Mental health among adolescents exposed to social inequality in Latin America and the Caribbean: a scoping review.

Background and objective: Adolescents from Latin America and the Caribbean grow up in a context of social inequality, which diminishes their well-being and leads to impaired emotional-cognitive development. To understand the problem, it is important to synthesize the available research about it. This study aims to explore the knowledge about adolescents' mental health in Latin America and the Caribbean exposed to social inequality. Methods: A systematic scoping review was conducted encompassing a search in five databases (Medline, CINAHL, PsycINFO, Scopus, and LILACS) in June 2022. Articles of various typologies were included without time limit. After two rounds of screening, relevant data were manually extracted and synthesized into self-constructed themes using thematic analysis. Results: Out of 8,825 retrieved records, 42 papers were included in the final review, with a predominance of quantitative approaches. The synthesis revealed two main analytical themes: (a) defining social inequality, wherein intersecting inequalities produce discrimination and determine conditions for social vulnerability; (b) social inequality and mental health, which highlights the association between socio-structural difficulties and emotional problems, amplifying vulnerability to mental ill health and poor mental health care. Conclusion: The scientific evidence reveals that social inequality is related to impaired well-being and mental ill health on the one hand and a lack of access to mental health care on the other hand.

Cuidados populares de las enfermedades crónicas entre indígenas Pijao durante la pandemia por Covid-19 / Folk care of chronic diseases among Pijao indigenous people during the Covid-19 pandemic

Justificación: la pandemia por Covid-19 ocasionó interrupción de los servicios dirigidos a atender las enfermedades crónicas provocando reajustes en el cuidado de los pacientes. Objetivo: Describir los cuidados populares empleados por los indígenas Pijao para el tratamiento y control de enfermedades crónicas, en contexto de pandemia, en Bogotá (Colombia). Metodología: Estudio cualitativo de tipo micro-etnográfico. Participaron 16 indígenas Pijao. Los datos, recolectados por medio de entrevistas y observación, fueron analizados temáticamente. Resultados: emergieron tres categorías, (1) del territorio de origen a la ciudad: cuidados populares para el tratamiento de las de enfermedades, (2) viviendo con la enfermedad: signos y síntomas de las de enfermedades, y (3) procura de otros recursos para el cuidado: autoatención y apoyo familiar. Conclusión: la trayectoria de cuidado de los Pijao con enfermedades crónicas fue permeada por la pandemia, convirtiendo los cuidados populares, caracterizados por un sincretismo de saberes, en parte fundamental de su rutina de cuidados. (AU)

Justification: The Covid-19 pandemic caused an interruption in the services aimed at attending to chronic diseases, resulting in readjustments in the care of patients. Objective: To describe the popular care used by the Pijao indigenous people for treating and controlling chronic diseases in the context of the pandemic in Bogotá (Colombia). Methodology: Qualitative micro-ethnographic study. Sixteen Pijao indigenous people participated. The data collected through interviews and observation were analyzed thematically. Results, three categories emerged: (1) from the territory of origin to the city: popular care for the treatment of illnesses, (2) living with the illness: signs and symptoms of illnesses, and (3) seeking other resources for care: self-attention and family support. Conclusion: the care trajectory of the Pijao with chronic diseases was permeated by the pandemic, turning popular care, characterized by a syncretism of knowledge, into a fundamental part of their care routine. (AU)

Atención Primaria en Salud en una región de la Amazonía colombiana: una aproximación al cotidiano / Primary Health Care in a region of the Colombian Amazon: an approach to everyday life

RESUMEN En 2016 comenzó en Colombia la implantación de un nuevo modelo de salud con foco en la atención primaria, siendo Guainía, en la Amazonía colombiana, la primera región en iniciar el test piloto. El objetivo de este estudio fue comprender el cotidiano de implementación de la atención primaria, en el marco del Modelo Integral de Atención en Salud, desde la perspectiva de indígenas y profesionales de la salud en Guainía, Colombia. Se trata de un estudio de caso único, con abordaje cualitativo, fundamentado en la sociología comprensiva del cotidiano. Los datos, recolectados mediante observación directa y entrevistas semiestructuradas con 26 profesionales de salud y 22 usuarios indígenas, fueron sometidos a análisis de contenido temático. Emergieron cinco categorías: 'vivir en el puesto', 'resolver solo', 'el desafío de la cobertura territorial', 'comisiones de salud: solventando vacíos' y 'apoyo de líderes locales'. A pesar de la propuesta reestructurante traída por el nuevo modelo, se evidenció en el cotidiano la persistencia de un enfoque asistencialista y basado en la lógica curativista en la prestación de los servicios. Aunque los atributos de la atención primaria se ven comprometidos, se identificaron acciones cotidianas que pueden favorecer la integralidad en la atención y aportar a una transición exitosa.

ABSTRACT In 2016, the implementation of a new health model focused on primary health care began in Colombia, being Guainía, in the Colombian Amazon, the first region to start the pilot test. The objective of this study was to understand the daily implementation of primary care, within the framework of the Comprehensive Health Care Model, from the perspective of indigenous people and health professionals, in Guainía, Colombia This is a single case study with a qualitative approach, based on the comprehensive sociology of everyday life. The data, collected through direct observation and semi-structured interviews with 26 health professionals and 22 indigenous users, were subjected to thematic content analysis. Five categories emerged: 'living at the post', 'solving alone', 'the challenge of territorial coverage', 'health commissions: filling gaps' and 'support from local leaders'. Despite of the restructuring proposal brought by the new model, the persistence of a care approach based on curativist logic in the provision of services was evidenced in daily life. Although the attributes of primary care are compromised, daily actions that can favor comprehensive care and contribute to a successful transition were identified.

Análisis en clave decolonial de la interculturalidad en el modelo integral de atención en salud en Guainía, Colombia / Análise em chave decolonial da interculturalidade no modelo integral de atenção em saúde em Guainía, Colômbia / A decolonial analysis of interculturality in the integral model of health care in Guainía, Colombia

Objective: to analyze interculturality in the daily implementation of the integral healthcare model in Guainía, Colombia, under the critical lens of decolonial thinking. Methodology:Holistic single case study with the voluntary participation of 22 indigenous users, 26 healthprofessionals and 3 key participants (a traditional doctor, an administrative official and anindigenous leader). The study settings were the hospital, health posts and health centers belongingto the public health care network. Data were collected through semi-structured interviews anddirect observation. The analysis was guided by Bardin's thematic content analysis technique.Results: interculturality has been configured in the daily implementation of the health care modelANTROPOLOGÍA164Cultura de los Cuidados. 1º Cuatrimestre 2022. Año XXVI. nº 62in Guainía, according to three different perspectives: relational, functional and critical.Conclusions: it is evident that interculturality can acquire different meanings in the field of healthcare in culturally diverse territories, being fundamental to promote a critical perspective based onthe daily actions and the agency of the people, as well as working together with the communitiesto identify needs, limitations and potentialities, which allow the scope and concretization of a truedialogue of knowledge.

Objetivo: analizar bajo el lente crítico del pensamiento decolonial la interculturalidad enel cotidiano de implementación del modelo integral de atención en salud en Guainía,Colombia. Metodología: Estudio de caso único holístico que contó con la participaciónvoluntaria de 22 usuarios indígenas, 26 profesionales de salud y 3 participantes clave (un médicotradicional, un funcionario administrativo y un líder indígena). Los escenarios de estudio fueronel hospital, los puestos y centros de salud pertenecientes a la red pública de atención. Los datosfueron recolectados mediante entrevistas semiestructuradas y observación directa. El análisis seorientó siguiendo la técnica de análisis de contenido temático de Bardin. Resultados: lainterculturalidad se ha configurado en el cotidiano de implementación del modelo de atención ensalud, en Guainía, conforme tres perspectivas distintas: relacional, funcional ycrítica. Conclusiones: se evidencia que la interculturalidad puede adquirir diferentes sentidos enel ámbito de la atención en salud en territorios culturalmente diversos, siendo fundamentalpromover una perspectiva crítica que parta de las acciones cotidianas y la agencia de las personas,así como del trabajo junto con las comunidades para la identificación de necesidades, limitacionesy potencialidades, que permitan el alcance y concretización de un verdadero diálogo de saberes.

Objetivo: analisar a interculturalidade na implementação diária do modelo integrado desaúde em Guainía, Colômbia, através da lente crítica do pensamento descolonial. Metodologia:Um único estudo de caso holístico com a participação voluntária de 22 usuários indígenas, 26profissionais de saúde e 3 participantes-chave (um médico tradicional, um funcionárioadministrativo e um líder indígena). Os ambientes de estudo foram o hospital, postos de saúde ecentros de saúde pertencentes à rede pública de saúde. Os dados foram coletados através deentrevistas semi-estruturadas e observação direta. A análise foi guiada pela técnica de análise deconteúdo temático de Bardin. Resultados: a interculturalidade foi configurada na implementaçãodiária do modelo de saúde em Guainía, de acordo com três perspectivas diferentes: relacional,funcional e crítica. Conclusões: é evidente que a interculturalidade pode adquirir diferentessignificados no campo da saúde em territórios culturalmente diversos, sendo fundamental parapromover uma perspectiva crítica baseada nas ações cotidianas e no agenciamento do povo, bemcomo trabalhar em conjunto com as comunidades para identificar necessidades, limitações epotencialidades, que permitam o alcance e a concretização de um verdadeiro diálogo deconhecimento.

Interculturality in the daily routine of primary health care: The case of the health model in Guainía, Colombia. / A interculturalidade no cotidiano da atenção primária à saúde: O caso do modelo de saúde em Guainía, Colômbia.

Colombia is currently implementing a new health model, which is being tested initially in a region of the Amazon, with the main objective of primary health care with an intercultural approach. It is a cut of a doctoral thesis outlined by the case study methodology, which aimed to understand the daily construction process of primary health care from the perspective of indigenous and health professionals in Guainía, Colombia. Twenty-two indigenous users and 26 health professionals participated in the study, as well as three key participants. The data were collected through semi-structured interviews and direct observation, and were later transcribed and analyzed by Bardin's thematic content analysis technique. The results show that interculturality, as a permanent process of negotiations and articulations present in the daily lives of indigenous and health professionals, is a fundamental part of the construction of primary health care in Guainía. In it materializes the encounter and exchange of heterogeneous forms of thinking-knowledge, that allow new interpretations and reinventions of knowledge and practices in health, although this process is permeated by conflicts, ambiguities, asymmetries and contradictions.

A Colômbia encontra-se atualmente em fase de implantação de um novo modelo de saúde, que está sendo testado em uma região da Amazônia, e tem como principal objetivo estratégico a atenção primária à saúde com enfoque intercultural. Trata-se do recorte de uma tese de doutorado delineada pela metodologia de estudo de caso, que teve por objetivo compreender o processo de construção cotidiana da atenção primária à saúde na perspetiva de indígenas e profissionais de saúde, em Guainía, Colômbia. Participaram do estudo 22 usuários indígenas, 26 profissionais de saúde e três participantes chave. Os dados foram coletados por meio de entrevistas semiestruturadas e observação direta, sendo posteriormente transcritos e analisados pela técnica de análise de conteúdo temática de Bardin. Os resultados mostram que a interculturalidade, como um processo permanente de negociações e articulações presentes no cotidiano de indígenas e profissionais de saúde, constitui-se parte fundamental da construção da atenção primária à saúde em Guainía. Nela materializa-se o encontro e intercâmbio de formas heterogêneas de pensar-saber, que permitem novas interpretações de conhecimentos e práticas em saúde, apesar desse processo estar permeado por conflitos, ambiguidades, assimetrias e contradições.

Competencia cultural de las enfermeras en el área de salud pública: una metasíntesis / Cultural Competence of Nurses in the Field of Public Health: A Meta-Synthesis / Competência cultural dos enfermeiros na área da saúde pública: uma meta-síntese

Resumen Objetivo: explorar las experiencias y vivencias sobre la competencia cultural de enfermeras en salud pública. Metodología: metasíntesis cualitativa. Las bases utilizadas fueron: Medline, OvidNursing, OvidJournal, Embase y BVS-LILACS, publicados en inglés, español o portugués, entre 2009 y 2014. Se incluyeron diez estudios y fueron valorados usando el Critical Appraisal Skills Programme en español (CASPe). Se implementaron las tres fases del proceso de metaagregación en la extracción y síntesis de hallazgos. Resultados: los hallazgos fueron agregados en seis categorías y dos resultados: 1) paradojas en la atención de salud pública a personas de diversas culturas; 2) sobrepasando barreras: la osadía de las enfermeras de salud pública. Conclusión: las enfermeras vivenciaron y expresaron la competencia cultural desde lo paradójico que resulta el encuentro con el otro culturalmente diferente, manifestaron apertura a comprender y dar sentido a la cultura, aunque fue difícil generar intervenciones culturalmente competentes.

Abstract Objective: To explore the experiences and life events regarding the cultural competence in the public health practice. Methods: A qualitative meta-synthesis covering the databases Medline, OvidNursing, OvidJournal, Embase and BVS-LILACS, including papers in English, Spanish and Portuguese between 2009 and 2014. Ten studies were included and assessed by using the Critical Appraisal Skills Programme in Spanish (CASPe). The three stages of the meta-aggregation programme were applied to do the obtaining and synthesis of findings. Results: The findings were aggregated in six categories and two types of results: 1) paradoxes when providing public health care to people from different culture and 2) going beyond the barriers - the daring by the public health nurses. Conclusion: The nurses experienced and expressed their cultural competence from the paradoxical situation produced when encountering another culturally different people. They showed a stance open to both understand and make sense of the other's culture, even though it was hard to produce culturally competent interventions.

Resumo Objetivo: explorar as experiências e vivências sobre competência cultural de enfermeiras em saúde pública. Metodologia: meta-síntese qualitativa. As bases utilizadas foram: Medline, OvidNursing, OvidJournal, Embase e BVS-LILACS, publicados em inglês, espanhol ou português, entre 2009 e 2014. Dez estudos foram incluídos e valorados usando o Critical Appraisal Skills Programme em espanhol (CASPe). As três fases do processo de meta-agregação na extração e síntese de achados foram implementados. Resultados: os achados foram agregados em seis categorias e dois resultados: 1) paradoxos no atendimento de saúde pública a pessoas de diversas culturas; 2) ultrapassando barreiras: a ousadia das enfermeiras de saúde pública. Conclusões: as enfermeiras vivenciaram e expressaram a competência cultural desde o paradoxal que resulta o encontro com um outro culturalmente diferente, manifestaram apertura para compreender e dar sentido à cultura, embora fosse difícil gerar intervenções culturalmente competentes.

Experiencia de enfermeras cuidando a familias multiculturales: una metasíntesis cualitativa / Nurses' experience caring for multicultural families: a qualitative meta-synthesis

Antecedentes: Los estudios sobre el fenómeno de la experiencia de las enfermeras cuidando a familias multiculturales han generado hallazgos significativos que aún no habían sido sintetizados para servir como soporte a la práctica basada en la evidencia. Objetivo: Interpretar y sintetizar los hallazgos de las investigaciones cualitativas acerca de la experiencia de enfermeras cuidando a familias multiculturales. Método: Revisión sistemática de estudios cualitativos tipo metasíntesis, siguiendo la propuesta de Sandelowski y Barroso (2007). La búsqueda exhaustiva se implementó en siete bases de datos, tres repositorios y adicionalmente búsqueda manual en referencias, incluyendo estudios de diversos diseños cualitativos sin límite inicial de años, publicados antes de abril de 2014. La evaluación de estudios se llevó a cabo a través de evaluación individual aplicando los criterios propuestos por el Critical Appraisal Skills Programme (CASP) y evaluación comparativa caracterizando los estudios según datos publicación, diseño, escenarios y participantes. La síntesis implicó análisis comparativo constante. Resultados: Un total de catorce estudios fueron incluidos. Los hallazgos se sintetizaron en cuatro categorías y un meta-tema denominado: "Cuidar a la familia culturalmente diversa, la experiencia de cruzar una cuerda floja". Conclusión: Los resultados de la síntesis indican que la experiencia de las enfermeras es gratificante y admirable, pero a la vez exigente y desafiante porque imprime una constante tensión entre barreras internas, externas, manifestaciones culturales y la responsabilidad ética de cuidado. Los hallazgos derivados de esta metasíntesis generan evidencia a nivel de la práctica para la formulación de directrices en el cuidado a las familias culturalmente diversas y recomendaciones en el ámbito de la investigación para el reporte de informes de investigación y el planteamiento de estudios futuros.

Background: The studies about the phenomenon of the experience of nurses caring for multicultural families have generated significant findings that had not yet been synthesized to serve as a support for evidence-based practice. Aim: To Interpret and synthesize the findings of qualitative research on the experiences of nurses caring for multicultural families. Method: A systematic review of qualitative research studies type meta-synthesis, following the procedures outlined by Sandelowski and Barroso (2007). The exhaustive search was implemented in seven databases, three repositories and hand search of references, including qualitative studies of different designs without limit initial years, published before April 2014. The appraising reports were conducted through individual appraisal using the criteria proposed by the Critical Appraisal Skills Programme (CASP) and comparative appraisal characterizing the studies according publication, design, scenarios and participants. The synthesis implicated the constant comparative analysis. Findings: A total of fourteen studies were included. The findings were synthesized in four categories and one meta-theme called: "Caring for the multicultural family, the experience of crossing a tightrope". Conclusion: The synthesis of results indicate that nurses' experience is rewarding and admirable, yet demanding and challenging because it prints a constant tension between internal barriers, external barriers, cultural behaviors and an ethical responsibility to care. The findings from this meta-synthesis generate evidence to practice level for the formulation of guidelines on the care of culturally diverse families and recommendations in the field of research for the research reports and the approach of future studies.

Culture brokerage as a form of caring / La intermediación cultural como forma de cuidado / A intermediação cultural como forma de cuidado

Objective. To identify the meanings, uses, and contexts of applying the culture brokerage concept in nursing articles published from 1995 to 2011. Methodology. A total of 32 articles were identified from the following databases: Cuiden, SciElo, Ovid Nursing, Ovid, Medline and Pubmed. Results. It was found that 56.2% of the articles were about research, 37.5% on reflection, and 6.2% topic revision. Five categories emerged from the analysis: culture brokerage concepts, culture brokerage and cultural competence, culture brokerage and the performers, culture brokerage in the care of immigrants, and culture brokerage in the care of individuals with chronic diseases. Conclusion. Culture brokerage is a type of emerging care; it has various approaches and applications in both the community and hospital environments. Its conceptualization helps in the development of the nursing discipline.

Objetivo. Identificar los significados, usos y contextos de aplicación del concepto intermediación cultural en enfermería en artículos publicados entre 1995 y 2011.Metodología. Se identificaron 32 artículos de las bases de datos Cuiden, Scielo, Ovid Nursing, Ovid, Medline y Pudmed. Resultados. El 56.2% de los artículos fue de investigación; el 37.5%, de reflexión, y el 6.2%, de revisión de tema. Cinco categorías surgieron del análisis: conceptos de intermediación cultural, intermediación cultural y la competencia cultural, la intermediación cultural y los intérpretes, la intermediación cultural en el cuidado de las personas inmigrantes y la intermediación cultural en el cuidado de las personas con enfermedades crónicas. Conclusión. La intermediación cultural es una forma de cuidado emergente, la cual presenta diversos enfoques y usos en el ámbito tanto comunitario como hospitalario. Su conceptualización ayuda al desarrollo de la disciplina de enfermería.

Objetivo. Identificar os significados, usos e contextos de aplicação do conceito intermediação cultural em enfermagem em artigos publicados de 1995 a 2011. Metodologia.Identificaram-se 32 artigos das bases de dados: Cuidem, Scielo, Ovid Nursing, Ovid, Medline e Pudmed. Resultados. 56.2% dos artigos foram de investigação, 37.5% de reflexão e 6.2% de revisão de tema. Cinco categorias surgiram da análise: conceitos de intermediação cultural, intermediação cultural e a concorrência cultural, a intermediação cultural e os intérpretes, a intermediação cultural no cuidado das pessoas imigrantes e a intermediação cultural no cuidado das pessoas com doenças crônicas. Conclusão. A intermediação cultural é uma forma de cuidado emergente, apresenta diversos enfoques e usos no âmbito tanto comunitário como hospitalar. Sua conceptualização ajuda ao desenvolvimento da disciplina de enfermagem.