Understanding intimate self-care among riverine women: qualitative research through the lens of the Sunrise Model.

OBJECTIVES: to contribute to the change in understandings and knowledge of the popular system among riverine women about female intimate self-care before and after the application of an educational dynamic. METHODS: a qualitative-participative study based on the Sunrise Model. Twenty women registered at a Basic Health Unit on the Combu island, state of Pará, Brazil, participated in the second half of 2022. Semi-structured interviews were conducted before and after the educational dynamic; followed by reflective inductive analysis. RESULTS: these are pointed out: a female mechanism of generational education; the cultural act of bathing as synonymous with intimate self care and disease prevention; intimate care with medicinal herbs; lack of professional system approach to the topic; fear of using "muddy water"; and lack of financial resources to purchase specific products for genitourinary care. FINAL CONSIDERATIONS: companionship and social factors drive intimate self-care; however, riverine women experience taboos, ignorance, and poverty.

Effect of Self-transcendence, Self-distancing, and Family Functionality on Self-care Agency in Older Adults.

Objective: To determine the effect of self-distancing, self-transcendence, and family functioning on self-care agency in Mexican older adults. Methods: Correlational-explanatory design, with a sample of 253 elderly, collecting data through a simple random sampling. A personal data questionnaire was applied, the scale of: self-transcendence, the self-distancing subscale, the family APGAR and the ability to self-care in Mexican population from different demographic groups. Descriptive and inferential statistics were applied (Mann-Whitney U and a structural equation model) and the study was approved by a registered ethics committee. Results: The study had participation from 253 elderly, with a mean age of 68.02 years, with prevalence of the female sex (60.1%); the level of education was primary school or lower (51.4%). It was observed that the group of chronic diseases had lower self-distancing (U = 4.449.5, p = 0.038) and greater self-transcendence (U = 4177.0, p = 0.008), and selfcare (U = 4365.5, p = 0.024) than the group without chronic diseases. It was also found that self-transcendence, self-distancing, and family functionality produce a positive effect of 37% on selfcare. Conclusion: Self-distancing, self-transcendence, and family functionality explain an important proportion of selfcare in the elderly. Said knowledge permits understanding the care behavior of the elderly and, thus, propose future educational interventions by nursing to prevent or avoid functional, cognitive loss and social effects.

Cultural context and self-care impact on medical students' quality of life. A mixed-methods approach.

BACKGROUND: Medical education can make it difficult for students to take actions to improve their health. OBJECTIVE: To evaluate the influence of the university context on self-care behaviors and quality of life. MATERIAL AND METHODS: A mixed-methods approach was used, with surveys being combined to assess self-care and quality of life, with in-depth interviews to explore cultural influences and perceptions. Statistical analysis and qualitative data coding were carried out, with methods being integrated through network analysis. RESULTS: Self-care scores exceeded 50 points, and quality of life scores exceeded 60 points. Medical students' context is shaped by motivations, expectations, skills, and goals that influence identity formation and contribute to the medical profession. CONCLUSIONS: There is a positive connection between self-care practices and quality of life. However, academic stress can potentially disrupt self-care routines. Furthermore, an association between obesity and a decrease in quality of life stands out, which emphasizes the need for health promotion actions.

ANTECEDENTES: La educación médica puede dificultar que los estudiantes realicen acciones para mejorar su salud. OBJETIVO: Evaluar la influencia del contexto universitario en los comportamientos de autocuidado y la calidad de vida. ­. MATERIAL Y MÉTODOS: Se empleó un enfoque de métodos mixtos, combinando encuestas para evaluar el autocuidado y la calidad de vida, con entrevistas en profundidad para explorar influencias culturales y percepciones. Se llevaron a cabo análisis estadísticos y codificación de datos cualitativos; los métodos se integraron a través del análisis de redes. RESULTADOS: Las puntuaciones de autocuidado superaron los 50 puntos y las de calidad de vida, los 60 puntos. El contexto de los estudiantes de medicina está moldeado por motivaciones, expectativas, habilidades y metas que influyen en la formación de la identidad y contribuyen a la profesión médica. CONCLUSIONES: Existe una conexión positiva entre prácticas de autocuidado y la calidad de vida; sin embargo, el estrés académico pueden interrumpir potencialmente las rutinas de autocuidado. Además, se destaca la asociación entre la obesidad y la afectación en la calidad de vida, lo que enfatiza la necesidad de acciones de promoción de la salud.

Mixed-Methods Study of Disability Self-Management in Mexican Americans With Osteoarthritis.

BACKGROUND: Health disparities in osteoarthritis (OA) outcomes exist both in the occurrence and treatment of functional limitation and disability for Mexican Americans. Although the effect of self-management of chronic illness is well established, studies demonstrate little attention to self-management of function or disability, despite the strong potential effect on both and, consequently, on patients' lives. OBJECTIVE: The purpose of this study pilot was to develop and test key variable relationships for a measure of disability self-management among Mexican Americans. METHODS: In this sequential, two-phased, mixed-methods, biobehavioral pilot study of Mexican American women and men with OA, a culturally tailored measure of disability self-management was created, and initial relationships among key variables were explored. RESULTS: First, a qualitative study of 19 adults of Mexican American descent born in Texas (United States) or Mexico was conducted. The Mexican American Disability Self-Management Scale was created using a descriptive content analysis of interview data. The scale was tested and refined, resulting in 18 items and a descriptive frequency of therapeutic management efforts. Second, correlations between study variables were estimated: Disability and function were negatively correlated. Disability correlated positively with social support and activity effort. Disability correlated negatively with disability self-management, pain, and C-reactive protein. Function was positively correlated with age, pain, and depression. Liver enzymes (alanine transaminase) correlated positively with pain and anxiety. DISCUSSION: This mixed-methods study indicates directions for further testing and interventions for disability outcomes among Mexican Americans.

Exploring self-care practices and health beliefs among men in the context of emerging infectious diseases: Lessons from the Mpox pandemic in Brazil.

Our goal was to explore self-care practices among men who have sex with men in the context of Mpox in Brazil. This study used qualitative research methods, including interviews and thematic analysis, to collect and analyze data from male participants across the Brazilian territory. The narratives unveil men's perspectives on self-care, risk reduction, and health beliefs during the Mpox pandemic. Our findings highlight a multifaceted approach to self-care among men, encompassing hygiene, physical contact management, mask usage, skin lesion vigilance, and adherence to official guidelines. Men's attitudes toward sexual behaviors emphasize the importance of reducing sexual partners, practicing safe sex, and combating misinformation through accurate information dissemination. The development of these behaviors and self-care practices can be facilitated by nurses guided by Dorothea Orem's Self-Care Theory, supported by patient-centered care, with strategies to address and confront the stigma associated with the disease and provide emotional support. Thus, the study underscores the pivotal role of self-care in mitigating infection risks, especially in the context of emerging infectious diseases. It acknowledges the impact of socio-cultural factors and healthcare policies on men's preventive measures. However, it also recognizes limitations, such as potential bias due to stigma concerns and a nonrepresentative sample. Ultimately, the research advocates for tailored education, promotion of gender equity, and healthcare empowerment to effectively manage health risks in such contexts.

Avaliação de intervenção psicológica positiva para a promoção de saúde de aposentados / Evaluación de intervención psicológica positiva para promoción de la salud de jubilados / Evaluation of a positive psychology intervention for health promotion of retirees

RESUMO Este estudo teve como objetivo avaliar a intervenção psicológica positiva para promoção de saúde de aposentados, a partir da avaliação dos participantes, no que se refere à satisfação com o programa e com o moderador, clareza/compreensão/aplicação dos conteúdos e manutenção da aplicação ao longo de tempo, com delineamento longitudinal misto e avaliação pré (T1), pós-teste (T2) e seguimento (T3 - 03 meses). Participaram 65 aposentados que responderam ao questionário misto de avaliação do programa. Análises quantitativas indicaram maiores médias para satisfação com o programa e com o moderador; e menor média para tempo de duração do programa. 77,7% participantes em T2 e 87,2% em T3 utilizaram nas suas vidas os conteúdos trabalhados no programa. Foi observada manutenção da aplicação dos conteúdos de empatia, autocuidado, otimismo, gratidão, perdão e autoperdão. Resultados positivos demonstram que este modelo de intervenção para promoção de saúde - com base na psicologia positiva e TCC - apresenta potencial para ser aplicado em contextos de saúde pública e promoção de envelhecimento ativo.

RESUMEN Este estúdio evaluó una intervención psicológica positiva para La promoción de la salud de jubilados, basado em laevaluación de los participantes, encuanto a satisfacción com el programa y com el moderador, claridad/comprensión/aplicación de los contenidos y mantenimiento de La aplicaciónen el tiempo, condiseño longitudinal mixto y evaluación pre (T1), posterior a laprueba (T2) y seguimiento (T3 - tres meses). Participaron 65 jubilados que respondieron los cuestionarios de evaluación del programa. Los análisis cuantitativos indican promedios más altos para satisfacción conel moderador y programa; y más bajo para laduración del programa. 77.7% de los participantes en T2 y 87.2% en T3 usaron en sus vidas los contenidos trabajados em el programa. Se observo mantenimiento de la aplicación de lãs variables empatía, autocuidado, optimismo, gratitud, perdón y autoperdón. Los resultados positivos demuestran que este modelo de intervención presenta potencial de ser aplicado en contextos de salud pública y promoción Del envejecimiento activo.

ABSTRACT This study aimed to evaluate a Positive Psychology programme for health promotion of retirees, based on evaluation of participants with regard to levels of satisfaction with the programme/group and with the moderator, comprehension and application of contents and maintenance/long-term application of contents. A mixed longitudinal design, with pre-test (T1), post-test (T2), and follow-up (T3 - three months) evaluations was used. 65 retirees answered a programme evaluation questionnaire. Quantitative results indicated higher mean rates for satisfaction with the moderator and programme; and lower rates for the programme length/duration. Qualitative analysis indicated that 77.7% of the sample at T2, and 87.2% at T3 reported having used contents of the programme in their lives. Maintenance of application of contents was observed for empathy, self-care, optimism, gratitude, forgiveness and self-forgiveness. Positive outcomes demonstrate this pattern of intervention for health promotion - based on Positive Psychology and CBT - presents the potential to be applied within public health contexts for the promotion of active aging.

Entre zelar e cuidar: sentidos sobre saúde-doença em dirigentes da Umbanda / Entre celar y cuidar: significados sobre salud-enfermedad en los líderes de Umbanda / Between watching over and caring: meanings about health-disease in Umbanda leaders

RESUMO Por meio da antropologia da saúde, podemos compreender o terreiro de umbanda como parte de um sistema popular de cuidado. Este estudo teve por objetivo investigar as concepções de saúde e doença produzidas por zeladores de terreiro de umbanda. Participaram dez zeladores de terreiro da cidade de Uberaba (MG/Brasil), sendo três mulheres e sete homens, com idades entre 40 e 76 anos. O tempo médio de atuação como dirigente foi de 18,4 anos, variando de cinco a 43 anos. Os terreiros chefiados por esses participantes atendem entre 15 e 280 pessoas por dia de funcionamento. Pela análise das entrevistas, destaca-se que o cuidado em saúde oferecido pelos zeladores ultrapassa os limites rituais, nas cerimônias públicas, sendo prestado de modo contínuo nos terreiros. As posturas assumidas pelos entrevistados envolvem ações de escuta, acolhimento e proximidade física no momento da urgência. Pelas narrativas, pode-se concluir que o zelar, no sentido de gerenciar o espaço do terreiro, espiritual e materialmente, não pode ser dissociado do cuidar, significando os zeladores como importantes agentes populares de saúde.

RESUMEN A través de la antropología de la salud podemos entender el terreiro de umbanda como parte de un sistema de atención popular. Este estudio tuvo como objetivo investigar las concepciones de salud y enfermedad producidas por los cuidadores del terreiro de umbanda. Participaron diez cuidadores de terreiro de la ciudad de Uberaba (MG/Brasil), tres mujeres y siete hombres, con edades comprendidas entre 40 y 76 años. El tiempo promedio como gerente fue de 18.4 años, que van de cinco a 43 años. Los terreiros encabezados por estos participantes atienden entre 15 y 280 personas por día de operación. Del análisis de las entrevistas, se destaca que la atención médica ofrecida por los cuidadores va más allá de los límites rituales, en ceremonias públicas, que se brindan continuamente en los terreiros. Las actitudes asumidas por los entrevistados implican escuchar, acoger y proximidad física en el momento de urgencia. A través de las narrativas, se puede concluir que el cuidado, en el sentido de administrar el espacio del terreiro, espiritual y materialmente, no se puede disociar del cuidado, lo que significa que los cuidadores son importantes agentes de salud populares.

ABSTRACT Through health anthropology we can understand the umbanda terreiro (specific place for the religious ritual) as part of a popular system of care. This study aimed to investigate the conceptions of health and illness produced by saint keepers of umbanda terreiro. Ten leaders of the terreiros in the city of Uberaba (MG/Brazil) participated, being three women and seven men, between 40 and 76 years old. The average time of performance as a manager was 18.4 years, ranging from 5 to 43 years. The terreiros led by these participants attend between 15 and 280 people working day. The health care offered by saint keepers exceeds ritual limits in public ceremonies and is provided on a continuous basis in the terreiros. The postures assumed by the interviewees involve actions of listening, welcoming and physical proximity at the moment of urgency. From the narratives, it can be concluded that care, in the sense of managing the space of the terreiro, both spiritually and materially, can not be dissociated from caring, meaning saint keepers as important popular health.

Mediação remota das afecções do corpo: reflexões sobre virtualidade e corporeidade / The remote mediation of body affections: reflections on virtuality and corporeity / La mediación a distancia de los afectos del cuerpo: reflexiones sobre la virtualidad y la corporeidad

Este ensaio teórico se propõe a pensar o corpo sob a ótica da pluralidade e das afecções, para compreender como o trabalho da psicologia na modalidade remota atinge a corporeidade e a sua potência de existir. Tais questões foram evocadas num Grupo de Escuta e Acolhimento na modalidade remota. O olhar teórico parte da concepção espinosana das afecções, articulada com a noção de cuidado de si. A solidão relatada nos grupos foi tomada como analisador para refletir sobre o enfraquecimento da produção do encontro. Isso nos levou a pensar os impactos da perda do corpo na presença on-line, a (im)possibilidade do encontro com a diferença e sobre o papel da virtualidade na atualidade do modelo econômico liberal aplicado à psicologia. É necessário considerar as possibilidades de atuação e mediação que não se abstenham perante as demandas da atualidade, mas que reconheçam também os perigos dos aparelhos de captura. (AU)

This theoretical study proposes to think about the body from the plurality and the affections' perspectives, in an attempt to understand how the psychology works, on the virtual modality, reaches corporeity and the expansion of its power to exist. These questions were raised from a Group for Listening and Welcoming Services o the virtual modality. The theoretical perspective starts from Spinoza's conception of the affections, articulated with the notion of self-care. The loneliness reported on the group was our analyzer, in an attempt to reflect about the encounter's weakening. This led us to reflect about the impacts of the body's loss on the online presence, the (im)possibility of encountering the difference and the role of virtuality in the liberal economic model applied to psychology. It is necessary to cover the possibilities of action that do not abstain from present time demands, but also to recognize the dangers of capture devices. (AU)

Este ensayo teórico propone pensar el cuerpo desde la perspectiva de las afecciones, intentando comprender cómo el trabajo de la psicología en la modalidad a distancia alcanza la corporeidad y su potencia de existir. Tales interrogantes surgieron en la experiencia de un Grupo de Escucha y Acogida en la modalidad a distancia. Orientó el trabajo la concepción Spinozista de los afectos, articulada con la noción de cuidado de sí. La soledad relatada en los grupos fue el analizador para reflexionar sobre la producción del encuentro y nos llevó a pensar en los impactos de la pérdida del cuerpo en la presencia online, la (im)posibilidad de encontrar la diferencia y a reflexionamos sobre la virtualidad en el modelo económico liberal aplicado a la psicología. Es necesario abarcar las posibilidades de acción que no se abstengan de las exigencias de hoy, pero que también reconozcan los peligros de los dispositivos de captura. (AU)

Público e privado: masculinidades e práticas de cuidados na pandemia / Public and private: masculinities and care practices in the pandemic / Público y privado: masculinidades y prácticas de cuidado en la pandemia

Frente ao cenário pandêmico de COVID-19 vivenciado por todo o mundo, fomos forçados a produzir rearranjos relacionais para lidar com as dificuldades impostas por esse momento e uma das grandes mudanças que tivemos foi a necessidade de distanciamento social para não propagação do vírus. Neste sentido, trazemos para análise as mudanças da dimensão do público para o privado de homens brasileiros, tendo como objetivo compreender como tal mudança reverberou em suas práticas de cuidado para si e para o outro. Tivemos como referencial metodológico as práticas discursivas para a análise de entrevistas realizadas com homens que participam de um grupo terapêutico virtual. Concluímos que no contexto pandêmico, estes homens tiveram que lidar com dimensões do cuidado doméstico, de filhos, do outro e de si de forma inédita, que por vezes acarretaram situações angustiantes e desafiadoras que exigiram ressignificação e novas relações com as práticas de cuidado. (AU)

Front to COVID-19 pandemic scenario experienced around the world, we were forced to produce relationshiprearrangements to deal with the difficulties imposed by this moment and one of the great changes we had was the need for social distance to avoidthe vírus spreading. Therefore, we bring to analysis the changes from the public to the private dimension of Brazilian men, aiming to understand how this change reverberated in their care practices for themselves and for the others.We had as a methodological reference the discursive practices tointerviewsanalysiscarried out with men who participate in a virtual therapeutic group. We conclude that inthe pandemic context, these men had to deal with domestic carecontextual, of children, of theother and of themselves in an unprecedented way, which sometimes led to distressing and challenging situations that required a re-signification of their forms ofcare and a change in the theme perception. (AU)

Ante el escenario de pandemia del COVID-19 vivido en todo el mundo, nos vimos obligados a producir reacomodos relacionales para hacer frentea las dificultades que impone este momento y uno de los grandes cambios que tuvimosfue la necesidad del distanciamiento social para evitar la propagación del virus. En ese sentido, traemos para el análisis los cambios de la dimensiónpública a la privadade los hombres brasileños, con el objetivo de comprender cómo ese cambio repercutióen sus prácticas de cuidado para sí y para el otro. Tuvimos como referente metodológico las prácticas discursivas para el análisis deentrevistas realizadas a hombres que participan en un grupo terapéutico virtual. Concluimos que en el contexto de la pandemia, estos hombres debieron lidiar con dimensiones del cuidado doméstico, de los niños, del otro y de sí mismos de una forma inédita,lo que en ocasiones condujo a situaciones angustiosas y desafiantes que exigieron una resignificación de sus formas. del cuidado y un cambio en la percepción del tema. (AU)

Repercussões laborais no autocuidado em saúde de bombeiros militares brasileiros / Labor effects on the self-care of brazilian firefighters

Introdução: O autocuidado é uma importante estratégia para o bombeiro militar manter sua saúde em meio a uma atividade laboral que convive diariamente com situações de insegurança e estresse. Objetivo: identificar as percepções de bombeiros militares sobre as repercussões do seu trabalho no autocuidado em saúde. Metodologia: Trata-se de uma pesquisa qualitativa, realizada nos moldes da Pesquisa Convergente Assistencial desenvolvida por meio de observação participante, grupos focais, oficinas e entrevistas coletivas junto a 34 bombeiros militares pertencentes a um Batalhão localizado no Sul do Brasil. Os dados obtidos foram submetidos a análise temática. Resultado: Obtiveram-se três temas finais, sendo eles, ''Estratégias de autocuidado e de promoção da saúde dos profissionais bombeiros''; e ''Repercussões do labor sob o autocuidado''. Enquanto, a análise dos dados das entrevistas coletivas propiciou a produção do tema ''Pontos de convergências: a pesquisa como promotora de autocuidado''. Conclusão: Embora os participantes estejam conscientes de estratégias que contribuam para o autocuidado, eles também destacam a repercussão negativa que o trabalho tem sobre sua saúde.

Introducción: El autocuidado es una estrategia importante para que el bombero militar mantenga su seguridad en su actividad laboral, donde convive diariamente con situaciones de inseguridad y estrés. Objetivo: Identificar las percepciones de los bomberos militares sobre las repercusiones de su trabajo en el autocuidado de su salud. Metodología: Se trata de una investigación cualitativa, siguiendo el modelo de la investigación convergente asistencial. Fue desarrollada por medio de la observación participante, grupos focales, talleres de trabajo y entrevistas colectivas con 34 bomberos militares pertenecientes a un batallón localizado en el Sur de Brasil. Los datos obtenidos fueron sometidos a análisis temático. Resultados: Se obtuvieron tres temas finales: ''Estrategias de autocuidado y promoción de la salud para bomberos profesionales''y ''Repercusiones del trabajo en el autocuidado''. Además, el análisis de los datos de las entrevistas colectivas condujo a la producción del tema ''Puntos de convergencia: la investigación como promotora del autocuidado''. Conclusión: Aunque los participantes son conscientes de las estrategias que contribuyen al autocuidado, también destacan las repercusiones negativas que el trabajo tiene en su salud.

Introduction: Self-care is an important strategy for military firefighters to preserve their health in a work activity involving daily insecurity and stress. Objective: To identify military firefighters' perceptions about their work's health repercussions. Methodology: This is qualitative research, conducted in the framework of the Convergent Care Research developed through participant observation, focus groups, workshops, and collective interviews with 34 military firefighters from a battalion located in Southern Brazil. The data obtained were subjected to thematic analysis. Results: There were three final themes: ''Strategies for self-care and health promotion for professional firefighters''and ''Repercussions of work on self-care''. The analysis of the data from the collective interviews included the theme ''Points of convergence: research as a promoter of self-care''. Conclusion: Although participants are aware of the strategies that contribute to their self-care, they also emphasize the negative repercussions that work has had on their health.

[Evaluation of the behavioral program in type 2 diabetes mellitus: a randomized clinical trial]. / Avaliação do programa comportamental em diabetes mellitus tipo 2: ensaio clínico randomizado.

The scope of this article was to evaluate the effect of the behavioral group education program and telephone intervention in modifying psychological attitudes, enhancing empowerment, and self-care practices aimed at improving clinical control in type 2 diabetes mellitus. It involved a randomized cluster clinical trial, carried out with 199 people with diabetes. In order to perform intragroup comparisons (final and initial phases) and between groups with respect to the indices of the psychological attitude, empowerment, self-care and glycated hemoglobin level variables, the Generalizing Estimating Equation (GEE) approach was used. In all analyses, a 5% significance level and 95% confidence interval were used. When compared to the CG, the IG showed a significant reduction in the mean values of glycated hemoglobin (95%CI: -1.49 to -0.45), a statistically significant increase in the change in psychological attitude scores (95%CI: 9.70 to 15.40), on the empowerment scale (95%CI: 0.81 to 2.72) and adherence to self-care practices (95%CI: 1.44 to 2.10) at the end of the study. The behavioral program proved to be capable of modifying psychological attitudes, improving empowerment, self-care practices and clinical control.

O objetivo deste artigo é avaliar o efeito do programa comportamental educação em grupo e intervenção telefônica na modificação das atitudes psicológicas, melhora do empoderamento e das práticas de autocuidado visando à melhora do controle clínico em diabetes mellitus tipo 2. Trata-se de um ensaio clínico com cluster randomizado, realizado em 199 pessoas com diabetes. Para realizar as comparações intragrupos (tempos final e inicial) e entre grupos quanto aos valores das variáveis atitudes psicológicas, empoderamento, autocuidado e medidas da hemoglobina glicada, foi utilizada a abordagem das Generalizing Estimating Equations (GEE). Em todas as análises, utilizou-se um nível de significância de 5% e intervalos de 95% de confiança. Quando comparado ao GC, o GI apresentou uma redução significativa nos valores médios de hemoglobina glicada (IC95%: -1,49 a - 0,45), aumento estatisticamente significativo na modificação dos escores de atitudes psicológicas (IC95%: 9,70 a 15,40), na escala do empoderamento (IC95%: 0,81 a 2,72) e na adesão às práticas de autocuidado (IC95%: 1,44 a 2,10) ao final do estudo. O programa comportamental se mostrou capaz de modificar as atitudes psicológicas, melhorar o empoderamento, as práticas de autocuidado e o controle clínico.

Dynamic Self-Determination of Self-Care and Positive Deviance Model for Stunting Prevention in Indonesia

ABSTRACT Objective: To describe the dynamic self-determination of self-care (DSDoSC) and positive deviance (PD) models in changing stunting prevention behavior. Material and Methods: This research is a quasi-experimental study with a sample of 90 mothers taken by purposive sampling. Thirty mothers were given the DSDoSC intervention, 30 were given the PD intervention, and another 30 were in the control group. This research was conducted in July - October 2019. The variables studied were feeding behavior, nurturing behavior, personal hygiene behavior, environmental cleanliness and air sanitation, and behavior seeking health services. To analyze the difference in mother behaviour before and after test, we used Paired t-test. Analysis of Variance (MANOVA) was used to analyze the difference of mother behaviour among groups. The level of significance was p<0.05. Results: The PWD group showed that eating behavior, parenting behavior, personal hygiene behavior, environmental hygiene and water sanitation, and behavior seeking health services had significant numbers. In the DSDoSC group, eating behavior, parenting behavior, environmental hygiene, water sanitation and health service-seeking behavior were significantly (p<0.05). The results of the Manova test showed that there was an effect of PD and DSDoSC on stunting prevention behavior. Conclusion: Self-dynamic for self-care model and the positive deviance model both can change a mother's behavior for the better in feeding, parenting, environmental hygiene, and water sanitation, seeking health services, but not changing behavior about personal hygiene behavior.

Expectativas en salud de las personas mayores que acuden a la atención primaria / Health expectations of older people attending primary care

INTRODUCCIÓN: Desde la última década se ha evidenciado el aumento de la población de personas mayores en Chile. Muchos de ellos son usuarios regulares del sistema público de salud el cual se caracteriza por entregar una atención de tipo integral. En este sentido, resulta relevante conocer los requerimientos en salud desde la perspectiva de las experiencias de las personas mayores con respecto al uso de este servicio. OBJETIDO: El objetivo de este estudio fue identificar las expectativas de las personas mayores que asisten a los centros de APS. MATERIAL Y MÉTODOS: Este es un estudio cualitativo, descriptivo, donde la muestra fue de 13 personas mayores de 65 años y más, autovalentes, de tres centros APS, los cuales fueron entrevistados mediante instrumento semiestructurado, con análisis cualitativo de datos método que incluyó codificación abierta y focalizada. RESULTADOS: Las expectativas de las personas mayores fueron categorizadas como requerimiento de una atención profesional integral, oportunidad de atención, accesibilidad de la atención, promoción de salud sobre el autocuidado, explicación de cambios en el envejecimiento con enfoque biológico y alfabetización en salud. CONCLUSIONES: Las expectativas de las personas mayores en este estudio dan cuenta de una atención profesional integral poco efectiva, además de la necesidad de un trato especializado al grupo poblacional específico, no sólo de los profesionales, sino también del personal administrativo de los centros de APS, considerándolos una barrera en la calidad de la atención.

INTRODUCTION: Since the last decade there has been evidence of an increase in the population of older people in Chile. Many of them are regular users of the public health system (PHS) which is characterized by providing comprehensive care. In this sense, it is relevant to know the health requirements from the perspective of the experiences of the older people regarding the use of this health service. OBJECTIVE: The objective of this study was to identify the needs and expectations of older people attending PHS centers. MATERIAL AND METHODS: It were a qualitative and descriptive study. The sample was compounded by 13 people over 65 years and over, self-sufficient, from three PHS centers. It was used a semi-structured instrument. RESULTS: The main needs of the elderly were categorized as a requirement for comprehensive professional care, the opportunity for care, accessibility of care, health promotion on self-care, explanation of changes in aging with a biological focus and health literacy. CONCLUSIONS: The needs and expectations of the older people in this study account for an ineffective comprehensive professional care, in addition to the need for specialized treatment of the specific population group, not only of professionals but also of the administrative staff of the centers of PHS, considering them a barrier in the quality of care.

Foucault: subjetividade e verdade à luz do cuidado de si / Foucault: subjetividad y verdad a la luz del cuidado de sí / Foucault: subjectivity and truth in the light of care of self

RESUMO. Buscamos, no presente artigo, situar o conjunto nocional da relação consigo (rapport à soi) na construção da categoria de subjetividade do pensamento tardio de Michel Foucault. Atrelamos a ele a questão da relação com o Outro e propomos a possibilidade de inscrever a psicanálise na história do cuidado de si. Nosso material primário é a transcrição das aulas ministradas pelo filósofo no começo de 1982 e o livro L'herméneutique du sujet (Foucault, 2001); e nosso suporte principal para análise são as conferências de 1980, L'origine de l'herméneutique de soi, e o livro Foucault, de Deleuze (2005). Como resultado, apresentamos a capacidade de afecção de si por si proporcionada pela relação consigo, demonstramos o modo como a posição do Outro influencia a produção da verdade do sujeito, e reforçamos a necessidade de se pensar práticas como a da psicanálise a partir do arranjo deixado pela história das técnicas de si.

RESUMEN. En el artículo, buscamos identificar el conjunto nocional de la relación con usted (rapport à soi) en la construcción de la categoría de subjetividad del pensamiento posterior de Michel Foucault. Le atribuimos la cuestión de la relación con el Otro y proponemos la posibilidad de inscribir el psicoanálisis en la historia del cuidado de sí. Nuestro material principal es la transcripción de las clases impartidas por el filósofo a principios del 1982, el libro L'herméneutique du sujet (Foucault, 2001) y nuestro principal apoyo para el análisis son las conferencias del 1980, L'origine de l'herméneutique de soi y el libro Foucault, de Deleuze (2005). Como resultado, presentamos la capacidad de autoafecto (de ti para ti) proporcionada por la relación con usted, demostramos lá manera en que la posición del Otro influye en la producción de la verdad del sujeto, y reforzamos la necesidad de pensar sobre las prácticas como de la psicoanálisis desde del arreglo dejado por la historia de las técnicas de sí.

ABSTRACT. In this article, we situate the notional set of the relation with oneself (rapport à soi) in the construction of the category of subjectivity in Michel Foucault's later thought. We show how that relation is attached to the relation with the Other, and we propose the possibility of inscribing psychoanalysis in the history of the care of the self. Our primary material is the transcription of the lectures the philosopher gave in early 1982, the book L'herméneutique du sujet (Foucault, 2001), and our main basis for analysis is the 1980 conferences, L'origine de l'herméneutique de soi, and the book Foucault, by Deleuze (2005). As a result, we present the capacity for self-affection afforded by the relation with oneself, we demonstrate the way in which the Other's position influences the production of the subject's truth, and we concur with the need to think about practices such as psychoanalysis from the perspective of the arrangement left by the history of techniques of the self.

Self-Care Instruments to Measure Nutrition Practices in Children and Parents: Psychometric Analysis.

The purposes of this study were to evaluate the psychometric properties of English and Spanish instruments that measure the nutrition behavior and practices of children and their parents. Orem's self-care deficit nursing theory was used in this methodological study. A convenience sample of 333 children and 262 mothers participated from two schools in Washington, D.C. and two schools in Santiago, Chile. Principal component analysis indicated three component per instrument corresponding to Orem's Theory of operations demonstrating construct validity of the instrument. The study findings showed evidence for validity and reliability of the English and Spanish versions and indicated that the instruments appropriately represented Orem's operations. The results have implications for the development of health behavior measurement instruments that are valid, reliable, designed for children, culturally appropriate, and efficient. Measuring the nutrition behavior of children and parents is critical for determining the effectiveness of nutrition intervention programs. Furthermore, instruments are needed so that researchers can compare corresponding child and parent behaviors or compare behaviors across cultures.

Peer Support Added to Diabetes Education Improves Metabolic Control and Quality of Life in Mayan Adults Living With Type 2 Diabetes: A Randomized Controlled Trial.

BACKGROUND: Yucatán, located in the southern region of Mexico, is the state with the country's highest prevalence of uncontrolled diabetes. Because of its particular cultural and socioeconomic characteristics, the residents of Yucatán face unique health-care challenges. The objective of our study was to evaluate the effect of peer support added to a diabetes education program on glycemic control and diabetes-related quality of life when compared with a conventional diabetes education program in patients with type 2 diabetes in a Mayan community in Mexico. METHODS: In March 2015, a total of 58 participants with a previous diagnosis of type 2 diabetes who were recruited from community health centres in Komchén were randomly assigned in equal numbers to 1 of 2 groups: 1) a peer support and diabetes self-management education group (PSEG) or 2) a conventional diabetes self-management education-only group. The primary outcomes of interest were glycated hemoglobin (A1C) values and diabetes-related quality of life. The majority of subjects were bilingual (Mayan and Spanish speakers), female and middle aged, and had a low level of formal education and high baseline A1C (mean, 8.7%). RESULTS: Whereas both groups showed significant improvements from baseline to study end in absolute levels of A1C, the PSEG group had a more pronounced clinical improvement, but no statistical improvement, in A1C compared with the conventional diabetes self-management education-only group. PSEG participants exhibited statistically significant improvement in diabetes-related quality of life at 8 months. CONCLUSIONS: Our study demonstrates the benefits of peer-support education above and beyond the impact of diabetes self-management education on diabetes-related quality of life in an underserved Mayan community in Mexico.

Testing a Proactive Model of Successful Aging Among Older Adults in Costa Rica and Spain.

The purpose of this study is to examine successful aging among Spanish-speaking older adults in Costa Rica and in Spain using the proactive framework proposed by Kahana et al. (2014). More specifically, we hypothesized that older adults' life satisfaction would be positively associated with the frequency and perceived level of social support, spirituality/having purpose in life, and the use of proactive physical, cognitive, and social self-care behaviors. Our results confirmed these hypotheses, not only for the overall group of participants, but also separately for older adults in Costa Rica and in Spain. The present study contributes to the literature of successful aging among older adults, by examining the protective factors associated with life satisfaction among Spanish speaking older adults in Costa Rica and in Spain. It identifies specific protective factors (spirituality/purpose in life, social support, and self-care) associated with the values and preferences held by participants in the study.

Significado atribuído pelos enfermeiros ao cuidado de si na relação com o cuidado de Enfermagem / Meaning attributed by nurses to self-care in relation to nursing care

A presente Tese de Doutorado, inserida no Núcleo de Fundamentos do Cuidado de Enfermagem (NUCLEARTE) da EEAN, tem como objeto o significado atribuído pelos enfermeiros ao cuidado de si. Para tanto, foram traçados os seguintes objetivos: Compreender o significado atribuído pelos enfermeiros ao cuidado de si; analisar o significado atribuído pelos enfermeiros ao cuidado de si; relacionar os achados sobre o cuidado de si ao cuidado de enfermagem; e, discutir as repercussões simbólicas para a saúde à luz de uma teoria substantiva emergente. O referencial teórico do estudo é o Interacionismo Simbólico sob a necessidade da análise na ótica das relações interpessoais que geram significados. Foi utilizada a abordagem metodológica qualitativa, guiada pelos conceitos da Teoria Fundamentada nos Dados (TFD). O cenário de estudo compreendeu os setores onde atuam enfermeiros no Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro. O grupo amostral foi composto por 20 enfermeiros, sendo, deste total, 15 enfermeiros assistencialistas e 05 enfermeiros gestores, tendo sido utilizado o critério de saturação teórica para determinação da amostra. A coleta dos dados se deu mediante entrevista semiestruturada em profundidade a fim de captar as subjetividades que compõem o discurso do entrevistado de forma a imergir em profundidade no seu universo de vivências. s. Os depoimentos coletados foram analisados de acordo com os procedimentos próprios da TFD: codificação aberta, codificação axial e integração, para posterior construção da categoria central, cerne do estudo. A partir da conjunção dos fenômenos relacionados ao objeto de estudo, foi possível identificar a categoria central "ENTRE O IDEALIZADO E O VIVIDO: A BUSCA POR UM RESSIGNIFICADO DO CUIDADO DE SI NA ENFERMAGEM". Assim, demonstram-se as percepções e os significados sobre o cuidado de si. Também, a sua relação com o cuidado de enfermagem e a urgência presente no ressignificado subjetivo deste conceito para o enfermeiro.

The present Doctoral Thesis inserted in the Nursing Care Fundamentals Nucleus (NUCLEARTE) of EEAN has as its object the meaning attributed by nurses to self-care. For that, the following objectives were outlined: Understand the meaning attributed by nurses to self-care; analyze the meaning attributed by nurses to self-care; relate the findings about self- care to nursing care and discuss the symbolic repercussions for health in the light of an emerging substantive theory. The theoretical framework of the study is Symbolic Interactionism under the need for analysis from the perspective of interpersonal relationships that generate meanings. The qualitative methodological approach was used, guided by the concepts of Grounded Theory (TFD). The study scenario comprised the sectors where nurses work at the Hospital Universitário Clementino Fraga Filho of the Federal University of Rio de Janeiro. The sample group was made up of 20 nurses, of which 15 were nurse assistants and 05 nurse managers, using the criterion of theoretical saturation to determine the sample. Data collection took place through a semi-structured in-depth interview in order to capture the subjectivities that make up the interviewee's discourse in order to immerse himself in depth in his universe of experiences. The testimonies collected were analyzed according to the TFD's own procedures: open coding, axial coding and integration for later construction of the central category, the core of the study. From the conjunction of the phenomena related to the object of study, it was possible to identify the central category "BETWEEN THE IDEALIZED AND THE LIVED: THE SEARCH FOR A MEANING OF THE CARE OF YOURSELF IN NURSING". Thus, perceptions and meanings about self-care are demonstrated. Also, its relationship with nursing care and the urgency present in the subjective reframing of this concept for nurses.

Esta Tesis Doctoral insertada en el Núcleo de Fundamentos del Cuidado de Enfermería (NUCLEARTE) de la EEAN tiene como objeto el significado que los enfermeros atribuyen al autocuidado. Para ello, se plantearon los siguientes objetivos: Comprender el significado que el enfermero atribuye al autocuidado; analizar el significado atribuido por las enfermeras al autocuidado; relacionar los hallazgos sobre el autocuidado con los cuidados de enfermería y discutir las repercusiones simbólicas para la salud a la luz de una teoría sustantiva emergente. El marco teórico del estudio es el Interaccionismo Simbólico bajo la necesidad de análisis desde la perspectiva de las relaciones interpersonales que generan significado. Se utilizó el enfoque metodológico cualitativo, guiado por los conceptos de Grounded Theory (TFD). El escenario de estudio comprendió los sectores en los que laboran enfermeras del Hospital Universitario Clementino Fraga Filho de la Universidad Federal de Río de Janeiro. El grupo de muestra estuvo compuesto por 20 enfermeras, 15 auxiliares de enfermería y 05 enfermeras gestoras, utilizando el criterio de saturación teórica para determinar la muestra. La recogida de datos se realizó a través de entrevistas semiestructuradas en profundidad, con el fin de captar las subjetividades que componen el discurso del entrevistado, con el fin de profundizar en su universo de experiencias. Los testimonios recogidos fueron analizados según los procedimientos propios del TFD: codificación abierta, codificación axial e integración para la posterior construcción de la categoría central, núcleo del estudio. A partir de la conjunción de los fenómenos relacionados con el objeto de estudio, se pudo identificar la categoría central "ENTRE IDEALIZADO Y VIVIR: LA BÚSQUEDA DE UN SIGNIFICADO DEL CUIDADO DE SÍ MISMO EN ENFERMERÍA". Así, se demuestran las percepciones y significados sobre el autocuidado. Además, su relación con el cuidado de enfermería y la urgencia presente en el replanteamiento subjetivo de este concepto para el enfermero.

Integração dos cuidados paliativos no planejamento assistencial ao paciente com insuficiência cardíaca crônica / Integration of palliative care in care planning for patients with chronic heart failure

A Insuficiência Cardíaca é o desfecho final comum às doenças de origem cardiovascular. Cerca de 23 milhões de pessoas no mundo são afetadas por esta patologia. Como parte integrante do tratamento são indicados os cuidados paliativos para prevenção e alívio do sofrimento. Nesse cenário de múltiplas interações surgem desafios que influenciam o planejamento da assistência. Objetivos: apreender a percepção dos profissionais de saúde acerca dos fatores intervenientes à integração dos cuidados paliativos no processo de planejamento assistencial ao binômio paciente/familiar com insuficiência cardíaca crônica, e discutir os limites e as possibilidades de integração dos cuidados paliativos neste contexto. Método: estudo qualitativo, descritivo e exploratório, realizado com profissionais experientes na assistência aos pacientes com insuficiência cardíaca em cuidados paliativos, em uma instituição federal de referência para o tratamento de doenças cardiovasculares no Rio de Janeiro, Brasil. Os dados foram coletados entre julho de 2020 e julho de 2021. Foram realizadas entrevistas semiestruturadas e o conteúdo analisado a partir da análise de conteúdo temática. Resultados: a partir da percepção dos profissionais os maiores desafios vivenciados pelos indivíduos que necessitam desses cuidados se encontram na esfera social com repercussão para as demais áreas da vida. Na macropolítica, evidenciou-se a necessidade de estruturação de serviços de atenção domiciliar especializados na assistência a esse perfil de pacientes. Fragilidades na formação dos profissionais sobre esse tema, a alta rotatividade na instituição, somado a sobrecarga de trabalho, foram percebidos como fatores desafiadores para o alcance da qualidade assistencial. Considerações finais: A realidade identificada nesse estudo pode ser a mesma enfrentada em outras instituições do país, apontando possíveis necessidades de intervenção por meio do fortalecimento de políticas públicas. Ainda é preciso investir na construção de diretrizes mais claras que unam os cuidados paliativos em cada fase da insuficiência cardíaca.

Heart failure is the final outcome common to cardiovascular diseases. About 23 million people worldwide are affected by this pathology. As an integral part of the treatment, palliative care is indicated for the prevention and relief of suffering. In this scenario of multiple interactions, challenges arise that influence care planning. Objectives: to understand the perception of health professionals about the factors involved in the integration of palliative care in the care planning process for the patient/family with chronic heart failure, and to discuss the limits and possibilities of integrating palliative care in this context. Method: qualitative, descriptive and exploratory study, carried out with experienced professionals in the care of patients with heart failure in palliative care, in a federal institution of reference for the treatment of cardiovascular diseases in Rio de Janeiro, Brazil. Data were collected between July 2020 and July 2021. Semi-structured interviews were conducted and the content analyzed using thematic content analysis. Results: from the perception of professionals, the greatest challenges experienced by individuals who need this care are in the social sphere with repercussions for other areas of life. In macropolitics, the need for structuring home care services specialized in assisting this profile of patients was evidenced. Weaknesses in the training of professionals on this topic, the high turnover in the institution, added to the workload, were perceived as challenging factors for achieving quality of care. Final considerations: The reality identified in this study may be the same faced in other institutions in the country, pointing out possible intervention needs through the strengthening of public policies. It is still necessary to invest in the construction of clearer guidelines that unite palliative care in each phase of heart failure.

La insuficiencia cardíaca es el resultado final común a las enfermedades cardiovasculares. Cerca de 23 millones de personas en todo el mundo se ven afectadas por esta patología. Como parte integral del tratamiento, los cuidados paliativos están indicados para la prevención y alivio del sufrimiento. En este escenario de múltiples interacciones, surgen desafíos que influyen en la planificación de la atención. Objetivos: comprender la percepción de los profesionales de la salud sobre los factores que intervienen en la integración de los cuidados paliativos en el proceso de planificación del cuidado del paciente / familia con insuficiencia cardíaca crónica, y discutir los límites y posibilidades de integrar los cuidados paliativos en este contexto. Método: estudio cualitativo, descriptivo y exploratorio, realizado con profesionales experimentados en la atención de pacientes con insuficiencia cardíaca en cuidados paliativos, en una institución federal de referencia para el tratamiento de enfermedades cardiovasculares en Rio de Janeiro, Brasil. Los datos se recopilaron entre julio de 2020 y julio de 2021. Se realizaron entrevistas semiestructuradas y se analizó el contenido mediante análisis de contenido temático. Resultados: desde la percepción de los profesionales, los mayores desafíos que experimentan las personas que necesitan este cuidado se encuentran en el ámbito social con repercusiones en otros ámbitos de la vida. En macropolítica se evidenció la necesidad de estructurar los servicios de atención domiciliaria especializados en atender este perfil de pacientes. Las debilidades en la formación de los profesionales en este tema, la alta rotación en la institución, sumada a la carga de trabajo, se percibieron como factores desafiantes para lograr la calidad de la atención. Consideraciones finales: La realidad identificada en este estudio puede ser la misma que enfrentan otras instituciones del país, señalando posibles necesidades de intervención a través del fortalecimiento de políticas públicas. Todavía es necesario invertir en la construcción de pautas más claras que unan los cuidados paliativos en cada fase de la insuficiencia cardíaca.