Competencias interculturales desde un enfoque ético intercultural en la formación inicial de profesionales en ciencias de la salud. un desafío ineludible

Chile es un país culturalmente diverso cuya población debe enfrentar dificultades relacionadas con la salud. Este ensayo tiene por objetivo reflexionar en torno a las competencias interculturales desde un enfoque ético intercultural, en la formación inicial de profesionales en ciencias de la salud. Se constata una salud carente y descontextualizada de la realidad cultural en la formación inicial en ciencias de la salud. Para evolucionar en esta área, se requiere imperiosamente formar a los profesionales en competencias interculturales desde un enfoque ético intercultural. Ello contribuirá al reconocimiento y comprensión de la otredad desde su propia cultura, a partir de la relación e intercambio de experiencias, conocimientos, saberes, entre otros. Para ello se requiere del diálogo intercultural entre profesionales y expertos pertenecientes a distintos sistemas de salud, con el fin de coconstruir desde la salud y enfermedad, para responder de forma oportuna y adecuada a las demandas de salud, y brindar un cuidado en salud digno y de calidad. En efecto, mitigará las desigualdades e injusticias, a la vez que proporcionará una vida más plena a las personas que conviven en una sociedad culturalmente diversa.

Chile is a culturally diverse country, and this population must face difficulties related to health. This essay aims to reflect on intercultural competencies from an intercultural ethical approach, in the initial training of professionals in health sciences. The initial training in health sciences shows that health is lacking and decontextualized from the cultural reality. In order to evolve in this area, it is imperative to train professionals in intercultural competencies from an intercultural ethical approach. This will contribute to the recognition and understanding of otherness from their own culture, based on the relationship and exchange of experiences, knowledge, wisdom, among others. This requires intercultural dialogue between professionals and experts belonging to different health systems, in order to co-construct from health and disease. This will allow a timely and adequate response to health demands. It will also provide quality and dignified health care and attention. In effect, it will mitigate inequalities and injustices, while providing a fuller life to people living in a culturally diverse society.

O Chile é um país culturalmente diverso, essa população deve enfrentar dificuldades relacionadas à saúde. Este ensaio tem como objetivo refletir sobre as competências interculturais a partir de uma abordagem ética intercultural, na formação inicial de profissionais em ciências da saúde. A saúde carente e descontextualizada da realidade cultural é verificada na formação inicial em ciências da saúde. Para evoluir nesta área, é imperativo formar profissionais em competências interculturais a partir de uma abordagem ética intercultural. Isso contribuirá para o reconhecimento e compreensão da alteridade a partir da própria cultura, do relacionamento e troca de experiências, saberes, saberes, entre outros. Para isso, é necessário o diálogo intercultural entre profissionais e especialistas pertencentes a diferentes sistemas de saúde; a fim de co-construir a partir da saúde e da doença. Isso permitirá uma resposta oportuna e adequada às demandas de saúde. Da mesma forma, prestará cuidados e atenção à saúde dignos e de qualidade. Com efeito, atenuará as desigualdades e as injustiças, ao mesmo tempo que proporcionará uma vida mais plena às pessoas que vivem numa sociedade culturalmente diversa.

The Commoditization of Ecosystems within Chile's Mapuche Territory: A Violation of the Human Right to Health.

The Araucanía region of Chile is characterized by a significant rural Indigenous population-the Mapuche people-who preserve their cultural beliefs about the world around them. This region is also distinguished by the conflict between the Mapuche people and the Chilean government. The Chilean state has supported the development of extractive projects such as industrial plantations, hydroelectric plants, and aquaculture, using nature to generate profits. This has collided with the Mapuche's inextricable relationship with nature and territory, which they value as a spiritual and historical space. Our qualitative study, conducted between 2016 and 2019 in three Araucanía territories with large Mapuche populations, sought to explore Mapuche perceptions of nature, their right to health, Indigenous rights generally, and Indigenous communities' relationship with the state. The results show an overall perception among Mapuche communities of an extractive mentality at the heart of the Chilean state, regardless of the administration in power, as well as a belief that the industrial occupation of their territories represents a process of colonialism and the transgression of ancestral rights. This extractivist approach by the state has caused Mapuche communities to witness enormous changes to their ecosystem, with negative impacts on their well-being.

Spanish version of the Pediatric Anesthesia Emergence Delirium scale: translation and cross-cultural adaptation.

BACKGROUND: Emergence delirium (ED) is a mental disturbance in children during recovery from general anaesthesia. The Pediatric Anesthesia Emergence Delirium (PAED) scale is the only validated scale that assesses ED in paediatric patients undergoing general anaesthesia. The aim of this study was the translation and cross-cultural adaptation of the PAED scale into Spanish (Chile).  METHODS: A five-stage translation and cross-cultural adaptation process was carried out. The reliability of the Spanish version of the PAED scale was evaluated in paediatric patients independently by a set of two raters (anaesthesiologists or postanaesthesia care unit nurses) in the postanaesthetic period after major outpatient surgery. ED was defined by a cut-off level of ≥ 10 points on the PAED scale.  RESULTS: The PAED scale was evaluated in 353 consecutive children. Patients had a mean age of 7.4 ± 3.22 years. The preoperative ASA Physical Status class was 62%, 37%, and 1% (ASA class I, II and III, respectively). The distribution of patients by service was as follows: 45% of patients underwent paediatric surgery; 33% underwent otorhinolaryngological surgery; 11% underwent orthopaedic surgery; 10% underwent ophthalmological surgery; and 1% underwent other types of surgery. The interrater agreement ranged from 96.9% to 97.9%, with Kappa values ranging from 0.59 to 0.79. The Cronbach's alpha value was 0.91. The ED global incidence was 9.1% and was higher in the younger age groups (3-10 years). CONCLUSIONS: The translated and cross-culturally adapted Spanish version of the PAED scale is a reliable instrument to measure ED in the postanaesthetic period in Chilean children.

Fundamentos éticos que sustentan la relación mapuche y naturaleza. Aportes para una salud intercultural / Ethical foundations that sustain the Mapuche and nature relationship. Contributions for intercultural health / Fundamentos éticos que sustentam a relação mapuche e natureza. Contribuições para uma saúde intercultural

Resumen: La contaminación ambiental es un gran problema que afecta la Tierra. El territorio mapuche no es la excepción, dado que el modelo extractivista transgrede los espacios sagrados, explota los recursos naturales y contamina, afectando los modos de vida y de salud del mapuche. El objetivo del artículo es reflexionar acerca de los fundamentos éticos de la relación mapuche y naturaleza como aportes para la salud intercultural. Se aprecia que los fundamentos "Az-mapu", "küme mogen" y "ixofil mogen" influyen fuertemente en el comportamiento del mapuche frente a la naturaleza. El respeto, amor, cuidado, empatía y reciprocidad del mapuche hacia la naturaleza, a sí mismo y a las demás personas, le permite estar en armonía y equilibro desde lo físico y espiritual. Es relevante considerar estos fundamentos éticos para mejorar el servicio de salud desde una perspectiva intercultural, considerando para ello la complementariedad, sobre la base del diálogo, con la finalidad de bridar una salud humanizadora, diversa y, por tanto, de calidad, para transitar hacia un bienestar más pleno de sujetos pertenecientes a culturas distintas.

Abstract: Environmental pollution is a big problem that affects the earth. The Mapuche territory is no exception, given that the extractivist model violates sacred spaces, exploits natural resources, and pollutes, affecting the Mapuche's ways of life and health. The objective was proposed: reflect on the relevance of the ethical foundations that sustain the Mapuche and nature relationship as contributions to intercultural health. It is appreciated that the ethical foundations: "Az-mapu", "küme mogen" and "ixofil mogen", have a fundamental role in ethical behavior regarding the relationship between the Mapuche and nature, where respect, love, care, empathy and reciprocity of the Mapuche towards nature, himself and with other people, allows him to be in harmony and balance from the physical and spiritual. In this sense, it is relevant to consider these ethical foundations to improve the health service, from an intercultural perspective, considering complementarity based on dialogue, in order to provide a humanizing, diverse and, therefore, quality health to move towards a good to be more full of subjects belonging to different cultures.

Resumo: A contaminação ambiental é um grande problema que afeta a Terra. O território mapuche não é uma exceção, dado que o modelo extrativista transgride os espaços sagrados, explora os recursos naturais e contamina, afetando os modos de vida e de saúde do mapuche. O objetivo do artigo é refletir acerca dos fundamentos éticos da relação mapuche e natureza como contribuições para uma saúde intercultural. Se considera que os fundamentos "Az-mapu", "küme mogen" e "ixofil mogen" influem fortemente o comportamento do mapuche frente à natureza. O respeito, amor, cuidado, empatia e reciprocidade do mapuche para com a natureza, para consigo mesmo e para com as demais pessoas, lhe permite estar em harmonia e equilíbrio desde o físico ao espiritual. É relevante considerar estes fundamentos éticos para melhorar o serviço de saúde desde uma perspectiva intercultural, considerando para isso a complementariedade, tendo como base o diálogo, com a finalidade de fornecer uma saúde humanizadora, diversa e, portanto, de qualidade, para transitar a um bem estar mais pleno de sujeitos pertencentes a culturas distintas.

[Psychomotor development in offspring of mothers with post partum depression]. / Alteración del desarrollo psicomotor en hijos de mujeres con depresión posparto de la ciudad de Valdivia-Chile.

BACKGROUND: Postpartum depression (PPD) has adverse effects on psychomotor development of the offspring. AIM: To evaluate the relationship between PPD and psychomotor development in children aged 18 months, consulting in primary care. MATERIAL AND METHODS: Cross-sectional study with 360 infants and their mothers. Children had their psychomotor evaluation at l8 months and mothers completed the Edinburgh Postnatal Depression Scale at 4 and 12 weeks postpartum. The prevalence of both PPD and psychomotor alteration was estimated. The association between PPD and psychomotor alteration, including confounding variables, was estimated through logistic multiple regression analysis. RESULTS: The prevalence of PPD and psychomotor alteration was 29 and 16%, respectively Mothers with PPD had twice the probability of having an offspring with psychomotor alteration (Odds ratio = 2.0, confidence intervals = 1.07-3.68). This probability was significantly higher among single mothers or those with an unstable partner. CONCLUSIONS: PPD has a detrimental impact on psychomotor development of children.

Alteración del desarrollo psicomotor en hijos de mujeres con depresión posparto de la ciudad de Valdivia-Chile / Psychomotor development in offspring of mothers with post partum depression

Background: Postpartum depression (PPD) has adverse effects on psychomotor development of the offspring. Aim: To evaluate the relationship between PPD and psychomotor development in children aged 18 months, consulting in primary care. Material and Methods: Cross-sectional study with 360 infants and their mothers. Children had their psychomotor evaluation atl8 months and mothers completed the Edinburgh Postnatal Depression Scale at 4 and 12 weeks postpartum. The prevalence of both PPD and psychomotor alteration was estimated. The association between PPD and psychomotor alteration, including confounding variables, was estimated through logistic multiple regression analysis. Results: The prevalence of PPD and psychomotor alteration was 29 and 16%, respectively Mothers with PPD had twice the probability of havingan offspring with psychomotor alteration (Odds ratio = 2.0, confidence intervals = 1.07-3.68). This probability was significantly higher among single mothers or those with an unstable partner. Conclusions: PPD has a detrimental impact on psychomotor development of children.

[Validation of quality of life questionnaire ConQol for Chilean children with congenital heart diseases]. / Validación del cuestionario de calidad de vida ConQol, en niños chilenos portadores de cardiopatías congénitas.

BACKGROUND: ConQoL questionnaire assesses health related quality of life among children with congenital heart diseases. It has a version for children aged 8 to 11 years and another for children aged 12 to 16 years. AIM: To validate ConQol questionnaire for Chilean children with a congenital heart disease. MATERIAL AND METHODS: Using a multicentric cross sectional design, 334 children from four hospitals (54% males), were surveyed. Among them 45% were aged 8 to 11 years and 55%, 12 to 16 years. The study involved three stages: cross cultural adjustment of the original questionnaire, pre-test study, and estimation of its psychometric properties. Content, construct and criterion validity and internal consistency with Cronbach's alpha, were assessed. RESULTS: The version for children aged 8 to 11 years and comprised by three domains (symptoms, activity and relationships), obtained and α ≥ 0.60. In the questionnaire for children aged 12 to 16 years, there is one more domain called coping, which obtained an α of 0.53, that was different to the other three domains that obtained an α > 0.70. The correlation between Health Quality of Life and Perception of Health Quality of Life was statistically significant for both groups. The association between Health Quality of Life and health capability was only significant among children aged 12 to 16 years (p < 0.01). CONCLUSIONS: The adapted ConQol questionnaire matched properly with the original one. The adapted questionnaire is valid and reliable to assess Health Quality of Life among Chilean children with congenital heart diseases.

Age of menarche and nutritional status of indigenous and non-indigenous adolescents in the Araucanía Region of Chile.

BACKGROUND: Early onset of menarche has been linked to prevalence of obesity; however, this may differ for indigenous females. OBJECTIVE: To analyse the relationship between age of menarche and nutritional status among indigenous and non-indigenous girls. METHOD: The design of this study was cross-sectional. Date of menarche was determined through interviews, and all responses were confirmed by the girls' mothers. A total of 8504 adolescents were screened for recent menarche. One hundred and thirty-one girls of Mapuche (indigenous) and 143 girls of Chilean-Spanish background were identified and evaluated by anthropometric measurements. RESULTS: Median age of menarche was 150 months, interquartile range (IR) 143-157 in indigenous, and 145.5 months, IR 139-153 in non-indigenous girls (p = 0.04). The indigenous females showed a higher prevalence of overweight (36.4% vs 23.1%), although the frequency of obesity was similar (16.8% vs 16.3%). For indigenous girls, age of menarche was delayed by 2.69 months (confidence intervals (CI) -0.38 to 5.77). It was observed that girls with overweight experienced age of menarche 7.59 months earlier than those with normal weight, CI -10.78 to -4.41. In the analysis of obesity, the effect on age of menarche was similar, with onset 7.53 months earlier than for the normal weight, CI -11.34 to -3.72. CONCLUSION: Age of menarche is younger than has been previously reported and occurs earlier in girls with overweight and obesity, while being indigenous was not related.

Satisfacción del cliente interno y externo en el Hospital San Juan de Dios de la ciudad de Challapata gestión 2006

La satisfacción de los clientes (internos y externos) de las instituciones es uno de los componentes fundamentales de la nueva política de calidad de servicios, en este caso salud, como inicio del proceso, imprescindible realizar un diagnóstico base sobre las percepciones, requerimientos, factores de satisfacción e insatisfacción entre los clientes con la finalidad de proponer cambios y modificaciones en el sistma de prestaciones de servicios de salud.

[Intercultural health care policy from the perspective of health care providers and Mapuche clients]. / Política de Salud Intercultural: perspectiva de usuarios mapuches y equipos de salud en la IX región, Chile.

BACKGROUND: Intercultural health is becoming an emergent topic in the design of health care programs for Mapuche people of Chile. This process faces important challenges such as the scarce theoretical support about the meaning of intercultural health and their practical consequences for providers and clients. AIM: To explore the perception in providers and Mapuche clients about intercultural health. MATERIAL AND METHODS: A survey performed in 11 counties with the highest concentration of Mapuche people, of the IX region of Chile. The perception about the development of a new health policy specially designed for Mapuche patients was surveyed in 399 Mapuche patients and 64 providers of primary health care centers. RESULTS: Mapuche clients considered, as the main regional challenges, the indifference and discrimination of health care teams towards Mapuche patients, aggravated by the indifference of authorities. Providers considered that the main problem was a lack of knowledge about Mapuche culture and skills to deal with this ethnic group. Patients and providers agreed on the need to use Mapuche dialect in health care attentions, to coordinate actions with traditional healers and to accept ethnical therapeutic practices. CONCLUSIONS: There is scarce agreement between providers and Mapuche clients about the need for an special intercultural health policy, its contents, and the regional conditions for its implementation and development.

Epilepsias catastroficas en la infancia: más que un concepto biológico / Catastrophic epilepsy in childhood: more than a biological concept

Não existe cinsenso na definição de epilepsia catastrófica. Neste artigo, designamos como tal as epilepsias resistentes a todas terapêuticas disponíveis e que alteram severamente a organização e a economia familiar. Foram analisadas 10 crianças com epilepsias resistentes (4 ou mais crises/mes) a tratamento clínico ou cirúrgico (conceito biológico), onde foi calculado o custo direto (conceito econômico). Foi utilizado o dicionário da Real Academia Espanhola que designa como catástrofe, evento indesejável que altera a ordem regular dos fatos. Mediante a prova de Hoare y Alvarez foi construído um conceito psicolingúístico, onde foi assimilado um custo intangível. As crianças tinham em média 5.4 anos de epilepsia refratária e toda terapia disponível e foram observados em média por 5 anos. A maioria dos pacientes tinha epilepsia parcial sistomática resistente, dois foram operados sem êxito e o custo direto para o grupo de US$ 4032. Todas as crianças pertenciam a classe socioeconômica desfavorável. Na maioria, o pai tinha baixa escolaridade e a metade deles eram desempregados. A doença gerou um severo impacto na qualidade de vida da criança e da família. A característica comum de todas as crianças é que possuíam epilepsias resistentes a todo tratamento disponível, de alto custo direto e que alterava severamente a estrutura familiar

Una perspectiva cultural de la donación de organos y tejidos / A cultural perspective of organ and tissue donations

Este es un estudio cualitativo realizado con 92 pacientes mapuches del Hospital Regional de Temuco durante el año 1997. Su propósito fue explorar la opinión de los pacientes mapuches acerca del tema de los transplantes y donación de orgános. Los resultados develaron que la mayoría de los pacientes mapuches estuvieron en desacuerdo con la donación de órganos y transplantes. Los pacientes fundamentaron su opinión en las reglas y normas propias de la cultura mapuche que les impediría someterse a este tipo de procedimientos. Los pacientes que estuvieron de acuerdo con la donación de órganos y transplantes mencionaron que este procedimiento debería ser realizado sólo con la familia y / o personas de la misma identidad étnica y cultural: "mapuche". Los datos de este estudio constituyen el primer paso hacia una mejor comprensión de la relación entre ética y cultura

Seminario de Mortalidad Materno-Infantil / x

Mortalidad Materna, Epidemiologia, Estadísticas, Factores de riesgo, salud reproductiva