Early Identification of Autism Spectrum Disorder (ASD): Strategies for Use in Local Communities

Early diagnosis of autism spectrum disorder (ASD) is essential for improved outcomes. There is a paucity of data on the prevalence of ASD in low- and middle-income countries (LMIC), but early identifcation may be further delayed in those communities. In this paper, recent studies on strategies for the early detection of ASD, and the prevalence of ASD in LMIC are reviewed. The limitations that can arise in the early identifcation of ASD in LMIC communities are discussed, and screening tools and strategies that can be helpful are identifed. The goal is to recommend models that are culturally appropriate and scientifcally valid, easily integrated within community settings while strengthening community systems and reducing disparities in the early identifcation of ASD. Starting locally by simplifying and demystifying the ASD identifcation process and building community connections will inform global researchers and policymakers while making a diference in the lives of the children and families afected by ASD.

Control penal y género. ¡Baracunátana!: una elegía al poder sobre la rebeldía femenina / Penal control and gender: Baracunátana: an elegy to power on female rebellion / Baracunátana!: uma elegia ao poder sobre a rebeldia femenina

Este artículo se centra en la letra de la canción popular titulada "Baracunátana" para describir y analizar la cultura machista en las relaciones de género. La historia narrada en la canción, con su entramado machista, a un nivel microsocial, es el punto de partida de una exploración sobre los conflictos de género. A continuación, el artículo examina las consecuencias macrosociales de la cultura machista y, en especial, su influencia en la violencia de género. Esas problemáticas, micro y macro, son las bases para emprender una revisión crítica de las principales políticas y acciones de control penal desarrolladas para combatir la violencia en las relaciones de género en el sistema jurídico colombiano. Como resultado, se identifican varios nodos críticos que neutralizan e impiden un manejo adecuado de este tipo ascendente de violencia. Esto permite demostrar que las políticas en materia penal han derivado, con preocupante ineficacia, pese al sensacionalismo y la algarabía política que hacen, en un inoficioso populismo penal. En contraposición, el artículo propone dar prioridad al desarrollo de políticas sociales contra el machismo, cuyo objetivo sería afectar las disposiciones de poder, porque el problema de Baracunátana no es de amor, ni de celos, es una cuestión de poder.

This article focuses on the lyrics of the popular song "Baracunátana" to describe and analyze the machista culture in gender relations. The story narrated in the song, with its machista framework, at a micro-social level, is the starting point for an exploration of gender conflicts. The article then examines the macro-social consequences of macho culture and, in particular, its influence on gender violence. These micro and macro issues are the basis for a critical review of the main policies and criminal control actions developed to combat violence in gender relations in the Colombian legal system. As a result, several critical nodes are identified that neutralize and impede an adequate management of this ascending type of violence. This allows demonstrating that criminal policies have derived, with worrying ineffectiveness, despite the sensationalism and political hullabaloo they make, in an ineffective criminal populism. In contrast, the article proposes to give priority to the development of social policies against machismo, whose objective would be to affect the dispositions of power, because the problem of Baracunátana is not one of love or jealousy, it is a question of power.

Este artigo enfoca a letra da canção popular "Baracunátana" para descrever e analisar a cultura machista nas relações de gênero. A história contada na canção, com sua estrutura machista, em nível micro-social, é o ponto de partida para uma exploração dos conflitos de gênero. O artigo examina então as conseqüências macro-sociais da cultura machista e, em particular, sua influência sobre a violência baseada no gênero. Essas questões micro e macro são a base para uma revisão crítica das principais políticas e ações de controle penal desenvolvidas para combater a violência nas relações de gênero no sistema jurídico colombiano. Como resultado, são identificados vários nós críticos que neutralizam e impedem uma gestão adequada deste tipo de violência. Isto torna possível demonstrar que as políticas de justiça criminal se tornaram, com preocupante ineficácia, apesar do sensacionalismo e do alarido político que geram, um populismo criminoso ineficaz. Em contraste, o artigo propõe dar prioridade ao desenvolvimento de políticas sociais contra o machismo, cujo objetivo seria afetar as disposições de poder, pois o problema de Baracunátana não é de amor ou ciúme, é uma questão de poder.

Psiquiatría cultural: más allá del DSM-5 / Cultural psychiatry: beyond DSM-5

RESUMEN Introducción: La psiquiatría cultural evalúa las manifestaciones, los síntomas de sufrimiento emocional o los trastornos mentales en los distintos contextos culturales; asimismo, aborda problemas sociales como la pobreza, la violencia y las desigualdades entre grupos o clases sociales. Objetivo: Presentar una revisión narrativa de los aspectos culturales más relevantes en el contexto de la práctica clínica en psiquiatría y proponer algunas alternativas para mejorar la competencia cultural de los profesionales de la salud. Métodos: Se llevó a cabo una revisión narrativa de los artículos más relevantes en el área. Resultados: Habitualmente se utiliza la perspectiva cultural para explicar diferencias en las prevalencias que se observan en algunos trastornos mentales según el sexo y la localización geográfica. Las diferencias culturales modifican la expresión de distress o sufrimiento emocional, y esto puede reducir la precisión y afectar a la confiabilidad de las clasificaciones y la validez de los diagnósticos actuales usados en psiquiatría. La Asociación Psiquiátrica Americana, en la clasificación más reciente, revisó los trastornos asociados con la cultura pero solo incluyó un reducido número de situaciones. La formación médica y la psiquiatría deben responder a las necesidades de comunidades diversas y proporcionar un cuidado de calidad mediante el desarrollo de competencias transculturales en los currículos. Conclusiones: Se debe considerar que las diferencias culturales modifican la expresión de distress y con ello se menoscaba la validez y la confiabilidad de los diagnósticos hegemónicos en distintos contextos culturales. En un mundo cada vez más globalizado, es posible que futuras clasificaciones diagnósticas omitan los «síndromes culturales¼.

ABSTRACT Background: Cultural psychiatry evaluates manifestations, symptoms of emotional distress and mental disorders in diverse cultural contexts; it also addresses social problems such as poverty, violence, inequalities between groups or social classes. Objective: To present a narrative review of the most relevant cultural aspects in the context of clinical practice in psychiatry and to suggest some alternatives to improve the cultural competence of health care professionals. Method: A narrative review was carried out of the most relevant articles in the area. Results: Usually, the cultural argument is used to explain differences in observed prevalences in some mental disorders according to gender and geographical location. Cultural differences modify the expression of emotional distress and this can reduce the accuracy and affect the reliability and validity of the current diagnostic classification used in psychiatry. The American Psychiatric Association, in the most recent classification, revised cultural syndromes but only included a limited number of situations. Consequently, medical education and psychiatry must respond to diverse populations and provide quality care through the development of trans-cultural competence in the curriculum. Conclusions: It should be considered that cultural differences modify the expression of distress and thereby undermine the validity and reliability for diagnoses in distinct cultural contexts. In an increasingly globalised world, future classifications may completely omit 'cultural syndromes'.

Societal Determinants of Anemia among Women of Reproductive Age and Role of Community Pharmacist for Its Management

Aims:To studysocietal determinants of anemia among women of reproductive age (WRA) and elaborate the role of community pharmacist for its management. Study Design:To investigatethe societal determinants of anemia, a cross-sectional study was conducted in the Muzaffarabad district of AJK, Pakistan.Methodology:We collected the data from 384 women of reproductive age (15-49 years) having at least one child using a self-constructed interview schedule.The population sample size was calculated using Krejcie formula and purposive sampling was used for data collection. Two hospitals, Abbas Institute of Medical Sciences and combined military hospital Muzaffarabad were selected for blood samples to screen the hemoglobin (Hb) level of the respondents and data collection. Univariate analysis was performed to examine the frequency distributions and percentages of cases depending on a single variable at a time. The bivariate analysis was performed usingchi-square test to determine empirical relationship between the anemia severity and socio-cultural risk factors of this ailment. The odd ratios were computed to investigate the odds of occurrence of anemia among respondents. The results were considered statistically significant at significance level ≤ 0.05. Results:The findings revealed that prevalence of mild, moderate and severe anemia are 26.3%, 40.9% and 14.3% respectively among WRA, which showsthat anemia is a significant health problem from public health perspective in the region. Major contributing factors are respondent’s and her husband’s education, age at marriage, number of pregnancies, knowledge about balanced diet and anemia, male preference in food intake and violence.Conclusion:Anemia is a multifactorial problem among WRA in the study population, which can be dealt with using an integrated approach by combating malnutrition, provision of adequate healthcare, quality education and devising strategies for avoiding domestic violence. The community pharmacists can play an effective role to educate people about the selection of iron supplementation for adequate management of anemia among WRA

Association Between Cold Exposure and Asthma: Systematic Review and meta-analysis, 1965-2015 / Asociación entre la exposición al frío y el asma: revisión sistemática y meta-análisis, 1965-2015

ABSTRACT Objectives: To conduct a systematic review and a meta-analysis of observational and experimental studies that explore the relation between asthma and cold exposure. Materials and methods: Systematic review of experimental and observational studies published up to August 2015 in Pubmed, Embase and Lilacs. Two researchers selected studies that measured the occurrence of asthma in individuals exposed to different environmental temperatures. A meta-analysis used RevMan 5.3's random effects model to calculate a summary weighted Odds Ratio with 95% confidence intervals, and a sensitivity analysis identified the influence of each study. Subsequent subgroup analyses identified summary measures by type of cold exposure and study design. Additional analysis measured heterogeneity and risk of bias. Results: We found 86 studies measuring the relation between cold exposure and asthma. We included 11.6% (10/86) of the studies in the meta-analysis and found an association between cold exposure and asthma with all the studies (ORw 2.0 95%CI 1.28-3.14), with the subgroup of experimental studies (ORw 3.8 IC95% 1.70-8.86), and with cold environmental air (ORw 1.59 IC95% 1.10-2.30). The studies had high risk of bias and statistical heterogeneity [I2: 63.1% (27%-81.4%)]. Conclusions: The results support the hypothesis of an association between asthma and cold exposure. This study encourages to explore the concepts proposed by traditional medicine to establish its benefits on prevention and care of respiratory diseases, such as asthma.

RESUMEN Objetivos: Realizar una revisión sistemática y meta-análisis de estudios observacionales y experimentales que exploren la relación entre asma y exposición al frío Materiales y Métodos: Revisión sistemática de estudios experimentales y observacionales publicados hasta agosto de 2015 en Pubmed, Embase y Lilacs. Dos investigadores seleccionaron estudios midiendo la ocurrencia de asma tras la exposición a diferentes temperaturas ambientales. Usando un modelo de efectos aleatorios en RevMan 5.3, un meta-análisis calculó un resumen de Odds Ratio ponderado con intervalos de confianza de 95%. Un análisis de sensibilidad identificó la influencia de cada estudio. Análisis de subgrupo identificaron las medidas de resumen de acuerdo a tipo de exposición al frío y diseño de estudio. Finalmente, medimos heterogeneidad y riesgo de sesgos. Resultados: Encontramos 86 estudios explorando la relación entre la exposición al frío y el asma. Incluimos 11.6% (10/86) de los estudios en el meta-análisis y encontramos una asociación entre la exposición al frío y asma en todos los estudios (ORw 2.0 95%CI 1.28-3.14), en el subgrupo de estudios experimentales (ORw 3.8 IC95% 1.70-8.86), y aire frío ambiental (ORw 1.59 IC95% 1.10-2.30). Los estudios tienen alto riesgo de sesgos y heterogeneidad [I2: 63.1% (27%-81.4%)]. Conclusiones: Los resultados apoyan la hipótesis de una asociación entre asma y exposición al frío. Este estudio invita a explorar los conceptos de la medicina tradicional para la prevención y cuidado de enfermedades respiratorias.

Factores que inciden en la aceptabilidad de la vasectomía / Factors that influence the acceptability of vasectomy

La vasectomía es un procedimiento que genera mínimas complicaciones y ostenta una tasa de éxito del 99 %; además tiene menor costo que la esterilización femenina, por lo cual se debe tener en cuenta el rol que desempeña el hombre en el número de hijos que se proyecta tener. En esta revisión de tema se identificaron los factores que inciden en la aceptabilidad de la vasectomía. Se realizó la búsqueda de la literatura en las bases de datos de PubMed, ProQuest, BioMed Central, ScienceDirect y Clinical Key para el periodo 2008-2017. Se seleccionaron 39 artículos por haber cumplido los criterios de inclusión: (a) publicado entre el 2008 y el 2017, en inglés, español o portugués y b) reportar resultados afines al tema de interés con evidencia de calidad científica durante la aplicación de las listas de chequeo. La sistematización y análisis de la información permitió la construcción de tres categorías temáticas: Entorno cultural, Condiciones sociales y Educación e información. Sobre la temática se evidenció que los factores como las creencias, el entorno sociocultural y la educación e información que tienen los hombres y sus parejas sobre la vasectomía influyen en la decisión de realizarse o no este procedimiento. Un hallazgo novedoso fue que el sexo de la descendencia también incide en esta decisión. Se recomienda una educación masiva para aumentar el acceso y conocimiento de la vasectomía.

Vasectomy is a procedure that generates minimum complications and garners a success rate of 99 %; In addition, it is an inex-pensive procedure in comparison to female sterilization, consequently the role of men should be taken into account when considering family planning. In this review of the topic, the factors that currently affect the acceptability of vasectomy were identified. We searched PubMed, ProQuest, BioMed Central, ScienceDirect and Clinical Key databases for articles published between 2008-2017 in English, Spanish or Portuguese, and included articles that met the inclusion criteria and showed scien-tific quality during the application of checklists. A total of 39 articles were admitted into the topic review. The systematization and analysis of the information allowed the construction of three thematic categories: cultural-environment, social conditions, and education and information. In this review, it is evidenced that factors such as beliefs, socio-cultural environment, and education and information that men and their partners have about vasectomy influences the decision to undergo or avoid this procedure. The sex of the offspring was evidenced as a novel factor because the children's gender influenced the decision. Therefore, mass education to increase the access and knowledge about vasectomy is recommended

Impact of Socio Economic Status and Cultural Factors on the Prevalence of Epilepsy: Study in Kashmir

Introduction: The social and economic problems cuased byepilepsy are offen under appricaiated. The message shouldreach the broadest population of effected individuals, many ofwhom are in low socio economic groups and are at higher riskfor development of epilepsy. Study aimed to asess the impactof socio economic status and cultural factors on the prevalenceof Epilepsy in school going Children (6-16 years) in Kashmir.Material and methods: This was a population based studyconducted in school children. The selection of school wasdone by using PPS Method (Proportionate to PopulationSize) used in cluster surveys. The Pretexed Questionnairewas administered to 60 randomly selected children from eachselected school, the positive responders were examined by theneurologist and psychologistResults: The crude Prevelance of epilepsy in school goingchildren was 3.8/1000 for males which was higher thanfemales 2.77. The Govt schools had higher prevalence3.81/1000 as compared to private schools 2.79/1000 reflectinghigher prevalence in economically weaker section. Childrenfrom lower middle class had highest prevalence 3.56/1000.Conclusion: The prevelance of Epilepsy seems to increasewith socio economic deprivation though the association maybe compounded by other factors. The over all prevelance wascomparable to other studies. However there is significantimprovement about the awareness of epilepsy in Kashmirvalley over the past decades.

Factores culturales y sociales asociados a la lactancia materna exclusiva en San Basilio de Palenque / Cultural and social factors associated with exclusive breastfeeding in San Basilio de Palenque

Estudio analítico transversal, que tuvo por objetivo identificar los factores culturales y sociales asociados a la lactancia materna exclusiva en San Basilio de Palenque. La población estuvo constituida por 195 madres de niños menores de 2 años de la población de San Basilio de Palenque - Bolívar, muestra tipo censo. Los instrumentos utilizados fueron Manual CAP (2014), escala de IIFAS y creencias. Para estimar la asociación entre las variables se utilizó Odd Ratio. En los resultados la prevalencia de lactancia materna exclusiva fue del 50%. Los factores sociales que se asociaron fueron: el ser adolescente OR= 2,47 (IC=1,33- 4,58) y haber recibido apoyo de la familia en la lactancia materna OR= 2,21 (IC=1,12- 4,37). Los factores culturales: haber escuchado hablar de lactancia materna exclusiva OR= 4,31 (IC=1,89- 9,81), estar preparadas para dar de lactar a su bebe OR= 4,48 (IC=1,96- 10,27) y el empezar a trabajar es posible dar de lactar OR= 3,99 (IC=1,74- 9,14). El creer dar seno genera dependencia tiene menor probabilidad de lactar exclusivamente OR= 0,45 (IC=0,22- 0,94).Tener una actitud positiva hacia la lactancia materna se asocia significativamente con el amamantamiento OR=3,068 (IC=1,58-5,955). Se concluyó que la lactancia materna exclusiva en las madres resulto más baja respecto a las recomendaciones globales y nacionales. Los factores culturales mantuvieron mayor influencia en la práctica de lactancia.

Cross-sectional analytical study, which aimed to identify the cultural and social factors associated with exclusive breastfeeding in San Basilio de Palenque. The population was constituted by 195 mothers of children under 2 years old from the population of San Basilio de Palenque - Bolívar, sample type census. The instruments used were the CAP Manual (2014), IIFAS scale and beliefs. Odd Ratio was used to estimate the association between the variables. In the results, the prevalence of exclusive breastfeeding was 50%. The social factors that were associated were: the adolescent being OR = 2, 47 (CI = 1, 33 - 4, 58) and having received support from the family in breastfeeding OR = 2, 21 (CI = 1, 12 - 4, 37). Cultural factors: having heard about exclusive breastfeeding OR = 4, 31 (CI = 1, 89 - 9, 81), be prepared to breastfeed your baby OR = 4, 48 (CI = 1, 96 - 10, 27) and when starting to work it is possible to breastfeed OR = 3, 99 (CI = 1, 74 - 9, 14). Believing giving breast generates dependency is less likely to breastfeed exclusively OR = 0, 45 (CI = 0, 22- 0, 94). Having a positive attitude towards breastfeeding is significantly associated with breastfeeding OR = 3,068 (CI = 1, 58-5,955). It was concluded that exclusive breastfeeding in mothers was lower compared to global and national recommendations. The cultural factors maintained a greater influence in the practice of breastfeeding.

Características socioculturales y de salud asociadas a enfermedad coronaria en mujeres. Estudio caso-control / Socio-cultural and healthcare characteristics associated with coronary artery disease in women. A case-control study / Características socioculturais e de saúde associadas à doença coronariana em mulheres. Estudo caso-controle

Resumen Introducción Las enfermedades cardiovasculares se constituyen un problema de salud pública, dentro de este grupo, la enfermedad coronaria ha mostrado incrementos especialmente en la prevalencia para infarto agudo de miocardio en mujeres de 35-54 años. La organización mundial de la salud propone estudiar el problema desde las diferencias regionales para encontrar soluciones al asunto. Objetivo Analizar la asociación entre características socioculturales y de salud con la enfermedad coronaria en mujeres de Nariño. Materiales y Métodos: Estudio de casos (mujeres con enfermedad coronaria) y controles (mujeres sin enfermedad coronaria) atendidas en instituciones de referencia para el departamento de Nariño. La muestra estuvo conformada por 35 casos y 105 controles por muestreo no probabilístico. Resultados Características como: ser fumadora, hipertensa y vivir en el área urbana mostraron mayor asociación con la enfermedad coronaria: Odd ratios= 21,11; IC 95% 3,97-112,26 y Odd ratios= 9,47; IC 95% 2,87-31,23 respectivamente. Se destaca la proporción de mujeres con enfermedad coronaria que culturalmente se caracterizan por callar su enfermedad para no preocupar. Discusión Ser fumadora e hipertensa se constituyen en determinantes para desarrollar enfermedad coronaria, situaciones que pueden ser inducidas por situaciones familiares, sociales, culturales, ocupacionales que la mujer debe enfrentar. Conclusiones La mujer con enfermedad coronaria se caracterizó por ser fumadora, hipertensa y vivir en el área urbana, lo anterior muestra que es necesario generar estrategias específicas de prevención y control en la mujer.

Abstract Introduction Cardiovascular diseases are a public health problem. In this group, coronary artery disease has shown an increase, in particular, in the prevalence of acute myocardial infarction in 35-54-year-old women. The World Health Organization suggests studying this issue based on regional differences to find solutions. Objective To analyze socio-cultural and healthcare characteristics associated with coronary artery disease in women from Nariño. Materials and Methods: Case study (women with coronary artery disease) and controls (women without coronary artery disease) served in reference institutions of Nariño. The sample was made of 35 cases and 105 controls through non-probability sampling. Results Features such as being a smoker, hypertensive and living in an urban area showed greater association with coronary artery disease: Odd ratios= 21.11; CI 95% 3.97-112.26 and Odd ratios= 9.47; CI 95% 2.87-31.23, accordingly. A proportion of women with coronary artery disease stand out as culturally characterized by keeping their illness a secret not to worry others. Discussion Being a smoker and hypertensive are key factors to develop coronary heart disease; these situations can be induced by family, social, cultural and occupational issues faced by women. Conclusions Women with coronary artery disease were characterized as being smokers, hypertensive and living in an urban area; it is thus necessary to generate specific prevention and control strategies for women.

Resumo Introdução As doenças cardiovasculares são um problema de saúde pública e, dentro desse grupo, a doença coronariana tem apresentado um aumento, principalmente, na prevalência de infarto agudo do miocárdio em mulheres de 35 a 54 anos. A Organização Mundial da Saúde propõe estudar o problema a partir de diferenças regionais para encontrar soluções ao problema. Objetivo Analisar a associação entre características socioculturais e de saúde com doença coronariana em mulheres de Nariño. Materiais e Métodos: Estudo de casos (mulheres com doença coronariana) e controles (mulheres sem doença coronariana) tratadas em instituições de referência no departamento de Nariño. A amostra foi composta por 35 casos e 105 controles por amostragem não probabilística. Resultados Características como: ser fumante, hipertensa e moradora da área urbana apresentaram maior associação com a doença coronariana: razão de possibilidades = 21,11; IC95% 3,97-112,26 e razão de possibilidades = 9,47; IC 95% 2,87-31,23, respectivamente. Destaca-se o número de mulheres com doença coronariana que são culturalmente caracterizadas por silenciarem sua doença para não preocupar. Discussão Ser fumante e hipertensa são fatores determinantes para o desenvolvimento da doença coronariana, situações que podem ser induzidas por situações familiares, sociais, culturais, ocupacionais que a mulher deve enfrentar. Conclusões A mulher com doença coronariana se caracterizou por ser tabagista, hipertensa e por morar em uma área urbana, o exposto anteriormente demonstra que é necessário gerar estratégias específicas de prevenção e de controle nas mulheres.

Desarrollo y validación de escalas para medir el valor que las mujeres dan a la saciedad y a la alimentación: un factor crítico para el tratamiento de la obesidad / Development and validation of scales to measure women's eating and satiation values: a criti- cal factor in the treatment of obesity

La sobrevaloración de la alimentación y de la saciedad en familias que viven en un medio influenciado por la globalización y desarrollo de la industria alimentaria, puede estar teniendo un efecto sinérgico en el desarrollo de la obesidad y sus comorbilidades en países de ingreso medio. El objetivo de este trabajo fue desarrollar y validar escalas para medir el valor otorgado a la alimentación y la saciedad en mujeres. Se desarrolló un instrumento y se aplicó en querétaro, México (n=243), se midieron variables socioeconómicas y de percepción de peso corporal. Se realizó análisis factorial explorato- rio, confirmatorio y ANOVA. Las escalas del valor que las mujeres dan a la alimentación como base del bienestar, a la saciedad y a la alimentación como base del bienestar del hijo, se validaron (α-Cronbach>0.66) y se confirmaron (CFI>0.98;RMSEA<0.05). Los puntajes de valor de la alimentación y de la saciedad se asociaron con un menor nivel socioeconómico y educativo, inseguridad alimentaria en el pasado, menor intención de perder peso y con percepción bajo peso en los hijos. En conclusión, las es- calas para medir el valor de la alimentación y la saciedad tienen validez para ser utilizadas en futuros estudios; su utilización puede contribuir a desarrollar estrategias que consideren la verdadera motivación de la alimentación en los segmentos poblacionales más desfavorecidos(AU)

The overvaluation of eating and satiation in families whose environment has been influenced by globalization and the food industry, could be inducing obesity and its co-morbidities in midd- le income countries. The objective was to develop and validate scales to measure women's eating and satiation values. A measurement instrument was developed and ad- ministered to women from querétaro, Mexico (n=243), it also measured socioeconomic (SE) and body weight per- ception variables. Analyses included exploratory and con- firmatory factorial analyses and ANOVA. The scales that represented the value of feeding as basis of wealth, the va- lue of satiation and the value of feeding a child as the basis of the child's wealth, were validated (Cronbach-α>0.66) and confirmed (CFI >0.98; RMSEA<0.05).The scores were associated with a lower SE status, lower education level, childhood food insecurity, low intention to lose weight and with an underweighted child perception. In conclusion, the scales that measure the value of eating and satiation have the validity to be used in future studies; its utilization can contribute to develop strategies to improve eating behavior of underprivileged population segments, that take into consideration the real motives of eating(AU)

Sistemas de salud móvil integrados: Rol de los factores socioculturales y el enfoque de sistemas sociotécnico / Integrated mobile health systems: Role of socio-cultural factors and the socio-technical systems approach

RESUMEN En este artículo se discute el rol de los factores socioculturales para el fortalecimiento de los sistemas de salud móvil integrados. Se enfatiza la importancia de que toda iniciativa en salud móvil integre el análisis de los factores socioculturales durante el proceso de diseño e implementación de programas e intervenciones de investigación. El enfoque sociocultural y sociotécnico consideran, además, el factor humano, así como los condicionantes del entorno y el contexto, más allá de los recursos tecnológicos del sistema de salud móvil y la infraestructura que lo acoge. Metodologías como estudios observacionales, grupos focales, y entrevistas a profundidad deberían ser incluidas, idealmente, en todo proyecto en salud móvil. Asimismo, se presenta un estudio de caso en la zona norte de Lima (Perú), adaptando la plataforma de investigación participativa basada en la comunidad (CBPR, por sus siglas en inglés) que se fundamenta en el enfoque sociotécnico y evalúa los factores socioculturales con el objetivo de optimizar el proceso de diagnóstico de la tuberculosis utilizando las tecnologías móviles en salud (salud móvil).

ABSTRACT This paper discusses the role of socio-cultural factors in strengthening integrated mobile health systems. Emphasis is placed on the importance that any initiative in mobile health should consider the analysis of socio-cultural factors during the process of the development and implementation of programs and research interventions. The socio-cultural and socio-technical approach also consider the human factor and considers the conditions of the environment and the context beyond the technological resources of the mobile health system and the infrastructure that supports it. Methodologies such as observational studies, focus groups, and in-depth interviews should be included ideally in any mobile health study. We also present a case study in the north area of Lima (Peru), adapting the Community-Based Participatory Research platform that is based on a socio-technical approach and evaluates the socio-cultural approach with the objective to optimize the diagnosis process of tuberculosis using mobile health.

Educación alimentaria: salud y cohesión social / Food education: health and social cohesion

RESUMEN Desde un abordaje teórico-reflexivo, este artículo interconecta los resultados de diversas investigaciones cualitativas con teorías del conflicto social y de la antropología médica, para investigar cómo la alimentación puede ser una herramienta de transformación social, en términos de salud, pero también de diálogo, respeto y convivencia de personas, grupos y comunidades. En este sentido, se presenta una primera aproximación a un nuevo enfoque teórico-metodológico sobre educación alimentaria. En este enfoque, la alimentación incorpora una perspectiva política, sociocultural y participativa que nos acerca a una comprensión innovadora del fenómeno: la alimentación como herramienta de análisis y diagnóstico de realidades socioalimentarias, pero también como instrumento de intervención educativo-sanitaria en la resolución de conflictos y en el fomento de sociedades más saludables en términos globales: nutricionales y también de igualdad y cohesión social.

ABSTRACT Using a theoretical-reflexive approach, this article connects the results of various qualitative studies in social conflict and medical anthropology, in order to investigate how food can be a tool for social transformation in terms of health but also in terms of the dialogue, respect and coexistence among people, groups and communities. In this sense the article presents a first approximation to a new theoretical and methodological approach to food education. In this approach, food adopts a political, sociocultural and participatory perspective that brings us closer to an innovative understanding of the phenomenon of food: not only as an analytic and diagnostic tool, but also as an instrument for health education interventions toward conflict resolution and the promotion of healthier societies overall - nutritionally, but also in terms of equality and social cohesion.

Socio-cultural Factors Affecting the Health of Pregnant and Puerperal Brazilian Women in Japan / 国際保健医療

<p>  In this study, we aimed to clarify the socio-cultural factors affecting the mental and physical health of pregnant and puerperal Brazilian women living in Japan. The study participants were 18 pregnant and puerperal Brazilian women living in two prefectures with large Brazilian populations. A Japanese investigator and a Portuguese interpreter comprised the team, and conducted semi-structured interviews at the participants’ homes. The study period was between 2013 and 2014. The interviews were carried out using the Cultural Determinants of Help Seeking theory. Analytical ethnography was used for data coding and theme extraction.</p><p>  The results revealed that “worry” and “shoulder and back pain” were the most common mental and physical symptoms, followed by “headache,” “irritability and anger,” “insomnia and sleeplessness,” and “anxiety.” The reasons given for these included: “pregnancy and child rearing;” “anxiety about work and income;” “complications of being a foreigner;” and “the absence of someone to depend upon.” Moreover, the following five core categories of socio-cultural factors influencing these causes were extracted: “equal and deeply connected family;” “strength to continue working;” “choosing the right conditions to settle down in;” “low satisfaction with the healthcare system;” and “the blessings of God.” </p><p>  Pregnant and puerperal Brazilian women living in Japan have various mental and physical distress symptoms, and our findings revealed that differences between Brazilian and Japanese patterns of family life and religion were the major influencers on these. These findings must be understood to provide intervention in order to lead pregnant and puerperal Brazilian women to appropriate health behaviors.</p>

Predictores de la satisfacción laboral en la industria automotriz de Ciudad Juárez, México

Introducción. En la literatura el estudio de la satisfacción laboral (SL) ha sido abordado desde múltiples enfoques por lo que se le vincula con variables psicológicas, organizacionales y económicas, entre otras, pero su relación con aspectos ergonómicos no ha sido suficientemente probada, principalmente en el contexto de la industria manufacturera. Objetivo. En este estudio se presenta un modelo predictor de la SL teniendo como variable independiente los factores ergoambientales (FEA), y como variable mediadora, los factores socioculturales (FSC), puesto que estos últimos han estado vinculados a la SL, aunque con distintos grados de intensidad. Materiales y métodos. Un instrumento de medición basado en la teoría es aplicado al personal operativo de ocho empresas maquiladoras del sector automotriz en Ciudad Juárez, México. Se obtiene una muestra de 301 casos y los datos se modelan con ecuaciones estructurales para probar las hipótesis de investigación. Resultados. Los resultados sugieren que los FEA se relacionan de manera positiva y significativa en la SL de los sujetos investigados (coeficiente estandarizado= 0.349, p<.01) y con una mediación parcial de los factores socioculturales (VAF=35.7 %). Conclusiones. El modelo predice razonablemente la SL con un efecto directo de los FEA, e indirecto a través de los FSC (R² = 40 %).

Introduction. In the literature, the study about labor satisfaction (LS) has been approached from several focuses and it has been related to psychological, organizational and economic variables, among others, but its relation to ergonomical aspects has not yet been proved enough, especially in the manufacturing industries. Objective. This paper introduces a predictive LS model having as independent variable the ergo environmental factors (EEF) and, as mediating variable, the socio cultural factors (SCF), as the latter have been related to the LS in different intensity degrees. Materials and methods. A measuring instrument based on the theory is applied to the operational staff in eight maquiladora companies in Ciudad Juarez, Mexico. A sample of 301 cases is obtained and the data are modeled with structural equations in order to demonstrate the research hypotheses. Results. The results obtained suggest that the EEF are positively and significantly related in the LS of the subjects studied (standardized coefficient = 0.349, p<.01) and with a partial mediation of the socio cultural factors (VAF=35.7 %). Conclusions. The model reasonably predicts the LS with a direct effect of the EEG, and with an indirect one of the SCF (R² = 40 %).

Introdução. Na literatura o estudo da satisfação laboral (SL) há sido abordado desde múltiplos enfoques pelo que se lhe vincula com variáveis psicológicas, organizacionais e econômicas, entre outras, mas sua relação com aspectos ergonômicos não há sido suficientemente provada, principalmente no contexto da indústria manufatureira. Objetivo. Neste estudo se apresenta um modelo preditor da SL tendo como variável independente os fatores ergoambientais (FEA), e como variável mediadora, os fatores socioculturais (FSC), posto que estes últimos há estado vinculados à SL, embora com diferentes graus de intensidade. Materiais e métodos. Um instrumento de medição baseado na teoria é aplicado ao pessoal operativo de oito empresas maquiladoras do setor automotriz na Ciudad Juárez, México. Se obtém uma amostra de 301 casos e os dados se modelam com equações estruturais para provar as hipóteses de investigação. Resultados. Os resultados sugerem que os FEA se relacionam de maneira positiva e significativa na SL dos sujeitos investigados (coeficiente padronizado= 0.349, p<.01) e com uma mediação parcial dos fatores socioculturais (VAF=35.7 %). Conclusões. O modelo prediz razoavelmente a SL com um efeito direto dos FEA, e indireto através dos FSC (R² = 40 %).

Factores socioculturales determinantes de los hábitos alimentarios de niños de una escuela- jardín en Perú: / Sociocultural factors determinants of eating habits of kindergarten schoolchildren in Peru:

RESUMEN Con el objetivo de explorar los factores socioculturales que determinan los hábitos alimentarios de niños menores de cinco años de una escuela inicial de Chachapoyas en Perú, realizamos un estudio cualitativo mediante entrevistas semiestructuradas a 18 padres y madres. Los factores determinantes de los hábitos alimenticios fueron: la disponibilidad y facilidad de preparación de los alimentos; horario y trabajo desempeñado por los padres; ingesta de café en niños como práctica común; falta de recursos e incertidumbre económica para la planificación alimenticia, y la falta de conocimientos nutricionales. Asimismo, se identificaron creencias que pueden explicar algunos hábitos alimenticios, como los efectos beneficiosos de la comida en familia, la lactancia materna y otros alimentos, o el papel de la alimentación para el buen desarrollo intelectual y físico de los niños. Los resultados aportan evidencia sobre el modo en que los padres afrontan y entienden la alimentación de sus hijos, determinando, a su vez, la calidad de la misma.

ABSTRACT To examine the sociocultural factors that determine the eating habits of children aged less than 5 years who attend kindergarten school in Chachapoyas in Peru, we carried out a qualitative study by means of semi-structured interviews of 18 fathers and mothers. The key factors related to eating habits were as follows: availability and easiness to prepare foods, schedule and work done by parents, intake of coffee in children as a common practice, lack of resources and economic uncertainty for food planning, and the lack of nutritional knowledge. Similarly, beliefs that might explain some eating habits, such as the beneficial effects of eating food as a family, maternal breastfeeding, and others, or the role of nutrition for the appropriate intellectual and physical development of children were identified. Our results provide evidence about the ways parents tackle and understand their children's nutrition while, in turn, determining its quality.

Harm to others from alcohol: the role of socio-cultural variables / Daño a otros por causa del alcohol: la contribución de las variables socioculturales / Dano a outros causado pelo álcool: o papel das variáveis socioculturais

This paper describes the changes in alcohol research, from a traditional individual focus on individual bodily and mental effects, to a broader focus on harm to others. This shift has coincided with broader sequential definitions of the progression from normal through harmful alcohol dependence, both in the specialized epidemiological and also in the newer classificatory systems (DSM 5 and CIE 11 draft). After presenting updated global, regional and chilean data, an international collaborative Project (Alcohol Harm to Others, ATOH) is described, with the participating institutions: the local study and the chilean components of the research team, the conceptual framework of harm to others (families, children, women; neighbors, friends, co-workers; society at large). Ethical aspects and institutional approval are presented and the principal results outlined: socio-demographic data (with special focus on the role of gender, socio-economic level and religiosity/spirituality). The data is presented for the chilean sample, with examples from other participating countries. The complexity of the link between alcohol harm to others and religious and spiritual factors is studied comparing data from several of the participating countries, and the impact upon vulnerable populations, especially women and children. The discussion reviews some of the confounding and intervening factors that could influence the results. The conclusion about prevention and policy development closes the paper.

Este artículo describe los cambios en investigación sobre el abuso de alcohol, desde un enfoque tradicional sobre los efectos corporales y mentales en el individuo, a un enfoque amplio sobre el daño a otros. Este cambio ha coincidido con definiciones secuenciales más amplias de la progresión desde el estado normal a la dependencia dañina al alcohol, ambas en la especialidad de la epidemiología y también en los nuevos sistemas de clasificación (DSM 5 y propuesta de CIE 11). Después de presentar datos actualizados globales, regionales y chilenos, se describe un proyecto internacional colaborativo (Daño a Otros por Causa del Alcohol, ATOH) con las instituciones participantes: el estudio local y los componentes chilenos del equipo de investigación, la estructura conceptual de daño a otros (familias, niños, mujeres; vecinos, amigos, compañeros de trabajo; la sociedad en general). Se presenta la aprobación institucional y aspectos éticos, así como se delinean los principales resultados: datos sociodemográficos (con enfoque especial en el rol de género, nivel socioeconómico y espiritualidad/religiosidad). Se presentan los datos de la muestra chilena, con ejemplos de otros países participantes. Se estudia la complejidad del vínculo entre el daño por alcohol a otros y factores religiosos y espirituales, comparando datos de varios de los países participantes, y el impacto sobre poblaciones vulnerables, especialmente mujeres y niños. La discusión revisa algunos de los factores de confusión y de intervención que podrían influenciar los resultados. Se cierra el artículo con conclusiones sobre prevención y desarrollo de normativas.

Este artigo descreve as alterações na pesquisa do álcool, a partir de um foco individual tradicional sobre os efeitos orgânicos e mentais individuais, para um foco mais amplo sobre danos a outros. Essa mudança coincidiu com mais amplas definições sequenciais da progressão do normal através de dependência de álcool prejudiciais, tanto na epidemiologia especializada como nos sistemas classificatórios mais recentes (DSM 5 e CIE 11 minuta). Depois de apresentar dados atualizados globais, regionais e chileno, um projeto internacional colaborativo (Alcohol Harm to Others, ATOH) é descrito, com as instituições participantes: o estudo local e os componentes chilenos da equipe de pesquisa, o quadro conceitual do dano a outrem ( famílias, crianças, mulheres, vizinhos, amigos, colegas de trabalho, e sociedade em geral). Aspectos éticos e aprovação institucional são apresentados e os principais resultados delineados: dados sócio-demográficos (com especial destaque para o papel do sexo, nível socioeconômico e espiritualidade / religiosidade). Os dados são apresentados para a amostra chilena, com exemplos de outros países participantes. A complexidade da relação entre efeitos nocivos do álcool para os outros e fatores religiosos e espirituais é estudada comparando os dados de vários dos países participantes, bem como o impacto sobre populações vulneráveis, especialmente mulheres e crianças. A discussão revê alguns dos fatores de confusão e intervenientes que poderiam influenciar os resultados. A conclusão sobre a prevenção e desenvolvimento de políticas define o papel.

Parir e nascer num novo tempo: o cuidado utilizado no puerpério pela Equipe Hanami / Give birth and be born in new times: care provided in the puerperium by the Hanami Team / Parir y nacer un nuevo tiempo: el cuidado que se ponga en el período posparto por el equipo de Hanami

O objetivo deste estudo é analisar a percepção do casal sobre o processo de cuidar da Equipe Hanami no parto domiciliar planejado no puerpério. Trata-se de uma pesquisa convergente-assistencial, qualitativa, realizada com 30 casais. Os dados foram coletados durante a observação participante e a entrevista semiestruturada. A análise compreendeu as etapas do processo de apreensão, síntese, teorização e transferência, embasadas na Teoria da Diversidade e Universalidade do Cuidado Cultural e nos Modelos de Atenção ao Parto. Dos resultados emergiram: uma categoria central – as percepções dos casais assistidos pela Equipe Hanami sobre o processo de cuidar no puerpério – e três subcategorias. Com isso, concluiu-se que os casais querem acolher o recém-nascido na chegada ao novo mundo, participando de todo cuidado prestado por saberem da importância para formação do vínculo afetivo familiar. O casal percebe e valoriza a competência cultural da enfermeira obstetra nos cuidados com a amamentação e participação nos rituais de cuidado com a placenta. As práticas de cuidados no puerpério se respaldam em construções culturais e no cuidado holístico.

The objective of this study is to analyze the couple's perception about the process of taking care of the Hanami Team in the planned puerperal home birth. It is a convergent-assistance, qualitative research carried out with 30 couples. Data were collected during the participant observation and the semi-structured interview. The analysis included the stages of the process of apprehension, synthesis, theorization and transfer, based on the Theory of Diversity and Universality of Cultural Care and Models of Attention to Childbirth. From the results emerged: a central category - the perceptions of couples assisted by the Hanami Team on the caregiving process in the puerperium - and three subcategories. With this, it was concluded that couples want to welcome the newborn upon arrival in the new world, participating in all the care provided for knowing the importance of forming the family affective bond. The couple perceives and values ​​the cultural competence of the obstetrician nurse in the care of breastfeeding and participation in the placenta care rituals. The practices of care in the puerperium are based on cultural constructions and holistic care.

El objetivo de este estudio es analizar la percepción de la pareja en el proceso del equipo que cuida Hanami en posparto planificada parto en casa. Este es un convergente asistencial, la investigación cualitativa realizada con 30 parejas. Se recogieron datos durante la observación participante y la entrevista semi-estructurada. El análisis incluyó los pasos del proceso de incautación, la síntesis, teorización y transferencia, con base en la teoría de la diversidad y la universalidad de la atención cultural y atención a los modelos de entrega. Los resultados se destaca: una categoría central - la percepción de las parejas asistidas por el equipo de Hanami en el proceso de atención en el período post-parto - y tres subcategorías. Por lo tanto, se concluyó que las parejas quieren dar la bienvenida al recién nacido a la llegada al Nuevo Mundo, participando en todo cuidado dado por conocer la importancia de la formación de la unión familiar. La pareja se da cuenta y valora la competencia cultural de la partera en el cuidado de la lactancia materna y la participación en el ritual de cuidado con la placenta. Las prácticas de atención en el período post-parto si son compatibles con los edificios culturales y atención integral.

Analysis Testing of Sociocultural Factors Influence on Human Reliability within Sociotechnical Systems: The Algerian Oil Companies

BACKGROUND: The influence of sociocultural factors on human reliability within an open sociotechnical systems is highlighted. The design of such systems is enhanced by experience feedback. METHODS: The study was focused on a survey related to the observation of working cases, and by processing of incident/accident statistics and semistructured interviews in the qualitative part. In order to consolidate the study approach, we considered a schedule for the purpose of standard statistical measurements. We tried to be unbiased by supporting an exhaustive list of all worker categories including age, sex, educational level, prescribed task, accountability level, etc. The survey was reinforced by a schedule distributed to 300 workers belonging to two oil companies. This schedule comprises 30 items related to six main factors that influence human reliability. RESULTS: Qualitative observations and schedule data processing had shown that the sociocultural factors can negatively and positively influence operator behaviors. CONCLUSION: The explored sociocultural factors influence the human reliability both in qualitative and quantitative manners. The proposed model shows how reliability can be enhanced by some measures such as experience feedback based on, for example, safety improvements, training, and information. With that is added the continuous systems improvements to improve sociocultural reality and to reduce negative behaviors.

Prevención del abuso sexual en una comunidad maya de Yucatán, México: relevancia de las características socioculturales (2014) / Prevention of sexual abuse within a Maya community in Yucatan, Mexico: Relevance of their sociocultural features (2014) / Prevenção do abuso sexual em uma comunidade maia de Yucatan, México: relevância das características socioculturais (2014)

Se presenta parte de un proyecto que consistió en realizar estrategias de prevención de abuso sexual con niños y niñas, a través de medios psicoeducativos acordes con el contexto sociocultural en el que se desenvuelven, con la finalidad de fortalecer sus recursos y mecanismos de autoprotección. El grupo participante estuvo compuesto por 623 niños y niñas entre seis y nueve años, residentes de una comunidad maya. Se realizaron estrategias de acuerdo con ejes de acción pertinentes en materia de prevención y las particularidades de la comunidad, tomando en cuenta la etapa de desarrollo de los participantes. Se encontró que los niños y niñas reconocen factores de riesgo y protección, y de igual forma, las personas a quienes ellos acuden para pedir ayuda se encuentran en su núcleo familiar; también se evidenció la influencia del contexto sociocultural en las respuestas ante las actividades llevadas a cabo. Se concluye que es importante involucrar en las estrategias preventivas a figuras presentes en la cotidianidad de los niños y niñas; se constata la importancia de la educación sexual, así como trabajar con estrategias específicas y acordes con la etapa de desarrollo de los participantes y las características socioculturales de cada comunidad en donde se lleve a cabo un proyecto social.

Part of a project consisting of implementing sexual abuse prevention strategies with boys and girls is presented through psycho-educational means in harmony with the socio-cultural context in which they grow and develop themselves, with an aim to strengthening their self-protection resources and mechanisms. The participant group consisted of 623 children of both genders between the ages of six and nine years residing in a Maya community. Strategies according to relevant main lines of activity ('axes of action') in the field of prevention and the community's peculiarities, taking into account the development stage of the participants. It was found that both. boys and girls are aware of the risk and protection factors and, likewise, they recognize those family unit individuals in their so-called 'nuclear family' they usually turn to for help. Also the influence of the socio-cultural context was evidenced in their responses to the activities carried out. It has been concluded that involving figures present in the everydayness of boys and girls is worth, as well as the importance of sexual education and working with specific strategies according to the children's developmental stage and the sociocultural features of each one of the communities where a social project is taking place.

Apresenta-se parte de um projeto que consistiu em fazer estratégias da prevenção do abuso sexual com meninas e meninos, através dos meios psicoeducativos acordes com o contexto sociocultural em que se desenvolvem, a fim de fortalecer seus recursos e mecanismos da autoproteção. O grupo participante foi composto por 623 meninos e meninas entre seis e nove anos, residentes de uma comunidade maia. Realizaram-se estratégias de acordo com os eixos de ação em matéria da prevenção e os particularidades da comunidade, levando em conta a etapa do desenvolvimento dos participantes. Descobrimos que os meninos e as meninas reconhecem fatores de risco e da proteção e, do mesmo modo, eles acudem as pessoas da sua família nuclear para pedir ajuda; também evidenciou-se a influência do contexto sociocultural nas respostas perante as atividades realizadas. Conclui-se que é importante envolver nas estratégias preventivas as figuras presentes na cotidianidade dos meninos e as meninas; a importância da educação sexual é constatada, assim como trabalhar com estratégias específicas e acordes com a etapa do desenvolvimento dos participantes e das características socioculturais de cada comunidade onde um projeto social é realizado.

Socioeconomic and cultural factors associated with mortality in Malaria induced anaemia among under-five children in Benin city, Nigeria.

Background: Children under the age of five years bear the brunt of malaria infection. Malaria induced anaemia (MIA) is the most prevalent presentation of malaria and a major cause of morbidity and mortality in Nigeria. Objective: To determine the socioeconomic and cultural factors associated with mortality in under-five children presenting with malaria induced anaemia. Methods: This is a cross-sectional descriptive study conducted at the Children Emergency Room of the University of Benin Teaching Hospital, Benin City, Nigeria. Questionnaires which were researcher-administered were used to collect information on the child’s age, gender, parents’ or caregiver’s education, occupation, recognition of symptoms of malaria and anaemia, cultural practices during child’s illness and patients’ outcome. Results: The case fatality rate was 3.1%. Poor parental education, low social class and lack of skilled job amongst the parents were associated with high mortality. Other factors associated with mortality include high patronage of chemists and prayer houses as well as poor recognition of pallor by mothers. Conclusion/Recommendations: Improvement in socioeconomic status especially female education and empowerment is again emphasized. This and other socioeconomic boost should be targeted alongside malaria-control programmes in order to reduce mortality associated with malaria induced anaemia. Parental enlightenment on recognition of symptoms of malaria and anaemia will improve their health-seeking behaviour, promote early diagnosis and prompt institution of effective antimalarial therapy.