[Motivations for alcohol consumption in schooled adolescents: analysis of discussion groups]. / Motivaciones para el consumo de alcohol en adolescentes escolarizados: análisis de grupos de discusión.

OBJECTIVE: To find out the motivations of adolescents for alcohol consumption. DESIGN: Qualitative methodology with discussion groups. PARTICIPANTS AND CONTEXT: 131 adolescents (15-17 years old) enrolled in nine schools in Tarragona (Spain). METHOD: Systematic coding strategy, adapted to focus groups. Educational centers were selected through a stratified purposive sampling by educational levels (segmentation criterion) and ownership of the center (public or private). Participants within the educational levels were randomly selected for the groups. Content analysis was conducted using an open and flexible coding strategy. RESULTS: Motivations for alcohol consumption were identified, revolving around six fundamental dimensions: a) seeking fun and new sensations, b) alleviating discomfort, c) consumption due to social contagion and group pressure, d) consumption as a rite of passage into adulthood, e) environmental availability of alcohol, and f) low perception of risk. This motivation varied according to the adolescent's gender. In girls, drinking behavior appeared related to overcoming negative emotional states, while for boys, belonging to the peer group took precedence: drinking reinforces hegemonic masculinity and ensures complicity among peers. Adolescents considered that the information they receive from educational centers is sufficient, but it does not motivate change. CONCLUSIONS: Public health strategies focused on preventing alcohol consumption in adolescents should incorporate their motivations to achieve greater efficiency, paying due attention to sex/gender variables.

WIDENING THE SCOPE OF SOCIAL SUPPORT: THE FLORIDA MATERNAL, INFANT, AND EARLY CHILDHOOD HOME VISITING PROGRAM.

The Florida Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program is designed to support pregnant women and families in developing skills and utilizing resources necessary to promote their children's physical, social, and emotional development. Little evaluation attention has focused on large-scale, public policy driven home-visiting programs. Social support provision is a critical component of a successful home-visiting program; therefore, there is a need to better understand participants' perceptions of social support provided to them in this context. Forty-five home-visiting participants from five Florida MIECHV programs completed semistructured telephone interviews. Participants discussed their experiences with the MIECHV program, including descriptions of their interactions with home visitors. Content analysis revealed that participants experienced multilayered social support from home-visiting staff. Families needed and received substantial emotional, instrumental, informational, and appraisal support at the individual level. This support was embedded within and strengthened by the strategies and activities of the home-visiting model of service provision. Results highlight the powerful opportunity home visiting offers as a method of service delivery within the larger system of care to increase social support in families experiencing high risk for negative maternal and child health outcomes. Implications for policy and practice are discussed.

[Changes in hazardous drinking in Spanish adolescent population in the last decade (2004-2013) using a quantitative and qualitative design]. / Cambios en el consumo alcohólico de riesgo en población adolescente en la última década (2004-2013): una aproximación cuanti-cualitativa.

OBJECTIVE: To determine the changes in hazardous drinking in adolescents in the last decade, as well as their motivations and experiences. DESIGN: Firstly, a descriptive design using a self-report questionnaire, and secondly an explanatory qualitative design, with video recordings of discussion groups with content analysis (coding, triangulation of categories and verification of results). SETTING AND PARTICIPANTS: Pupils from an urban High School, administering a questionnaire every 3 years from 2004 to 2013. Purposive sampling was used to elect groups in qualitative design. Homogeneity criteria: education level; heterogeneity criteria: age, gender, and drug use. MAIN MEASUREMENTS: Questionnaire: age, gender, drug use, and the CAGE test. Interviews: semi-structured on a previous script, evaluating experiences and expectations. RESULTS: Descriptive design: A total of 1,558 questionnaires, age 14.2±0.3years, 50% female. The prevalence of alcohol drinking decreases (13%), but its hazardous use increases (11%; P<.001, χ2). This is associated with being female (P<.01 χ2), higher alcohol consumption (>6 standard drink units weekly; P<.001, ANOVA), during the weekend (56%; P<.01, χ2) and multiple drug use (P<.01, χ2). CAGE questionnaire: 37% ≥1positive response (related to hazardous drinking, P<.05 χ2), 18% ≥2answers. QUALITATIVE: A total of 48 respondents, classified into 4 categories: personal factors (age, gender), social influences (family, friends), consumption standards (accessibility, nightlife), and addiction (risk, multiple drug use). CONCLUSION: Despite the decrease in the prevalence of alcohol drinking, the increase in the percentage of the hazardous drinking is a public health problem. It is related to being female, binge-drinking, and multiple drug use. Nightlife and social standards are the main reasons given by adolescents, who have no perception of risk.

A qualitative study about experiences and emotions of emergency medical technicians and out-of-hospital emergency nurses after performing cardiopulmonary resuscitation resulting in death. / Estudio cualitativo sobre las experiencias y emociones de los técnicos y enfermeras de emergencias extrahospitalarias tras la realización de maniobras de reanimación cardiopulmonar con resultado de muerte.

OBJECTIVE: To explore the experiences, emotions and coping skills among emergency medical technicians and emergency nurses after performing out-of-hospital cardiopulmonary resuscitation manoeuvres resulting in death. METHOD: An exploratory qualitative research was performed. Seven emergency medical technicians and six emergency nurses were selected by non-probability sampling among emergency medical system workers. The meetings took place up to information saturation, achieved after six individual interviews and a focal group. The meetings were then transcribed and a manual and inductive analysis of the contents performed. MAIN RESULTS: After a failed resuscitation several short and long-term reactions appear. They can be negatives, such as sadness or uncertainty, or positives, such as the feeling of having done everything possible to save the patient's life. Emotional stress increases when ambulance staff have to talk with the deceased's family or when the patient is a child. The workers don't know of a coping strategy other than talking about their emotions with their colleagues. CONCLUSIONS: Death after a failed resuscitation can be viewed as a traumatic experience for rescuers. Being in contact with the suffering of others is an emotional, stress-generating factor with direct repercussions on the working and personal lives of emergency staff. Nevertheless, structured coping techniques are not common among those professionals.

[Learning concepts of diagnosis in family medicine: the "mark robinson sign" - the traces that should not be there]. / Aprendiendo conceptos del diagnóstico en medicina de familia: a propósito del «signo de Robinson¼ - las huellas que no deberían estar allí.

We review the mechanisms of the mental operation to identify the disease in family medicine, using five cases where the diagnosis process began in "the trace that should not be there" or "Robinson sign" as happened to Robinson Crusoe when he saw a human footprint on the beach of the "desert island". How could it be there?; It was a mystery, and based on metaphors, we framed the mechanism of "the trace that should not be there" mainly in the first phase of clinical or intuitive reasoning, but this intuition of the doctor should be accompanied by the diagnostic process, like the "basso continuo" of Baroque music, allowing improvisation and personal style, and in this way, eventually observing the footprint "that should not have been there" that may arise in the analytical, as well as in the verification phase of the assumptions made.

[Community diagnosis using qualitative techniques of expectations and experiences in a health area in need of social transformation]. / Diagnóstico comunitario mediante técnicas cualitativas de las expectativas y vivencias en salud de una zona necesitada de transformación social.

OBJECTIVE: To know the views, experiences and expectations of care provided by the Andalusian Public Health System (SSPA) of users of an urban area in need of social transformation (ZNTS). DESIGN: Qualitative methodology (exploratory study). LOCATION: Urban basic health zone (16,000 inhabitants, 40% ZNTS). PARTICIPANTS: Purposive sampling of users of SSPA and community leaders. Homogeneity criteria: age. Heterogeneity criteria: sex, frequency, active/pensioner, level cultural/economic. MAIN INTERVENTIONS: Conversational techniques recorded by videotape and moderated by a sociologist (user dicussion groups and in-depth interviews for community leaders). ANALYSIS: transcription of speeches, coding, categories triangulation and final outcome. RESULTS: Seven groups (43 participants, 58% ZNTS) and 6 leaders. They want continuity of care and choice of professionals, but not the medical change without information and attention's discontinuity primary care/hospital. There's bad physical accesibility by the urban environment in the ZNTS and is criticized admission services and paperwork; the programmed appointment and the electronic prescriptions are improvements but asking more hospital referrals and reviews. There's good appreciation of the professionals (primary care-closer, hospital-greater technical capacity). It needs to improve nursing education and speed of emergency assistance. There's a lack of leadership in the system organization, very fragmented. They know a range of services focusing on the demand for care; other health activities not spread to the users. CONCLUSION: The SSPA should incorporate the views and expectations of communities in social risk to a real improvement in the quality of care.

Characterizing the perceived stigma towards mental health in the early implementation of an integrated services model in primary care in Colombia. A qualitative analysis.

BACKGROUND: Stigma is a sociocultural barrier to accessing mental health services and prevents individuals with mental health disorders from receiving mental health care. The Ministry of Health and Social Protection of Colombia acknowledges that a great number of people with mental disorders do not seek medical aid due to stigma. OBJECTIVES: Characterise the perceived stigma towards mental health among the stakeholders involved in the early implementation of the DIADA project [Detección y Atención Integral de Depresión y Abuso de Alcohol en Atención Primaria (Detection and Integrated Care for Depression and Alcohol Use in Primary Care)]. Explore whether the implementation of this model can decrease stigma. Describe the impact of the implementation on the lives of patients and medical practice. MATERIALS AND METHODS: Eighteen stakeholders (7 patients, 5 physicians and 6 administrative staff) were interviewed and a secondary data analysis of 24 interview transcripts was conducted using a rapid analysis technique. RESULTS: The main effects of stigma towards mental health disorders included refusing medical attention, ignoring illness, shame and labelling. Half of the stakeholders reported that the implementation of mental health care in primary care could decrease stigma. All of the stakeholders said that the implementation had a positive impact. CONCLUSIONS: The perceived stigma was characterised as social and aesthetic in nature. Communication and awareness about mental health is improving, which could facilitate access to mental health treatment and strengthen the doctor-patient relationship. Culture is important for understanding stigma towards mental health in the population studied.

The combined used of quantitative and qualitative longitudinal methods in the study of obesity.

OBJECTIVE: To explore the combined use of quantitative and qualitative methods with a longitudinal perspective in the field of obesity diet and physical activity. METHOD: A systematic scoping review following PRISMA guidelines. The databases searched were Web of Science, PubMed, and ASSIA. RESULTS: 1592 records were returned from the searches. In total, nine studies met the inclusion criteria and were included in the review. Authors of included studies mixed quantitative and qualitative methods to obtain a deeper understanding of their study subjects, but few documents use longitudinal data. Authors value the combination of methods and try to integrate the results in their conclusions. CONCLUSIONS: Total integration is rarely achieved in the analysis. The origin of this divergence can be found in the lack of theoretical guidance in these articles, but also in the difficulty of working in multidisciplinary teams in the field of obesity.

Access barriers, self-recognition, and recognition of depression and unhealthy alcohol use: A qualitative study.

INTRODUCTION: Access to healthcare services involves a complex dynamic, where mental health conditions are especially disadvantaged, due to multiple factors related to the context and the involved stakeholders. However, a characterisation of this phenomenon has not been carried out in Colombia, and this motivates the present study. OBJECTIVES: The objective of this study was to explore the causes that affect access to health services for depression and unhealthy alcohol use in Colombia, according to various stakeholders involved in the care process. METHODS: In-depth interviews and focus groups were conducted with health professionals, administrative professionals, users, and representatives of community health organisations in five primary and secondary-level institutions in three regions of Colombia. Subsequently, to describe access to healthcare for depression and unhealthy alcohol use, excerpts from the interviews and focus groups were coded through content analysis, expert consensus, and grounded theory. Five categories of analysis were created: education and knowledge of the health condition, stigma, lack of training of health professionals, culture, and structure or organisational factors. RESULTS: We characterised the barriers to a lack of illness recognition that affected access to care for depression or unhealthy alcohol use according to users, healthcare professionals and administrative staff from five primary and secondary care centres in Colombia. The groups identified that lack of recognition of depression was related to low education and knowledge about this condition within the population, stigma, and lack of training of health professionals, as well as to culture. For unhealthy alcohol use, the participants identified that low education and knowledge about this condition, lack of training of healthcare professionals, and culture affected its recognition, and therefore, healthcare access. Neither structural nor organisational factors seemed to play a role in the recognition or self-recognition of these conditions. CONCLUSIONS: This study provides essential information for the search for factors that undermine access to mental health in the Colombian context. Likewise, it promotes the generation of hypotheses that can lead to the development and implementation of tools to improve care in the field of mental illness.

SOCIAL REPRESENTATIONS ON BREASTFEEDING AMONG WOMEN LIVING IN URBAN AND RURAL AREAS IN JALISCO, MEXICO: A QUALITATIVE STUDY.

OBJECTIVE: To understand the social representations regarding breastfeeding among women in ru- ral and urban settings in Jalisco (Mexico), between 2016 and 2017. METHODS: Qualitative phenomenological study. Women living in rural and urban communities in the XIIth Health Jurisdiction, Tlaquepaque Center, Jalisco (Mexico), identified through key informants, were interviewed in focus groups, audio-recorded and semiotically analyzed until the technical saturation was reached in the following categories: meaning, meaning-generating players, and wishes pertaining to breastfeeding. RESULTS: Six focus groups of 14 women living in rural areas, aged 29.4 ± 7.8 years, and 9 women living in urban areas, aged 27.3 ± 7.1 years. Qualitatively, meanings were identified in the two set- tings and were categorized as myths, breastfeeding techniques, and infant growth and development. The following meaning-generating players were found: healthcare and hospital staff, social network, family, God, and community. In terms of wishes, women described the benefits of breastfeeding for themselves and their infants. CONCLUSIONS: There are differences and similarities in social representations regarding breastfeeding depending on the geographic context where they are developed; the elements and players that make them up determine the initiation, maintenance or termination of breastfeeding, and must be considered as part of health promotion and education targeted to women and their environment.

TITULO: REPRESENTACIONES SOCIALES FRENTE A LA LACTANCIA MATERNA EN MUJERES RURALES Y URBANAS DE JALISCO, MÉXICO: ESTUDIO CUALITATIVO. OBJETIVO: comprender las representaciones sociales frente a la lactancia materna en mujeres de contextos rural y urbano, en Jalisco (México), entre 2016 y 2017. METODOS: estudio cualitativo fenomenológico. En mujeres de comunidades rurales y urbanas de la Jurisdicción Sanitaria XII, Centro Tlaquepaque, Jalisco (México), identificadas por informantes clave, se realizaron entrevistas en grupos focales, grabadas en audio y analizadas semióticamente hasta llegar a la saturación teórica de las categorías: significado, actores generadores de significado y deseos frente a la lactancia materna. RESULTADOS: 6 grupos focales de 14 mujeres rurales, con edades de 29,4 ± 7,8 años, y 9 mujeres urbanas con edades de 27,3 ± 7,1 años. Cualitativamente, en ambos contextos se identificaron significados que se categorizaron en mitos, técnica de amamantamiento y crecimiento y desarrollo del lactante. Como actores generadores de significados se encontraron: personal de salud y hospital, red social, familia, Dios y comunidad. Como deseos las mujeres describen beneficios propios por amamantar y para el infante. CONCLUSIONES: las representaciones sociales frente a la lactancia materna tienen diferencias y similitudes de acuerdo con el contexto geográfico donde se desarrollan; los elementos y actores que las configuran determinan el inicio, mantenimiento o abandono de la lactancia y deben considerarse en las intervenciones de promoción y educación de la salud dirigidas a las mujeres y su entorno.

Life after a gastrectomy: Experience of patients with gastric cancer. / Vivir después de una gastrectomía: experiencia de pacientes con cáncer gástrico.

OBJECTIVE: To describe the experience of patients with gastric cancer who have undergone gastrectomy. METHOD: Qualitative study with 17 adults who underwent total gastrectomy in a cancer care centre in Bogotá, Colombia. The approach was phenomenological using the analysis proposed by Colaizzi. Descriptive codes, nominal codes and categories were identified as central issues. In-depth interviews were used and theoretical saturation sampling. RESULT: From 165 descriptive codes, 27 nominal codes emerged that make up 6 subjects that describe the experience of the person who has undergone total gastrectomy: 1) a new opportunity, 2) a foreign body, 3) yearning to feel useful, 4) understanding other treatments, 5) sensing discomfort and symptoms, and 6) eating what I can. CONCLUSIONS: The patient who has undergone total gastrectomy faces an experience as a cancer survivor that involves understanding how to manage physical discomfort, adaptation to diet, economic difficulty and unemployment. Viewing the experience as a new opportunity, and the requirements of other treatments implies having a social, emotional and spiritual support network. It is essential to consolidate monitoring programmes for survivors that respond in a timely manner to their needs.

Creatividad, identidad y subjetividad de personas con enfermedades crónicas: Estado del arte / Creativity, Identity, and Subjectivity of People with Chronic Diseases: State of the Art

Resumen Este artículo es parte de una investigación que pretende identificar el impacto que tienen las enfermedades crónicas en el desarrollo de la creatividad, la identidad y la subjetividad de los sujetos que las padecen. El documento presenta la revisión de 50 artículos con resultados de estudios que, en la última década, investigaron sobre la creatividad en relación con la identidad y la subjetividad de niños, niñas, adolescentes y jóvenes que viven con enfermedades crónicas. Desde lo metodológico, se trata de un estudio no probabilístico de tipo intencional, en el cual se abordaron datos bibliométricos construidos a partir de bases de datos especializadas y, posteriormente, se efectuó un análisis interpretativo crítico de estas investigaciones desde una perspectiva cualitativa, para el que se recurrió a la categorización de la información. Los resultados evidencian que el uso del arte como estrategia terapéutica facilita el afrontamiento de la enfermedad; sin embargo, también se evidencian afectaciones relevantes en el sistema familiar y relacional de quienes viven con estas enfermedades. Se concluye que la investigación en este campo se ha dado principalmente desde la medicina y la psicología, pero dejó un campo abierto que puede ser explorado por la investigación social.

Abstract This article presents a state of the art that integrates the review of fifty articles of the results of studies that, in the last decade, investigated creativity in relation to the identity and subjectivity of children, adolescents and young people living with chronic diseases .The document is part of a doctoral research that aims to identify the transformations that creativity undergoes in relation to the development of identity and subjectivity of children living with chronic diseases, such as HIV/AIDS, cancer and diabetes, given that these are the diseases that Sontag (2008) relates as the diseases that cause the greatest social and economic impacts and that modify the life project of people in the long term. From the methodological point of view, bibliometric data constructed from specialized databases such as PubMed, APA, Science Direct, Proquest, Redalyc, Scielo and Scopus were approached; subsequently a critical interpretive analysis of these investigations was carried out from a qualitative perspective. The results show that the use of art as a therapeutic strategy facilitates coping with the disease; however, relevant effects are also evident in the family and relational system of those who live with these diseases. It is also found that a large part of the research, as suggested by Sontag (2008), assumes diseases as an enemy, making use of the language of war, in addition to locating whoever experiences the disease as a battle hero or as a survivor when it is possible to go through the disease in a satisfactory way, however, it is also evident that this position implies a struggle of the subject with himself. Also, some of the authors state that the disease facilitates the recognition of abilities, tastes and skills of which one was not aware before experiencing it. Through these investigations, the understanding of the importance of relationships with peers as a key aspect for the development of self-regulation is broadened, which facilitates self-care practices far from victimization and family overprotection. Creativity has been understood mainly from artistic exercises, art-therapy and the use of some resources such as painting, drawing, music and dance for the approach to the subject who lives with chronic diseases, from the research exercises themselves, but also from an attempt to allow the subject to establish diverse communications with his context and to establish communication bridges with himself and with his new life circumstances. However, this perspective leaves aside the proposal of Lavie, Narayan and Rosaldo (1993), who argue that creativity is the human capacity to respond to daily circumstances in different ways, which allows expanding the field of action of what creative, facilitating that it is linked to the daily lives of the subjects and other ways of displaying creativity are explored, from relationships, from the practices of self-recognition and self-care regarding the same disease.It is also found that chronic diseases are related to metaphors that force the subject who experiences them to assume the role of warrior, war hero or war victim; these postures assume burdens for the subject and, although in some cases they help to assume the disease with a spirit of improvement, they also increase responsibility, guilt and difficulties in cases in which the disease is not overcome.

Representaciones sociales sobre la problemática de Chagas en un servicio de salud comunitaria del Gran La Plata, Buenos Aires, Argentina.

Hablar de Chagas es hablar de una problemática compleja, definida por elementos de carácter biomédico, epidemiológico, sociocultural y político, que se conjugan dinámicamente. En este trabajo buscamos identificar y analizar las representaciones sobre Chagas de los integrantes del equipo de salud de un centro de atención periurbano de la ciudad de La Plata, Argentina. Mediante un abordaje cualitativo, se realizaron entrevistas semiestructuradas y se analizaron las respuestas con la técnica del análisis de contenido. Los resultados mostraron que la mayor parte de las personas entrevistadas no contempla al Chagas como una problemática en su contexto laboral cotidiano y manifiestan un fuerte sesgo biologicista en su formación profesional. Con este trabajo señalamos la urgente necesidad de reflexionar críticamente en torno a la formación de los profesionales de la salud en relación a problemáticas socioambientales complejas de importancia regional, como lo es el Chagas.

[Knowledge, beliefs and attitudes of the Roma population regarding colorectal cancer screening]. / Conocimientos, creencias y actitudes de la población gitana ante el cribado del cáncer colorrectal.

OBJECTIVE: To identify predisposing, inhibitory and facilitating factors that may affect participation in colorectal cancer screening programs in the Roma population. METHOD: Qualitative and exploratory study by focus group technique. Three focus groups of men and three groups of women were carried out, with a total of 16 men and 18 women from the Roma population, aged 50-69 years, from the province of Alicante. A discourse analysis was performed with the PRECEDE model as an analysis framework. RESULTS: Several barriers to participation were identified, such as the aversion of the Roma population to talk about cancer, refusal to anticipate a diagnosis that can cause suffering to the person and their family, poor knowledge of the disease and the preventive programmes, refusal to collect and handle samples, fear and shame about the colonoscopy, acceptance of divine will, difficulties in understanding and reading, and the perception of being discriminated by their ethnicity in the health sector. However, predisposing factors to participate in the screening programme also were identified, for example willingness to receive relevant information through more appropriate pathways, as well as their confidence in professional counselling. CONCLUSION: A willingness to receive the recommendation to participate and understanding information from health professionals have been identified. This will enable us to envisage potential strategies for approaching this population group. This could contribute to improved participation of the Roma population in colorectal cancer screening programmes and to open up new ways to promote preventive behaviours.

Validación transcultural de cuestionario sobre literacidad en salud en el contexto chileno / Transcultural validation of a survey about oral health literacy in the Chilean context

Objetivos: Validar transculturalmente para contexto chileno, cuestionario en inglés que evalúa competencias comunicacionales empleadas por el odontólogo con sus pacientes. Métodos: Se realizaron seis etapas: traducción, panel de expertos, entrevistas cognitivas, adaptación en línea, método test y re-test, evaluando la consistencia interna y estabilidad, y retrotraducción al inglés. Se realizó un análisis descriptivo de las variables sociodemográficas y un análisis descriptivo de los ítems del cuestionario considerando la media de las puntuaciones, desviación estándar y proporción de respuestas positivas, neutras y negativas. Resultados: 70 participantes contestaron el cuestionario (42 mujeres y 28 hombres, edad promedio 38 años). Las entrevistas cognitivas y comité de expertos permitieron hacer adaptaciones a la cultura chilena. Con respecto a la consistencia interna y estabilidad del cuestionario, el valor obtenido para α-Cronbach fue mayor a 72% y λ-Guttman mayor a 81%. Para la estabilidad del cuestionario el coeficiente de correlación Spearman fue de 72% y los coeficientes de concordancia fueron mayores a 76% (valor-p<0,05). Conclusiones: El cuestionario sobre la literacidad de salud oral en el contexto chileno es válido desde la perspectiva de la adaptación transcultural y confiable desde la perspectiva de la consistencia interna y estabilidad.

Objectives: Transcultural validation of a survey in the Chilean context that assesses communication skills of dentists with patients, from English to Spanish. Methods: The process considered six stages: translation, a panel of experts, cognitive interviews, online adaptation, test and re-test practice to assess internal consistency and stability, and finally, back-translation into English. The method included the analysis of the sociodemographic variables and a descriptive analysis of the questionnaire items, considering the mean of the scores, standard deviation, and proportion of positive, neutral, and negative responses. Results: 70 participants answered the questionnaire (42 women and 28 men, average age 38 years). The cognitive interviews and the suggestions of the panel of experts allowed for some changes to better adapt to the Chilean culture. Regarding the internal consistency and stability of the questionnaire, the value obtained for α-Cronbach was greater than 72% and for λ-Guttman greater than 81%. Furthermore, the Spearman correlation coefficient was 72%, and the concordance coefficients were higher than 76% (p-value <0.05). Conclusions: The questionnaire on health literacy in the Chilean context is valid from the perspective of cross-cultural adaptation and reliable from the internal consistency and stability standpoint.

Avances en Psicología Social Libertaria para autogestión activa: QCA mejorada y reflexiones desde República Dominicana / Advances in Libertarian Socialist Social Psychology’s Self-management: enhanced QCA and reflections from the Dominican Republic

Profundizo en una observación participante en una comunidad libertaria que emerge como mi-noría activa en las metrópolis de República Dominicana, mediante veinte entrevistas en pro-fundidad a diez personas a principios y a finales del 2013. Reconstruyo un modelo teórico dis-tinguiendo entre el compromiso de autogestión activo del pasivo. En este adelanto, presento una explicación mejorada del resultado de interés (laautogestión activa), gracias a un diálogo entre teorías y evidencias, junto a una revisión metodológica mejorada. Para la explicación de la autogestión activa, opto por la conjugación de dos condiciones principales: 1) las multiplici-dades discursivas, el solapamiento de herramientas comunitarias del discurso autogestionario como optimizadores de la autogestión; y 2) las actitudes personales que facilitan asumir un rol protagónico en el compromiso autogestionario como sujeto. Distingo esta explicación cuando hay un compromiso autogestionario libertario más general en comparación con el compromiso específicamente anarquista. (AU)

Drawing from exploratory participant observation with libertarian socialist groups and indi-viduals emerging as active minorities in the metropolitan areas of the Dominican Republic, twenty in-depth interviews were conducted with ten participants in the beginning and the end of 2013. An advanced theoretical model was reconstructed, which distinguished itself between the persons as the commitment of active self-management, and the passive self-management commitment. This improvement is done thanks to a more profound dialogue between theories and evidence and an enhanced methodological framework. From the explanation of the active self-management we can see the combination of: 1) discursive multiplicities, the overlap of communitarian tools of discourse self-management of the cases studied as optimizers; and 2) personal attitudes that facilitate one taking a protagonist role in self-management commit-ment as a subject. These conditions are differentiated when explaining the most general lib-ertarian socialist self-management commitment separated from the specifically anarchist commitment. (AU)

Apropiación de los elementos de innovación social en organizaciones comunitarias agropecuarias del departamento de Boyacá, Colombia / Appropriation of the elements of social innovation in community agricultural organizations of the department of Boyaca, Colombia

RESUMEN Con el objetivo de establecer criterios mínimos relativos a la innovación social en organizaciones comunitarias agropecuarias, se hizo uso de herramientas propias de la investigación cualitativa que incluyeron búsquedas especializadas y uso de programas para análisis de datos bibliográficos (por ejemplo VOSviewer™) para determinar los elementos relativos a la gestión, gobernanza, capacidades, modelo de negocio sostenibilidad para ocho (8) organizaciones comunitarias de productores agropecuarios de la provincia del Sugamuxi, en el departamento de Boyacá, Colombia. Se pudo establecer que algunas organizaciones de productores agropecuarios que ejercen actividades en el departamento de Boyacá no están apropiando de forma integral los elementos de innovación social (en niveles operativos y gerenciales) y, consecuentemente, existe toda una ruta de mejoramiento por desarrollar con estas para optimizar los índices de eficiencia organizacional; además, se evidencia la complejidad de la temática, dado que la sostenibilidad de las innovaciones sociales dependerá en gran medida de la gestión de las organizaciones, donde se establezcan agendas institucionales compartidas contextualizadas y ajustadas a los territorios. Es necesario optimizar los canales de participación de manera mancomunada entre el Estado, las organizaciones y los mismos productores para poder dinamizar procesos, metas y alcances reales de la innovación social a la luz de los acelerados cambios a los que se enfrenta el productor agropecuario agremiado en Colombia, relativos estos a la dinámica del mercado, el acceso a recursos y otros.

ABSTRACT In order to establish minimum criteria related to social innovation in agricultural community organizations, qualitative research tools were used, including specialized searches and the use of programs for the analysis of bibliographic data (for example VOSviewer™), with the purpose of defining the elements related to management, governance, capacities, business model and sustainability for eight (8) community organizations of agricultural producers in the province of Sugamuxi, in the department of Boyacá, Colombia. It was possible to establish that some organizations of agricultural producers that carry out activities in the department of Boyacá are not integrally appropriating the elements of social innovation (at operational and managerial levels) and, consequently, there is a whole route of improvement to be developed with them to optimize the organizational efficiency indexes; in addition, the complexity of the subject is evident, given that the sustainability of social innovations will depend largely on the management of the organizations, where shared institutional agendas contextualized and adjusted to the territories are established. It is necessary to optimize the channels of participation in a joint manner between the State, the organizations, and the producers themselves to be able to dynamize processes, goals and the real scope of social innovation in light of the accelerated changes faced by the agribusiness producer in Colombia, related to market dynamics, access to resources and others.

Representaciones sociales sobre el Programa Mais Médicos entre consejeros municipales de salud de Brasil / Social representations on Mais Médicos Program among municipal health councelors of Brazil

Introducción: La atención primaria de salud en Brasil se considera una prioridad. En el año 2013 se creó el Programa Mais Médicos, de formación en servicio y de ampliación de la cantidad de médicos en el país. La cooperación cubana, gestionada por la Organización Panamericana de la Salud fue quien envió la mayor cantidad de profesionales. Objetivo: Analizar las representaciones sociales de los consejeros de salud sobre el Programa Mais Médicos, en municipios en los que prestaron atención a su población médicos provenientes de Cuba. Métodos: Estudio de caso descriptivo de corte transversal abordado con metodología cualitativa. La muestra fue intencional. Se trabajó con 58 entrevistas semiestructuradas y el análisis fue realizado mediante el software gratuito Iramuteq con la técnica de análisis lexical. Resultados: Se pudo distinguir cuatro grupos de representaciones, sobre el funcionamiento de los consejos municipales de salud, sobre las representaciones del Programa Mais Médicos, sobre las redes de atención y sobre los médicos brasileños y cubanos. El estudio aporta evidencias de la aplicación de un nuevo modelo de atención para los consejeros que objetivaron y anclaron en el concepto de nacionalidad. El modelo cubano incorpora características de humanismo, atributos que no estaban contenidos en las representaciones sobre los médicos locales. Conclusiones: Las representaciones sociales sobre el Programa Mais Médicos aluden a una acción que mejora la calidad de los servicios, no obstante, la literatura sobre atención básica aún deja ver algunos problemas de acceso y tránsito por la red del sistema único de salud(AU)

Introduction: Primary health care in Brazil is considered a priority. In 2013, Mais Médicos Program was created, providing in-service training and expanding the number of doctors in the country. Cuban cooperation, managed by the Pan American Health Organization, sent the largest number of professionals. Objective: Analyze the social representations of health counselors on Mais Médicos Program, in municipalities in which doctors from Cuba cared to their population. Methods: Descriptive cross-sectional case study approached with qualitative methodology. The sample was intentional. It was conducted a work with 58 semi-structured interviews and the analysis was carried out using the free software Iramuteq with the lexical analysis technique. Results: Four groups of representations could be distinguished: on the functioning of the municipal health councils, on the representations of Mais Médicos Program, on the care networks and on Brazilian and Cuban doctors. The study brings evidence of the application of a new model of care for counselors who objectified and anchored in the concept of nationality. The Cuban model incorporates characteristics of humanism, attributes that were not contained in the representations about local doctors. Conclusions: The social representations on Mais Médicos Program allude to an action that improves the quality of services, however, the literature on basic care still shows some problems of access and transit through the network of the health system(AU)

Evaluation of mobile emergency service with the use of mixed method / Avaliação do serviço móvel de urgência com o uso de método misto / Evaluación de la atención móvil de urgencias con el uso del método mixto

This is an evaluative study, with sequential explanatory mixed methods, aimed at evaluating the performance of the Brazilian Mobile Emergency Medical Service (SAMU) in the Grande ABC region, located in the state of São Paulo, Brazil. In the quantitative approach, an analysis of interrupted time series was performed to evaluate the immediate and gradual effects of the SAMU on hospital mortality due to acute myocardial infarction. The qualitative approach was conducted via semi-structured interviews and a thematic analysis was applied for the interpretation of the results, exploring the attitudes and values of the interviewees regarding the performance of SAMU in the Grande ABC region. Interrupted time series analysis showed a -0.04% reduction in the underlying mortality rate since SAMU implementation (95%CI: -0.0816; -0.0162; p-value = 0.0040) and a reduction in the mortality level, -2.89 (95%CI: -4.3293; -1.4623; p-value = 0.0001), both with statistical significance. To improve the robustness of the results, a control region was used, showing a statistically significant difference in the post-intervention result of -0.0639 (95%CI: -0.1060; -0.0219; p-value = 0.0001). The interviews revealed that the SAMU has the potential to intervene in the prognosis of transported cases, however, challenges related to the availability of beds, expansion of telemedicine, and continuous training of professionals for qualified emergency care in the event of a heart attack must be overcome. The results indicate that the studied intervention is part of a set of factors that, together, generate more conditions to achieve a better result.

Estudo avaliativo com uso de métodos mistos na tipologia explanatória sequencial cujo objetivo foi avaliar o desempenho do Serviço de Atendimento Móvel de Urgência (SAMU) na região do Grande ABC, Estado de São Paulo, Brasil. Na abordagem quantitativa, foi realizada análise de séries temporais interrompidas para testar os efeitos imediatos e graduais da intervenção sobre a mortalidade hospitalar por infarto agudo do miocárdio. A abordagem qualitativa foi realizada através de entrevistas semi-estruturadas, e a análise temática foi aplicada para a interpretação dos resultados, explorando as atitudes e valores dos entrevistados em relação ao desempenho do SAMU no Grande ABC. A análise de série temporal interrompida mostrou uma redução de -0,04% na taxa de mortalidade subjacente desde a implementação do SAMU (IC95%: -0,0816; -0,0162; p = 0,0040) e uma redução no nível de mortalidade, de -2,89 (IC95%: -4,3293; -1,4623; p = 0,0001), ambas estatisticamente significativas. Para melhorar a robustez dos resultados, foi utilizada uma região de controle, o que mostrou uma diferença estatisticamente significativa na tendência pós-intervenção de -0,0639 (IC95%: -0,1060; -0,0219; p = 0,0001). De acordo com as entrevistas, o SAMU tem o potencial de intervir no prognóstico dos pacientes transportados; entretanto, em casos de infarto agudo do miocárdio, diversos desafios precisam ser superados, relacionados à disponibilidade de leitos, expansão da telemedicina e capacitação permanente das equipes de atendimento qualificado em emergências. Os resultados indicam que a intervenção faz parte de um conjunto de fatores que, conjuntamente, geram mais condições para alcançar melhores resultados.

Investigación evaluativa, utilizando métodos mixtos explicativos secuenciales, cuyo objetivo fue evaluar el desempeño del Servicio de Atención Móvil de Urgencia (SAMU) en una región de Brasil, denominada Grande ABC, estado de São Paulo, Brasil. En el enfoque cuantitativo, se realizó un análisis de series temporales interrumpidas para comprobar los efectos inmediatos y graduales de la intervención sobre la mortalidad intrahospitalaria por infarto agudo de miocardio. El enfoque cualitativo se llevó a cabo a través de entrevistas semiestructuradas y para la interpretación de los resultados se aplicó un análisis temático, investigando las actitudes y valores de los entrevistados sobre el desempeño del SAMU en la región Grande ABC. Los análisis de series de tiempo interrumpido mostraron una reducción -0,04% en la tasa de mortalidad subyacente desde la implementación del SAMU (IC95%: -0,0816; -0,0162; p = 0,0040) y una reducción en el nivel de mortalidad, -2,89 (IC95%: -4,3293; -1,4623; p = 0,0001), ambos con significación estadística. Con el fin de mejorar la solidez de los resultados, se utilizó un control de región, que mostró una diferencia estadísticamente significativa en la tendencia del resultado post intervención de -0,0639 (IC95%: -0,1060; -0,0219; p = 0,0001). Las entrevistas revelaron que el SAMU tiene el potencial de intervenir en la prognosis de los casos trasportados, sin embargo, deben superarse los desafíos relacionados con la disponibilidad de camas, expansión de la telemedicina y el entrenamiento continuo de profesionales para la asistencia cualificada en emergencias, en caso de un ataque al corazón. Los resultados indican que la intervención estudiada es parte de un conjunto de condiciones que, juntas, generan más condiciones para alcanzar un mejor resultado.

Transiciones migratorias de profesionales de enfermería mexicanos en alemania

RESUMEN Objetivo: Examinar las transiciones migratorias de profesionales de enfermería mexicanos que residen en Alemania. Material y Método: Estudio cualitativo de tipo etnográfico focalizado, guiado por la Teoría de Transiciones; se realizó entre los meses de noviembre de 2020 y mayo de 2021; se utilizó un muestreo por bola de nieve, donde los participantes de la red social Facebook, que aceptaron participar, hicieron referencia a otras personas. Se reclutaron a 11 profesionales de enfermería mexicanos; se realizaron entrevistas por Zoom, audiograbadas con previo consentimiento. La información obtenida fue transcrita en su totalidad y examinada mediante el análisis temático con el apoyo del software QUIRKOS. Resultados: El 63,6% fueron mujeres con una edad promedio de 30,8 años y un tiempo promedio de 1,26 años en Alemania. Las transiciones migratorias se clasificaron en 10 categorías: 1) Condiciones económicas y laborales, 2) Idioma, 3) Proceso de homologación de estudios, 4) Costos, 5) Discriminación, 6) Costumbres y tradiciones, 7) Gastronomía, 8) Clima, 9) Recreación y 10) Seguridad. Conclusiones. Conocer las transiciones migratorias de profesionales de enfermería mexicanos en Alemania permite realizar una serie de recomendaciones a la práctica, las políticas públicas y futuros proyectos de investigación e intervención.

ABSTRACT Objective: To examine the migration transitions of Mexican nursing professionals residing in Germany. Materials and Methods: A focused ethnography guided by the Theory of Transitions was conducted between the months of November 2020 and May 2021; snowball sampling was used, where the participants of the social network Facebook, who agreed to participate, referred to other people. Eleven Mexican nurses living in Germany were recruited; interviews were conducted using the Zoom platform and audio-recorded with prior consent. The information obtained was transcribed verbatim and examined through thematic analysis using the QUIRKOS software. Results: 63.6% of the nurses were women, with an average age of 30.8 years; and an average time of 1.26 years living in Germany. Migration transitions were classified into 10 categories: 1) Economic and labor conditions, 2) Language, 3) Study accreditation process, 4) Costs, 5) Discrimination, 6) Customs and traditions, 7) Gastronomy, 8) Climate, 9) Recreation, and 10) Safety. Conclusions: Understanding the migration transitions of Mexican nurses in Germany allows us to make a series of recommendations for practice, public policies, and future research and intervention projects.

RESUMO Objetivo: Examinar as transições migratórias de profissionais de enfermagem mexicanos que residem na Alemanha. Material e Método: Estudo qualitativo de tipo etnográfico focado, guiado pela Teoria das Transições e realizado entre os meses de novembro de 2020 e maio de 2021. Utilizou-se uma amostragem de bola de neve, na qual os participantes da rede social Facebook, que concordaram em participar, contactaram outras pessoas. Onze profissionais mexicanos residentes na Alemanha foram recrutados; foram realizadas entrevistas usando a plataforma Zoom e gravadas em áudio com consentimento prévio. As informações obtidas foram transcritas textualmente e examinadas por meio de análise temática utilizando o software QUIRKOS. Resultados: 63,6% dos profissionais de enfermagem eram mulheres, com idade média de 30,8 anos; e tempo médio de 1,26 anos vivendo na Alemanha. As transições migratórias foram classificadas em 10 categorias: 1) Condições econômicas e trabalhistas, 2) Idioma, 3) Processo de acreditação de estudos, 4) Custos, 5) Discriminação, 6) Costumes e tradições, 7) Gastronomia, 8) Clima, 9) Lazer, e 10) Segurança. Conclusões: Conhecer as transições migratórias dos profissionais de enfermagem mexicanos na Alemanha permite fazer uma série de recomendações para a prática, as políticas públicas e os futuros projetos de pesquisa e intervenção.