Attitudes towards childcare practices in rural and urban caregivers with high rates of multidimensional poverty

Objective: To analyse the relationship between poverty and attitudes towards childcare practices in rural and urban areas of Colombia. Method: This article presents a cross-sectional correlational study conducted in the department of Atlántico, northern Colombia. Attitudes towards childcare and living conditions were assessed among 1189 caregivers of preschool children. The multidimensional poverty index and the participants' area of origin (urban or rural) were considered. Results: No direct relationship was found between attitudes towards childcare and the multidimensional poverty index. However, it was observed that urban participants from deprived areas had a higher poverty index and less positive attitudes towards childcare, especially regarding cognitive, sleep and health care. There was a moderating effect of area on attitudes towards childcare. Conclusions: The study highlights the influence of poverty and social vulnerability on attitudes towards childcare, particularly in urban areas. These findings underline the importance of considering socio-economic and geographical conditions when addressing childcare practices. It also highlights the need to implement specific strategies to promote positive childcare practices in more vulnerable contexts to improve early childhood development in Colombia.

Objetivo: Analizar la relación entre la pobreza y las actitudes hacia las prácticas de cuidado infantil en áreas rurales y urbanas de Colombia. Método: El presente artículo es un estudio transversal correlacional en el departamento del Atlántico, al norte de Colombia. Se indagó sobre las actitudes hacia el cuidado infantil y las condiciones de vida en 1189 cuidadores de niños en edad preescolar. Se tuvo en cuenta el índice de pobreza multidimensional y el área de procedencia de los participantes (urbana o rural). Resultados: No se encontró una relación directa entre las actitudes hacia el cuidado infantil y el índice de pobreza multidimensional. Sin embargo, se observó que los participantes de áreas urbanas provenientes de zonas vulnerables presentaron un mayor índice de pobreza y mostraron actitudes menos positivas hacia el cuidado infantil, especialmente en el cuidado cognitivo, del sueño y de la salud. Se evidenció un efecto moderador del área sobre las actitudes de cuidado. Conclusiones: El estudio destaca la influencia de la pobreza y la vulnerabilidad social en las actitudes de cuidado infantil, especialmente en áreas urbanas. Estos hallazgos subrayan la importancia de considerar las condiciones socioeconómicas y geográficas al abordar el cuidado infantil. Además, se resalta la necesidad de implementar estrategias específicas para promover prácticas de cuidado positivas en contextos más vulnerables, con el fin de mejorar el desarrollo de la primera infancia en Colombia.

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

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

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

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

"Grupo de hombres" como dispositivo de promoción de la salud: experiencias singulares en prácticas de cuidado / "Group of men" as a health promotion device: singular experiences in care practices / "Grupo de homens" como dispositivo de promoção da saúde: experiências singulares em práticas de cuidado

El "Grupo de Hombres" es un espacio de promoción de la salud desarrollado en una UBS brasileña. El estudio buscó identificar y comprender el contexto de la producción de las prácticas de cuidado y la participación de los hombres-usuarios en el Grupo, a través de la etnografía. Después de sistematizar y analizar los datos empíricos, surgieron dos categorías temáticas: espacio de comunicación (una apertura al "intercambio de experiencias" que no se reducía a la conversación centrada en patologías) y; desarrollo del vínculo (relación entre los usuarios y equipo de salud: proximidad y libertad para manifestarse, señalando las ventajas del vínculo para el cuidado). Los resultados indicaron que la potencia del "Grupo de Hombres" residía en la inversión en procesos de trabajo involucrados con estrategias colectivas de cuidado, 'encuentros' que favorecían la acogida, la escucha cualificada y el vínculo. (AU)

Abstract The "Group of Men" is a health promotion space developed in a Brazilian Basic Health Unity. The study sought to identify and understand the context of the production of care practices and the participation of men-users in the Group, through ethnography. After systematizing and analyzing the empirical data, two thematic categories emerged: communication space (an opening to the 'exchange of experiences' that was not reduced to pathology-focused conversation) and; development of the bond (relationship between users and the health professionals: proximity and freedom to express themselves, pointing out the advantages of the link for men's care). The results indicated that the power of the "Group of Men" resided in the investment in 'health work processes' involved with collective care strategies, 'meetings' that favored reception, qualified listening and bonding. (AU)

Resumo O "Grupo de Homens" é um espaço de promoção da saúde desenvolvido numa UBS brasileira. O estudo buscou identificar e compreender o contexto de produção de práticas de cuidado e de participação dos homens-usuários no Grupo, através da etnografia. Depois de sistematizado e analisado todo material empírico, emergiram duas categorias temáticas: espaço de comunicação (uma abertura à 'troca de experiências' que não se reduzia a conversas sobre patologias específicas) e; desenvolvimento de vínculo (relação entre os usuários e a equipe de saúde: proximidade e liberdade para manifestar-se, sinalizando as vantagens do vínculo para o cuidado desses homens). Os resultados indicaram que a potência do "Grupo de Homens" residia no investimento dos processos de trabalho em saúde articulados a estratégias coletivas de cuidado, 'encontros' que favoreciam o acolhimento, a escuta qualificada e o vínculo. (AU)

Comparison of Pregnancy Outcomes of Booked and Unbooked Patients in the Niger Delta

Background:Sub-Saharan African countries have some of the worst maternal mortality ratios in the world sub-regions. Uncoordinated antenatal care practices and delivery outside health institutions are some of the determinants of thesedeaths experienced in the region. The objective of the study is todetermine some of these erring behavioral antenatal practices that are inimical to good obstetric outcomes and how health care planners can use the results to close thesegaps of maternal mortality and save lives.Method:This study was a cross sectional retrospective study of the women who delivered at The Niger Delta University Teaching Hospital, Okolobiri, between 1 st June,2021 to 1st June, 2022. The study compared the maternal and fetal outcomes between the booked andunbooked patients who delivered during this period. Relevant data to the study were extracted from patients' medicalrecords using a proforma and data collected entered SPSS Version 25 foranalysis.Results:Three hundred and forty-six patients participated in the stud, 72.3 % were booked and 27.7%were unbooked. Place of delivery N = 253, 75.5 % delivered in health facilities and 24.5 in non-Health facilities. Unbooked patients have prolonged labor lasting more than 24 hours, suffered more blood loss during delivery, their babies have more unfavorable one minute Apgar, all compared to outcomes of the booked patientsConclusion:Booked patients have more favorable pregnancy outcomes compared to the unbooked patients. Health care planners and care providers should devote more time and resources to unbooked patients to have favorable pregnancy outcomes

Funcionamiento familiar, prácticas de atención y cuidado en la primera infancia durante la Pandemia Covid -19 en el Municipio de La Paz

El presente artículo describe el funcionamiento familiar y las prácticas de atención y cuidado aplicadas en la primera infancia durante la pandemia Covid -19. La investigación fue realizada tomando en cuenta un enfoque cuantitativo, tipo de estudio descriptivo y diseño transversal no experimental. Conforme a las características de la investigación se aplicó una muestra intencional de tipo no probabilístico, participaron de la investigación 323 madres, 92 padres y 105 cuidadores de familia de niñas y niños de la primera infancia del Municipio de La Paz. Los resultados muestran que las familias con niños y niñas de primera infancia, durante la pandemia han presentado mayores retos para adaptarse, el nivel de funcionamiento familiar fue moderado, sin embargo el manejo de la disciplina y el liderazgo principalmente asumido por los padres, madres y cuidadores han presentado mayores dificultades. Para mantener el equilibrio al interior de la familia conforme a Rodríguez, (1995) citado por Amar et al, 2016, es importante los periodos de cambio y estabilidad, este último componente producto de la pandemia, fue limitado, ocasionando así mayores tiempos de inestabilidad, incertidumbre afectando a los procesos de adaptación al interior de las familias, sumando que la atención a un niño, niña de 0 a 5 años demanda de mayor tiempo y aplicación de prácticas específicas de cuidado. La atención y cuidado durante la primera infancia es crucial para el desarrollo óptimo del niño y la niña, los resultados del estudio revelan que se aplican las prácticas de forma moderada, las que han sido más afectadas son la alimentación y el descanso, las que han sido mejor atendidas son la salud y afectividad. Es destacable mencionar que el cuidado es asumido en su mayoría por las madres y cuidadores, revelando aún que la figura del padre no se involucra en todas las prácticas de cuidado con sus hijos e hijas de la primera infancia, asumir un rol de crianza compartida entre el padre y madre por la pandemia fue afectada. Finalmente indicar que, la pandemia ha influido en diferentes áreas de la vida y son más afectadas las poblaciones más vulnerables como las niñas y niños de primera infancia aumentando las brechas y vulneraciones al ejercicio de sus derechos en educación, salud y protección.

This article describes and analyzes family functioning and the care and attention practices applied in early childhood during the Covid -19 pandemic. The research was carried out taking into account a quantitative approach, a descriptive type of study and a non-experimental cross-sectional design. According to the characteristics of the investigation, a non-probabilistic intentional sample was applied, 323 mothers, 92 fathers and 105 family caregivers of early childhood children from the Municipality of La Paz participated in the investigation. The results show that families with children in early childhood, during the pandemic, have presented greater challenges to adapt, the level of family functioning was moderate, however the management of discipline and leadership mainly assumed by fathers, mothers and caregivers have presented greater difficulties. To maintain balance within the family according to Rodríguez, (1995) cited by Amar et al, 2016, periods of change and stability are important, this last component, product of the pandemic, was limited, thus causing greater times of instability. , uncertainty affecting adaptation processes within families, adding that caring for a child from 0 to 5 years of age demands more time and the application of specific care practices. The attention and care during early childhood is crucial for the optimal development of the boy and the girl, the results of the study reveal that the practices are applied in a moderate way, those that have been most affected are feeding and resting, those that have been better attended are health and affectivity. It is noteworthy to mention that care is assumed mostly by mothers and caregivers, still revealing that the figure of the father is not involved in all care practices with his sons and daughters in early childhood, assuming a shared parenting role between the father and mother by the pandemic was affected. Finally, indicate that the pandemic has influenced different areas of life and the most vulnerable populations such as children in early childhood are more affected, increasing the gaps and violations of the exercise of their rights in education, health and protection.

Este artigo descreve e analisa o funcionamento familiar e as práticas de cuidado e atenção aplicadas na primeira infância durante a pandemia de Covid -19. A pesquisa foi realizada considerando uma abordagem quantitativa, um estudo do tipo descritivo e um desenho transversal não experimental. De acordo com as características da investigação, foi aplicada uma amostra intencional não probabilística, 323 mães, 92 pais e 105 cuidadores familiares de crianças da primeira infância do Município de La Paz participaram da investigação. Os resultados mostram que as famílias com crianças na primeira infância, durante a pandemia, têm apresentado maiores desafios de adaptação, o nível de funcionamento familiar foi moderado, no entanto a gestão da disciplina e liderança assumida principalmente por pais, mães e cuidadores têm apresentado maiores dificuldades. Para manter o equilíbrio dentro da família segundo Rodríguez, (1995) citado por Amar et al, 2016, períodos de mudança e estabilidade são importantes, este último componente, produto da pandemia, foi limitado, causando maiores momentos de instabilidade. , incerteza afetando os processos de adaptação das famílias, acrescentando que cuidar de uma criança de 0 a 5 anos demanda mais tempo e aplicação de práticas de cuidado específicas. A atenção e os cuidados durante a primeira infância são cruciais para o desenvolvimento ideal do menino e da menina, os resultados do estudo revelam que as práticas são aplicadas de forma moderada, as que foram mais afetadas são a alimentação e o descanso, as que têm melhor atendidas são a saúde e a afetividade. Ressalta-se que o cuidado é assumido majoritariamente por mães e cuidadores, revelando ainda que a figura do pai não está envolvida em todas as práticas de cuidado com seus filhos e filhas na primeira infância, assumindo um papel parental compartilhado entre pai e mãe por a pandemia foi afetada. Por fim, indicam que a pandemia influenciou diferentes áreas da vida e as populações mais vulneráveis, como as crianças na primeira infância, são mais afetadas, aumentando as lacunas e violações no exercício de seus direitos em educação, saúde e proteção.

Funcionamiento familiar, prácticas de atención y cuidado en la primera infancia durante la Pandemia Covid -19 en el Municipio de La Paz / Family functioning, attention and care practices in early childhood during the Covid -19 pandemic in the municipality of La Paz / Funcionamento familiar, atenção e práticas de cuidado na primeira infância durante a pandemia de Covid -19 no Municipio de La Paz

El presente artículo describe el funcionamiento familiar y las prácticas de atención y cuidado aplicadas en la primera infancia durante la pandemia Covid -19. La investigación fue realizada tomando en cuenta un enfoque cuantitativo, tipo de estudio descriptivo y diseño transversal no experimental. Conforme a las características de la investigación se aplicó una muestra intencional de tipo no probabilístico, participaron de la investigación 323 madres, 92 padres y 105 cuidadores de familia de niñas y niños de la primera infancia del Municipio de La Paz. Los resultados muestran que las familias con niños y niñas de primera infancia, durante la pandemia han presentado mayores retos para adaptarse, el nivel de funcionamiento familiar fue moderado, sin embargo el manejo de la disciplina y el liderazgo principalmente asumido por los padres, madres y cuidadores han presentado mayores dificultades. Para mantener el equilibrio al interior de la familia conforme a Rodríguez, (1995) citado por Amar et al, 2016, es importante los periodos de cambio y estabilidad, este último componente producto de la pandemia, fue limitado, ocasionando así mayores tiempos de inestabilidad, incertidumbre afectando a los procesos de adaptación al interior de las familias, sumando que la atención a un niño, niña de 0 a 5 años demanda de mayor tiempo y aplicación de prácticas específicas de cuidado. La atención y cuidado durante la primera infancia es crucial para el desarrollo óptimo del niño y la niña, los resultados del estudio revelan que se aplican las prácticas de forma moderada, las que han sido más afectadas son la alimentación y el descanso, las que han sido mejor atendidas son la salud y afectividad. Es destacable mencionar que el cuidado es asumido en su mayoría por las madres y cuidadores, revelando aún que la figura del padre no se involucra en todas las prácticas de cuidado con sus hijos e hijas de la primera infancia, asumir un rol de crianza compartida entre el padre y madre por la pandemia fue afectada. Finalmente indicar que, la pandemia ha influido en diferentes áreas de la vida y son más afectadas las poblaciones más vulnerables como las niñas y niños de primera infancia aumentando las brechas y vulneraciones al ejercicio de sus derechos en educación, salud y protección.

This article describes and analyzes family functioning and the care and attention practices applied in early childhood during the Covid -19 pandemic. The research was carried out taking into account a quantitative approach, a descriptive type of study and a non-experimental cross-sectional design. According to the characteristics of the investigation, a non-probabilistic intentional sample was applied, 323 mothers, 92 fathers and 105 family caregivers of early childhood children from the Municipality of La Paz participated in the investigation. The results show that families with children in early childhood, during the pandemic, have presented greater challenges to adapt, the level of family functioning was moderate, however the management of discipline and leadership mainly assumed by fathers, mothers and caregivers have presented greater difficulties. To maintain balance within the family according to Rodríguez, (1995) cited by Amar et al, 2016, periods of change and stability are important, this last component, product of the pandemic, was limited, thus causing greater times of instability, uncertainty affecting adaptation processes within families, adding that caring for a child from 0 to 5 years of age demands more time and the application of specific care practices. The attention and care during early childhood is crucial for the optimal development of the boy and the girl, the results of the study reveal that the practices are applied in a moderate way, those that have been most affected are feeding and resting, those that have been better attended are health and affectivity. It is noteworthy to mention that care is assumed mostly by mothers and caregivers, still revealing that the figure of the father is not involved in all care practices with his sons and daughters in early childhood, assuming a shared parenting role between the father and mother by the pandemic was affected. Finally, indicate that the pandemic has influenced different areas of life and the most vulnerable populations such as children in early childhood are more affected, increasing the gaps and violations of the exercise of their rights in education, health and protection.

Este artigo descreve e analisa o funcionamento familiar e as práticas de cuidado e atenção aplicadas na primeira infância durante a pandemia de Covid -19. A pesquisa foi realizada considerando uma abordagem quantitativa, um estudo do tipo descritivo e um desenho transversal não experimental. De acordo com as características da investigação, foi aplicada uma amostra intencional não probabilística, 323 mães, 92 pais e 105 cuidadores familiares de crianças da primeira infância do Município de La Paz participaram da investigação. Os resultados mostram que as famílias com crianças na primeira infância, durante a pandemia, têm apresentado maiores desafios de adaptação, o nível de funcionamento familiar foi moderado, no entanto a gestão da disciplina e liderança assumida principalmente por pais, mães e cuidadores têm apresentado maiores dificuldades. Para manter o equilíbrio dentro da família segundo Rodríguez, (1995) citado por Amar et al, 2016, períodos de mudança e estabilidade são importantes, este último componente, produto da pandemia, foi limitado, causando maiores momentos de instabilidade. , incerteza afetando os processos de adaptação das famílias, acrescentando que cuidar de uma criança de 0 a 5 anos demanda mais tempo e aplicação de práticas de cuidado específicas. A atenção e os cuidados durante a primeira infância são cruciais para o desenvolvimento ideal do menino e da menina, os resultados do estudo revelam que as práticas são aplicadas de forma moderada, as que foram mais afetadas são a alimentação e o descanso, as que têm melhor atendidas são a saúde e a afetividade. Ressalta-se que o cuidado é assumido majoritariamente por mães e cuidadores, revelando ainda que a figura do pai não está envolvida em todas as práticas de cuidado com seus filhos e filhas na primeira infância, assumindo um papel parental compartilhado entre pai e mãe por a pandemia foi afetada. Por fim, indicam que a pandemia influenciou diferentes áreas da vida e as populações mais vulneráveis, como as crianças na primeira infância, são mais afetadas, aumentando as lacunas e violações no exercício de seus direitos em educação, saúde e proteção.

Contribuições psicanalíticas na compreensão do cuidado em saúde mental no Brasil: revisão de literatura / Psychoanalytic Contributions to the Understanding of Mental Health Care in Brazil: A Literature Review

Resumo Objetivo. O objetivo foi identificar as contribuições da psicanálise na formulação das práticas de cuidado em saúde mental no Brasil. Método. Utilizou-se o método da revisão integrativa de literatura com metassíntese nas bases de dados PubMed, BVS, LILACS, SciELO, com buscas nos períodos de 2008 a 2018. Resultados. Os resultados indicam que a psicanálise contribuiu com a noção de diagnóstico estrutural, nova perspectiva de cura, trabalho com o delírio e a arte, "prática feita por muitos", construção do caso clínico, clínica ampliada e escuta singular. Conclui-se que a psicanálise faz parte da reestruturação e criação de práticas de cuidado em instituições de saúde mental, no âmbito de dispositivos teóricos e técnicos, para que as especificidades do paciente direcionem o tratamento.

Abstract Objective. The objective is to identify the contributions of psychoanalysis in the formulation of mental health care practices in Brazil. Method. The method of integrative literature review with meta-synthesis was used in the PubMed, BVS, LILACS, SciELO databases, with searches from 2008 to 2018. Results. The results indicate that psychoanalysis contributed to the notion of structural diagnosis, a new perspective of healing, work with delirium and art, "practice made by many" construction of the clinical case, expanded clinic, and unique listening. In conclusion, psychoanalysis is part of the restructuring and creation of care practices in mental health institutions within the scope of theoretical and technical devices, so the patient specificities guide the treatment.

Assessment of Self-Care Practices among Type 2 Diabetes Patients at a Tertiary Care Hospital - A Cross-Sectional Study.

Diabetes mellitus is a category of hyperglycaemic metabolic disorders. It is linked with the failure of the synthesis of sugars, fat, and proteins, contributing to medical complications like thinning, macro-vascular, and neuropathic disorders. This study was planned to assess the self-care practices among type 2 diabetes patients at the tertiary care hospital of Wardha city. MethodsThis cross-sectional study was conducted in a tertiary care rural hospital in Wardha city. Sampling was done by convenient sampling method, and 105 participants were included in this study. Data was collected using a pre-designed and pre-tested questionnaire. ResultsMale were 62 (59.00 %) and females were 43 (41.00 %). Majority was more than 60 years of age (64.70 %). Participants had followed satisfactory self-care practices on diet. Most (61.53 %) of the participants who followed satisfactory self-care practice on exercise, were in the age group of 30 - 60 years. Significant association (p - 0.005) was observed between socio-economic status and self-care practice with regard to foot care. ConclusionsThis study shows that practices of self-care practices related to diabetic Mellitus in patients were relatively good but health functionaries working in the periphery should conduct regular information education and communication activities for better adoption of all the self-care activities of diabetes for all the seven days in a week for the reduction of diabetic complications.

Modelo matemático pra uma coisa que não é matemática: narrativas de médicos/as infectologistas sobre carga viral indetectável e intransmissibilidade do HIV / Mathematical model for something that is not mathematical: narratives of infectologists about undetectable viral load and HIV non-transmissibility

Resumo Este artigo parte de uma discussão internacional sobre a intransmissibilidade do vírus HIV, quando a pessoa soropositiva está em tratamento e com carga viral indetectável. Trata-se de um dos resultados da pesquisa qualitativa sobre sociabilidades de jovens vivendo com HIV, com ênfase nos novos discursos/práticas biomédicos e seu impacto nas relações afetivo-sexuais desses/as jovens. Durante os meses de março a novembro de 2017, houve a interação com pessoas vivendo com HIV/Aids (PVHA), com idade entre 18 e 30 anos, e médicos/as infectologistas de um Serviço de Assistência Especializada em Salvador-BA. Para além das mudanças significativas em relação ao HIV, decorrentes dos avanços atuais das biotecnologias, colocamos em pauta algumas controvérsias em torno da intransmissibilidade do vírus do ponto de vista de quatro médicos/as infectologistas. Realizamos entrevistas abertas e a leitura exploratória das narrativas, identificando temas, questões e atores que se deslocavam nos relatos em torno da condição de indetectável. Discutimos que a carga viral indetectável aparece como um assunto delicado/controverso nos consultórios médicos, atualizando a posição de PVHA como potencialmente perigosas, podendo reincidir em práticas sexuais desprotegidas ou "relaxar" no cuidado consigo e com o outro. São narrativas que suscitam questões éticas fundamentais na relação de cuidado, tais como o direito à informação na perspectiva da saúde como um direito humano.

Abstract This article is based on an international discussion on HIV non-transmissibility when the HIV-positive person is under treatment and has an undetectable viral load. This is one of the results of research on the sociability of young people living with HIV, with emphasis on new biomedical discourses/practices and their impact on the affective-sexual relationships of young people. From March to November of 2017, the researchers interacted with people living with HIV (PLHIV), aged between 18 and 30 years, and infectologists in a Specialized Service in Salvador-BA, Brazil. Beyond significant changes in relation to HIV due to advances in biotechnology, the study focused on some controversies surrounding the non-transmissibility of the virus from the viewpoint of four infectologists. Open interviews and exploratory reading of the narratives were conducted, identifying themes, issues and actors that moved in the reports on the condition of undetectable. The article argues that undetectable viral load appears as a sensitive/controversial subject in medical offices, updating the PLHIV's position as potentially dangerous that may engage in unprotected sexual practices or "relax" in mutual care. Such narratives raise fundamental ethical issues in care relations, such as the right to information from the perspective of health as a human right.

Prácticas de cuidado cultural en gestantes del sector rural del municipio de Combita Boyacá / Cultural care practices in pregnant women in the rural sector of the municipality of Combita Boyacá

INTRODUCCIÓN: Las mujeres en gestación del municipio de Combita que residen en el sector rural representan un grupo poblacional enriquecido con los saberes culturales propios del altiplano Cundiboyacense es por ello que, describir las prácticas de cuidado cultural en un proceso de creación de saberes conjuntos con las gestantes, aporta conocimientos desde y para la disciplina de enfermería, en pro de mejorar la salud materno perinatal. OBJETIVO: Describir las prácticas de cuidado cultural que tienen las mujeres gestantes del sector rural del municipio de Cómbita, Boyacá, que permitan orientar el cuidado desde el primer nivel de atención. MÉTODO: Esta investigación es cualitativa, etnográfica y el método usado fue la etnoenfermería. La muestra está compuesta por diecinueve mujeres gestantes y dos participantes generales. El análisis se hizo con el facilitador de "Guía de fases de análisis de datos de la etnoenfermería" de Leininger. RESULTADOS: Surgieron dos temas: "Significados de la gestación" con cinco patrones, y "Prácticas de cuidado" con diez. CONCLUSIONES: Las mujeres se enfrentan con diferentes barreras para obtener los servicios de salud, dentro de ellas se encuentran los factores económicos, la canalización inadecuada hacia los servicios de salud y el uso de un lenguaje impositivo sobre el cuidado, lo que conlleva a la pérdida de confianza en los profesionales para expresar el cuidado del emic. Es importante promover la actualización y la capacitación de los profesionales de la salud orientados a la empatía para poder progresar hacia la sensibilidad y la conciencia cultural, y de este modo garantizar una mayor calidad en la atención de la salud

INTRODUCTION: The pregnant women of the Combita municipality that reside in the rural area represent a population group enriched with the cultural knowledges typical of the Altiplano Cundiboyacense is therefore that, to describe the practices of cultural care in a process of creation of joint knowledges with the pregnant women, provide understanding since and for the nursing discipline, in support of improve the maternal perinatal health. OBJECTIVE: To describe the cultural care practices that have the pregnant women of the rural area of the Combita municipality, Boyacá, that permit orient the care of the first level of attention. METHOD: This investigation is qualitative, ethnographic, the Ethno nursing was the method used. The sample were nineteen pregnant women and two general participants. The analysis was made with the facilitator "Ethnonursing datums analysis Guide" of Leininger. RESULTS: Arose two themes: "pregnancy meanings" with five patterns and "care practices" with ten. CONCLUSION: The women are dealing with different barriers to get the health services, in these are the economic factors, the unsuitable channeling to the health services and the use of an imposing language over the care, that involves the loss of the confidence on the professionals to express the emic care. Is important to promote the update and the training of the health professionals oriented to empathy to be able to progress to the sensitivity and the cultural conscience, and by this guarantee a biggest quality in the health attention

Infant Mortality and Infant-Care Practices in the Rural Field Practice Area of JNIMS, Manipur: A Cross-Sectional Study

Background: In spite of the weak health care delivery system, the Infant Mortality Rate (IMR) of the state of Manipur as reported in the Sample Registration System Bulletins has been consistently very low (≈11 per 1,000 live births) for the last five years or so. This warranted a study to re-affirm it and also to explore the important reasons of why and how the IMR could be brought down to very low levels. Objectives: The study objectives were to make an estimate of IMR in the Rural Field Practice Area (RFPA) of JN Institute of Medical Sciences, Manipur and also to assess the important infant-care practices starting from before the child is born till infancy. Methods: A community-based cross-sectional study was done in the RFPA of JNIMS during Sept-Oct 2018. Using a pre-tested semi-structured and semi-open interview schedule that had sections on socio-demographic profile, details of infant deaths and infant-care practices starting from ante-natal visits, information were collected from a scientifically calculated sample size of 150 women who had live births in the last one year prior to the study, immaterial of the survival status of the infant. Data collected were analysed and presented by using descriptive statistics. Results: Not even a single infant died in the last one year. Better infant care practices were seen in the study area when compared to the latest NFHS-4 Report for the state of Manipur. Some of these important better practices were pregnant women having ≥ 3 ANC visits (98%), institutional delivery rate (94%), conducting home deliveries by skilled health personnel (22.2%), exclusive breastfeeding rate (77.3%) and proportion of infants aged 6-12 months adequately fed (35%). Conclusion: The estimated IMR in the study area was zero. The better infant-care practices prevailing in the study area might have averted infant deaths.

Prevalence of diarrhoea and child care practices among under-five children in tea gardens of Jorhat district, Assam

Background: Globally diarrhoea remains the second leading cause of mortality among children of below five years age. Objective was to find out the prevalence of diarrhoea and child care practices associated with diarrhoea in under five children of tea garden workers of Jorhat district, Assam. Methods: A community based cross sectional study was conducted among the under five children of selected tea gardens of Jorhat district of Assam, India from July 2017 to June 2018. Results: Prevalence of diarrhoea among the study participants in last 2 weeks was found to be 26.4%. Out of 315 study participants, 24.1% belonged to the age group of 12-24 months, 55.2% were males. Exclusive breast feeding was recorded in 95.9% of the children. Prevalence of diarrhoea was less among exclusively breast fed children 25.5% as compared to not exclusively breastfed 46.1%. Health advice during diarrhea was sought by 97.8% of the respondents. Available records showed almost all of the children 99.3% got vaccinated with measles vaccine and contrary to this majority 64.4% study participants had not received Rota virus vaccination. Conclusions: Diarrhoea is still a significant public health problem among fewer than five children of tea garden workers with low Rota virus vaccine coverage. Our study findings recommends for the awareness building among the tea garden dwellers in regard to hand hygiene, timely initiation of complementary feeding, importance of vaccinating children with Rota virus vaccine as a part of containment programme.

Identidades em transição: Narrativas de mulheres negras sobre cabelos, técnicas de embranquecimento e racismo / Identities in transition: Black women's narratives about hair, whitening techniques and racism / Indentidades en transición: Narrativas de mujeres negras sobre cabellos, técnicas de blanquiamiento y racismo

Neste trabalho, analisamos as narrativas de mulheres negras sobre seus cabelos, nos cuidados e apresentação dos mesmos, que trazem suas experiências e reflexões sobre como essas (trans)formaram suas identidades. As falas analisadas foram recolhidas de blogs e portais de notícias, disponíveis na Internet, em textos dedicados a discutir relações raciais, racismo, estética negra e feminismos negros. Para a análise, tomamos como referencial teórico os trabalhos de autoras/es que discutem questões raciais e processos de produção da identidade. Na análise do material foi possível pensar, a partir dos olhares dessas mulheres, seus processos de subjetivação desde a infância, na relação com as gerações mais velhas e o cuidado estético cotidiano. Em suas narrativas, dialogadas com referências teóricas que discutem processos de produção de identidade, bem como relações étnico-raciais, emergem experiências atravessadas por episódios explícitos e sutis de racismo. Os resultados apontam para a necessidade de uma maior interlocução da Psicologia com referenciais feministas e anti-racistas na teorização de processos de subjetivação de mulheres negras.(AU)

In this work, we analyze the narratives of black women on their hair, selfcare practices and appearence, which bring their experiences and reflections on how these (trans)formed their identities. The speeches analyzed were collected from blogs and news portals, available on the Internet, in texts dedicated to discuss racial relations, racism, black aesthetics and black feminisms. For the analysis, we take as theoretical referent the work of authors that discuss racial issues and processes of identity production. In the analysis of the material it was possible to think, from the perspective of these women, their processes of subjectivation since childhood, the relation with the older generations, and the daily aesthetic selfcare. In their narratives, dialogued with theoretical references that discuss processes of production of identity, as well as ethnic-racial relations, emerge experiences crossed by explicit and subtle episodes of racism. The results point to the need for a greater interlocution of Psychology with feminists and anti-racists references to theorize the processes of subjectivation of black women.(AU)

En este trabajo, analizamos las narrativas de mujeres negras sobre sus cabellos, en los cuidados y presentación de los mismos, que traen sus experiencias y reflexiones sobre cómo estas (trans) formaron sus identidades. Las palabras analizadas fueron recogidas de blogs y portales de noticias, disponibles en Internet, en textos dedicados a discutir relaciones raciales, racismo, estética negra y feminismos negros. Para el análisis, tomamos como referencias teóricas los trabajos de autoras/es que discuten cuestiones raciales y procesos de producción de la identidad. En el análisis del material fue posible pensar, a partir de las miradas de esas mujeres, sus procesos de subjetivación desde la infancia, en la relación con las generaciones más viejas, y el cuidado estético cotidiano. En sus narrativas, dialogadas con referencias teóricas que discuten procesos de producción de identidad, así como relaciones étnico-raciales, emergen experiencias atravesadas por episodios explícitos y sutiles de racismo. Los resultados apuntan a la necesidad de una mayor interlocución de la Psicología con referencias feministas y antirracistas en la teorización de procesos de subjetivación de mujeres negras.(AU)

Self-care practices among known type 2 diabetic patients in Haldwani, India: a community based cross-sectional study

Background: The prevalence of diabetes worldwide is expected to rise to 9.9% by 2045 and with this rising prevalence raises the need for good self-care practices by patients themselves, which play a key role in effective management and prevention of complications.Methods: Present community-based cross-sectional study was conducted among 168 type 2 diabetes mellitus patients by interviewing them using a structured questionnaire assessing their self-care practices using summary of diabetes self-care activities (SDSCA) scale. Different domains were diet, exercise, blood glucose monitoring, medication compliance, foot care and smoking and responses were graded according to number of days in previous week a particular self-care activity of a domain was followed. Data analysis was done with help of SPSS version 21.Results: Mean age of diabetic patients in this study subjects was 54.37±13.24 years. 43.45% respondents have poor self-care practice scores. Bivariate analysis showed that self-care practices were significantly poorer among the diabetic patients less than 60 years of age, residing in rural area, either illiterate or studied till primary/intermediate, had diabetes for less than a year and were taking treatment from public health facilities. Poor self-care practices were insignificantly related with gender, marital status, occupation, monthly family income, type of family, food habits, hypertension as comorbidity, family history, BMI and mode of diagnosis. Multivariate analysis indicates that age, education and duration of diabetes are significant predictors for self-care practices.Conclusions: Self-care practices among diabetic patients were poor among 43.45% patients and there is a need for improving them across all assessed domains.

A study on self-care practices and dietary barriers among type 2 diabetes patients attending outpatient department in Karnataka Institute of Medical Sciences, Hubballi

Background: Diabetes is a chronic, progressive disease characterized by elevated levels of blood glucose and is recognized as an important cause of premature mortality and morbidity. Self-care practice in diabetes patient is a critical factor to achieve glycaemic control thus in preventing or delaying its complications.Methods: A cross sectional study was conducted among 140 type 2 diabetic patients attending the outpatient department in Karnataka Institute of Medical Sciences, Hubballi during the period of June-July 2018. Diabetic patients diagnosed more than 3 months were included. Data was collected by interview method using pre-designed, pre-tested and semi-structured questionnaire which consists of information on socio-demographic data, diabetic profile, self-care practices and dietary barriers. Statistical analysis was done using SSPS package.Results: This study showed that 67.9% of study participants were consuming diabetic diet, 17.1% practice exercise for more than 3 days a week, 93.6% were taking medication regularly, 15% practised foot care for >3times a week and 89.3% monitored their blood glucose regularly. The main barriers for dietary practices were lack of knowledge (24%) and lack of motivation (18%). Compliance to diabetic diet was more among the urban population compared to rural (p=0.025).Conclusions: Study concludes that the practice of self-care activities was poor in almost all aspects except for blood sugar monitoring and adherence to medication which necessitates the need to create awareness regarding self-care practices and its importance among diabetic patients.

Emergence of visceral leishmaniasis in Kollam district, Kerala, southern India

An outbreak investigation was initiated following an unusual occurence of kala azar reported among people residing in the tribal belt of Kulathupuzha area, eastern part of Kollam district, Kerala, Southern India. 2 cases of kala azar were investigated during 2016-2018. Epidemiological analysis indicated no epidemiological link between the cases. However the Visceral leishmaniasis and cutaneous leishmaniasis intruding into newer regions pose a major threat to ongoing leishmaniasis elimination and maintenance programs.

A study to assess the newborn care practices among mothers at a tertiary care hospital in Hyderabad, Telangana

Background: Early neonatal period (<1 week) is the crucial period in the life of an infant as the risk of death is greatest during the first 24- 48 hours after birth. In India, around 61.3% of all infant deaths occur during neonatal period (<28 days) and more than half of these deaths occur during early neonatal period. Most of these deaths can be attributed to harmful newborn care practices in relation to bathing, feeding, cord care etc. The aims and objectives of the study were to assess the newborn care practices among women who delivered in Gandhi Hospital; to assess the relationship between maternal education and newborn care practices among study population.Methods: A cross sectional study was carried out among 200 women who delivered in Gandhi Hospital, Hyderabad, Telangana from March to June 2017 and a predesigned, pre tested questionnaire was used to obtain information.Results: The mean age of study population was 21.5±2.3 years. Around 61.9% of mother’s breastfed within first hour of life and 93.5% fed colostrum. Around 17% were given pre lacteal feeds like cow milk, honey, water etc. No harmful cord care practices like application of cow dung etc. were not followed.Conclusions: Majority of the study population had correct knowledge regarding newborn care practices. Although some of the traditional practices were still observed like giving pre lacteal feeds, discarding colostrum and avoidance of certain foods like pulses, meat, curd etc. by mother.

Cross sectional study on newborn care practices in a rural area

Background: NMR contributes to two-third of infant mortality and proper newborn care is essential for achieving the target of reduction in IMR. The present study was conducted to find the newborn care practices in a rural community and to explore the associated factors.Methods: The present community based cross sectional study was conducted upon children born in the study area within past three months. Mothers were interviewed using pretested proforma.Results: It was seen that 87.3% children were cared by their mothers, rooming-in was universal, 82.1% children were kept warm, early bathing was avoided by 45.8% mothers, 96.2% of children were given vaccine at birth and umbilical stump hygiene was maintained in 61.3% cases.Conclusions: The newborn care practices are far from ideal. Community based interventions can be helpful to improve the same

Estrategias de adaptación y prácticas de cuidado en comunidades desplazadas climáticas: caso colombiano / Estratégias de adaptação e práticas de cuidados em comunidades deslocadas pelo clima: caso colombiano / Adaptation strategies and care practices among climate-displaced communities: colombian case

RESUMEN. El desplazamiento climático puede constituir un desafío para el desarrollo infantil, dado que las estrategias adoptadas por las familias y la comunidad, así como aquellas iniciativas o medidas institucionales para garantizar la supervivencia en este nuevo orden, no siempre se orientan al desarrollo integral de los infantes. Las prácticas de cuidado se ven afectadas por los dramáticos cambios a los que se enfrentan las familias en situación de desplazamiento, traduciéndose en la ruptura o transformación repentina de la cotidianidad. En ese sentido, el proyecto que se presenta, buscó conocer los retos en materia de cuidado infantil tras la ola invernal de 2010-2011, tomando como caso de estudio, las comunidades afectadas en el sur del departamento del Atlántico en Colombia.

RESUMO. As mudanças climáticas podem constituir um agravamento para o desenvolvimento infantil, dado que as estratégias adotadas pelas famílias e comunidade, assim como as iniciativas e medidas institucionais para garantir a sobrevivência nesta nova ordem, nem sempre são adequadas ao desenvolvimento integral das crianças. As práticas de cuidados são afetadas pelas mudanças dramáticas enfrentadas pelas famílias em situações de deslocamento, resultando na quebra repentina ou transformação da vida cotidiana. Neste sentido, o projeto apresentado, procurou conhecer os desafios da assistência à infância após o inverno de 2010-2011, tomando como estudo de caso, as comunidades afetadas no sul do departamento do Atlântico na Colômbia.

ABSTRACT. Climate displacement may be challenging to child development, since strategies adopted by families and communities, as well as those public initiatives and measures in order to ensure survival in this new order, are not always oriented to infants' full development. Care practices are affected by the dramatic changes faced by displaced families, resulting in a sudden rupture or transformation in everyday life. In this regard, the following project seeks to identify the challenges in terms of care after the 2010-2011 rainy season, taking as its point of reference the case of the communities affected in the South of the department of Atlántico in Colombia.

Programa para a Melhoria do Acesso e da Qualidade na Atenção Básica: repercussões nas práticas de cuidado do enfermeiro / Programme d'Amélioration de l'Accès et de la Qualité des Soins Primaires: répercussions pour la pratique des soins infirmiers / The Program for the Improvement of Access and Quality in Primary Care: repercussions for nurse care practice

A Estratégia Saúde da Família (ESF), modelo assistencial prioritário da Atenção Primária à Saúde, vem se expandindo com ampliação gradativa e significativa do número de equipes em todo o Brasil, contexto que contribuiu de modo expressivo para a inserção do enfermeiro nesse campo de atuação. A diversidade e complexidade das práticas de cuidado desenvolvidas pelo enfermeiro da ESF ao longo desses anos instigam à reflexão sobre essas práticas, quais são e como têm sido desenvolvidas. Nessa perspectiva, o Programa para a Melhoria do Acesso e da Qualidade na Atenção Básica (PMAQ-AB), que surge como um movimento do Ministério da Saúde para estimular práticas de monitoramento e avaliação na Atenção Primária à Saúde, apesar de não obter informações específicas da atuação do enfermeiro, pode contribuir para a análise das práticas de cuidado desses profissionais, assim como das suas equipes. Defende-se a tese de que o PMAQ-AB contribui para a reorientação das práticas de cuidado do enfermeiro da ESF. Definiu-se como objetivo geral: Analisar as práticas de cuidado dos enfermeiros da ESF, tendo como base o PMAQ-AB nos municípios de Macaé e Quissamã, no Norte-Fluminense. O estudo teve abordagem qualitativa, com método descritivo-exploratório. A produção de dados foi realizada por meio de entrevista semiestruturada com 19 enfermeiros da ESF dos municípios selecionados. Para análise dos dados, foi utilizada a técnica de análise hermenêutica-dialética. A partir do estudo, constatou-se que o PMAQ-AB contribui para o redirecionamento das equipes quanto às ações necessárias para a melhoria dos padrões referentes ao acesso aos serviços e à qualidade da assistência prestada. Identificou-se que a valorização do registro das práticas de cuidado foi o aspecto de maior mudança. A investigação apontou que as práticas de cuidado dos enfermeiros estão ancoradas nos manuais do Ministério da Saúde, o que sugere a necessidade de problematizá-las no sentido de contribuir para uma ampliação do pensamento crítico do enfermeiro com vistas ao desenvolvimento de práticas capazes de produzir mudanças. Por fim, o que se atesta é que os investimentos voltados à institucionalização de políticas, como o PMAQ-AB, não são suficientes para a garantia da sua concretude, já que a materialização dessas propostas se dá no cotidiano, através das relações, do diálogo e do cumprimento de compromissos. Nesse sentido, o enfermeiro deve se fortalecer enquanto agente social, político, crítico, questionador, capaz de traduzir para a sua prática um cuidado mais empático, amoroso, efetivo, resolutivo e transformador.

The Family Health Strategy - Estratégia Saúde da Família (ESF) -, a primary care model of primary health care, has been expanded with a gradual and significant increase in the number of teams throughout Brazil, a context that has significantly contributed to the inclusion of nurses in this field. The diversity and complexity of the care practices developed by the EFS nurse throughout these years provoke thinking about these practices, what they are and how they have been developed. From this perspective, the Program for the Improvement of Access and Quality in Primary Care - Programa para a Melhoria do Acesso e da Qualidade na Atenção Básica (PMAQ-AB) -, which emerges as a movement of the Ministry of Health to encourage monitoring and evaluation practices in Primary Health Care - Atenção Primária à Saúde -, despite not obtaining specific information about the nurse performance, can contribute to the analysis of these professionals' care practices, as well as their teams. It is defended the thesis that PMAQ-AB contributes to the reorientation of EFS's nurse care practices. The general objective was: To analyze EFS nurses care practices based on the PMAQ-AB in the cities of Macaé and Quissamã, in North Fluminense. The study had a qualitative approach, with a descriptive-exploratory method. The data production was performed through semi-structured interviews with 19 EFS nurses from the selected cities. To analyse the data, was used the hermeneutic-dialectic method. After this study, it was found that the PMAQ-AB contributes to the teams redirection towards the necessary actions to improve standards regarding to the access to services and the quality of the provided care. It was identified that the greater appreciation of the care practices records was the aspect of greatest change. The research pointed out that nurses 'care practices are anchored in the Ministry of Health manuals, which suggests the need to problematize them in order to contribute to the expansion of nurses' critical thinking in order to develop practices capable of producing changes. Lastly, it's attested that investments aimed to the institutionalization of policies such as PMAQ-AB are not sufficient to guarantee their concreteness, since the materialization of these proposals occurs in the daily, through relationships, dialogue, and fulfilling commitments. Therefore, nurses must strengthen themselves as social, political, critical, questioning agents, capable of translating into their practice a more empathic, loving, effective, resolute and transformative care.

La Stratégie de Santé Familiale - Estratégia Saúde da Família (ESF), modèle de soins de santé prioritaires de soins de santé primaires, s'est développée avec une augmentation progressive et significative du nombre d'équipes dans tout le Brésil, un contexte qui a considérablement contribué à l'inclusion d'infirmières dans ce domaine. La diversité et la complexité des pratiques de soins développées par l'infirmière de la ESF au fil des ans incitent à réfléchir à ces pratiques, à leur nature et à la façon dont elles ont été élaborées. Dans cette perspective, le Programme pour l'Amélioration de l'Accès et de la Qualité des soins primaires ­ Melhoria do Acesso e da Qualidade na Atenção Básica (PMAQ-AB) apparaît comme une initiative du ministère de la Santé d'encourager les pratiques de suivi et d'évaluation dans les Soins de Santé Primaires - Atenção Primária à Saúde. Bien qu'il n'obtienne pas d'informations spécifiques sur les performances des infirmières, il peut contribuer à l'analyse des pratiques de soins de ces professionnels, ainsi que de leurs équipes. La thèse selon laquelle le PMAQ-AB contribue à la réorientation des pratiques de soins infirmiers ESF est défendue. L'objectif général était le suivant: Analyser les pratiques de soins des infirmières ESF sur la base du PMAQ-AB dans les municipalités de Macaé et Quissamã, dans le Nord Fluminense. L'étude a eu une approche qualitative, avec une méthode descriptive-exploratoire. La production de données a été réalisée par le biais d'entretiens semi-structurés avec 19 infirmières ESF des municipalités sélectionnées. La technique d'analyse herméneutique-dialectique a été utilisée pour l'analyse des données. Il ressort de l'étude que le PMAQ-AB contribue à la réorientation des équipes en ce qui concerne les actions nécessaires pour améliorer les normes en matière d'accès aux services et à la qualité des soins fournis. Il a été identifié que la plus grande appréciation des pratiques en matière de casier judiciaire constituait l'aspect du plus grand changement. La recherche a montré que les pratiques de soins des infirmières sont ancrées dans les manuels du Ministère de la Santé, ce qui suggère la nécessité de les problématiser afin de contribuer à l'élargissement de la pensée critique des infirmières en vue de développer des pratiques capables de produire des changements. Enfin, ce qui est attesté, c'est que les investissements visant à institutionnaliser des politiques telles que PMAQ-AB ne sont pas suffisants pour garantir leur caractere concret, car la concrétisation de ces propositions se fait au quotidien, à travers les relations, le dialogue et le respect des engagements. En ce sens, l'infirmière doit se renforcer en tant qu'agent social, politique, critique et questionneur, capable de traduire dans sa pratique des soins plus empathiques, affectueux, efficaces, résolus et transformateurs.