Family care prior to the admission of the elderly in a nursing home and continuity in family care: A comparative study of Colombia and Spain.

This study examined the background before admission to a nursing home and the conditions for the continuity of care, of the relatives of older adults of Colombia and Spain. The study sample comprised 546 participants: 278 and 268 from Colombia and Spain, respectively. Structured interviews were conducted with the older adults' relatives. Sociodemographic similarities predominated, although in the Colombian sample there were significantly more unrelated people. Similarities in previous and current care conditions also predominated too. Cluster 1 included all the cases of Colombian low-resource nursing homes, and Cluster 2 included all the relatives of Colombian high-resource nursing homes and all the Spanish centers. The type of nursing home was the variable more important to identify the abovementioned clusters. Conclusions: Family members from Colombia and Spain continue to care for the elderly admitted to geriatric homes. The type of geriatric center is what establishes the differences in the users.

Percepciones del personal sanitario sobre el manejo familiar del aislamiento social infantil durante la COVID-19 / Perceptions of Health Personnel on Family Management of Children's Social Isolation during COVID-19

Introducción: La propagación del nuevo coronavirus responsable de la COVID-19, amenaza la vida de millones de infantes, por lo cual, en la mayoría de los países, los niños han sido confinados en sus casas, lo que favorece de manera proporcional su protección. En sentido general, la familia no ha mostrado preparación para manejar con calidad la convivencia permanente de los niños en casa y se manifiestan violaciones del aislamiento físico de los menores. Objetivo: Analizar las percepciones del personal de salud sobre el cuidado y protección familiar de los niños a través del aislamiento social. Métodos: Se realizó un estudio de tipo exploratorio bajo un diseño transversal descriptivo, en el Consejo Popular 26 de Julio del municipio Holguín en el periodo comprendido entre diciembre de 2020 y mayo de 2021. Se aplicó una encuesta al personal sanitario (n = 17) asociado a las pesquisas en dicha área de salud. Resultados: Se identificaron fortalezas y debilidades en la atención médica a las familias con niños en la zona estudiada. El 100 por ciento de los participantes identificaron las pesquisas como una excelente herramienta para la promoción del cumplimiento del aislamiento de los pequeños. Según el criterio del 96,1 por ciento de los encuestados ocurrieron violaciones en el distanciamiento físico infantil en el área de salud seleccionada. Conclusiones: La familia tiene un rol primordial en el cumplimiento del confinamiento de los pequeños, a la vez, tiene la responsabilidad de lograr calidad en este proceso. No obstante, se evidencia la violación del distanciamiento infantil como resultado de la indisciplina familiar, que incrementa la vulnerabilidad de la infancia(AU)

Introduction: The spread of the new coronavirus responsible for COVID-19 threatens the lives of millions of infants, for which, in most countries, children have been confined to their homes, which proportionally favors their protection. In general terms, the family has not shown preparation to handle with quality the permanent coexistence of the children at home and there are violations of the physical isolation of the minors. Objective: To analyze the perceptions of health personnel about the family care and protection of children through social isolation. Methods: An exploratory study was carried out under a descriptive cross-sectional design, in 26 de Julio People´s Council in Holguín municipality from December 2020 to May 2021. A survey was applied to health personnel (n = 17) associated with the investigations in said health area. Results: Strengths and weaknesses in medical care for families with children in the studied area were identified. One hundred percent of the participants identified the studies as an excellent tool for promoting compliance with the isolation of children. According to the criteria of 96.1percent of the respondents, violations of children's physical distancing occurred in the selected health area. Conclusions: The family has a fundamental role in the fulfillment of the isolation of the children and, at the same time, it is committed to achieving quality in this process. However, the violation of childhood distancing is evident as a result of family indiscipline, which increases the vulnerability of childhood(AU)

Care among siblings and repercussions of generational transmission on the sibling group / Cuidado entre irmãos e repercussões da transmissão geracional na fratria / Cuidado entre hermanos y repercusiones de la transmisión generacional en la fratría

This research is part of a broader study concerning siblings and the family network. Its objective was to investigate care among siblings and the repercussions of generational transmission on the sibling group. It employed clinical-qualitative methodology, centered on preliminary clinical interviews with families during the family assessment period. Clinical data were gathered at the Applied Psychology Service of a private university in Rio de Janeiro. The 14 families who took part in the study had the following configurations: four married-couple families, four stepfamilies, three single-parent families and three separated-parent families. We observed that both reduced parental investment and excessive family-care workload made it difficult to establish a more health-promoting parent-child relationship, often leading to the parentification of one or more of the children, with the assignment of parental functions to them. Flaws in the psychic assimilation of elements of generational transmission also influence in the creation of sibling bonds, inhibiting the development of family ties of solidarity and the establishment of healthy care practices among siblings.

Este estudo faz parte de uma pesquisa mais ampla sobre fratrias e rede familiar. Teve-se como objetivo investigar o cuidado entre irmãos e repercussões da transmissão geracional na fratria. Utilizou-se metodologia clínico-qualitativa, centrada em entrevistas clínicas preliminares com famílias no período de avaliação familiar. Os dados clínicos foram coletados no Serviço de Psicologia Aplicada de uma universidade privada carioca. Participaram da pesquisa 14 famílias, com as seguintes configurações: quatro casadas, quatro recasadas, três monoparentais e três separadas. Constatou-se que tanto o reduzido investimento parental quanto a sobrecarga nos cuidados familiares dificultam o estabelecimento de uma relação parento-filial mais promotora de saúde, muitas vezes levando à parentalização de um ou mais filhos, com atribuição de funções parentais a eles. Falhas na apropriação psíquica de elementos da transmissão geracional também repercutem na constituição do vínculo fraterno, dificultando a construção de laços familiares solidários e o estabelecimento de práticas salutares de cuidado entre os irmãos.

Este estudio es parte de una investigación más amplia sobre fratrías y redes familiares. El objetivo fue investigar el cuidado entre hermanos y las repercusiones de la transmisión generacional en la fratría. Se utilizó metodología clínico-cualitativa, centrada en entrevistas clínicas preliminares a las familias durante el período de evaluación familiar. Los datos clínicos se recolectaron en el Servicio de Psicología Aplicada de una universidad privada en Rio de Janeiro. Catorce familias participaron en la investigación, con las siguientes configuraciones: cuatro casadas, cuatro vueltas a casar, tres monoparentales y tres separados. Se encontró que tanto la menor inversión de los padres como la sobrecarga por los cuidados con la familia dificultan el establecimiento de una relación entre padres e hijos que promueva la salud, lo que a menudo conduce a la crianza de uno o más hijos con atribución de las funciones parentales a ellos. Las fallas en la apropiación psíquica de elementos de transmisión generacional también inciden en la constitución de un vínculo fraterno, dificultando la construcción de lazos familiares solidarios y el establecimiento de prácticas de cuidado saludable entre los hermanos.

The significance of overlooked objects: Materiality and care at home for people with dementia.

An increase in the number of older people with dementia is currently a trend around the world. In low and middle countries, effective public health services are not yet well-developed, and family care-givers may be overwhelmed by the requirements of care. This paper has two purposes: to share findings from an ethnographic study about family dementia care practices in Brazil and to draw attention to the significance of the materiality of care practices in the family context. The study was conducted in Belo Horizonte, Brazil. We describe the care trajectory of one family and, analysing data using the insights of Actor Network Theory, show the significance of objects in a networked relation of care. In particular, we show how incontinence products such as adult diapers assume different positions in the network, acting as either mediator or intermediary of care in relation to other elements of the network composed of family members and their living situation, the person with dementia herself, the doctor, and Brazilian health policies. Although the diaper is often seen as an ordinary object for care providers, its participation in a care network shapes relations, activating conflict, financial constraint, and disciplining the body of the person with dementia.

Prevalence and factors associated with suicidal ideation among family caregivers of people with mental disorders.

AIMS AND OBJECTIVES: This study aimed to analyse the prevalence and factors associated with suicidal ideation among family caregivers of people with mental disorders. BACKGROUND: Studies conducted with family caregivers of people with dementia and cancer point out a high prevalence of suicidal ideation among these subjects; however, this aspect has not yet been investigated among family caregivers of people with mental disorders. DESIGN: This is a cross-sectional study, conducted with 537 family caregivers of patients from 16 Psychosocial Care Centers (CAPS) of the 21st Health Region of the state of Rio Grande do Sul, Brazil. METHODS: Question 17 of the Self-Reporting Questionnaire (SRQ-20) was used for suicidal ideation screening. The prevalence of suicidal ideation was calculated according to sociodemographic and care variables, with confidence interval estimate (95% CI). Crude and adjusted odds ratios were calculated by logistic regression. The Guidelines to Reporting of Observational Studies in Epidemiology (STROBE Statement) was adhered in this study (See File S1). RESULTS: The prevalence of suicidal ideation found in this study for the 30 days preceding the interview was 12.5% (95% CI: 10-15). The factors associated with the outcome were lower age, lower schooling, feeling of burden, self-report of stress problem and dissatisfaction with family relationships. CONCLUSION: The prevalence of suicidal ideation among the studied family caregivers was high and strongly associated with issues regarding care, showing the need for interventions that provide support. RELEVANCE FOR CLINICAL PRACTICE: Nurses are a large part of the workforce of the community mental health services. The careful characterisation of the subjects who show suicidal ideation, as performed in this study, may reveal specificities capable of refining the diagnostic potential for establishment of action plans in a timely manner, avoiding possible attempts or even the consummation of suicide.

Quedas da pessoa idosa ­ Repercussão para o cuidar no ambiente familiar-domiciliar / Falls in the elderly: The impact of family-care in the household environment / Caídas en el anciano: Repercusiones del cuidado en el ambiente familiar-domiciliario

Objetiva-se, neste estudo, conhecer como a família se reorganiza para o processo de cuidar e viver com o ente parental, pessoa idosa, em estado de fragilidade por queda no ambiente domiciliar; e, verificar o grau de conhecimento da família sobre o processo de cuidar da pessoa idosa fragilizada por quedas. Como método: pesquisa de perspectiva crítico-interpretativo, no enlace da pesquisa-ação, realizada entre set./2013 e abr./2014. Os participantes foram três idosos e três cuidadores familiares. Como resultados, acena-se para o olhar atencioso às atividades instrumentais da vida diária pós-queda da dinâmica familiar, no que concerne à remodelação dos modos de vida para vencer o medo de um novo episódio de queda, e ao cuidado da família em sua globalidade para evitar desvio de saúde. Conclui-se que medidas promotoras para um envelhecer saudável e mais seguro sejam de compartilhamento sociocultural à qualidade de saúde e vida das pessoas.

Objective: to know how the family is reorganized for the process of caring for and living with an elderly in a state of fragility by fall in the household environment; and to verify the degree of knowledge of the family on the process of caring for the dependent elderly from falls. Methods: A critical interpretive research in the field of action research, conducted between September/2013 to April/2014. The participants were three old and three-family caregivers. The Results induced to the watchful eye of the instrumental activities of daily living post-collapse of family dynamics, which refers to the remodeling of lifestyles to overcome the fear of a new episode of falling and caring for the family as a whole, in order to prevent the deviation of health. We conclude that measures promoting a safety and healthy aging must be shared, in order to improve the quality of health and life of people.

Objetivo: conocer como la familia se reorganiza para el proceso de cuidar y vivir con un anciano en estado de fragilidad por caída en el ambiente domiciliario; y verificar el grado de conocimiento de la familia sobre el proceso de cuidar del anciano fragilizado por caídas. Métodos: Investigación crítico-interpretativa, en el ámbito de la investigación-acción, realizada entre septiembre/2013-abril/2014. Los participantes fueron tres ancianos y tres cuidadores-familiares. Los Resultados inducen para la mirada atenta a las actividades instrumentales de la vida diaria post-caída de la dinámica familiar, en lo que se refiere a la remodelación de los modos de vida para vencer el miedo de un nuevo episodio de caída y al cuidado de la familia en su globalidad para evitar el desvío de la salud. Se concluye que medidas promotoras para un envejecimiento saludable y seguro sean compartidas para mejorar la calidad de salud y de vida de las personas.

Explanatory models and openness about dementia in migrant communities: A qualitative study among female family carers.

Background The prevalence of dementia is increasing among people with a Turkish, Moroccan and Surinamese-Creole background. Because informal care is very important in these communities, it is pertinent to see what explanations female family carers have for dementia and whether they can discuss dementia openly within the community and the family. Method Forty-one individual interviews and six focus group interviews ( n = 28) were held with female Turkish, Moroccan and Surinamese Creole family carers who are looking after a close relative with dementia, and who live in The Netherlands. Qualitative analysis has been carried out, supported by the software MaxQda. Results The dominant explanations of dementia given by the female family carers interviewed are in line with what Downs et al. describe as the explanatory models 'dementia as a normal ageing process' and 'dementia as a spiritual experience'. In addition, some female family carers gave explanations that were about an interplay between various factors. Turkish and Moroccan informal caregivers ascribe the causes of dementia relatively often to life events or personality traits, whereas Surinamese Creole caregivers frequently mention physical aspects, such as past dehydration. However, the explanatory model 'dementia as a neuropsychiatric condition', which is dominant in Western cultures, was rarely expressed by the informal caregivers. The female family carers generally talked openly about the dementia with their close family, whereas particularly in the Turkish and Moroccan communities open communication within the broader communities was often hampered, e.g. by feelings of shame. Conclusions Female family carers of Turkish, Moroccan or Surinamese Creole backgrounds often consider dementia as a natural consequence of ageing, as a spiritual experience, and/or as an interplay between various factors. They feel they can talk openly about dementia within their close family, while outside the close family this is often more difficult.

The care network of the families involved in violence against children and adolescents: the Primary Health Care perspective.

AIMS AND OBJECTIVES: To contribute the understanding of the network care provided to families involved in family violence against children and adolescents (FVACA), from the Primary Health Care (PHC) perspective. BACKGROUND: Children and adolescents figure among the main victims of violence around the world, which occurs predominantly in the family context. PHC-guided network care has emerged as a new process that contrasts with traditional approaches, which rely on fragmented, punctual and compensatory actions and produce simplified and segmented interventions in response to complex phenomena like violence. The Paradigm of Complexity interacts with the network care approach and, by articulating the multiple dimensions of the research phenomenon, contributes to its understanding. DESIGN: Qualitative research, based on the Paradigm of Complexity. METHODS: Data were collected through minimal maps of the external institutional social network, focus groups and semi-structured interviews held with 41 PHC professionals in Brazil. The notions of comprehension and contextualisation as well as dialogical, recursive and holographic principles from complexity theory guided the data analysis. RESULTS: The two thematic categories that emerged revealed reduced institutional networks, with low-density and homogeneous bonds, which resulted in fragmented care in all stages of the care process. CONCLUSIONS: Although the network organisation of care for the families involved in FVACA is fundamental, the construction of these networks still represents a great challenge, as it requires the joint work of a multiprofessional team. RELEVANCE TO CLINICAL PRACTICE: For nursing to respond to the contemporary care demands in a contemplative and pertinent manner, a perspective and a reference framework need to be developed, leading to broader and more contextualised actions, with a multidimensional approach to the families and communities of which child and adolescent victims of violence are a part.

Diálise peritoneal: cuidado familiar ao cliente renal crônico em tratamento no domicílio / Diálisis peritoneal: cuidado familiar al paciente renal crónico en tratamiento domiciliario / Peritoneal dialysis: family care for chronic kidney disease patients in home-based treatment

RESUMO Objetivo: propor um modelo de cuidado familiar ao cliente renal crônico em tratamento com a Diálise Peritoneal a partir das evidências apontadas pelos familiares. Método: estudo descritivo com abordagem qualitativa, tendo como método a Pesquisa Convergente Assistencial. O cenário foi um hospital estadual do Rio de Janeiro, onde foram realizadas as técnicas de entrevista individual gravada e de um grupo de encontro com 19 participantes da pesquisa. Os dados foram analisados de acordo com as etapas propostas pelo método, emergindo uma categoria sobre a questão cultural como base para o cuidado: uma proposta de cuidado familiar no domicílio. Resultados: o modelo de cuidado proposto contempla o diálogo e a reflexão, no sentido de compartilhar os saberes dos sistemas "profissional" e "popular", visando à melhoria da qualidade de vida dos clientes. Conclusão: os familiares conseguiram realizar a preservação, acomodação e repadronização cultural do cuidado propostas pelo modelo Sunrise de Leininger.

RESUMEN Objetivo: proponer un modelo de cuidado familiar al paciente renal crónico en tratamiento con Diálisis Peritoneal partiendo de las evidencias informadas por familiares. Método: estudio descriptivo, con abordaje cualitativo, usando como método la Investigación Convergente Asistencial, realizado en hospital estatal de Rio de Janeiro, donde fueron realizadas las técnicas de entrevista individual grabada y un grupo de encuentro con 19 participantes de la investigación. Datos analizados según las etapas propuestas por el método, emergiendo una categoría sobre la cuestión cultural como base para el cuidado: una propuesta de cuidado familiar domiciliario. Resultados: el modelo de cuidado propuesto contempla el diálogo y la reflexión, apuntando a compartir los saberes de los sistemas "profesional" y "popular", con objetivo de mejorar la calidad de vida del paciente. Conclusión: los familiares consiguieron realizar la preservación, acomodación y reestandarización cultural del cuidado propuestas por el modelo Sunrise de Leininger.

ABSTRACT Objective: to propose a family care model for patients with chronic kidney disease in peritoneal dialysis based on evidence indicated by family members. Method: this was a qualitative descriptive study that used the Convergent Care Research method. It was conducted at a state hospital in Rio de Janeiro, including techniques for recording individual interviews and consisted of a group of 19 study participants. Data were analyzed according to the stages proposed by the method, generating a category that used a cultural question as the basis for patient care resulting in a proposal for home-based family care. Results: the patient care model proposed includes dialogue and reflection in sharing the knowledge of "professional" and "popular" systems, aiming to improve the patient's quality of life. Conclusion: family members were able to promote care based on cultural preservation, accommodation and repatterning, as proposed by Leininger's Sunrise Model.

Tipos de apoyo a las familias con hijos con discapacidad y su influencia en la calidad de vida familiar / Types of support to families of children with disabilities and their influence on family quality of life

Resumen Entre los aspectos que contribuyen a la calidad de vida familiar están los diferentes apoyos a las familias. Este estudio tiene como objetivo identificar el tipo de apoyos que consideran relevantes las familias de niños con discapacidad usuarios de servicios de fisioterapia en atención temprana y en qué manera la administración pública influencia la calidad de esos apoyos. Se trata de un estudio cualitativo fundamentado en un paradigma crítico social. Los participantes han sido 16 madres y 4 padres que han sido entrevistados, y sus aportaciones se analizaron con análisis de discurso. Entre las aportaciones se destaca la importancia de los apoyos familiares y de las redes de padres de niños con discapacidad. También se destaca el papel de los apoyos profesionales y por lo tanto cómo los recortes en servicios públicos de tipo sanitario y social han agudizado una inequidad en salud en relación a las familias que pueden o no disponer de servicios adicionales. Se sugieren otros enfoques en los servicios que pueden apoyar a las familias.

Abstract Different types of supports to families are among the aspects that contribute to family quality of life. This study aims to identify the types of supports that families of children with disabilities, users of early intervention services, consider relevant and how public administration influences the quality of this support. This is a qualitative study based on a critical social paradigm. Sixteen mothers and four fathers were interviewed and their contributions were analyzed using discourse analysis. The importance of family support and networks of parents of children with disabilities were highlighted. The role of the supports by health professionals is also crucial and, therefore, cuts in public health and social services have exacerbated the inequity in health. In practice this is highlighted in relation to those who can and the ones who cannot afford additional services. Other approaches in the support to families are suggested.

¿Negociaciones o decisiones colectivas? Las dinámicas familiares tras la llegada de un bebé

En las décadas precedentes, la participación de la mujer en el mercado de trabajo en Latinoamérica ha dado cuenta de un crecimiento sostenido. Este fenómeno ha planteado la necesidad de comprender cómo aquellos involucrados en estos procesos organizan sus rutinas y relaciones de cara a los nuevos escenarios de movilidad, segmentación y resignificación de lo laboral y lo familiar En dicho marco, este trabajo analiza cómo los miembros de hogares de sectores medios profesionales de la Ciudad de Buenos Aires conforman sus arreglos familiares luego del nacimiento de un hijo. La hipótesis central del mismo es que el modo en que las personas involucradas respondieron a dichos cambios y reorganizaron sus espacios cotidianos no se ajustó primariamente a las lógicas de la negociación intrahogar sino que por el contrario el mismo puede ser descrito de modo más adecuado por procesos de decisión colectiva, acontecidos dentro y fuera de los hogares.

In previous decades, the participation of women in the labor market in Latin America has steadily grown. Consequently the need to understand how are organized the routines and the relationships of those who are involved in these processes -facing new mobility scenarios, segmentation and redefinition of the labor and the family- has emerged. In this context, this paper analyzes how members of professional middle class households in the City of Buenos Aires make their family arrangements after the birth of a child. The main hypothesis is that the way the people involved responded to these changes and reorganized their everyday spaces are not primarily adjusted to the logic of intra-household negotiations, but instead it can be more adequatdy described by processes of collective decision occurred inside and outside the households.

Em décadas anteriores, a participação das mulheres no mercado de trabalho na América Latina se deu conta de um crescimento sustentado. Isso tem levantado a necessidade de entender como as pessoas envolvidas nestes processos organizar suas rotinas e relacionamentos em face de novos cenários de mobilidade, segmentação e redefinição do trabalho e familiar Neste quadro, o presente artigo analisa como os membros das famílias de mídia sectores profissionais da Cidade de Buenos Aires fazer seus arranjos familiares após o nascimento de uma criança. A hipótese central é que a maneira como as pessoas envolvidas respondeu a estas mudanças e reorganizou seus espaços comuns não são ajustadas principalmente para a lógica da negociação intra-familiar, mas, pelo contrário, pode ser descrito de forma mais adequada por processos de decisão coletiva, ocorreu dentro e fora casas.

Dimensiones del cuidado en familias urbanas mexicanas / Care dimensions among mexican urban families / Dimensões do cuidado em famílias urbanas mexicanas

La familia es el grupo donde se provee la atención a sus integrantes tanto para la preservación de la salud como para su desarrollo. Los profesionales de la salud para una práctica asertiva deben contemplar a la familia como una persona con sus propios procesos de cuidado que son válidos y validados por sus integrantes. El cuidado familiar debe ser explorado como un proceso donde interactúan dimensiones que le dan sentido al hacer, deber hacer y al ser en acción del grupo. El objetivo del estudio fue explorar el cuidado familiar en población mexicana desde las dimensiones que le subyacen. Métodos: El estudio fue cualitativo, exploratorio, descriptivo. Resultados: El cuidado en familias mexicanas expone tres dimensiones del cuidado: la ética en donde los hábitos y actitudes virtuosas del cotidiano vivir impulsan el deber hacer; la estética en donde el hacer del cuidado emerge de los sentimientos para con el otro y la ontológica, que apunta a rescatar el estar ahí y la alteridad del cuidado en la familia. Conclusiones: El cuidado familiar tiene tres dimensiones: ética, estética y ontológica que interactúan entre sí; la primera recupera el sentido virtuoso de las actitudes, hábitos, esperanzas, obligaciones que impulsan el deber hacer de la familia, la segunda pondera los sentimientos como parte del arte del cuidado familiar para precipitar el hacer del cuidado y la tercera moviliza el ser-familia para expresar el cuidado del grupo a través de las resonancias del mismo.

The family provides support to its members in areas such as development and health maintenance. In order to provide assertive practices, health professionals should treat families as entities whose care processes are validated by their own members. Family care should be explored as a process where, the to do, the ought to do, and the being dimensions interact. The objective of the study was to explore the family care in the mexican population from its underlying dimensions. Methods: This was a qualitative, exploratory, and descriptive study. Results: Care in mexican families exposes three dimensions of care: the ethics in which the habits and virtuous attitudes of daily living propel the ought to do; the aesthetics in where the to do of care emerges from the sentiments towards the other, and ontology, which aims to rescue the being in the family care. Conclusions: The family care has three dimensions which interact among each other: ethics, aesthetics, and ontology; the first recovers the virtuous sense of attitudes, habits, hopes, obligations which propel the ought to do of the family, the second weights the feelings as part of the family care to convey the to do of care, and the third mobilizes the being of the family to express the care of the group through its resonances.

A família é o grupo onde se fornece a atenção aos seus integrantes tanto para a preservação da saúde como para o desenvolvimento. Os profissionais da saúde para uma prática assertiva devem contemplar à família como uma pessoa com seus próprios processos de cuidado que são válidos e validados pelos seus integrantes. O cuidado familiar deve ser explorado como um processo onde interagem dimensões que lhe dão sentido ao fazer, dever fazer e ao ser em ação do grupo. O objetivo do estudo foi explorar o cuidado familiar na população mexicana desde as dimensões que lhe integram. Métodos: O estudo foi qualitativo, exploratório, descritivo. Resultados: O cuidado em famílias mexicanas expõe três dimensões do cuidado: a ética onde os hábitos e atitudes virtuosas do cotidiano viver, impulsionam o dever fazer, a estética onde o fazer do cuidado emerge dos sentimentos para os outros e a ontológica, que atinge a resgatar o estar ali e a alteridade do cuidado no familiar. Conclusões: O cuidado familiar tem três dimensões: ética, estética e ontológica que interagem entre si, a primeira recupera o sentido virtuoso das atitudes, hábitos, esperanças, obrigações que impulsionam o dever fazer da família, a segunda considera os sentimentos como parte da arte do cuidado familiar para precipitar o fazer do cuidado e a terceira movimenta o ser-família para expressar o cuidado do grupo a través das ressonâncias do mesmo.

Evaluation of the impact on non-communicable chronic diseases of a major integrated primary health care program in Mexico.

BACKGROUND: Primary health care is the best framework for implementing actions for the prevention and control of non-communicable diseases at an appropriate scale. In 2002, the Mexican Institute for Social Security (IMSS), which provides health care to half of the Mexican population, implemented a primary care-based integrated program that included the improvement of the family health care practice and a preventive strategy called PREVENIMSS, to reduce the burden of disease. OBJECTIVE: To asess the impact of this program on selected non-communicable chronic diseases. METHODS: Morbidity and mortality were compared before and after implementation of the program and time trends in IMSS affiliates and non-affiliates using the difference-in-differences (DD) method. RESULTS: Incidence rates of diabetes and hypertension increased whereas those of cervical cancer, breast cancer and other cerebrovascular diseases decreased from 2000 to 2013. The DD in mortality rates, expressed per 100000 persons, showed a decrease of 49.4 for diabetes mellitus, 9.1 for hypertensive disease, 42.9 for ischemic heart disease, 17.4 for cerebrovascular disease, 7.5 for cervical cancer and 5.8 for breast cancer. CONCLUSIONS: The reductions in mortality rates could be explained by both changes in incidence rates and changes in case fatality rates associated with early detection and treatment. These initial findings can be interpreted as the potential impact of integrated programs based on primary health care in a developing country.

Falls of older people living in the community- A critical review / Las caídas de las personas mayores que viven en la comunidad: Una revisión crítica

Falls are the most prevalent and serious accident older people suffer in their homes and also, they are the main reason for their hospital admission. In a great part of the cases falls expose at risk elderly people’s well-being and quality of life. A critical narrative literature review was undertaken to inform research in the area of falls in older people living in the community. Articles were retrieved from Medline and Scopus data bases from November 2011 to January 2013. Citation searching was also used as a complement by hand searching of relevant journals. Additionally, an alert mechanism was established in Scopus for a period of one year to identify relevant studies or literature. Reviewed studies have provided valuable evidence about falls in older people and potential prevention strategies. However, evidence from relatives, caregivers and significant others is conspicuously absent. Falls in the community and falls prevention happen in social and family contexts that must be empirically studied and reported.

Las caídas son el accidente más serio y prevalente que los mayores sufren en sus domicilios y son la principal razón de ingreso hospitalario. Las caídas ponen en riesgo el bienestar y la calidad de vida de los mayores. Se llevó a cabo una revisión narrativa crítica de la bibliografía a fin de informar estudios de investigación en el área de las caídas de los mayores que viven en la comunidad. Se recuperaron estudios de las bases de datos Medline y Scopus de Noviembre 2012 a Enero 2013. Se usó también búsqueda de citaciones que se complementó con búsqueda manual en revistas relevantes. Se estableció un sistema de alertas en Scopus a lo largo de un año para identificar estudios relevantes o bibliografía. Los estudios revisados han proporcionado una evidencia valiosa sobre las caídas de las personas mayores y las estrategias potenciales de prevención. No obstante, evidencia proveniente de sus familiares, cuidadores y otros significativos esta notablemente ausente. Las caídas en la comunidad y su prevención suceden en contextos familiares y sociales que deben ser empíricamente estudiados y registrados.

Consideraciones sobre el Modelo de Atención Integral de Salud del Ecuador / Considerations on the Model of Comprehensive Health Care in Ecuador

Introducción: en Ecuador, a raíz de los cambios sociales propiciados por la Revolución Ciudadana, se han realizado transformaciones en el sector salud, donde se destaca el Modelo de Atención Integral de Salud Familiar, Comunitario e Intercultural. Objetivo: analizar las bases conceptuales de este modelo como estrategia fundamental para mejorar la salud de la población. Métodos: se utilizaron métodos teóricos para realizar la revisión bibliográfica del tema y se revisaron documentos elaborados por el Ministerio de Salud Pública de Ecuador, así como artículos publicados en Internet.Desarrollo: se abordan las transformaciones ocurridas en el sector salud con la Revolución Ciudadana, destacándose la implementación de un nuevo modelo de atención, con objetivos, propósitos y principios bien definidos,y 4 componentes que hacen viable la operación y desarrollo del mismo.Conclusiones: este nuevo modelo se centra a la Atención Primaria de Salud Renovada, con prioridad no solo en la atención individual, sino en la familiar y comunitaria, con enfoque hacia las acciones de promoción de salud y prevención de enfermedades, propiciando la equidad en los servicios de salud y el respeto a la interculturalidad(AU)

Introduction: in Ecuador, following the social changes brought about by the Citizen Revolution, changes in the health sector have been made where the Model for Comprehensive Health, Family, Community and Intercultural stands out.Objective: To analyze the conceptual foundations of this model as a key to improving population health strategy.Methods: theoretical methods were used to conduct the literature review and documents which were prepared by Ecuador Ministry of Public Health, also articles published on the Internet were reviewed. Development: transformations in the health sector with the Citizen Revolution were addressed, highlighting the implementation of a new model of care with goals, objectives and well-defined principles, and four components that make feasible the process and development. Conclusions: This new model focuses on Renewed Primary Health Care prioritizing not only on individual care but family and community, with focus on health promotion actions and disease prevention, promoting equity in health services and respect for multiculturalism(AU)

As repercussões do cuidado na vida do cuidador familiar do idoso com demência de Alzheimer / Repercussions of care in the life of family caregivers of elderlies with Alzheimer's disease

Nos últimos anos tem aumentado progressivamente o número de famílias que se tem confrontado com a situação de cuidar de familiares idosos em condição de dependência, principalmente quando esta é provocada em virtude da Doença de Alzheimer (DA). O objetivo deste estudo é o de investigar as repercussões do cuidado na vida do cuidador familiar de idoso com demência de Alzheimer. Através da epistemologia qualitativa utilizou-se a técnica da entrevista na modalidade de história de vida temática aplicada a vinte cuidadores de idosos cadastrados na Associação Brasileira de Alzheimer do estado do Amazonas (ABRAZ-AM). Os resultados mostraram que as renúncias aparecem nos depoimentos dos familiares como uma repercussão significativa do cuidado. A privação social em função do cuidado é uma realidade presente na vida dos cuidadores deste estudo. A raiva, a impaciência, o medo, a solidão e a vergonha são sentimentos vivenciados pelos cuidadores em seu cotidiano, que se alternam com sentimentos de satisfação, felicidade, compaixão e de retribuição. É importante salientar que neste estudo, a situação de cuidado vivenciada pelos cuidadores é permeada por sentimentos que se contrapõem, em determinados momentos se configurando como desagradáveis e em outros momentos como agradáveis. Sendo assim, percebe-se que é possível e relevante os profissionais da saúde identificarem esses aspectos favorecedores de prazer na relação de cuidado, buscando exaltá-los perante os outros. Dessa forma, a possibilidade de enfrentar da melhor forma os percalços deve ser considerada uma realidade eminentemente presente no cotidiano de cuidado.

Hijos adultos mayores al cuidado de sus padres, un fenómeno reciente / Elderly children in care of their parents, a recent phenomenon

Es un hecho inédito en la historia de la humanidad que hijos que han llegado a la ancianidad cuiden de sus padres. Se mostrarán las particulares vicisitudes y desafíos que se plantean en el seno de la familia extensa cuando se trata de hijos adultos mayores quienes asumen la tarea de cuidar a sus padres, ya que éstas difieren de aquellas que se formulan cuando los hijos se encuentran en la adultez media. Si bien muchas familias se adaptan sin grandes sobresaltos a esta transición biográfica, otras se enfrentan a auténticas crisis. Distinguirlas puede ayudar a los profesionales de salud a manejar de mejor modo a sus pacientes y también ayudar a quienes se encuentran abocados a esta tarea.

The growing aging population has given rise to unprecedented event in human history: elderly children in care of their parents. The work will show the particular vicissitudes and challenges within the extended family when it comes to elderly children who assume the task of caring for their parents because they differ from those that are made when children are in the middle adulthood. While many families adapt without major surprises to this biographical transition, others face a real crisis. Distinguishing between both, could help health professionals to best manage their patients and also help those who are working on this task.

Experiencia de cuidadores familiares sobre el cuidado de transición en mujeres mastectomizadas / Experience of family caregivers on transition care in mastectomized women / Experiência de cuidadores familiares no cuidado de transição em mulheres mastectomizadas

En la actualidad presenciamos cambios en la presentación de servicios de salud e implementación de políticas públicas cada vez más eficientes, sin embargo gran parte de los cuidados a mujeres con cáncer sometidas a tratamiento quirúrgico como la mastectomía se administran en el hogar. Esta situación establece un compromiso para la paciente y su familia. Con frecuencia, algún familiar se encarga del cuidado de la paciente que en muchos casos podría considerarse altamente especializado. En nuestra sociedad se desconoce el nivel de la experiencia o la calidad de la misma que tienen los cuidadores familiares posteriormente al alta hospitalaria y previa a la siguiente consulta. Este espacio de tiempo podría definirse como de transición. Los cuidados de transición se refieren al periodo durante el cual los pacientes pasan de una fase a otra de la enfermedad o del tratamiento, o bien, cuando cambian de un entorno de atención a otro. Los cuidados de transición tienen repercusiones importantes en la salud de la paciente. Estos periodos de cambio se ubican generalmente en el hogar. El presente estudio expone y analiza el factor de la experiencia durante el cuidado de transición por los cuidadores familiares de mujeres mastectomizadas. Se realizó una investigación cualitativa, con entrevistas semiestructuradas realizadas a tres familiares responsables del cuidado así como un análisis de contenido. Después de validad los resultados, situamos como la principal preocupación la curación de herida quirúrgica sin lastimar a la paciente. Se identifican momentos clave perfectamente determinados durante la transición. La falta de conocimientos por el cuidador se sustituye por buena voluntad y utilizando su propio criterio. Está presente la fe en el cuidador como su principal sostén, así como una necesidad de información orientada hacia la técnica de curación. Los cuidados de transición encauzados hacia la curación de herida quirúrgica cuentan con elementos que están más en función de una lógica primaria que de una capacitación sobre el tema. Esto contrasta con la literatura que se hace re4ferencia en el cuidador, donde frecuentemente se ocupa de aspectos puntuales como: la dieta, medicación, el estado general y anímico de la paciente. Finalmente se elaboran propuestas para conformar un puente de cuidados de transición hospital-hogar-hospital, considerando una consultoría de enfermería durante el proceso para favorecer el bienestar de la mujer mastectomizada, al disminuir complicaciones, disminuyendo costos previsibles para la institución y evitando una atención biomédica fragmentada.

Nowadays, we witness changes in health services presentation and public policies implementation more4 and more efficient. Nevertheless, most care for women with cáncer, subjected to surgical treatment, such as mastectomy, is provided at home. The aforementioned situation establishes an engagement for the patient and her family. Frequently some family members take charge of the care of the patients. In many cases, this care could be regarded as specialized. In our society, the level of experience and the care quality of the care givers, afte4r the hospital discharge and before the following medical consultation, are unknown. This mentioned period could be named as the transitional period. Transitional cares are referred to the period during qhich patients go from one phase to another in the disease or in the treatment; or when the patients move from one attention background to another fifferent ambience. Transitional cares present an important impacto n patients´ health. Those change periods are usually located at home. The present study exposes and analyzes the experience factor during transitional cares for the mastectomized women by part of family care providers. The study performed a qualitative reserch, with semi-structured interviews carried out on family members responsible for the care, as well as an analysis of contets. After validating the results, our first concern was the surgical wound healing, without causing the patient any harm. Several completely well-determined key moments were identified during the transitional period. The lack of care knowledge by part of the care providers may be substituted by good willin and the use of their own criterion. The reliance on the caregiver is always present, as well the need for information oriented to the healing technique. The transitional cares guided to healing the surgical wound count on some elements that are more in terms of a prmary logic tan guided by training on the matter. This is opposed to the concept found in the literatura that makes reference to the caregiver, where the main points refer to certain punctual aspects, such as diet, medication, and the patient´s physical and psychic condition. Finally, the study gives some propositions in order to establish some kind of hospital-home-hospital brindging transitional care, considering a nursing consulting during the process so as to improve mastectomized women´s welfare, diminishing complications for the patients, decreasing predictable costs, and avoiding a fragmented biomedical attention.

Atualmente testemunhando mudanças na apresentação dos serviços de saúde e implementar políticas públicas cada vez mais eficientes, por mais cuidados para mulheres com submetidos a cirurgia de câncer, como a mastectomia são administradas em casa. Essa situação estabelece um compromisso para o paciente e sua família. Freqüentemente, um membro da família cuida do paciente, que em muitos casos pode ser considerado altamente especializado. Em nossa sociedade o nível de experiência ou a qualidade do que tem posteriormente parentes para alta hospitalar e antes de as seguintes cuidadores de consulta é desconhecida. Esse espaço de tempo poderia ser definido como transitório. tratamento de transição são relativos ao período durante o qual os pacientes se mover a partir de uma fase para outra doença ou tratamento, ou quando alterar o ambiente cuidado para outro. O cuidado de transição tem importantes repercussões na saúde do paciente. Esses períodos de mudança geralmente estão localizados em casa. Este estudo descreve e analisa o fator experiência para cuidar de transição para cuidadores familiares de mulheres mastectomizadas. A pesquisa qualitativa foi realizada por meio de entrevistas semi-estruturadas com três cuidadores familiares, bem como uma análise de conteúdo. Após validar os resultados, colocamos como principal preocupação a cicatrização da ferida cirúrgica sem prejudicar o paciente. Momentos chave perfeitamente identificados durante a transição são identificados. A falta de conhecimento do cuidador é substituída por boa vontade e usando seus próprios critérios. A fé está presente no cuidador como seu esteio, assim como a necessidade de uma técnica de cura orientado a informações. cuidados de Transição introduzido a cicatrização da ferida cirúrgica tem elementos que são mais em termos de uma lógica primária de formação sobre o assunto. Isto contrasta com a re4ferencia literatura no cuidador, que muitas vezes lida com aspectos específicos, tais como dieta, medicação e o humor geral do paciente. Finalmente, as propostas são feitas para formar um cuidado transicional ponte do hospital-home-hospitalar, considerando-se uma enfermeira de consultoria durante o processo para promover o bem-estar das mulheres com mastectomias, diminuindo complicações, diminuindo custos previsíveis para a instituição e evitando cuidados biomédica fragmentado

Reorganização da demanda para atendimento odontológico no município de Amparo/SP: o desafio de garantir o acesso equânime às ações de saúde bucal / Reorganization of the demand for dental care in Amparo/SP: the challenge of ensuring equal access to oral health actions

Planejar o acesso ao atendimento odontológico de forma eqüitativa e integrar toda a equipe com a proposta de saúde bucal para atendimento familiar.Metodologia: este trabalho relata a experiência de reorganização do processo de trabalho da saúde bucal de uma unidade de saúde da família na cidade de Amparo, SP, discutindo em equipe sobre a problemática da saúde bucal na unidade, levantando os dados da lista de espera, e elaborando um instrumento de avaliação de risco onde se buscou a construção de um instrumento que possibilitasse ordenar prioritariamente as famílias com maior necessidade de atendimento e que pudesse ser utilizado por qualquer profissional da equipe. Cada individuo da família foi avaliado e pontuado numa graduação de 1 a 3, em relação aos critérios idade, condição bucal e saúde geral. Posteriormente foi feita uma somatória da pontuação de todas as pessoas da família e realizada uma média. Esta média foi somada a uma nota familiar que considera a condição sócio-econômica e moradia. A necessidade sentida pelo usuário também foi considerada na nota familiar.Resultados: obteve-se um instrumento de avaliação em saúde bucal simples, de fácil compreensão e manuseio e que fez do Agente Comunitário de Saúde, em especial, um elo de ligação entre o paciente e a equipe; uma lista de espera mais equânime, reorientação das triagens familiares, caracterização da busca de atendimento por micro-áreas, para planejamento de atividades educativas, diminuição do número de urgências e maior integração entre os profissionais da equipe.Conclusão: observou-se durante os trabalhos, além da reorganização da demanda e da faixa etária atendida, que até 2001 era prioritária para gestantes e crianças até 14 anos, restringindo assim o acesso dos adultos e consequentemente limitando os programas de saúde e com a implantação das Equipes de Saúde Bucal na Estratégia de Saúde da Família, houve um ganho de qualidade para os usuários e também para os profissionais...

To plan access to dental care in an equitable and integrate the entire team with the proposed oral health care for families. Methodology: this study reports the experience of reorganizing the work process of oral health in the health unit's family Garden Brazil, discussing team on the issue of oral health in the unit, raising the data from the waiting list, and making an instrument of risk assessment where we sought in this step to build an instrument capable of ordering priority to families most in need of care and that could be used by any professional team. Each individual family is assessed and scored on a grading 1 to 3, against the criteria age, oral health and general health. Later it made a summation of the scores of all family members and held an average. This average is added to a familiar note finds that socioeconomic status and housing. The need felt by the user was also considered in footnote family. Results: we obtained an instrument for assessing oral health in simple, easy to understand and handle and that makes the ACS, in particular, a link between the patient and staff, a waiting list of more equitable, reorientation of family screening , characterization of seeking medical assistance for micro-areas for planning educational activities, reducing the number of emergencies and greater integration between the professional team.Conclusion: it was observed during the deliberations that in addition to the reorganization of demand there was a gain in quality for professionals in the unit that came to better understand, deal with specific aspects of dentistry and contributed their knowledge and insights in the construction of the evaluation form and in redirecting the flow, bringing dental issues closer to the day-to-day team. There was also a satisfying response team to provide the families who waited in the waiting list...