Abstract Introduction The optimal time for tracheostomy changes is unknown. Most surgeons opt to wait until five to seven days postoperatively, while more recent studies suggest that changes occurring as early as two to three days postoperatively are also safe. Objective To evaluate the safety of changing the tracheostomy tube later than 14 days postoperatively. Methods The charts of patients who underwent tracheostomy placement and change at a tertiary care center from 2015 to 2019 were retrospectively reviewed, and the subjects were divided into 2 cohorts (late and very late), depending on the time of the first tracheostomy change. Results The study included 198 patients, 53 of whom aged between 0 and 18 years, and 145, aged > 18 years. The time until the first tracheostomy change was on average of 131.1 days. The most common indication for tracheostomy tube placement was prolonged intubation. Adverse events were observed in 30.8% of the cases (the most common being the formation of granulation tissue), a rate that does not differ much from the incidence reported in the literature (of 34% to 77%) when tracheostomy tubes are changed as early as 3 to 7 days postoperatively. There was no significant difference in the incidence of complications between patients undergoing late and very late changes (p = 0.688), or between pediatric and adult subjects (p = 0.36). There were no significant correlations regarding the time of the first or second change and the incidence of complications (r = −0.014; p = 0.84 for the first change; and r = −0.57; p = 0.64 for the second change). Conclusion The late first tracheostomy tube change was safe and could save resources and decrease the financial burden of frequent changes. It is always crucial to provide adequate information about home tracheostomy care for patients. unknown 1 201 reviewed late, , late) 19 5 years 145 1311 131 131. intubation 308 30 8 30.8 tissue, tissue tissue) 34 77% 77 0.688, 0688 0.688 688 0.688) 0.36. 036 0.36 . 36 0.36) −0.014 0014 014 084 84 0.8 −0.57 057 57 064 64 0.6 change) 20 13 30. 068 0.68 68 03 0.3 −0.01 001 01 08 0. −0.5 05 06 6 −0.0 00 −0. −0 −

Abstract The informal caregiver provides non-remunerated permanent or regular care to dependent older adults. This qualitative study aimed to identify the perceptions of informal caregivers about motivations, needs, and benefits of caring for dependent older adults. It was conducted with ten Portuguese informal caregivers, based on an instrument with questions about the care provided to older adults and their perceptions about performing this role. The results revealed the following motivations for care: proximity and trust relationship, duty of care, more available family members, home proximity, lack of vacancies, high cost of shelter institutions, and older adults’ desire to remain in their homes. The primary care activities for older adults are hydration, hygiene, food, therapeutic administration, companionship, emotional support, comfort, entertainment, and promoting autonomy and dignity. The needs identified by the caregivers were home, social security, and the caregiver’s employer support, financial help, psychological support, and training to care for the older adults. The benefits of informal care for dependent older adults were prompt family support, physical and emotional security, affection, and companionship. This study gives voice to crucial citizens. nonremunerated non remunerated role relationship members vacancies institutions homes hydration hygiene food administration companionship support comfort entertainment dignity security s help affection citizens

Resumo O cuidador informal presta cuidados permanentes ou regulares a pessoas idosas em situação de dependência, sem remuneração. Objetivou-se identificar as percepções de cuidadores informais sobre motivações, necessidades e benefícios do cuidado ao idoso dependente. Estudo qualitativo realizado com 10 cuidadoras informais portuguesas, a partir de um instrumento com questões sobre o cuidado prestado ao idoso e suas percepções sobre o exercício dessa função. Os resultados revelaram como motivações para o cuidado: relação de proximidade e confiança, dever de cuidar, familiar mais disponível, proximidade da residência, inexistência de vagas e elevado custo das instituições de acolhimento e desejo do idoso permanecer na sua habitação. Os principais cuidados aos idosos são: hidratação, higiene, alimentação, administração terapêutica, companhia, apoio emocional, conforto, entretenimento, promoção da autonomia e dignidade. As necessidades identificadas pelas cuidadoras foram: apoio domiciliário, da segurança social e da entidade empregadora do cuidador, ajuda financeira, suporte psicológico e capacitação para cuidar do idoso. Os benefícios do cuidado informal para o idoso dependente apontados foram: celeridade do apoio familiar, segurança física e emocional, afeto e companheirismo. Este estudo dá voz a cidadãos cruciais. dependência remuneração Objetivouse Objetivou se 1 portuguesas função confiança disponível residência habitação são hidratação higiene alimentação terapêutica companhia emocional conforto entretenimento dignidade foram domiciliário financeira companheirismo cruciais

BACKGROUND: Despite inpatient rehabilitation many stroke survivors struggle with community reintegration on returning home. The environment to which the stroke survivor returns affects and may limit participation in home and community-based activities. AIM: To describe stroke survivors' lived experiences of the environmental barriers and facilitators to community reintegration in an under resourced urban metropolitan sub-district in the Western Cape, South Africa. METHODS: A descriptive, qualitative study design with a phenomenological emphasis used semi-structured interviews to collect the data from purposefully selected stroke survivors who had been discharged for more than one year following inpatient rehabilitation. Supporting data were collected from interviews with two occupational therapists providing rehabilitation services to the stroke survivors. Deductive priori coding of semi-structured interviews with 11 stroke survivors, based on the environment subsystems described in the Person-Environment-Occupation-Performance (PEOP) model explored the barriers and facilitators to their community reintegration. FINDINGS: Of the six environmental sub systems in the PEOP model the systems and policy, access to information and health education, social determinants of health in the form of poor rehabilitation planning and loss of income as well as the built and natural environment presented the greatest barriers to the stroke survivor participants' community reintegration. However, reintegration was facilitated by social support and social capital, social determinants of health in the form of support groups as well as assistive technologies. CONCLUSION: Community reintegration continues to be a challenge for stroke survivors in an under-resourced urban sub-district due to environmental barriers associated with factors such as poor social support, inadequate implementation of policies and systems, poor compliance with home programmes, low socioeconomic status, poor access within the built and natural environment and inappropriate assistive devices. Several facilitators that occupational therapists can focus on to enable community reintegration included ensuring effective social support, access to community-based organisations, the introduction of home visits and provision of appropriate assistive devices. IMPLICATIONS FOR PRACTICE All stroke survivors must receive a comprehensive discharge plan to facilitate adequate access to continued rehabilitation and support for successful community reintegration. • There must be a specific referral to primary health care rehabilitation services on discharge from hospital. • Occupational therapists at community level have the responsibility to: o advocate for, or assist stroke survivors to self-advocate, the removal of inter-sectoral environmental barriers that limit their community reintegration and community participation, o where possible provide services in the home and involve midlevel workers when conducting home visits to enable successful reintegration into the home and resumption of occupational roles where possible, o look to other resources in their community that can assist in facilitating the community reintegration of stroke survivors to enable access to health, education, productive activities, and social and leisure participation opportunities, o improve their collaboration with the communities that they service.

BACKGROUND: There was a need to investigate the appropriateness of the standard manual wheelchairfor occupational performance in Thulamela Municipality Vhembe District, Limpopo. METHODS: An observational cross-sectional descriptive design using simple random sampling was used to select n=60 wheelchair users who were issued with standard manual wheelchairs between 2014 and 2018. The Wheelchair Outcome Measure was used to investigate the participants' level of satisfaction in engagement in ADL and IADL and the suitability of the wheelchair in terms of the user's comfort and satisfaction with positioning and prevention of skin breakdown. Descriptive statistics were used to analyse the data. RESULTS: The wheelchair users viewed activity participation in the home as important and were generally satisfied with their standard manual wheelchairs while performing occupational activities at home and outside the home. A total of (n=46; 78%) of the participants felt comfortable in their wheelchair. CONCLUSIONS: Wheelchair prescription should take into consideration the occupational choices of the user. Further qualitative studies to explore the factors that determined the participants' choices for their activity participation goals should be undertaken. IMPLICATIONS FOR PRACTICE • Training of new occupational therapy staff in each facility in the Thulamela district to equip them with the skills to prescribe wheelchairs is necessary. • The level of importance that wheelchair participants attached to level of importance of activity participation inside and outside the home was high therefore there is a need to consider the client's occupational choices when prescribing wheelchairs. • The wheelchair needs to facilitate participation in a wide range of occupational choices ranging from self-care activities and watching TV in the home to visiting friends and family and attending events outside the home.

BACKGROUND. Many studies have shown that South African women tend to initiate antenatal care late in their pregnancies. This presents challenges in the provision of quality healthcare to both mother and child. There are several studies on the social and cultural reasons for late booking. However, understanding the factors in a woman's choice to initiate antenatal care is important in informing healthcare strategies and policies. METHODS. This study was an analytical cross-sectional study of household and general health factors associated with attendance of antenatal care by pregnant women in Tshwane in 2015. It was a secondary data analysis from complete data sampling households registered on AitaHealth™. Univariate and multivariate logistic regression was used to assess which factors are associated with antenatal care attendance. RESULTS. The age of the head of the household was a significant factor in the attendance of antenatal care. The odds of attending antenatal care were 3.3, 2.1 and 1.8 times higher in households where the head of the household was 30 - 39 years of age, 20 - 29 or 40-49 years of age, respectively, than when between 10-19 years of age. Factors that increased the odds of attending antenatal care were living in households that had electricity and piped water, and running a business from home. Residing in a permanent dwelling and being food secure increased the odds of antenatal care attendance. CONCLUSION. The identified health and household factors should inform policies and programmes geared towards improving services around antenatal care provision.

Abstract This study aims to report on the development and validation of digital educational materials based on the dimensions of home cooking skills (HCS) assessed on a scale destined for PHC professionals, following the recommendations of The Dietary Guidelines for the Brazilian Population and on The Food and Nutrition Education Framework (FNE) for Public Policies. Five videos and graphic materials were developed with proposals for activities to develop HCS and encourage its implementation in actions and guidelines in the community and in professional care. The content of the materials was evaluated by experts using the Two-Round Delphi-based technique and statistical analyses for evidence of consensus. Specialists presented comments to improve the products and their applicability. The materials presented decoded language and playful illustrations with characters representative of the target population. Evidence of satisfactory content validity was presented and can be used in permanent education actions, seeking the qualification of the workforce and in FNE actions within the scope of the law. The graphic materials make it possible to associate the content of the videos with practice in contexts consistent with the reality of the individuals. (HCS professionals (FNE Policies care TwoRound Two Round Delphibased Delphi consensus applicability population law individuals

Resumo Este estudo visa reportar desenvolvimento e validação de materiais educativos digitais baseados nas dimensões de habilidades culinárias domésticas (HCD) avaliadas por escala destinada aos profissionais da APS, nas recomendações do Guia Alimentar Para a População Brasileira e no Marco de Educação Alimentar e Nutricional (EAN) para Políticas Públicas. Foram desenvolvidos 5 vídeos e materiais gráficos com propostas de atividades para desenvolvimento de HCD e estímulo à sua implementação em ações e orientações junto à comunidade e em atendimentos profissionais. O conteúdo dos materiais foi avaliado por especialistas utilizando técnica Delphi de 2 rounds e análises estatísticas para evidência de consenso. Especialistas proferiram comentários para aprimoramento dos produtos e sua aplicabilidade. Os materiais apresentaram linguagem decodificada, ilustrações lúdicas, com personagens representativos da população-alvo. Apresentaram evidência de validade de conteúdo satisfatória e podem ser utilizados em ações de educação permanente, visando a qualificação da força de trabalho, e em ações de EAN junto aos sujeitos de direito. Os materiais gráficos possibilitam associar o conteúdo dos vídeos à prática, em contextos condizentes com a realidade dos sujeitos. (HCD APS (EAN Públicas consenso aplicabilidade decodificada lúdicas populaçãoalvo. populaçãoalvo população alvo. alvo população-alvo permanente trabalho direito prática

Resumo Este estudo visa reportar desenvolvimento e validação de materiais educativos digitais baseados nas dimensões de habilidades culinárias domésticas (HCD) avaliadas por escala destinada aos profissionais da APS, nas recomendações do Guia Alimentar Para a População Brasileira e no Marco de Educação Alimentar e Nutricional (EAN) para Políticas Públicas. Foram desenvolvidos 5 vídeos e materiais gráficos com propostas de atividades para desenvolvimento de HCD e estímulo à sua implementação em ações e orientações junto à comunidade e em atendimentos profissionais. O conteúdo dos materiais foi avaliado por especialistas utilizando técnica Delphi de 2 rounds e análises estatísticas para evidência de consenso. Especialistas proferiram comentários para aprimoramento dos produtos e sua aplicabilidade. Os materiais apresentaram linguagem decodificada, ilustrações lúdicas, com personagens representativos da população-alvo. Apresentaram evidência de validade de conteúdo satisfatória e podem ser utilizados em ações de educação permanente, visando a qualificação da força de trabalho, e em ações de EAN junto aos sujeitos de direito. Os materiais gráficos possibilitam associar o conteúdo dos vídeos à prática, em contextos condizentes com a realidade dos sujeitos.

Abstract This study aims to report on the development and validation of digital educational materials based on the dimensions of home cooking skills (HCS) assessed on a scale destined for PHC professionals, following the recommendations of The Dietary Guidelines for the Brazilian Population and on The Food and Nutrition Education Framework (FNE) for Public Policies. Five videos and graphic materials were developed with proposals for activities to develop HCS and encourage its implementation in actions and guidelines in the community and in professional care. The content of the materials was evaluated by experts using the Two-Round Delphi-based technique and statistical analyses for evidence of consensus. Specialists presented comments to improve the products and their applicability. The materials presented decoded language and playful illustrations with characters representative of the target population. Evidence of satisfactory content validity was presented and can be used in permanent education actions, seeking the qualification of the workforce and in FNE actions within the scope of the law. The graphic materials make it possible to associate the content of the videos with practice in contexts consistent with the reality of the individuals.

RESUMEN La orientación familiar como práctica inclusiva en la educación inicial, respaldada por una adecuada formación docente, crea un entorno en el cual las diferencias son valoradas y se promueve el desarrollo equitativo de todos los niños. En este ámbito la formación del profesional, desde este enfoque busca involucrar a las familias en el desarrollo educativo de sus hijos desde una etapa temprana, reconociendo la importancia de la colaboración entre la escuela y el hogar.El presente artículo muestra resultados teóricos y prácticos, de un proyecto de investigación, de la carrera Licenciatura en Educación Inicial, de la Universidad Metropolitana del Ecuador. Se presenta una concepción para evaluar la dinámica familiar, utilizando indicadores de orientación como una práctica inclusiva en el ámbito de la educación inicial, para identificar elementos relacionados con el desarrollo socioafectivo de niños de 1 a 3 años, y mejorar la atención integral de estos.

ABSTRACT Family guidance as an inclusive practice in early education, supported by adequate teacher training, creates an environment in which differences are valued and the equitable development of all children is promoted. In this area, professional training, from this approach, seeks to involve families in the educational development of their children from an early stage, recognizing the importance of collaboration between school and home. This article shows theoretical and practical results of a research project from the bachelor’s degree in early childhood education at the Metropolitan University of Ecuador. A concept is presented to evaluate family dynamics, using guidance indicators as an inclusive practice in the field of initial education, to identify elements related to the socio-affective development of children from 1 to 3 years old, and improve their comprehensive care.

Abstract Introduction: Suffering is complex and individual. It is essential to assess it for healthcare. The objective was to map the literature about the patients suffering in Palliative Care. Method: It was performed a scoping review, based on the Joanna Briggs Institute protocol. The research was carried out in three databases: CINAHL, Pubmed and Web of Science (studies published between January 1, 2017 and October 12, 2022). Results: Six articles were analyzed, published in Portugal, Italy and Canada, into inpatient and home settings. Interpretation of results and conclusion: Were identified 3 dimensions of suffering, somatic suffering, non-somatic suffering and experiential responses to disease situations. It is concluded that the perception of suffering is unique for each patient, with non-somatic suffering predominance, and its intensity is related to the way the patient reads his experiences.

Resumo Introdução: O sofrimento é complexo e individual, sendo a sua avaliação fundamental para os cuidados. Estabeleceu-se como objetivo mapear a literatura acerca do sofrimento do doente em Cuidados Paliativos. Método: Realizou-se uma scoping review de acordo com o protocolo do Joanna Briggs Institute. A pesquisa foi realizada em três bases de dados: CINAHL, Pubmed e Web of Science (estudos publicados entre 01 de janeiro de 2017 e 12 de outubro de 2022). Resultados: Foram analisados 6 artigos, originários de Portugal, Itália e Canadá, em contexto de internamento e de domicílio. Interpretação dos resultados e conclusão: Como dimensões do sofrimento identificaram-se o sofrimento somático, o sofrimento não somático e as respostas vivenciais às situações de doença. Conclui-se que a perceção do sofrimento é única, com predomínio do sofrimento não somático, encontrando-se a sua intensidade relacionada com a forma como o doente vivencia as suas experiências.

Abstract Introduction: The patient with sarcoma undergoing surgery, upon hospital discharge, requires the knowledge and skills for symptom’s self-management such as pain and those related to the post-surgical wound and symptoms. Objectives: To gather a consensus of a set of therapeutic guidelines for self-management of pain and post-surgical wound care in sarcoma’s patient after surgery. Method: The Delphi technique was employed with a group of eight experts. The results were analysed based on content validity indices, and expert suggestions were considered in the guideline revision. Results: The overall Content Validity Index was 0.963 for pain and 0.991 for symptoms related to the surgical wound, indicating a high level of consensus among experts. Conclusion: The selected guidelines to be integrated into the IgestSaúde application will contribute to better management of postoperative symptoms at home, promoting the well-being of patients with sarcoma.

Resumo Introdução: O doente com sarcoma submetido a cirurgia, quando recebe alta hospitalar, necessita de conhecimento e competências necessárias à autogestão de sintomas como a dor pós-operatória e os sintomas relacionados com a ferida cirúrgica. Objetivos: Consensualizar um conjunto de orientações terapêuticas para a autogestão da dor pós-operatória e dos cuidados com a ferida cirúrgica em pessoas com sarcoma após uma cirurgia. Método: Utilizou-se a técnica de Delphi, com um grupo de oito peritos. Os resultados foram analisados com base em índices de validade do conteúdo e as sugestões dos especialistas foram consideradas na revisão das diretrizes. Resultados: O Índice de Validade de Conteúdo geral foi de 0,963 para dor e de 0,991 para os sintomas relacionados com a ferida cirúrgica, indicando um alto nível de consenso entre os peritos. Conclusão: As orientações selecionadas a integrar no aplicativo do IgestSaúde serão um contributo para uma melhor gestão dos sintomas pós-operatórios no domicílio, promovendo o bem-estar dos doentes com sarcoma.

Abstract Introduction: The negotiation process between parents, children, and nurses during hospitalization must be structured for a successful interaction. However, there is limited scientific evidence on parents' perspectives. Objective: Understand the negotiation process that takes place between nurses and parents in the Paediatric Ward. Methods: A qualitative descriptive study was conducted with 11 parents using semi-structured interviews. The data was analysed using content analysis techniques by Bardin (2016). Results: Five domains emerged from the discourse and perspectives of parents regarding care negotiation. The structuring conditions and knowledge of the child and family serve as foundations to support the negotiation process. During the negotiation itself, two roles converge: the parental role, involving the assumption and adaptation to the parental role, and the role of the nurses. Some behaviours promote negotiation, aimed at making the process more natural. However, some behaviours on the part of the nurses could hinder negotiation. Post-discharge support is acknowledged as an essential extra support once the child returns home. Conclusion: The findings provide clarification of the roles of the different participants in care negotiation, with potential contributions to the implementation of actions that improve the negotiating process in a more sustained and intentional manner.

Resumen Introducción: La negociación de los cuidados es un aspecto clave para el éxito de la interacción entre padres, hijos y personal de enfermería durante la hospitalización. Sin embargo, hay poca evidencia científica sobre las perspectivas de los padres en el proceso de negociación. Objetivo: Comprender la negociación de los cuidados entre enfermeras y padres en el servicio de Pediatría Médica. Métodos: Estudio de enfoque cualitativo de tipo descriptivo, que contó con la participación de 11 padres. La recolección de datos se llevó a cabo a través de entrevistas semiestructuradas y los datos fueron analizados mediante la técnica de análisis de contenido según Bardin (2016). Resultados: De los discursos y perspectivas de los padres sobre la negociación de cuidados, surgieron cinco dominios. Las condiciones estructurantes y el conocimiento del niño y la familia se presentan como pilares para sustentar el proceso negociador. En la negociación propiamente dicha, convergen dos roles: el parental, con la asunción y adaptación a la condición del rol parental, y el rol de los enfermeros. Hay comportamientos que favorecen la negociación, que tienden hacia la naturalidad del proceso de negociar; sin embargo, también existen comportamientos por parte de los enfermeros que perjudican la negociación. El apoyo después del alta es reconocido como un soporte importante después del regreso del niño a casa. Conclusión: Los hallazgos permiten aclarar los roles de los diferentes intervinientes en la negociación de cuidados, con el potencial de contribuir a la implementación de acciones favorecedoras del proceso negociador de manera más sostenida e intencional.

Resumo Introdução: A negociação de cuidados assume uma dimensão estruturante para o sucesso da interação entre pais, criança e enfermeiros durante a hospitalização. Contudo, constata-se uma escassa evidência científica sobre as perspetivas de pais relativamente ao processo negocial. Objetivo: Compreender a negociação de cuidados desenvolvida entre enfermeiros e pais no serviço de Pediatria Médica. Métodos: Estudo de abordagem qualitativa de tipo descritivo, que contou com a participação de 11 pais. A recolha de dados realizou-se através de entrevistas semiestruturadas e os dados analisados com recurso à técnica de análise de conteúdo segundo Bardin (2016). Resultados: Dos discursos e perspetivas dos pais sobre a negociação de cuidados, emergiram cinco domínios. As condições estruturantes, e o conhecimento da criança e família, são alicerces para sustentar o processo negocial. Na negociação propriamente dita, confluem dois papéis, o parental, com a assunção e a adaptação à condição do papel parental, e o papel dos enfermeiros. Há comportamentos promotores da negociação, que tendem para a naturalidade do processo de negociar, não obstante, existirem também comportamentos por parte dos enfermeiros que inibem a negociação. O apoio após a alta é reconhecido como um importante suporte após o regresso da criança a casa. Conclusão: Os achados permitem uma clarificação dos papéis dos diferentes intervenientes na negociação de cuidados, com potencial para contribuir para a implementação de ações favorecedoras do processo negocial de uma forma mais sustentada e intencional.

Abstract Introduction: Non-invasive mechanical ventilation is part of the ventilation therapy modality and is mostly used in the home context. Although there are many studies relating to ventilation therapy experiences in a hospital context, little has been investigated about the use of this therapy in a home context. Objective: To describe the implications of the use of NIMV at home from the individual's perspective. Methods: Exploratory and descriptive study of a qualitative nature with a total of 10 participants. Data collection was carried out through a semi-structured interview, which was subsequently treated using content analysis. Results: 6 categories emerged related to the implications of using NIMV at home: people involved, complications, benefits, difficulties, adaptive strategies, and implemented habits. Conclusion: The use of NIMV in a home context has implications for the individual. The results of this study may contribute to deeper knowledge of the topic. The family nurse must integrate this knowledge in the design of the care process for the person using NIMV in the home and family.

Resumen Introducción: La ventilación mecánica no invasiva forma parte de la modalidad de terapia ventilatoria más utilizada en el contexto domiciliario. Aunque existen muchos estudios relacionados con experiencias de terapia ventilatoria en el contexto hospitalario, poco se ha investigado sobre el uso de esta terapia en el contexto domiciliario. Objetivo: Describir las implicaciones del uso de VMNI en el hogar, desde la perspectiva del individuo. Métodos: Estudio exploratorio y descriptivo, de carácter cualitativo con un total de 10 participantes. La recolección de datos se realizó a través de una entrevista semiestructurada, que posteriormente fue tratada mediante análisis de contenido. Resultados: Surgieron 6 categorías relacionadas con las implicaciones del uso de la VMNI en el hogar: personas involucradas, complicaciones, beneficios, dificultades, estrategias adaptativas y hábitos implementados. Conclusión: El uso de VMNI en el contexto domiciliario tiene implicaciones para el individuo. Los resultados de este estudio pueden contribuir a un conocimiento más profundo sobre el tema. La enfermera de familia debe integrar estos conocimientos en el diseño del proceso de atención a la persona que utiliza VMNI en el hogar y la familia.

Resumo Introdução: A ventilação mecânica não invasiva enquadra-se na modalidade de ventiloterapia maioritariamente utilizada no contexto domiciliário. Apesar de existirem muitos estudos relativos às experiências de ventiloterapia em contexto hospitalar, pouco ainda se tem investigado sobre a utilização desta terapia em contexto domiciliário. Objetivo: Descrever as implicações sobre o uso de VMNI no domicílio, na perspetiva do indivíduo. Métodos: Estudo exploratório e descritivo, de natureza qualitativa num total de 10 participantes. A colheita de dados realizou-se através de uma entrevista semiestruturada, sendo os mesmos posteriormente tratados com recurso à análise de conteúdo. Resultados: Emergiram 6 categorias relacionadas com as implicações do uso de VMNI no domicílio: pessoas envolvidas, complicações, benefícios, dificuldades, estratégias adaptativas e hábitos implementados. Conclusão: A utilização de VMNI em contexto domiciliário tem implicações para o indivíduo. Os resultados deste estudo poderão contribuir para um conhecimento mais aprofundado sobre o tema. O enfermeiro de família deverá integrar este conhecimento na conceção do processo de cuidados à pessoa utilizadora de VMNI no domicílio e família.

ABSTRACT Introduction: Infant mortality is a health phenomenon directly related to the deleterious living conditions of both the infant’s home and adverse socioeconomic and sanitary factors. Objective: To characterize inequalities in infant mortality according to differential living conditions in two populations districts of Santiago de Cuba. Methods: A descriptive, exploratory ecological study was carried out in the municipality of Santiago de Cuba in 1995-1997. The units of analysis were constituted by the areas framed in two populations districts of the city. Results: Bothe population districts were stratified, according to their living conditions, in settlements with less unfavorable and more unfavorable living conditions. Higher infant mortality was estimated in the settlement with more unfavorable living conditions (8.7 deaths per 1000 live births), where asphyxia, anoxia and hypoxia predominated as clinical causes of death and clinical causes reducible for good care at birth. Conclusions: A differential profile of infant mortality, according to living conditions, was identified within the population settlements of the urban districts of Santiago de Cuba. The distinctive risks of infant death were at the expense of the neonatal component, mainly for clinical causes reducible by good care at birth.

RESUMEN Introducción: La mortalidad infantil es un fenómeno sanitario relacionado directamente con las condiciones de vida deletéreas, tanto del hogar del infante como de factores socioeconómicos e higiénico-sanitarios adversos. Objetivo: Caracterizar las desigualdades de la mortalidad infantil, según condiciones diferenciales de vida en dos distritos poblacionales de Santiago de Cuba. Métodos: Se llevó a cabo un estudio descriptivo, de tipo ecológico exploratorio, en el municipio Santiago de Cuba, en el trienio 1995-1997. Las unidades de análisis estuvieron constituidas por las áreas de salud enmarcadas en dos distritos poblacionales de la ciudad. Resultados: Se estratificaron ambos distritos poblacionales, según sus condiciones de vida, en asentamientos con condiciones de vida menos desfavorables y más desfavorables. Se estimó mayor mortalidad infantil en el asentamiento con condiciones de vida más desfavorables (8,7 fallecidos por 1000 nacidos vivos), donde predominaron como causas clínicas de muerte las asfixias, la anoxia e hipoxias y causas clínicas reducibles por buena atención en el parto. Conclusiones: Se identificó un perfil diferencial de mortalidad infantil, según las condiciones de vida, al interior de los asentamientos poblacionales de los distritos urbanos de Santiago de Cuba. Los riesgos distintivos de muerte infantil fueron a expensas del componente neonatal, en lo fundamental por causas clínicas reducibles por buena atención en el parto.

ABSTRACT The theme of “citizenship”, object of study in the social and political sciences, is also addressed in the Social Doctrine of the Church. An example of this is the concept of “integral ecology” developed in the encyclical letter Laudato si´ (LS).1 The analysis of the two concepts allows a broader understanding of both, making it a contemporary and relevant reflection for the debate on the care for the common home and the participation of people in society. This article intends to explain how the notion of citizenship dialogues with the concept of integral ecology, so that the understanding of one and the understanding of the other are mutually enriched. To this end, A. Cortina’s theory of citizenship and the vision of ecology of Catholic social thought will be analyzed, highlighting the elements of contact and convergence between them. In this way, it makes explicit that as citizens exercise their rights, they will contribute to the creation of favorable conditions in the struggle for an integral ecology. On the other hand, commitment to caring for our common home implies guaranteeing a dignified life for people as members of society. citizenship, , “citizenship” sciences Church si LS.1 LS1 LS .1 1 (LS). both society enriched end A Cortinas Cortina s analyzed them way rights hand “citizenship LS. . (LS) (LS

RESUMO O tema da “cidadania”, que é objeto de estudo das ciências sociais e políticas, também é tratado na Doutrina Social da Igreja. Exemplo disso é o conceito de “ecologia integral” desenvolvido na Carta encíclica Laudato si´ (2015). A análise dos dois conceitos permite uma compreensão ampliada de ambos tornando-se uma reflexão atual e relevante para o debate sobre o cuidado da casa comum e a participação das pessoas na sociedade. Neste artigo, pretende-se explicitar como a noção de cidadania dialoga com o conceito de ecologia integral, de modo que o entendimento de um e o entendimento do outro são mutuamente enriquecidos. Para tanto, serão analisadas a teoria da cidadania de A. Cortina e a visão de ecologia do pensamento social católico, destacando-se os elementos de contato e convergência entre eles. Dessa forma, explicita-se que à medida que os cidadãos e as cidadãs exercerem seus direitos, eles contribuirão para que se configurem condições favoráveis à luta por uma ecologia integral. Por outro lado, o emprenho no cuidado da casa comum implica a garantia da vida digna das pessoas como membros da sociedade. cidadania, , “cidadania” políticas Igreja integral si 2015. 2015 . (2015) tornandose tornando sociedade artigo pretendese pretende enriquecidos tanto católico destacandose destacando forma explicitase explicita direitos lado “cidadania 201 (2015 20 (201 2 (20 (2 (

Abstract: The aim of this work was to investigate the sense of place of 35 mexican second grade elementary school students as a fundamental element to improve teaching and learning processes, especially in socio-environmental topics. Methodologically, an interpretative perspective is used. The students were asked to draw three pictures: the environment, their favorite places at school and their favorite places at home. Based on their individual drawings, three separate individual interviews were conducted with 35 students. All data was analyzed using Atlas.ti software and an inductive approach to data analysis was used. A compositional interpretation was used to analyze the drawings. The principles of conversational analysis were used to analyze the text of the interviews. The results show that a sense of place is a complex concept in which not only the biophysical and spatio-temporal, but also the psychological, socio-cultural, economic, and emotional aspects are present. The students explain environmental degradation by the lack of rules or sanctions related to environmental care. The students' gender as an indicator of the sense of place was also different for boys and girls. Finally, emotions, freedom and autonomy are three important aspects that explain students’ attachment to place. Consequently, these aspects could be considered when designing and developing teaching strategies to strengthen the sense of place.

Resumen: El propósito de este estudio fue explorar el sentido de lugar de 35 estudiantes mexicanos de segundo grado de primaria como un elemento básico para mejorar los procesos de enseñanza y de aprendizaje, especialmente en temas socioambientales. Metodológicamente, utilizamos una perspectiva interpretativa. A los estudiantes se les pidió que realizaran tres dibujos: el medioambiente, los lugares favoritos de su escuela y los de su casa. Con base en sus tres dibujos, se hicieron tres entrevistas individuales a los 35 estudiantes. Todos los datos fueron analizados utilizando el software ATLAS.ti y un enfoque inductivo. Para analizar los dibujos aplicamos la interpretación de sus elementos composicionales y para analizar el texto producto de las entrevistas usamos los principios del análisis conversacional. Los resultados indican que el sentido de lugar es una noción compleja en la que no solo están presentes los aspectos biofísicos de espacio y tiempo sino también aspectos psicológicos, socioculturales, económicos y emocionales. Los estudiantes explican la degradación ambiental indicando que faltan normas o sanciones asociadas con el cuidado del medioambiente. Asimismo, el género de los estudiantes como indicador de sentido de lugar, marcó diferencias entre niños y niñas. Finalmente, las emociones, la libertad y la autonomía son tres aspectos importantes que explican el apego al lugar de los estudiantes. En consecuencia, estos aspectos podrían considerarse en el diseño y desarrollo de estrategias de enseñanza que fortalezcan el sentido de lugar.