Desarrollo de la Competencia Intercultural desde la formación de pregrado en la educación médica superior

La necesidad de desarrollar competencias interculturales no solo es un imperativo ético, en términos del respeto y comprensión de aquellas culturas diferentes, sino también un requisito técnico. Un profesional que pueda vincularse exitosamente con personas de diversas culturas probablemente logrará una interacción efectiva con usuarios y comunidades, un mayor nivel de confianza, que se traducirá en una mayor satisfacción con el cuidado y mejor adherencia terapéutica. En el presente artículo se analiza desde el punto de vista teórico la incorporación de la competencia intercultural en los currículos de las carreras de la salud. Se realizó una revisión bibliográfica de artículos y documentos relacionados con la competencia intercultural en la educación superior en bases de datos Pubmed y Scielo, y en páginas web de organizaciones ligadas con la temática de enseñanza y aprendizaje en educación superior, cultura y diversidad.

The need to develop intercultural competences is not only an ethical imperative, in terms of respect and understanding of those different cultures, but also a technical requirement. A professional who can successfully connect with people from diverse cultures will probably achieve effective interaction with users and communities, a higher level of trust, which will translate into greater satisfaction with care and better therapeutic adherence. This article analyzes from a theoretical point of view the incorporation of intercultural competence in the curricula of health careers. A bibliographic review of articles and documents related to intercultural competence in higher education was carried out in Pubmed and Scielo databases, and in web pages of organizations linked to the subject of teaching and learning in higher education, culture and diversity.

Nuevos paradigmas: 12 años de trombólisis sistémica. Unidad ACV, Hospital de Clínicas / New paradigms: 12 years of systemic thrombolysis. Stroke Unit, Clinicas Hospital / Novos paradigmas: 12 anos de trombólise sistêmica. Unidade AVC, Hospital de Clínicas

Introducción: el ACV constituye un problema de salud y la trombólisis sistémica una estrategia de reperfusión con alto nivel de evidencia para su tratamiento. Los reportes nacionales sobre su utilización son escasos. Objetivos: comunicar y analizar los resultados de esta terapia en el Hospital de Clínicas. Establecer predictores de buena evolución, hemorragia intracraneana y mortalidad. Métodos: estudio observacional analítico de los pacientes trombolizados en el Hospital de Clínicas (2010-2021). Resultados: se realizó trombólisis sistémica a 268 pacientes. La mediana del NIHSS al ingreso fue 12 puntos. Un 42% fueron infartos totales de la circulación anterior. La cardioembolia constituyó la etiopatogenia más frecuente. El 59,3% de los pacientes fueron externalizados con independencia funcional y 55,2% con déficit neurológico mínimo. Las tasas de hemorragia intracraneana sintomática y mortalidad fueron 7,1% y 18,7% respectivamente. El 57% de los pacientes se trataron con tiempo puerta aguja ≤60 minutos. El porcentaje de trombólisis en el total de ACV fue 18,9%. La edad, NIHSS al ingreso e internación en unidad de ACV se comportaron como variables importantes para predecir buena evolución, hemorragia intracraneana y muerte. Discusión y conclusiones: se comunicó la mayor casuística nacional sobre el tema. Los parámetros de efectividad y seguridad del tratamiento fueron comparables a los reportados internacionalmente. Se destacaron los buenos tiempos puerta aguja y tasa trombólisis sobre ACV totales como indicadores satisfactorios de calidad asistencial. La internación en unidad de ACV se comportó como un factor predictor de independencia funcional y protector frente a mortalidad hospitalaria.

Introduction: Strokes are a health problem and systemic thrombolysis constitutes a reperfusion strategy backed up by significant evidence on its positive therapeutic impact. National reports on its use are scarce. Objectives: To report and analyze results obtained with this therapeutic approach at the Clinicas Hospital. To establish predictive factors for a good evolution, intracranial hemorrhage and mortality. Method: Observational, analytical study of thrombolysed patients at Clinicas Hospital (2010-2021). Results: Systemic thrombolysis was performed in 268 patients. Average NIHSS score was 12 points when admitted to hospital.42 % of cases were total anterior circulation infarct (TACI). Cardioembolic ischaemmic stroke was the most frequent etiopahogenesis. 59.3% of patients were discharged with functional independence and 55.2% had minimal neurologic deficit. Symptomatic intracranial hemorrhage and mortality rates were 7.1% and 18.7% respectively. 57% of patients were assisted within ≤60 minutes they showed up at the ER. Thrombolysis percentage in total number of strokes was 18.9%. Age, NIHSS score upon arrival to hospital and admission to the stroke unit were significant variables to predict a good evolution, intracranial hemorrhage and death. Discussion and conclusions: The large number of cases in the country was reported. Effectiveness and safety parameters for this treatment were comparable to those reported internationally. The good door-to-needle time and thrombolysis rate versus total number of strokes stood out as satisfactory indicators of healthcare quality. Admission to the stroke unit behaved as a predictive factor of functional independence and it protected patients from hospital mortality.

Introdução: o AVC é um problema de saúde sendo a trombólise sistêmica uma estratégia de reperfusão com alto nível de evidência para seu tratamento. Os dados nacionais sobre seu uso são escassos. Objetivos: comunicar e analisar os resultados desta terapia no Hospital de Clínicas. Estabelecer preditores de boa evolução, hemorragia intracraniana e mortalidade. Métodos: estudo observacional analítico de pacientes trombolisados no Hospital de Clínicas (2010-2021). Resultados: a trombólise sistêmica foi realizada em 268 pacientes. A mediana do índice NIHSS na admissão foi de 12 pontos. 42% eram infartos totais da circulação anterior. A cardioembolia foi a etiopatogenia mais frequente. 59,3% dos pacientes tiveram alta da unidade com independência funcional e 55,2% com déficit neurológico mínimo. As taxas de hemorragia intracraniana sintomática e mortalidade foram de 7,1% e 18,7%, respectivamente. 57% dos pacientes foram tratados com tempo porta-agulha ≤60 minutos. A porcentagem de trombólise no AVC total foi de 18,9%. Idade, NIHSS na admissão e internação na unidade de AVC se comportaram como variáveis importantes para prever boa evolução, hemorragia intracraniana e óbito. Discussão e conclusões: este trabajo inclui a maior casuística nacional sobre o tema. Os parâmetros de eficácia e segurança do tratamento foram comparáveis aos descritos na bibliografia internacional. Foram destacados como indicadores satisfatórios da qualidade do atendimento os bons tempos porta-agulha e taxa de trombólise em relação ao AVC total. A internação em unidade de AVC comportou-se como preditor de independência funcional e protetor contra a mortalidade hospitalar.

Binder Selection to Modify Hydrocarbon Cracking Properties of Zeolite-Containing Composites.

Activity, selectivity, and deactivation behavior of catalyst materials determine their efficiency in hydrocarbon conversion processes. For hydrocarbon cracking, the industrial catalyst is an important parameter in reaction technology to produce valuable compounds, e.g., light olefins (C3-C5) and gasoline from crude oil fractions with high molecular weight (C16+). One strategy to enhance the catalytic activity for precracking is increasing the matrix activity, which depends on the used binder and additives. In this work, three binders (water glass, aluminum chloride, and a mixture of colloidal silica with aluminum dihydrogen phosphate) were used in combination with active zeolite Y, kaolin as filler, and ZSM-5 as additive to produce composite materials. Specific surface area and surface acidity measurements were combined with catalytic testing of the formulated samples in order to find the relation between the catalyst morphology and its activity. In addition, constraint index was used as a control parameter for the determination of the shape-selective properties and their correlation with the catalytic activity. The results show that the binders determine the porosity of the matrix and so the accessibility to zeolite pores and active sites. Matrixes with low porosity and activity enhance coke production and deactivate faster than matrixes with mesopores. Furthermore, ZSM-5 modifies the individual morphological and catalytic effects of the binders. Everything considered, the small crystals of ZSM-5 together with mesopores increase the olefins yield, reduce coking, and therefore enhance the performance of the final grain.

Simulación como estrategia de desarrollo de competencias culturales en estudiantes del área de la salud / Simulation as a strategy for the development of cultural competences in students from the health area

El contexto global actual, pluricultural y dinámico requiere de competencias específicas presentes en los profesionales sanitarios, que deben desplegarse con el fin de construir un vínculo terapéutico culturalmente pertinente. El presente artículo tuvo como objetivo exponer las ventajas de la simulación como estrategia de enseñanza-aprendizaje de competencias culturales en estudiantes del área de la salud, a través de distintas experiencias realizadas en Europa y América del Norte. Se sistematizaron las ventajas y desventajas de la estrategia, y se propusieron las consideraciones necesarias que debían incorporarse en las experiencias de enseñanza-aprendizaje de competencias culturales implementadas en nuevos escenarios y espacios educativos. Los autores reconocen potencialidades en la simulación, que deben tenerse en cuenta para lograr el desarrollo de competencias culturales en los estudiantes del área de la salud que cursan estudios superiores. Se concluye que la implementación y adaptación de procesos de simulación en competencias culturales requieren de revisiones extensas de la literatura, junto con contar con equipos interdisciplinarios y disponer de docentes capacitados en la estrategia de enseñanza y aprendizaje particular, que permitan ejecutar tales procesos de manera exitosa(AU)

The current, multicultural and dynamic global context requires specific competences in health professionals, which must be deployed in order to build a culturally relevant therapeutic link. The objective of this article was to present the advantages of simulation as a teaching-learning strategy concerning cultural competences in students from the health area, through different experiences carried out in Europe and North America. The advantages and disadvantages of the strategy were systematized, and the necessary considerations were proposed that should be incorporated into the teaching-learning experiences of cultural competences implemented in new educational settings and spaces. The authors recognize the potentialities of simulation, which must be taken into account to achieve the development of cultural competences in higher education students from the health area. The implementation and adaptation of simulation processes in cultural competences are concluded to require extensive literature reviews, together with having interdisciplinary teams and having professors trained in that particular teaching and learning strategy, which allow such processes to be executed successfully(AU)

Beneficios del rol de enfermería en salud escolar, implementación a nivel internacional. Revisión sistemática / Benefits of the nursing role in school health, implementation at international level. Systematic review

La salud escolar en Chile se desarrolla a nivel de la Atención Primaria en salud a cargo de los profesionales de enfermería, quienes por su rol deben velar por el bienestar integral de la comunidad escolar, fortaleciendo conductas de autocuidado y hábitos saludables a través de la promoción y prevención e investigación en salud. OBJETIVO: Analizar los beneficios del rol de enfermería en salud escolar desde el punto de vista político y social en países en que ha sido legalmente implementada a nivel internacional. MÉTODOS: Se realizó una revisión sistemática de la literatura científica en bases de datos (Scielo, Pubmed, Scopus, Sciencedirect, Oxford, Web of Science). Se utilizó el flujograma PRISMA. La calidad metodológica consideró los criterios de alto, medio y bajo cumplimiento de 46 indicadores de una pauta de lectura crítica. RESULTADOS: Se identificaron 32 artículos en los últimos 5 años. Las líneas temáticas encontradas fueron las políticas públicas en salud escolar, destacando países como EEUU, España y México con regulación sobre la Enfermera escolar, en cambio en Latinoamérica, existe una regulación parcial o carencia como en Chile. Las competencias y acciones del profesional de enfermería en establecimientos educacionales tienen como prioridad la promoción de la salud y la educación a la comunidad escolar. Se evidencia que las consultas que atiende la enfermera escolar son de urgencia y son variables según la zona geográfica. CONCLUSIONES: La implementación legal del rol de enfermería escolar ofrece ventajas significativas para la mejora del sistema sanitario del país, incrementando la calidad asistencial y mejorando el acceso a salud.

Chilean school health is developed at the level of Primary Health Care in charge of nursing professionals, who for their role must ensure the comprehensive well-being of the school community, strengthening self-care behaviors and healthy habits through promotion and prevention and health research. OBJECTIVE: To analyze the benefits of the nursing role in school health from the political and social point of view in countries where it has been legally implemented internationally. METHODS: A systematic review of the scientific literature in databases (Scielo, Pubmed, Scopus, Sciencedirect, Oxford, Web of Science) was carried out. The PRISMA flow chart was used. The methodological quality considered the criteria of high, medium and low compliance with 46 indicators of a critical reading pattern. RESULTS: 32 articles were identified in the last 5 years. The thematic lines found were public policies in school health, highlighting countries such as the US, Spain and Mexico with regulations on school nurses, on the other hand in Latin America, there is a partial regulation or lack as in Chile. The competences and actions of the nursing professional in educational establishments have as a priority the promotion of health and education to the school community. It is evident that the consultations attended by the school nurse are urgent and vary according to the geographical area. CONCLUSIONS: The legal implementation of the role of school nursing offers significant advantages for the improvement of the country's health system, increasing the quality of care and improving access to health.

Postcontractile blood oxygenation level-dependent (BOLD) response in Duchenne muscular dystrophy.

Duchenne muscular dystrophy (DMD) is characterized by a progressive replacement of muscle by fat and fibrous tissue, muscle weakness, and loss of functional abilities. Impaired vasodilatory and blood flow responses to muscle activation have also been observed in DMD and associated with mislocalization of neuronal nitric oxide synthase mu (nNOSµ) from the sarcolemma. The objective of this study was to determine whether the postcontractile blood oxygen level-dependent (BOLD) MRI response is impaired in DMD and correlated with established markers of disease severity in DMD, including MRI muscle fat fraction (FF) and clinical functional measures. Young boys with DMD (n = 16, 5-14 yr) and unaffected controls (n = 16, 5-14 yr) were evaluated using postcontractile BOLD, FF, and functional assessments. The BOLD response was measured following five brief (2 s) maximal voluntary dorsiflexion contractions, each separated by 1 min of rest. FFs from the anterior compartment lower leg muscles were quantified via chemical shift-encoded imaging. Functional abilities were assessed using the 10 m walk/run and the 6-min walk distance (6MWD). The peak BOLD responses in the tibialis anterior and extensor digitorum longus were reduced (P < 0.001) in DMD compared with controls. Furthermore, the anterior compartment peak BOLD response correlated with function (6MWD ρ = 0.87, P < 0.0001; 10 m walk/run time ρ = -0.78, P < 0.001) and FF (ρ = -0.52, P = 0.05). The reduced postcontractile BOLD response in DMD may reflect impaired microvascular function. The relationship observed between the postcontractile peak BOLD response and functional measures and FF suggests that the BOLD response is altered with disease severity in DMD.NEW & NOTEWORTHY This study examined the postcontractile blood oxygen level-dependent (BOLD) response in boys with Duchenne muscular dystrophy (DMD) and unaffected controls, and correlated this measure to markers of disease severity. Our findings indicate that the postcontractile BOLD response is impaired in DMD after brief muscle contractions, is correlated to disease severity, and may be valuable to implement in future studies to evaluate treatments targeting microvascular function in DMD.

[Intercultural skills in primary health care: a challenge for higher education in contexts of cultural diversity]. / Competencias interculturales en la atención primaria de salud: un desafío para la educación superior frente a contextos de diversidad cultural.

Contemporary society is marked by four interconnected phenomena leading to the need to develop intercultural skills in the framework of primary care: migratory movements, different ethnic groups, cultural diversity, and social and cultural construction of the Western medical system. The multicultural reality of the contexts in which primary care is practiced requires integrative theoretical models that allow understanding this reality in order to provide timely, high-quality care that is pertinent to the respective communities, considering the existing diversity. It is thus necessary to implement and teach intercultural skills for health care teams and students, allowing to sustain such care from a holistic perspective. Educational interventions in intercultural skills should be conducted from a comprehensive, integrative, and cross-disciplinary perspective that allows intervening in attitudes, feelings, social behaviors, and cultural agendas at the individual, institutional, and social levels. The current essay aims to reflect on the importance of learning and developing such skills in primary care teams, meanwhile producing a list of strategies that allow acquiring these skills in basic training, with the understanding that skills are the result of experiences and can change during the process.

Competencias interculturales en la atención primaria de salud: un desafío para la educación superior frente a contextos de diversidad cultural / Intercultural skills in primary health care: a challenge for higher education in contexts of cultural diversity / Competências interculturais na atenção primaria à saúde: um desafio para a educação superior frente a contextos de diversidade cultural

Resumen: En la sociedad actual están presentes cuatro fenómenos articulados que determinan la necesidad de desarrollar competencias interculturales en el ámbito de la atención primaria de salud: los movimientos migratorios, las diferentes etnias, la diversidad cultural y la construcción social y cultural del sistema médico occidental. La realidad multicultural de los contextos en que se ejerce la atención sanitaria exige incorporar modelos teóricos integradores que permitan comprenderla para brindar una atención en salud oportuna, de calidad y pertinente a las comunidades a quienes dirige sus acciones, considerando la diversidad existente. En este sentido, resulta necesario el despliegue y la enseñanza de competencias interculturales en los equipos y estudiantes del área de salud, que permitan sustentar la atención y los cuidados desde una perspectiva holística. La intervención educativa en competencia intercultural debe realizarse desde un enfoque global, integrador y transdisciplinario, que permita intervenir desde las actitudes, los sentimientos, las conductas sociales y las pautas culturales a nivel individual, institucional y social. El presente ensayo tiene como propósito reflexionar acerca de la importancia del aprendizaje y desarrollo de dichas competencias en los equipos de salud de atención primaria y enumerar un listado de estrategias con las que es posible adquirirlas en los procesos formativos previos, entendiendo que las competencias son producto de las experiencias y se pueden transformar como resultado de un proceso.

Abstract: Contemporary society is marked by four interconnected phenomena leading to the need to develop intercultural skills in the framework of primary care: migratory movements, different ethnic groups, cultural diversity, and social and cultural construction of the Western medical system. The multicultural reality of the contexts in which primary care is practiced requires integrative theoretical models that allow understanding this reality in order to provide timely, high-quality care that is pertinent to the respective communities, considering the existing diversity. It is thus necessary to implement and teach intercultural skills for health care teams and students, allowing to sustain such care from a holistic perspective. Educational interventions in intercultural skills should be conducted from a comprehensive, integrative, and cross-disciplinary perspective that allows intervening in attitudes, feelings, social behaviors, and cultural agendas at the individual, institutional, and social levels. The current essay aims to reflect on the importance of learning and developing such skills in primary care teams, meanwhile producing a list of strategies that allow acquiring these skills in basic training, with the understanding that skills are the result of experiences and can change during the process.

Resumo: Na sociedade atual estão presentes quatro fenômenos articulados que determinam a necessidade de desenvolver competências interculturais no âmbito da atenção primaria à saúde: os movimentos migratórios, as diferentes etnias, a diversidade cultural e a construção social e cultural do sistema médico ocidental. A realidade multicultural dos contextos nos quais é executada a atenção sanitária exige incorporar modelos teóricos integradores que permitam entendê-la para poder oferecer uma atenção oportuna na saúde, para que seja de qualidade e pertinente para as comunidades a quem estão focadas suas ações, levando em consideração a diversidade existente. Neste sentido, é necessária a implantação e o ensino de competências interculturais nas equipes e estudantes da área de saúde, que permitam sustentar a atenção e os cuidados desde uma perspectiva holística. A intervenção educativa em competência intercultural deve ser realizada desde um enfoque global, integrador e transdisciplinar, que permita intervir desde as atitudes, os sentimentos, as condutas sociais e as pautas culturais ao nível individual, institucional e social. O presente ensaio tem como propósito reflexionar sobre a importância da aprendizagem e desenvolvimento de ditas competências nas equipes de saúde de atenção primaria e enumerar uma listagem de estratégias com as quais é possível adquiri-las nos processos formativos prévios, entendendo que as competências são fruto das experiências e podem ser transformadas em resultado de um processo.

Expectativas y experiencias de aprendizaje en la práctica profesional de estudiantes del área de la salud / Learning expectations and experiences in the profesional practice of students from the health area

Introducción: la experiencia clínica a nivel intrahospitalario es un aspecto fundamental en la formación de los estudiantes de las carreras de la salud, lo que constituye una instancia de aprendizaje altamente significativa. Objetivo: analizar las expectativas y experiencias que tienen los estudiantes de la carrera de Tecnología Médica de la Universidad de Chile, durante su práctica profesional en el área de tomografía computada. Métodos: estudio de tipo cualitativo, descriptivo con enfoque hermenéutico. La muestra fue de 25 estudiantes, que se logró a través de la saturación de categorías. La producción de información se realizó con portafolios que realizaron los estudiantes durante toda su práctica. Se utilizó el análisis de discurso para el estudio de la información. Resultados: tanto en las expectativas como en las experiencias emergieron 6 categorías, a saber: Equipo de trabajo, aplicación de conocimientos teóricos, relación paciente-estudiante, incorporación de nuevos conocimientos, trabajo a realizar en la práctica y estado emocional. Se encontró que el desempeño de los estudiantes en la práctica es influenciado de forma importante por sus expectativas. Las experiencias vividas dependen en gran medida de factores emocionales propios, del equipo médico-docente a cargo y la capacidad del estudiante de desenvolverse en el lugar de práctica profesional. Conclusiones: la formación profesional de los alumnos en el área de la salud es compleja, ya que no solo consiste en aprendizaje teórico, la práctica se convierte en un proceso fundamental, en donde aprender a manejar no solo las condiciones patológicas y técnicas resultan importantes, sino que es relevante que los alumnos logren la capacidad de la atención integral del paciente, preocupándose de la persona, sus emociones y de su bienestar(AU)

Introduction: The clinical experience at hospital level is a fundamental aspect in the training of students of health majors, constituting a highly significant setting of learning. Objective: To analyze the expectations and experiences of the students of the Medical Technology major at University of Chile, during their professional practice in the area of Computed Tomography. Methods: Qualitative, descriptive study with a hermeneutic approach. The sample was 25 students, which was achieved through the saturation of categories. The production of information was carried out with portfolios made by the students throughout their practice. Discourse analysis was used to study the information. Results: Expectations and experiences both produced six categories, namely: work team, application of theoretical knowledge, patient-student relationship, incorporation of new knowledge, work to be done in practice and emotional state. The performance of students in practice was found to be highly influenced by their expectations. The experiences lived greatly depend on their own emotional factors, the medical-teaching team in charge and the student's ability to function in the place of professional practice. Conclusions: The professional training of students in the health area is complex, since not only does it consist of theoretical learning, but also practice becomes a fundamental process, where learning to manage not only the pathological and technical conditions are important; it is important for the students to achieve the capacity of the patient's comprehensive care, taking care of the person, their emotions and their well-being(AU)

Acompañamiento y cuidado holístico de enfermería en personas con enfermedades crónicas no adherentes al tratamiento

ntroducción. La enfermería apoya en forma continua a las personas en su proceso de adaptación a la enfermedad crónica, abordaje desde el que resulta esencial incorporar elementos holísticos en el acompañamiento y los cuidados con el propósito de enfocarse en la totalidad e integralidad de la persona y su entorno. Al respecto, el presente ensayo tiene como propósito reflexionar en torno a la importancia del acompañamiento y cuidados holísticos de enfermería en las personas con enfermedades crónicas no adherentes a su tratamiento. Dicha reflexión se basa en el concepto de adherencia terapéutica de la Organización Mundial de la salud y la mirada holística, humanizada y transpersonal de Jane Watson, principales referentes teóricos.Desarrollo. Los altos niveles de no adherencia terapéutica en las personas con enfermedades crónicas no trasmisibles se constituye en uno de los principales desafíos al que se enfrenta la enfermería. Considerar a la persona con ECNT como un todo que posee una historia de vida, emociones, experiencias, valores y creencias socioculturales, es relevante para otorgar cuidados de calidad y favorecer la adherencia terapéutica.Conclusiones. Incorporar la mirada holística y humanista en los cuidados y acompañamiento de enfermería en las personas con ECNT deviene en una estrategia clave al momento de favorecer la adherencia terapéutica y, por ende, mejorar el bienestar y los niveles de control de estas enfermedades.

SummaryIntroduction. Nursing supports continuously people in their process of adaptation to chronic illness, approach from which it is essential to incorporate holistic elements in the support and care in order to focus on the totality and integrity of the person and their environment . In this regard, this essay aims to reflect on the importance of accompaniment and holistic nursing care for people with chronic diseases adherent to their treatment. This debate is based on the concept of adherence of the World Health Organization and holistic, humane and transpersonal look Jane Watson, main theoretical references.Development. High levels of non-adherence in people with chronic non-communicable diseases constitutes one of the main challenges facing the nursing. Consider the person with CNCD as a whole that has a life story, emotions, experiences, values and cultural beliefs, is relevant to provide quality care and promote adherence.Conclusions. Incorporate holistic and humanistic look in nursing care and support for people with NCDs becomes a key strategy when promoting adherence and thereby improve welfare levels and control of these diseases.

ntrodução. A enfermagem apoia em forma contínua as pessoas em seu processo de adaptação à doença crônica, nesta abordagem resulta essencial incorporar elementos holísticos no acompanhamento e nos cuidados com o propósito de enfocar na totalidade e integralidade da pessoa e seu entorno. A respeito, o presente ensaio tem como propósito refletir em torno da importancia, do acompanhamento e cuidados holísticos da enfermagem nas pessoas com doenças crônicas não aderentes a seu tratamento. Esta reflexão é baseada no conceito de aderência terapêutica da Organização Mundial da saúde e no ponto de vista holístico, humanizado e transpessoal de Jane Watson, principais referentes teóricos.Desenvolvimento. Os altos níveis de não adêrencia terapêutica nas pessoas com doenças crônicas não trasmissíveis se constitui em um dos principais desafios que a enfermagem enfrenta. Considerar a pessoa com ECNT como um todo que possui uma história de vida, emoções, experiências, valores e crenças socioculturais, é relevante para outorgar cuidados de qualidade e favorecer a aderência terapêutica.Conclusões. Incorporar o olhar holístico e humanista nos cuidados e acompanhamento de enfermagem nas pessoas com ECNT torna-se uma importante estratégia no momento de favorecer a aderência terapêutica e, assim, melhorar o bem-estar e os níveis de controle destas doenças.

Integración metodológica en la investigación de fenómenos complejos en Enfermería / Methodological integration in complex phenomena in Nursing research

El presente artículo pretende analizar y reflexionar en torno a la integración metodológica. Se exponen algunos antecedentes para dar a conocer ciertos aspectos que hicieron posible este binomio en el quehacer investigativo, sin pretender dar cuenta histórica del debate. Se desarrolla una aproximación sobre la integración metodológica, los principios que subyacen su uso, su potencialidad, alcances, limitaciones y desventajas, junto con los aspectos necesarios para la construcción de su diseño. Finalmente, se considera que esta metodología permitiría desarrollar e impulsar el conocimiento de Enfermería hacia una perspectiva más holística e integral, favoreciendo el trabajo trans e interdisciplinario en el quehacer investigativo de enfermería

This article aims to analyze and reflect about methodological integration. Background information introduces certain aspects that made this binomial possible in this research, without providing the historical account of the debate. An approximation about the methodological integration, principles underlying to is use, its potential, scope, limitations and disadvantages, along with the necessary features for building design are developed. Finally, it is considered that this methodology would develop and promote nursing knowledge toward a more holistic and comprehensive perspective, promoting trans and interdisciplinary work in nursing research

[Health and economic benefits of reducing 10 µm particulate matter (PM10) in Metropolitan Area of Concepción, Chile]. / Cuantificación económica de los beneficios en salud asociados a la reducción de la contaminación por MP10 en Concepción Metropolitano, Chile.

BACKGROUND: Several international studies show the effects of PM10 pollution on health but specific analyses for many cities in Chile are lacking. AIM: To relate PM10 concentrations to effects with population health and quantify the economic benefits of its reduction in Concepción Metropolitan Area. MATERIAL AND METHODS: Poisson regression and generalized additive models were used to analyze the short-term effects of PM10 on mortality and morbidity, controlling for lags, seasonal, trend and weather variables. The damage function method to determine the economic impact of pollution reduction was used. RESULTS: The selected concentration-response (C-R) coefficients showed that PM10 concentrations had effects on hospital admissions with a two days lag for respiratory diseases in children under 15 years of age and with a one day lag for asthma in patients over 64 years. The effects on premature mortality had a six days lag. The decrease in 1 µg/m³ of PM10 concentration would generate benefits ranging from 1,025.8 to 32,490.9 million of Chilean pesos per year, with a confidence level of 95%, according the estimation based on concentration-response coefficients and their economic cost. CONCLUSIONS: Reduction of PM10 would have important health and economic benefits.

Cuantificación económica de los beneficios en salud asociados a la reducción de la contaminación por MP10 en Concepción Metropolitano, Chile / Health and economic benefits of reducing 10 µm particulate matter (PM10) in Metropolitan Area of Concepción, Chile

Background: Several international studies show the effects of PM10 pollution on health but specific analyses for many cities in Chile are lacking. Aim: To relate PM10 concentrations to effects with population health and quantify the economic benefits of its reduction in Concepción Metropolitan Area. Material and Methods: Poisson regression and generalized additive models were used to analyze the short-term effects of PM10 on mortality and morbidity, controlling for lags, seasonal, trend and weather variables. The damage function method to determine the economic impact of pollution reduction was used. Results: The selected concentration-response (C-R) coefficients showed that PM10 concentrations had effects on hospital admissions with a two days lag for respiratory diseases in children under 15 years of age and with a one day lag for asthma in patients over 64 years. The effects on premature mortality had a six days lag. The decrease in 1 µg/m³ of PM10 concentration would generate benefits ranging from 1,025.8 to 32,490.9 million of Chilean pesos per year, with a confidence level of 95%, according the estimation based on concentration-response coefficients and their economic cost. Conclusions: Reduction of PM10 would have important health and economic benefits.

Cambio climático y salud pública: acciones desde la institucionalidad en el escenario sociocultural actual / Climate Change and Public Health: Actions from Institutions in the Current Social-Culture Scene

Objetivo: Analizar el vínculo entre el cambio climático y la salud de las personas, reflexionando en torno a los desafíos que representa tanto para la atención primaria en salud pública cómo para los profesionales de la salud. Método: Este ensayo se organiza en tres momentos: En el primero, se describe brevemente la epistemología del medio ambiente como objeto de estudio. El segundo momento señala la influencia del desarrollo y crecimiento económico sobre los cambios ambientales, se reflexiona acerca de la vulnerabilidad de la población frente al cambio climático. Se analizan los efectos y consecuencias del cambio climático en la salud de las personas. Finalmente se exponen las acciones a nivel de la condicionante de la salud medio ambiental propuesta para la salud pública. Conclusión: El empoderamiento de las personas por parte de los profesionales de la salud resulta significativo al momento de movilizar capital social para el desarrollo de programas y políticas públicas en salud y medio ambiente.

Objective: To analyze the link between climate change and people’s health, reflecting on the challenges it poses for both primary care in public health as well as for health professionals. Method: The essay is divided in three stages: The first briefly describes environmental epistemology as an object of study. The second refers to the influence of economic growth and development on environmental change, reflecting on the population’s vulnerability to climate change. The effects and consequences of climate change on the health of people are analyzed. Finally, suggested actions towards conditions of environmental health proposed for public health are exposed. Conclusion: People`s empowerment by health professionals is significant when building social capital for the development of health and environmental public policies and programs.