papel das evidências a esclarecer questões complexas em um espaço em que o dissenso, visto como caminho para a democratização da sociedade, é importante para revelar as limitações das evidências científicas em um ambiente de assimetria de informações. Por fim, espera-se refutar a tecnocracia como instrumento de poder na regulação sanitária e assim alcançar o maior potencial democrático da regulamentação da Anvisa.

Abstract Anvisa's public consultation (PC) is the most widely used social participation mechanism in current health regulations, which was based on antagonistic movements: the democratization of decision-making and State counter-reformation. Starting from the concept of social participation, defined as various actions from society related to public decision-making, which values diversity and the exercise of citizenship, the present article discusses the possibility of PCs configuring a democratic regulation process by considering popular beliefs and colloquial evidence, and promoting the creation of hybrid evidence in an evidence-moderated model. Despite the different interests, the PCs open the door to opportunities for democratic deliberation by society in the search of understanding, where it is expected that the State will make the best decision and justify it. In this sense, the role of evidence in clarifying complex issues is defined as a space where dissent, believed to democratize society, is important in revealing the limits of scientific evidence in an environment of information asymmetry. Finally, this article aims to refute technocracy as an instrument of power in health regulations, thereby achieving the greatest democratic potential of Anvisa's regulations.

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Resumo O objetivo do presente estudo foi compreender o entendimento dos conselheiros de saúde do Estado do Rio Grande do Sul sobre o tema regionalização da saúde. Apresenta natureza qualitativa, sendo que para a coleta de dados foram empregadas entrevistas semiestruturadas com oito conselheiros de saúde indicados intencionalmente pelo Conselho Estadual de Saúde do Rio Grande do Sul (CES/RS), sendo um representante por macrorregião de saúde e um representante da mesa diretora do CES/RS. Na abordagem teórica do estudo utilizou-se o conceito de poder em Mario Testa e na análise de conteúdo foi aplicada a técnica de análise temática. Observou-se que, a regionalização em saúde não se traduziu como um tema de discussão específico para os conselheiros de saúde entrevistados. O acesso, o acolhimento, as relações de poder, as redes de conversações foram temas secundários que apareceram relacionados aos temas de regionalização e governança da saúde. Assim, no caso estudado, as temáticas da regionalização e da governança em saúde ainda carecem de serem aprofundadas pelo controle social e tem potência para ser exploradas em futuras pesquisas sobre o tema.

Abstract The study aimed to know the understanding of health counselors in the State of Rio Grande do Sul on the topic of health regionalization. It presents a qualitative nature, and for data collection, semi-structured interviews were used with eight health counselors intentionally appointed by the State Health Council of Rio Grande do Sul (CES/RS), one representative per Health Macro-region and one representative from the board director of CES/RS. In the theoretical approach of the study the concept of power in Mario Testa was used and in the content analysis the thematic analysis technique was applied. It was observed that regionalization in health did not translate into a specific topic of discussion for the health counselors interviewed. Access, user embracement, power relations, conversation networks were secondary themes that appeared related to the themes of regionalization and health governance. Thus, in the case studied, the theme of regionalization and governance in health still needs to be deepened by social control and has the potential to be explored in future research on the subject.

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Este artículo tuvo por objetivo situar la estrategia de Agentes Comunitarios de Salud adoptada recientemente en Chile como una intervención que podría contribuir a cerrar las brechas en salud. Para ello, empleamos como herramienta analítica la noción de participación de la sociedad civil, a menudo olvidada en los debates que contraponen los sistemas público y privado en el análisis de la salud. Al examinar esta iniciativa bajo el lente de la educación popular en Brasil, argüimos que esta forma de participación no puede plantearse como una intervención tecnocrática más, sino situarla en contexto, social e históricamente, donde la sensibilidad cultural es clave. En Chile, la participación ciudadana en salud tiene una larga tradición instalada y, en virtud de una reapropiación los discursos públicos en la última década, el aspecto agencial popular podría articularse e institucionalizarse.(AU)

O objetivo deste artigo foi situar a estratégia dos Agentes Comunitários de Saúde recentemente adotada no Chile como uma intervenção que poderia contribuir para fechar as lacunas na saúde. Para tanto, empregamos como ferramenta analítica a noção de participação da sociedade civil, frequentemente negligenciada nos debates que opõem os sistemas público e privado na análise da saúde. Ao examinar essa iniciativa por meio das lentes da educação popular no Brasil, argumentamos que essa forma de participação não pode ser vista como apenas mais uma intervenção tecnocrática, mas deve ser colocada em um contexto cultural e histórico, no qual a sensibilidade cultural é fundamental. No Chile, a participação cidadã na saúde tem uma longa tradição e, em virtude de uma reapropriação dos discursos públicos na última década, a agência popular pôde ser articulada e institucionalizada.(AU)

The purpose of this article is to situate the Community Health Agents strategy as a social intervention that may contribute to bridging the gap in health coverage. In doing this, we used the participation of nonprofit civil society as an analytical tool. Civil society is often neglected in debates about health, which tend to focus the analysis solely on the antagonism between public and private services. By examining this strategy through the lens of popular education in Brazil, we argue that this form of participation cannot be viewed as merely another technocratic solution, but should instead be understood within its cultural and historical context, emphasizing the importance of cultural sensitivity. Civil society's participation in health matters has a longstanding history in Chile. Considering the reappropriation of public debates over the past decade, the agential aspect of this intervention could be articulated and potentially institutionalized.(AU)

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ABSTRACT BACKGROUND: We aimed to develop and validate a practical instrument to assess older adults' satisfaction with their social participation (SP). DESIGN AND SETTING: This methodological validation study was conducted at a public higher education institution. METHODS: A two-phase study was designed, developed, and validated to assess older adults' satisfaction with their SP. In the first phase, we conceptualized SP and developed an "instrument to assess older adults' satisfaction with their SP (IAPSI)," as approved by a committee of specialists, pre-tested, and partially validated. Second, we determined the IAPSI's reproducibility using Cronbach's alpha to measure internal consistency, Pearson's and Spearman's coefficients to measure correlations, the Bland-Altman plot and intraclass correlation coefficient (ICC) to measure reproducibility. We also generated a receiver operating characteristic (ROC) curve. RESULTS: 102 older adults (mean age, 87.29) participated in the first phase. Moderate internal consistency (Cronbach's alpha 0.7) and significant moderate correlations with quality of life by World Health Organization Quality of Life (WHOQOL)-bref and by WHOQOL-old social domains (Pearson's coefficients 0.54 and 0.64, respectively; P < 0.001) were found. The ROC curve indicated an IAPSI score of 17 as the threshold for the impact of pain on satisfaction with SP (83.3% sensitivity and 88.9% specificity, P < 0.001). In the second phase, 56 older adults (between 81 and 90 years old) participated. We found adequate intra- and inter-observer reproducibility for the IAPSI (ICC 0.96 and 0.78, respectively). CONCLUSION: We have developed a practical instrument with appropriate psychometric properties to assess older adults' satisfaction with their SP.

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Resumo A participação de crianças com paralisia cerebral (PC) em atividades de recreação e lazer pode ser influenciada por fatores ambientais. O reconhecimento e compreensão desses fatores como barreiras ou facilitadores dessas atividades são essenciais para garantir o direito de participação dessas crianças em condições de igualdade com as demais pessoas da sociedade. Neste contexto, o objetivo desta revisão integrativa foi identificar as barreiras e facilitadores ambientais na participação de crianças com PC em atividades de recreação e lazer. Utilizou-se o método de revisão integrativa proposto por Whittemore e Knafl (2005). Estudos publicados entre 2011 e 2022 nos idiomas português e/ou inglês foram selecionados a partir das fontes de indexação MEDLINE via PubMed, EMBASE, SciELO, LILACS, SCOPUS e Web of Science. Nove estudos foram incluídos na revisão - a maioria de desenho transversal e abordagem qualitativa. Os seguintes facilitadores da participação foram identificados: apoio dos pais, pares e professores; interação com adultos; terapias; condições materiais; atividades em casa, na escola e na comunidade; diversidade de brinquedos; e atividades culturais. As seguintes barreiras à participação foram identificadas: falta de acesso a transportes públicos; atitudes negativas; falta de escolha e menor interação dos pais; e falta de adequação das atividades. A Classificação de Funcionalidade, Incapacidade e Saúde (CIF) e os conceitos pirâmide de participação e família de constructos foram fundamentais para identificar as barreiras e facilitadores ambientais na participação de crianças com PC. Sugere-se que estudos futuros sejam conduzidos para avaliar a qualidade e a força da evidência para participantes com 11 anos de idade incompletos.

Abstract The participation of children with cerebral palsy (CP) in recreation and leisure activities can be influenced by environmental factors. The recognition and understanding of these factors as barriers or facilitators of these activities are essential to guarantee the right of these children to participate on equal terms with other people in society. In this context, the objective of this integrative review was to identify environmental barriers and facilitators in the participation of children with CP in recreation and leisure activities. The integrative review method proposed by Whittemore and Knafl (2005) was used. Studies published between 2011 and 2022 in Portuguese and/or English were selected from MEDLINE indexing sources via PubMed, EMBASE, SciELO, LILACS, SCOPUS and Web of Science. Nine studies were included in the review - most of them cross-sectional in design and qualitative in approach. The following participation facilitators were identified: support from parents, peers and teachers; interaction with adults; therapies; material conditions; activities at home, school and in the community; diversity of toys; and cultural activities. The following barriers to participation were identified: lack of access to public transport; negative attitudes; lack of choice and less parental interaction; and lack of adequacy of activities. The Classification of Functioning, Disability and Health (ICF) and the concepts of participation pyramid and family of constructs were fundamental in identifying environmental barriers and facilitators in the participation of children with CP. It is suggested that future studies be conducted to assess the quality and strength of the evidence for participants under 11 years of age.

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Abstract Background To be objective and achievable, the rehabilitation goals must be focused on the functional expectations of patients with neuromuscular disease (NMD). Objective Investigate rehabilitation programs that are able to modify the activity/participation of patients with NMD. Data search: Embase, BVS/Lilacs, Physiotherapy Evidence Database (PEDro), CINAHL/EBSCO, and Medline were searched in June 2021. It was last updated in March 2023. Methods Randomized controlled trials investigating any rehabilitation therapy for patients with NMD with an outcome encompassing the activity/participation components of the International Classification of Functioning, Disability and Health (ICF) were included. Pharmacological therapy studies were excluded. The results were synthesized according to the ICF core sets for NMD. The methodological quality and level of evidence were assessed using PEDro criteria and Grading of Recommendations Assessment, Development, and Evaluation (GRADE). This systematic review followed the PRISMA 2020 guideline and was registered at PROSPERO (CRD42020209359). Results Of a total of 1943 identified studies, 12 were included in this review with a methodological quality between regular and good. Light to moderate-intensity aerobic exercise was the most studied intervention. The mobility was assessed in all included studies. Conclusion The variability of the types of NMD and the small sample size of the included studies demonstrates that there is very limited evidence of interventions focused on the activity/participation of individuals with NMD. Light to moderate-intensity aerobic exercise seems to improve the mobility, self-care, and social participation of patients with NMD, especially those with slow progression.

Resumo Antecedentes As metas de reabilitação devem ser focadas nas expectativas funcionais de pessoas com doenças neuromusculares (DNM) para que sejam objetivas e alcançáveis. Objetivo Investigar programas de reabilitação capazes de modificar a atividade/participação de pessoas com DNM. Foi realizada busca nas bases de dados: Embase, BVS/Lilacs, Physiotherapy Evidence Database (PEDro), CINAHL/EBSCO e Medline em junho/2021. A última atualização foi realizada em março de 2023. Métodos Foram incluídos estudos clínicos randomizados investigando qualquer terapia de reabilitação para pessoas com DNM com desfecho voltado para atividade/participação da Classificação Internacional de Funcionalidade e Saúde (CIF). Terapias farmacológicas foram excluídas. Os resultados foram sintetizados de acordo com os Core Sets da CIF para DNM. A qualidade metodológica e o nível de evidência foram avaliados usando os critérios PEDro e Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Esta revisão sistemática foi registrada na PROSPERO (CRD42020209359). Resultados De 1943 estudos identificados, 12 foram incluídos com uma qualidade metodológica entre regular e boa. O exercício aeróbio de intensidade leve a moderada foi a intervenção mais estudada. A mobilidade foi avaliada em todos os estudos incluídos. Conclusão A variabilidade dos tipos de DNM e o baixo número amostral dos estudos incluídos contribuem para uma evidência muito limitada de intervenções focadas na atividade/participação de pessoas com DNM. O exercício aeróbio de baixa a moderada intensidade parece melhorar a mobilidade, autocuidado e participação de pessoas com DNM, especialmente para as DNM de progressão lenta.

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El objetivo es analizar la eficacia de los procesos de participación ciudadana en Colombia. Como metodología se optó por la investigación cualitativa, bajo el enfoque hermenéutico y como estrategia la revisión documental por medio de la cual se recuperaron diferentes documentos científicos que giraban alrededor de los temas de interés para aclarar las preguntas de investigación. Entre los resultados se encontró que, a pesar de que la Constitución Política de 1991 definió los parámetros para la participación, aún existe mucha apatía y desconocimiento sobre ellos y, finalmente, se concluyó que, entre los factores que impiden las buenas prácticas en el ejercicio de participación ciudadana, están las brechas digitales, el abstencionismo electoral, el desconocimiento de la población y la apatía de los gobernantes de integrar a la población en las decisiones del país.

This article aims to analyze the effectiveness of citizen participation processes in Colombia. As a methodology, qualitative research was chosen, under the hermeneutical approach, and as a strategy, the documentary review where different scientific documents that revolved around the topics of interest were recovered to clarify the research questions. Among the results, it was found that even though the Political Constitution of 1991 defined the parameters for participation, there is still a lot of apathy and ignorance about them. It was finally concluded that among the factors that prevent good practices in the exercise of citizen participation are the digital gaps, electoral abstentionism, ignorance of the population, and the apathy of the rulers to integrate the people in the country's decisions.

O objetivo é analisar a eficácia dos processos de participação cidadã na Colômbia. Como metodologia, optou-se pela pesquisa qualitativa, sob a abordagem hermenêutica e, como estratégia, a revisão documental onde foram recuperados diferentes documentos científicos que giravam em torno dos temas de interesse para esclarecer as questões de pesquisa. Entre os resultados, verificou-se que, apesar da Constituição Política de 1991 ter definido os parâmetros para a participação, ainda há muita apatia e desconhecimento sobre eles e, por fim, concluiu-se que dentre os fatores que impedem as boas práticas no exercício de participação cidadã, são as lacunas digitais, o abstencionismo eleitoral, o desconhecimento da população e a apatia dos governantes em integrar a população nas decisões do país.

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Social participation in health is related to the ability of collectives to intervene in the healthcare system. From a bioethical perspective, the relevance of social participation in health has been emphasized due to its positive effects at the level of social groups, the healthcare structure, and democratic political systems. To ensure social participation in health, bioethics advocates for the incorporation of deliberation as a tool for making binding decisions. The aim of this essay is to reflect on social participation in the history of Chile's healthcare system from a bioethical perspective. The main reflections indicate that participation is consultative in nature, lacking deliberation and, therefore, the distribution of power. Additionally, social participation has been redefined under the label of "citizen," promoting an instrumental, individual, and client-oriented character in healthcare. To subvert this situation, it is necessary to incorporate bioethical reflections into the healthcare structure to enable communities to consistently influence the healthcare system.

La participación social en salud se relaciona con la capacidad de intervención de los colectivos en el sistema sanitario. Desde la bioética, se ha enfatizado en la relevancia de la participación social en salud debido a los efectos positivos a nivel de los grupos sociales, de la estructura sanitaria y de los sistemas políticos democráticos. Para asegurar la participación social en salud, la bioética aboga por la incorporación de la deliberación como herramienta para la toma de decisiones vinculantes. El objetivo del presente ensayo es reflexionar sobre la participación social en la historia del sistema de salud de Chile desde la óptica de la bioética. Las principales reflexiones indican que la participación es de tipo consultiva, sin deliberación y, por tanto, sin distribución de poder. Asimismo, la participación social fue resignificada por la etiqueta de "ciudadana", potenciando el carácter instrumental, individual y clientelar en salud. Para subvertir esta situación, se requiere incluir reflexiones bioéticas en la estructura sanitaria con el propósito que las comunidades puedan incidir de manera consistente en el sistema de salud.

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Com o objetivo de analisar a diretriz constitucional da participação social em saúde, considerando avanços e retrocessos do Sistema Único de Saúde, o presente artigo apoia-se numa breve revisão do estado da arte e em parte da produção do Observatório de Análise Política em Saúde. Discute, sucintamente, o conceito de participação social e suas conexões com as noções de democracia e de movimentos sociais. Descreve certos momentos da participação social nas origens da Reforma Sanitária Brasileira e do Sistema Único de Saúde e na conformação da Constituição de 1988, indicando avanços e retrocessos, especialmente após as Jornadas de Junho. Finaliza discutindo problemas da participação social no Sistema Único de Saúde e os desafios na constituição de sujeitos sociais.

Aiming to analyze the constitutional guideline of social participation in health, considering the advances and setbacks of the Unified Health System, this paper is based on a brief review of the state of the art and on part of the production of the Observatory for Political Analysis in Health. It briefly discusses the concept of social participation and its connections with the notions of democracy and social movements. It describes certain moments of social participation in the origins of the Brazilian Health Reform and the Unified Health System and in the shaping of the 1988 Constitution, indicating advances and setbacks, especially after the Jornadas de Junho(June Demonstrations). It ends by discussing problems of social participation in the Unified Health System and the challenges in the constitution of social subjects.

Con el objetivo de analizar la directriz constitucional de la participación social en salud, considerando los avances y retrocesos del Sistema Único de Salud, este artículo se basa en una breve revisión del estado del arte y en parte de la producción del Observatorio de Análisis Político en Salud. Discute, brevemente, el concepto de participación social y sus conexiones con las nociones de democracia y movimientos sociales. Describe ciertos momentos de participación social en los orígenes de la Reforma Sanitaria Brasileña y del Sistema Único de Salud y en la conformación de la Constitución de 1988, indicando avances y retrocesos, especialmente después de las Jornadas de Junho. Finaliza discutiendo los problemas de la participación social en el Sistema Único de Salud y los desafíos en la constitución de sujetos sociales.

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RESUMO A Política Nacional de Atenção Básica (PNAB), quando estabelecida em 2006, corroborou o direcionamento do modelo assistencial em conformidade com a universalização do sistema de saúde brasileiro. Contudo, alterações recentes na sua organização e financiamento demonstram inflexões. O objetivo do artigo foi analisar processos decisórios relacionados com a PNAB, em distintos espaços de deliberação do Sistema Único de Saúde (SUS), que incidiram em mudanças nessa política, no período de 2016 a 2020. Trata-se de um estudo de caso exploratório e retrospectivo, que adotou o process tracing. Foram analisadas as atas das reuniões do Conselho Nacional de Saúde (CNS) e da Comissão Intergestores Tripartite (CIT) de 2016 a 2020. As gravações de Reuniões Ordinárias da CIT, entre 2019 e 2020, também foram fontes de informações. Alterações na política deram-se sob a baixa interlocução e desaprovação da instância nacional de participação e controle social do SUS. O CNS atuou como um espaço de denúncia e resistência às mudanças, porém, com baixa capacidade de influenciar as decisões políticas. Por sua vez, o espaço intergovernamental do SUS revelou cooperação entre representantes de gestores subnacionais, com poucas tensões, no que diz respeito à agenda de mudança proposta pela União.

ABSTRACT The National Primary Care Policy (PNAB), when established in 2006, corroborated the direction of the care model in accordance with the universalization of the Brazilian health system. However, recent changes in its organization and funding demonstrate inflections. The aim of the study is to analyze decision-making processes related to the PNAB, in different deliberation spaces of the SUS, which influenced changes in such policy, in the period between 2016 and 2020. This is an exploratory and retrospective case study, which adopted process tracing. Meeting minutes of the National Health Council (CNS) and Tripartite Inter-managers Commission (CIT) from 2016 to 2020 were analyzed. Recordings of Ordinary CIT Meetings, between 2019 and 2020, were also sources of information. Changes in the policy took place under the low dialogue and disapproval of the national instance of participation and social control of the SUS. The CNS acted as a space for denunciation and resistance to changes, but with a low capacity to influence political decisions. In turn, the intergovernmental space of the SUS revealed cooperation between representatives of subnational managers, with few tensions, with regard to the change agenda proposed by the Union.

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Em entrevista à Reciis, a médica sanitarista Lucia Souto conta como seu trabalho em medicina comunitária a motivou à pesquisa científica, a fim de compreender as desigualdades que persistem no Brasil. Atuante em diversos movimentos populares e conferências nacionais voltadas à área da saúde, a pesquisadora faz um panorama sobre a trajetória das conferências nacionais de saúde, particularmente da 8ª à 17ª, realizada neste ano de 2023. Considera que houve um aumento da participação popular na garantia do direito à saúde. A sanitarista afirma que uma sociedade democrática não pode existir sem uma popularização radical dos meios de comunicação e informação, nos quais se manifeste uma pluralidade de vozes e uma ecologia dos saberes. Lucia Souto é chefe da Assessoria de Participação Social e Diversidade do Ministério da Saúde

In an interview with Reciis, public health physician Lucia Souto tells how her work in community medicine motivated her to pursue scientific research to understand the persistent Brazilian inequalities. Active in several popular movements and national conferences focused on health, the researcher provides an overview of the trajectory of national health conferences, particularly from the 8th to the 17th held this year (2023). She considers that there has been an increased popular participation in the guarantee of the right to health. The public health expert states that a democratic society cannot exist without a radical popularization of the means of communication and information, in which a plurality of voices and an ecology of knowledge are manifested. Lucia Souto is head of the Social Participation and Diversity Advisory Office at the Ministry of Health

En una entrevista con Reciis, la médica sanitarista Lucia Souto cuenta cómo su trabajo en medicina comunitaria la motivó a realizar investigaciones científicas para comprender las persistentes desigualdades brasileñas. Activa en varios movimientos populares y congresos nacionales centrados en la salud, la investigadora ofrece un panorama de la trayectoria de los congresos nacionales de salud, en particular del 8° al 17° celebrado este año (2023). Considera que ha habido una mayor participación popular en la garantía del derecho a la salud. El experto en salud pública afirma que no puede existir una sociedad democrática sin una popularización radical de los medios de comunicación e información, en la que se manifiesten una pluralidad de voces y una ecología de conocimientos. Lucia Souto es jefa de la Asesoría de Participación Social y Diversidad del Ministerio de Salud

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Estamos perdendo! No período entre 2016-2020, a Participação Social e a Política de Saúde Mental, no Sistema Único de Saúde (SUS), têm sofrido ameaças e riscos. O Brasil encontra-se em intenso conservadorismo político, produzindo marcas em sua incipiente democracia. Estaremos regredindo? A partir desse cenário, observa-se que o país está perdendo em termos de democracia participativa na política de saúde mental. Este ensaio teórico-crítico tem por objetivo analisar a situação atual da Política de Saúde Mental a partir da discussão sobre as possibilidades de participação e protagonismo das mulheres. Trata-se, também, de uma reflexão sobre o silêncio-silenciamento. Por que perdura uma prática de silenciamento das mulheres no SUS? Como produzir participação e protagonismo em saúde mental neste contexto? O ensaio sugere dois caminhos: a) demolição das barreiras simbólicas, construídas pelos sistemas de representações sociais sobre mulheres/usuárias do SUS, e (b) o grupo/coletivo como estratégia para ativar a participação e protagonismo. (AU)

Between 2016-2019, Social Participation and Mental Health Policy, in the Unified Health System (UHS), have suffered threats and risks: funding of psychiatric hospitals and therapeutic communities, changes in the Psychosocial Care Network, impacting its model of care and composition of services. These issues affect the country in terms of participatory democracy when, in mental health policy, one sees the weakening of the National Health Council itself and the lack of technical and financial support from the Ministry of Health for actions involving Social Participation. This essay aims to analyze the situation of the Mental Health Policy through the discussion about the possibilities of women's participation and protagonism. It is a reflection on silence-silencing. The essay suggests: a) demolition of symbolic barriers, built by the systems of social representations about women users of the UHS, and (b) the group/collective as a strategy to activate participation and protagonism. (AU)

Entre 2016-2019, la Política de Participación Social y Salud Mental, en el Sistema Único de Salud (SUS), ha sufrido amenazas y riesgos: financiamiento de hospitales psiquiátricos y comunidades terapéuticas, cambios en la Red de Atención Psicosocial, impactando su modelo de atención y composición de servicios. Estos temas afectan al país en términos de democracia participativa cuando, en la política de salud mental, se ve el debilitamiento del propio Consejo Nacional de Salud y la falta de apoyo técnico y financiero del Ministerio de Salud para las acciones de Participación Social. Este ensayo tiene como objetivo analizar la situación de la Política de Salud Mental a través de la discusión sobre las posibilidades de participación y protagonismo de las mujeres. Es una reflexión sobre el silencio-silenciamiento. El ensayo sugiere: a) demolición de barreras simbólicas, construidas por sistemas de representaciones sociales sobre las mujeres usuarias del SUS, y (b) el grupo/colectivo como estrategia paraactivar la participación y el protagonismo. (AU)

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The present narrative review discusses the relevance and challenges of community participation in health for health system strengthening. Based on a definition of community participation in health as a dynamic process that gives people access and control over health resources through involvement and experience, the article summarizes information obtained from documents and debate at an international event (Seminario Internacional: Experiencias y Modelos de Participación en Salud en América Latina y el Caribe). In addition, the SciELO, PubMed and Google Scholar databases were searched using the terms "community participation", "community engagement", "social control" and "community health planning" to identify national or transnational review and opinion articles. Community participation in health is a current concept, acknowledged in the recommendations for health policies described in recent documents and publications. Around the world, the number of studies on the subject is growing; however, in the Americas, three countries (United States, Canada and Brazil) accounted for most of the scientific publications identified in the databases. The studies address timely questions and show consensus among investigators within each individual research group. However, the area lacks exchanges and comparative analyses that contrast different experiences transcending national borders and expanding knowledge on community participation in health. The creation of more spaces for the sharing of experiences and research is advised, as well as the establishment of professional and research networks in the field of community participation in health.

En esta revisión narrativa se analizan la relevancia y los retos de la participación en salud para el fortalecimiento de los sistemas de atención de salud. A partir de una definición de la participación en salud como un proceso dinámico que da a las personas acceso y control sobre los recursos de salud por medio de la intervención y la experiencia, en el artículo se sintetiza la información obtenida de documentos y en un debate realizado en el denominado Seminario Internacional: Experiencias y Modelos de Participación en Salud en América Latina y el Caribe. A este material se agregaron los resultados de búsquedas en las bases de datos SciELO, PubMed y Google Académico con los términos "community participation", "community engagement", "social control" y "community health planning". Se seleccionaron artículos de revisión y opinión de los ámbitos nacional o transnacional, sin límite de fecha ni de idioma. La participación en salud es un concepto actual, legitimado en las recomendaciones sobre políticas de salud descritas en documentos y publicaciones recientes. El número de estudios sobre el tema ha aumentado en todo el mundo, pero en las Américas, la mayoría de las publicaciones se concentran en tres países (Brasil, Canadá y Estados Unidos). En los estudios se abordan asuntos de actualidad y se demuestra el consenso existente entre los investigadores de cada grupo independiente. Sin embargo, en este campo no hay intercambios ni análisis comparativos que permitan contrastar las diferentes experiencias más allá de las fronteras nacionales y ampliar el conocimiento sobre la participación en salud. Se recomienda crear ámbitos de intercambio de experiencias y oportunidades de investigación, y establecer redes profesionales y de investigación en el campo de la participación en salud.

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BACKGROUND: The Decade of Healthy Aging 2021-2030 calls for a strengthening of the policies for older people in Latin America. An example of successful oral aging is the Japanese "8020" campaign, which achieved 50% of people aged 80 years having ≥20 teeth by 2016. OBJECTIVE: To evaluate the association between having a functional dentition (≥20 teeth) and cognitive health, social participation, and quality of life in people aged ≥80 years. METHODS: Cross-sectional data from 299 complete observations (weighted N = 436 981) of individuals aged ≥80 years from Chile's National Health Survey 2016-2017 were included (3% of the population; total = 5520 clinical observations/weighted N = 14 518 969). Generalised structural equation models (GSEM) evaluated the association between having a functional dentition and cognitive health, measured with the Mini-mental score, between having a functional dentition and social participation, and between having a functional dentition and quality of life, measured with the EQ-5D-3L. Models included the effect of mediators (daily fruit and vegetable consumption; oral health-related quality of life score) and controlled for the exposure-induced mediator-outcome variables: sex, educational level, and location. Data were analysed using the STATA-17 survey module. Statistical significance was set at P < .05 (95% confidence interval [CI]). RESULTS: The sample was mostly female, had <8 years of education, and lived in urban areas. The prevalence of a functional dentition was 9.2% (95% CI 3.6,21.3/n = 21). GSEM demonstrated that the association between functional dentition and cognitive health was mediated by daily fruits and vegetables consumption (ß = 0.12/95% CI 0.02,0.21/P = .015), with moderate strength of evidence. Additionally, there was strong evidence of an association between functional dentition and social participation frequency (ß = 2.76/95% CI 0.60,4.73/P = .009). Finally, the association between functional dentition and quality of life was mediated by cognitive health (ß =0.05/95% CI 0.02,0.09/P = .002) and oral health-related quality of life (ß = -0.04/95% CI -0.08 to -0.01/P = .025), with strong and moderate evidence, respectively. CONCLUSION: Given the beneficial implications of functional dentition in social participation, nutritional benefits and quality of life and well-being of individuals aged ≥80 years.