Resumen A partir de 14 entrevistas a profundidad con personas migrantes peruanas residentes en Suiza, el artículo analiza los arreglos familiares entre las y los hermanos migrantes y no migrantes en favor de sus madres y padres radicados en Perú. Los hallazgos subrayan que la toma de decisiones está marcada por relaciones de poder, donde el género y los recursos económicos desempeñan un rol decisivo. Así mismo, las negociaciones entre hermanas y hermanos están relacionadas con la capacidad de cumplir el deber filial de cuidar y de sentirse reconocido como el hijo o la hija que cuida a sus padres, tal como estos lo hicieron cuando ellos eran niños. Si bien la muestra abarca a un grupo de migrantes establecidos en Suiza que logró importantes niveles de integración social, cultural y laboral, los resultados proporcionan pistas sobre la problemática de los cuidados transnacionales aplicables a otros contextos de migración sur-norte.

Abstract Based on fourteen in-depth interviews with Peruvian migrants living in Switzerland, the article analyzes the family arrangements between migrant and non-migrant siblings on behalf of their parents living in Peru. The findings highlight that decision-making is affected by power relations, where gender and economic resources play a decisive role. Sibling negotiations are also related to the capacity to fulfill the filial duty of taking care and feeling recognized as the son or daughter who takes care of the parents, just as the parents did when the siblings were children. While the sample covers a group of migrants settled in Switzerland who achieved important levels of social, cultural, and labor integration, the results provide insights on transnational care issues that are applicable to other South-North migration contexts.

Resumen El objetivo de esta investigación cualitativa es identificar los factores que facilitan u obstaculizan la adquisición o el fortalecimiento de competencias culturales en la labor de los profesionales de atención primaria de salud en Chile. Con base en las entrevistas semiestructuradas realizadas a 32 profesionales que trabajan en una comuna de Santiago, se efectuó un análisis de contenido considerando cuatro dimensiones de las competencias culturales: conciencia, conocimiento, habilidades y motivación. Este análisis fue discutido en ocho conversatorios con profesionales de atención primaria, académicos/as e integrantes de colectivos migrantes; esto permitió reconocer los patrones en el trato y en la atención que avalan ciertas prácticas y valores. Se concluye que los factores analizados interpelan a los/as profesionales y constituyen un insumo para estimular los procesos de reflexión individual y de los equipos.

Abstract The objective of this qualitative research is to identify the factors that facilitate or hinder the acquisition or strengthening of cultural competencies in the work of primary health care professionals in Chile. Based on semi-structured interviews carried out with 32 professionals who work in a municipality of Santiago, a content analysis was performed, considering four dimensions of cultural competencies: awareness, knowledge, skills, and motivation. This analysis was discussed in eight conversation groups with primary care professionals, academics, and members of migrant groups. This made it possible to identify patterns in treatment and attention that support certain practices and values. It is concluded that the factors analyzed challenge the professionals and constitute an input to stimulate the individual and team reflection processes.

Abstract Introduction: Health care involves cultural aspects that must be known to benefit people from the Nursing care provided. Objective: To describe the use of Ethnonursing as a research design and Madeleine Leininger’s Theory of Culture Care in the Nursing literature. Methods: n integrative review was carried out following the phases proposed by Withmoore and Knalf. The bibliographic search was conducted in Medline, Cuiden Plus, Lilacs, Scopus and ScienceDirect. The “qualitative research”, “nursing”, “culturally competent health care” and “transcultural nursing” descriptors were used in English, Spanish and Portuguese, including original articles published between 2013 and 2023. Results: A total of 12 articles were chosen and coded to give rise to four categories, namely: need for training in Ethnonursing and in the Theory of Culture Care; recognition of the cultural context and of barriers to culturally congruent care; culture care diversity and universality; and actions for culturally congruent care. Conclusions: The review allowed recognizing that the Theory of Culture Care and Ethnonursing have been scarcely used in the scientific and professional Nursing practice. It is necessary to encourage professionals to value due respect for different cultures in health services.

Resumo: Introdução: O atendimento em saúde envolve aspectos culturais que devem ser conhecidos para beneficiar as pessoas a partir dos cuidados de enfermagem. Objetivo: Descrever a utilização da etnoenfermagem como desenho de investigação e a teoria cultural do cuidado de Madeleine Leininger na literatura de enfermagem. Métodos: Foi efetuada uma revisão integrativa segundo as fases de Withmoore e Knalf. A pesquisa bibliográfica foi realizada nas bases de dados Medline, Cuiden Plus, Lilacs, Scopus e ScienceDirect, com os descritores “pesquisa qualitativa”, “enfermagem”, “assistência à saúde culturalmente competente” e “enfermagem transcultural” em inglês, espanhol e português, incluindo artigos originais publicados entre 2013 a 2023. Resultados: Selecionou-se 12 artigos, codificados para o surgimento de quatro categorias: necessidade de formação em etnoenfermagem e teoria cultural do cuidado; reconhecimento do contexto cultural e barreiras para o cuidado culturalmente congruente; diversidade e universalidade do cuidado cultural; e ações para o cuidado culturalmente congruente. Conclusões: A revisão permitiu reconhecer que a teoria dos cuidados culturais e a etnoenfermagem têm sido escassamente utilizadas na prática científica e profissional da enfermagem. É necessário incentivar nos profissionais a importância de valorizar o respeito pelas diferentes culturas nos serviços de saúde..

Resumen: Introducción: La atención en salud involucra aspectos culturales que deben conocerse para beneficiar a las personas desde el cuidado de enfermería. Objetivo: Describir el uso de la etnoenfermería como diseño de investigación y la teoría del cuidado cultural de Madeleine Leininger en la literatura de enfermería. Metodología: Se realizó una revisión integrativa bajo las fases de Withmoore y Knalf. La búsqueda bibliográfica se llevó a cabo en Medline, Cuiden Plus, Lilacs, Scopus y ScienceDirect, con los descriptores “investigación cualitativa”, “enfermería”, “asistencia sanitaria culturalmente competente” y “enfermería transcultural” en idioma inglés, español, portugués, incluyendo artículos originales publicados entre 2013 a 2023. Resultados: Se eligieron 12 artículos que fueron codificados para el surgimiento de cuatro categorías: necesidad de formación en etnoenfermería y teoría del cuidado de la cultura; reconocimiento del contexto cultural y barreras para el cuidado culturalmente congruente; diversidad y universalidad de los cuidados culturales; y acciones para el cuidado culturalmente congruente. Conclusiones: La revisión permitió reconocer que la teoría de cuidado cultural y la etnoenfermería han sido escasamente utilizadas en la práctica científica y profesional de enfermería. Es necesario incentivar en los profesionales la importancia de valorar el respeto por las diferentes culturas en los servicios de salud.

Heelwat navorsing is al gedoen in 'n poging om 'n greep op aspekte van goeie en slegte plaaslike regering te kry. 'n Kernvraag wat steeds onbeantwoord bly is die volgende: Wat is "plaaslike regering", en hoe kan die werklikheid waarna die begrip verwys, verstaan en herken word? 'n Begripsraamwerk van "plaaslike regering" is onlangs ontwikkel bestaande uit die herkenbare eienskappe van die begrip om dit te identifiseer. Gepaardgaande daarmee is 'n sosiale ontologie van sorg vir "plaaslike regering" ontwikkel. Die veronderstelling is dat plaaslike regerings in Suid-Afrika en ander lande aan die hand van daardie eienskappe herken sal word. Binne die Suid-Afrikaanse konteks is daar egter 'n moontlike nietipiese voorbeeld van plaaslike regering, naamlik Orania, 'n bestaande dorp binne die geografiese gebied van die Thembelihle Plaaslike Munisipaliteit in die Noord-Kaapprovinsie. Orania is nie 'n muni-sipaliteit ingevolge die Suid-Afrikaanse grondwet en wetlike raamwerk nie. Die vraag is gevolglik of Orania wel as 'n "plaaslike regering" beskou kan word. In antwoord op die vraag gee hierdie artikel 'n ontiese¹ beskrywing van Orania aan die hand van die gekose begripsraamwerk en sosiale ontologie van sorg. Dit blyk uit die beskrywing en ontleding daarvan dat Orania wel aan die institusionele, funksionele en territoriale eienskappe van die begrip "plaaslike regering" voldoen en op 'n outentieke wyse as plaaslike regering funksioneer. Die gevallestudie wys dat 'n outentieke plaaslike regering een is wat 'n integrerende deel uitmaak van sy plaaslike gemeenskap en omsluitende wêrelde, wat voortdurende ongemak met die hede beleef en met sorg, besorgdheid en sorgsaamheid daarop reageer.

Much research has been conducted to grasp aspects of good and bad local governance. A central question that remains unanswered is: What constitutes "local government" and how can the reality to which this concept refers be understood and recognised? Recently, a conceptual framework was developed by identifying recognisable characteristics of this concept's reference. The assumption is that local governments in South Africa and other countries will be recognised based on these characteristics. Alongside this, a social ontology of care for "local government" was established. However, within the South African context, a potentially atypical example of local government is found, namely Orania, an existing town situated within the geographical area of the Thembelihle Local Municipality in the Northern Cape province. Orania is not a municipality in terms of the South African constitution and legal framework. The question thus arises whether Orania can indeed be considered a "local government". In response to this query, this article provides a description of Orania using the chosen conceptual framework and social ontology of care as part of a case study design. The analysis and ontological description ofOrania, by means of the conceptual framework, reveal that the phenomenon of Orania does indeed possess a territorial jurisdictional sphere (the Orania Overlay Zone), a democratically elected representative council (the OVR), and a Town Council and its administration that performs a range of local functions and responsibilities. While the territory of a municipality is generally determined by authorising measures or decisions by other jurisdictions (such as province, state, and national government), the territorial area known as the Orania Overlay Zone results from the purchase and cultivation of land by members of a homogeneous cultural community. Therefore, the territory is not only a demarcation of jurisdiction, but the place to which this community is connected. The institutional aspect of local government is likely a universal feature. The nature and scope of the institutional structure of local governments are often also the result of standardised external authorising measures or decisions by other jurisdictions. Consequently, the structures may not necessarily resonate with the needs and resources of the sometimes diverse society that constitutes the inhabitants of such an area. In the case of Orania, the institutional structure of local government (the OVR and the Town Council) is directly determined by the community, as represented by various land entities, based on the community's specific needs and available resources. The performance of a limited range of local functions can also be considered a universal feature of local government. In this particular case, the functions of the relevant local government are determined by its decision-making bodies, such as the Town Council, in consultation with the community as represented by the various land entities. Consequently, typical local government functions are performed according to the community's needs and available resources. Non-typical local government functions, such as residence rights, are performed within the general scope of the 1996 Constitution of the Republic of South Africa and other national legislation. The analysis confirmed that Orania meets the characteristics consistent with the concept of "local government" as outlined in the conceptual framework. Additionally, viewing Orania through the theoretical lens of social ontology of care highlights that it is a human construct, making objective observation and description challenging. Orania is a network of interconnected individuals and social institutions situated within overlapping human, spiritual, natural, territorial, and political worlds. The authenticity of this existence lies in its concern for the affairs of the world in which it is situated and the conscientiousness with which it carries out its functions in conjunction with others. The case study shows that an authentic local government is one that forms an integral part of its local community and surrounding worlds, continually experiencing discomfort (anxiety) with the present, and responding to that anxiety with care, concern, and nurturing for society and its things.

Hierdie artikel ondersoek twee aspekte wat die outentiekheid van 'n plaaslike regering raak, naamlik die antesedente en die gevolglikheid daarvan. 'n Begripsraamwerk en 'n sosiale ontologie van sorg van "plaaslike regering" is as teoretiese lense vir die ondersoek gebruik. Wat die antesedente van plaaslike regering betref (magtiging, inwoners, natuurlike en fisiese ligging, samewerkende regerings, en vermoëns), het Orania nie as gevolg van magtigende maatreëls soos die Grondwet en voortspruitende wetgewing ontstaan nie, maar as gevolg van 'n kultuurgemeenskap se strewe en gevolglike aankoop van 'n stuk grond. Anders as die inwoners van munisipaliteite in die res van Suid-Afrika het Orania se inwoners verblyfreg verkry op grond van hul onderskrywing van Orania se ontstaansredes. Die eiesoortige fisiese ligging van Orania is doelbewus deur die grondleggers gekies en is bepalend vir die voorsiening van energie, water en ander infrastruktuur-verwante dienste deur Orania Dorpsraad. Die dorpsadministrasie blyk voorts oor voldoende fondse, raadslede en amptenare te beskik om sy funksies uit te voer en sodoende 'n tuiste vir sy gemeenskap te skep. Wat die gevolglikheid van plaaslike regering betref (lewensgehalte, demokratiese en verantwoordelike regering, volhoubare dienslewering, maatskaplike en ekonomiese ontwikkeling, en veilige en gesonde omgewing) blyk die Orania inwonersgemeenskap goeie lewensgehalte te ervaar. Hulle blyk deurlopend betrokke te wees by verskeie gemeenskapsorganisasies, 'n demokratiese en verant-woordingspligtige Orania Verteenwoordigende Raad (OVR) en dorpsadministrasie. Voorts ontvang hulle volhoubare munisipale dienslewering, ervaar maatskaplike en ekonomiese ontwikkeling en leef in 'n veilige en gesonde omgewing. 'n Outentieke plaaslike regering blyk een te wees wat goed geïntegreer is met sy plaaslike gemeenskap en omsluitende wêrelde, voortdurend ongemaklik is met die hede, en met sorg, besorgdheid en sorgsaamheid daarop reageer. Orania is klaarblyklik só 'n plaaslike regering.

Local government is distinguished from other spheres of government based on its unique institutional characteristics, the local nature of its governmental functions, and the territorial delineation of its local jurisdiction. Despite being localised, local governments often fail to meet the specific needs of their residents. The implication is that they are not authentic local governments. This article examines two aspects that have an impact on the authenticity of a local government: the necessary conditions (antecedents) for and the consequences of an authentic local government. These aspects are considered through a case study of Orania as a non-typical instance of a South African local government. A conceptual framework and a social ontology of care are used as theoretical lenses to analyse and understand the antecedents and consequences of a local government. In the preceding article, it was reported that the case of Orania does indeed align with the characteristics associated with the concept of "local government". The antecedents of local government have been shown to be authorisation, residents, natural and physical location, cooperative governments, and capabilities. It appears that Orania did not originate due to authorising measures such as the Constitution and subsequent legislation. Instead, it came about because of a cultural community's aspirations and the subsequent acquisition of a piece of land while obtaining legal authorisation at a later stage by means of an order of the High Court. The residents of Orania do not seem to be accidental inhabitants; but are residents based on their alignment with Orania's founding principles. The unique physical location of Orania was deliberately chosen and plays a crucial role in the provision of energy, water, and other infrastructure-related services by the Orania Town Council and administration. The Town Council and its administration appear to have sufficient funds, competent and ethical council members and officials to carry out its functions and create a home for its community. Regarding the consequences of local government, the Orania community seems to experience a good quality of life while actively engaging in various community organisations, participating in the democratic election of an accountable Orania Representative Council (OVR) and Town Council, receiving sustainable municipal services, and witnessing social and economic development. Additionally, they enjoy a safe and healthy environment. An authentic local government is thus one that is integrally connected to its local community and the surrounding world. It continually grapples with present challenges and genuinely cares for its community and the world it inhabits. Orania, therefore, appears to embody the characteristics of a local government.

Abstract Introduction. The flow of migrants between different countries is a reality in Portugal, Spain and Belgium. As a consequence, one of the main concerns is the care of migrants in health services. This healthcare is not systematised in the good practice manuals that are available. There is no training in this area, neither in educational curricula nor in the continuous training of health professionals. Objectives. To find out migrants' perceptions of the health care they receive in the three countries. Method(s). Cross-sectional descriptive study in which we adopted a qualitative approach based on Grounded Theory carried out through focus groups and semi-structured telephone interviews. For the analysis process, the main dimensions around which the discourse is articulated were identified, differentiating the most relevant aspects of each topic, grouping the data around the categories related to the objective of the study. The software Atlas-ti 8 and N-Vivo were used for the analysis. Results. The main difficulties faced by migrants in health care are: poor access to the health care system; barriers to healthcare, mainly communication barriers; frequent discriminatory behaviours; poor structural cultural competence, especially due to the lack of translation and intercultural mediation resources; poor health system flexibility and biomedical orientation; and insufficient professional cultural competence. Conclusions. Difficulties of access to the health system are evident: lack of language skills, ignorance of the care itinerary and the perception of discriminatory treatment by health professionals. In addition, the improvement of the competence and cultural sensitivity of health professionals and system improvement strategies, such as translation and intercultural mediation, are proposed.

Resúmen Introducción. El flujo de migrantes entre los diferentes países es una realidad en Portugal, España y Bélgica. Como consecuencia, una de las principales preocupaciones es la atención a personas migrantes en los servicios de salud. Esta atención no está sistematizada en los manuales de buenas prácticas que se encuentran disponibles. No se dispone de formación en esta área, ni en los currículos educativos ni en la formación continua de profesionales de la salud. Objetivos. Conocer la percepción de las personas migrantes sobre la atención sanitaria que reciben en los tres países. Método/s. Estudio descriptivo transversal en el que adoptamos un enfoque cualitativo basado en la Teoría Fundamentada realizado mediante grupos focales y entrevistas telefónicas semiestructuradas. Para el proceso de análisis se identificaron las dimensiones principales en torno a las cuales se articula el discurso, diferenciándose los aspectos más relevantes de cada tema, agrupando los datos en torno a las categorías relacionadas con el objetivo del estudio. Para el análisis se utilizaron los programas informáticos Atlas-ti 8 y N-Vivo Resultado/s. Las principales dificultades a las que se enfrentan las personas migrantes en la atención sanitaria son: déficit de acceso al sistema sanitario; las barreras en la atención, sobre todo la de la comunicación; el frecuente trato discriminatorio: la escasa competencia cultural estructural, sobre todo con la carencia de recursos de traducción y mediación intercultural, la escasa flexibilidad del sistema y su orientación biomédica y la insuficiente competencia cultural profesional. Conclusiones. Se evidencian dificultades de acceso al sistema sanitario: no manejo del idioma, desconocimiento del itinerario asistencial y percepción de un trato discriminatorio por parte de profesionales de la salud. Además, las personas migrantes proponen la mejora de la competencia y la sensibilidad cultural de profesionales de la salud y estrategias de mejora del sistema, como la traducción y la mediación intercultural.

Abstract Introduction/Frame: Some migrant women living in Portugal who have undergone female genital mutilation pass on this legacy to their daughters for cultural reasons. In this context, it is imperative that nurses specialising in maternal health and obstetric nursing (henceforth referred to as obstetric nurses) contribute to eradicating this harmful traditional practice and protecting the girls of future generations; Research Question/Objectives: The guiding research question is “What experiences do obstetric nurses have when caring for women with female genital mutilation?” and the objective is “To understand the experiences of obstetric nurses when faced with the challenges of caring for women with female genital mutilation”; Methodology: This is a hermeneutic phenomenological qualitative study, based on the assumptions of Max van Manen, who defends the importance of understanding and interpreting human experiences for nursing practice. A phenomenological interview script was used to collect the data, and 12 participants were interviewed who met the following inclusion criteria: being an obstetric nurse who provides, or has provided, preventive care and has notified or referred cases of FGM; Results: Two categories stand out: “Constraints experienced by obstetric nurses when caring for women who have undergone genital mutilation” and “Proposals to be implemented by obstetric nurses to prevent, notify and intervene to eradicate female genital mutilation”; Final considerations: The conclusions show that preventive, notification and intervention practices still fall short of what would be desirable. There is an urgent need to invest in and intensify the training of health professionals in female genital mutilation, making them more aware and knowledgeable about this practice. Training these professionals will enable them to empower populations to change their mentalities, including communities where FGM is prevalent, with a view to eradicating it.

Resumo Introdução/Enquadramento: Algumas mulheres migrantes residentes em Portugal, que foram alvo de mutilação genital feminina, transmitem esse legado às suas filhas, por questões culturais. Neste contexto, é premente que o enfermeiro especialista em enfermagem de saúde materna e obstétrica (doravante designado enfermeiro obstetra) contribua para erradicar esta prática tradicional nefasta, e proteger as meninas das gerações vindouras.; Questão de investigação/Objetivos: : A questão de investigação norteadora é “Que vivências tem o enfermeiro obstetra, no cuidar mulheres, com mutilação genital feminina?” e o objetivo é “Compreender as vivencias, do Enfermeiro Obstetra, face aos desafios que se lhe colocam ao cuidar mulheres com Mutilação Genital Feminina”; Metodologia: Estudo qualitativo fenomenológico hermenêutico, apoiado nos pressupostos de Max van Manen, que defendem a importância que recai no entendimento e interpretação das experiências humanas para a prática de enfermagem. Para a recolha de dados foi utilizado um guião de entrevista fenomenológica e entrevistados 12 participantes que corresponderam aos seguintes critérios de inclusão: ser Enfermeiro Obstetra que preste, ou tenha prestado, cuidados preventivos e realizado notificação ou referenciação de casos de MGF; Resultados: Destacam-se duas categorias: “Constrangimentos vivenciados pelo Enfermeiro Obstetra no cuidado a mulheres submetidas à mutilação genital” e “Propostas a implementar pelo Enfermeiro Obstetra para a prevenção, notificação e intervenção para a erradicar a mutilação genital feminina”; Considerações Finais: As conclusões revelam que as práticas preventivas, de notificação e intervenção ainda estão aquém do que seria desejável. Urge investir e intensificar a formação dos profissionais de saúde em mutilação genital feminina tornando-os mais despertos e conhecedores sobre esta prática. A capacitação destes profissionais vai permiti-los empoderar as populações rumo à mudança de mentalidades, incluído as comunidades, onde a MGF é prevalente, tendo em vista a erradicação da mesma.

Abstract: The Arte de la Lengua General del Reyno de Chile is a cultural object that, like every printed book, constitutes at the same time an intellectual creation and a material product. It is made up of two inseparable dimensions, one internal, which includes the cognitive-intellectual and graphic-linguistic strata and another external dimension, made up of the physical-material stratum that is, ultimately, the product of the intervention of all the agents involved in the publishing business. Precisely, beyond the author, the interventions of editors, printers and booksellers were decisive for the material configuration of the ancient book. The analysis of the material aspects of the Arte from the direct observation of an original copy reveals particularities in the composition and typographic printing that, together with the consideration of certain passages of the text, allow us to verify that Febrés, beyond the authorship, took care of some problems associated with material aspects of publication that generally depended on decisions made by editors or printers. This is how it provides concrete data and even gives advice to the reader to achieve a better reception of its printed work, taking into account the deficiencies that it presented at a material level related to the layout on the page or the quality of printing, issues that show the conditions of unfavorable production conditions to which the Lima printing presses of the 18th century were subjected.

Resumen: El Arte de la Lengua General del Reyno de Chile (en adelante Arte) es un objeto cultural que, como todo libro impreso, constituye al mismo tiempo una creación intelectual y un producto material. Está conformado por dos dimensiones indisociables una interna, que comprende los estratos cognitivo-intelectual y gráfico-lingüístico y otra dimensión externa, que comprende el estrato físico-material que es, en definitiva, producto de la intervención de todos los agentes involucrados en el negocio editorial. Precisamente, más allá del autor, las intervenciones de los editores, impresores y libreros eran determinantes para la configuración material del libro antiguo. El análisis de los aspectos materiales del Arte a partir de la observación directa de un ejemplar original revela particularidades en la composición e impresión tipográfica que, junto a la consideración de determinados pasajes del texto permiten comprobar que Febrés, más allá de la autoría se ocupó de algunos problemas asociados con aspectos materiales de la publicación que generalmente dependían de las decisiones tomadas por editores o impresores. Es así como proporciona datos concretos e incluso brinda consejos al lector para lograr una mejor recepción de su obra impresa, habida cuenta de las carencias que presentaba a nivel material relacionadas con la puesta en página o la calidad de impresión, cuestiones que evidencian las condiciones de producción desfavorables a las que estaban sometidas las imprentas limeñas del siglo XVIII.

Abstract The use and prescription of medicinal plants and herbal medicines within the Family Health Strategy faces new and old challenges in the post-pandemic COVID-19 context. Globally, the biomedical model has strengthened as the main guiding paradigm of care. In Brazil, the increase in poverty and the disinvestment in health policies have compounded the phenomenon of misinformation. This article discusses how the availability of herbal medicine and other integrative and complementary practices have been affected in this context, based on data from two studies conducted prior to the pandemic. The first, carried out with healthcare professionals in the municipality of Rio de Janeiro, identifies conflicts between professional categories in the use and prescription of these treatments. The second, an ethnographic approach, describes how popular groups have been claiming the recognition of knowledge about medicinal plants as intangible cultural heritage. In order to avoid categorizing these practices as health misinformation, it is necessary to understand their traditional use in local contexts. postpandemic post pandemic COVID19 COVID 19 COVID-1 context Globally care Brazil misinformation first Janeiro treatments second approach heritage contexts COVID1 1 COVID-

Resumo O uso e prescrição de plantas medicinais e fitoterápicos na Estratégia Saúde da Família enfrenta novos e velhos desafios no contexto pós-pandemia de Covid-19. No mundo, o modelo biomédico se fortaleceu como principal paradigma orientador do cuidado. No Brasil, o aumento da pobreza e o desinvestimento em políticas de saúde se somaram ao fenômeno da desinformação. O artigo discute como a oferta de fitoterapia e outras práticas integrativas e complementares foram afetadas nesse contexto a partir de dados de duas pesquisas anteriores à pandemia. A primeira, realizada com profissionais de saúde no município do Rio de Janeiro, identifica os conflitos entre categorias profissionais no uso e prescrição. A segunda, uma abordagem etnográfica, descreve como grupos populares têm reivindicado o reconhecimento de saberes sobre plantas medicinais como patrimônio cultural imaterial. A fim de evitar a categorização dessas práticas como desinformação em saúde, é necessário compreender o uso tradicional em contextos locais. póspandemia pós pandemia Covid19. Covid19 Covid 19. 19 Covid-19 mundo cuidado Brasil primeira Janeiro segunda etnográfica imaterial locais Covid1 1 Covid-1 Covid-

ABSTRACT Introduction: Influenza is a global threat, with high epidemic potential and affects between 5 and 15% of the world's population annually. In the hospital environment, vaccination is crucial to protect healthcare professionals. However, despite international recommendations, vaccination uptake is low due to safety concerns and/or distrust. Studies show that vaccinated professionals have lower rates of absenteeism, and when infected with the virus, they present milder symptoms. In this work, a retrospective cross-sectional observational study is carried out on the vaccination rate against this disease in a population of hospital-based workers, from 2019 to 2023. To understand the importance of vaccination against Influenza in these workers and which behavioral determinants may justify considering this evolution, we carried out a review of the challenges of vaccination among health professionals and identified key points to develop strategies with the aim of promoting adherence to vaccination campaigns. Methodology: For the observational study, vaccination data from hospital health professionals by the Occupational Health Service was used, recorded on a specific form at the time of administration. Professional category was the only variable considered. Data analysis was performed using Microsoft® Excel®. For the review, the databases Medline, Science Direct and Google Scholar were used, with the keywords "Influenza vaccine”, “health professional” and “behaviour”, selecting studies from 2010 to 2024. From the result of 1277 works, the exclusion criteria, which included vaccination for other diseases and target populations that did not include health professionals, 22 bibliographic sources were selected. To reflect the national reality, articles on the topic published by the Revista Portuguesa de Saúde Ocupacional Online were included, as well as complementary studies and reference documents. Results: The study of adherence to flu vaccination in this hospital peripheral to Lisbon, between 2019 and 2023, showed a variation in vaccination adherence, with an average of 30%, a value below the ones reported in other countries. The categories most hesitant about this vaccine were Nursing Staff and Technical Assistants; at the opposite extreme, there was greater adherence from Medical Personnel and Technical Assistants. During the COVID-19 Pandemic, an increasing number of professionals were vaccinated annually, with this trend reversing after the end of the global emergency of this disease. From the review of the literature on vaccine hesitancy, 8 of the 14 behavioral domains stand out that represent theories of behavioral change that constitute modifiable factors that influence behavior in relation to the vaccine. We approach each of them from this perspective, namely: knowledge, the environmental context and resources, social influence, beliefs and knowledge about consequences, beliefs about individual capacity, identity and social/professional role, reinforcement and emotion. Discussion: Flu vaccine hesitancy among healthcare professionals can be a cause of morbidity and mortality for patients. Understanding the barriers and motivation for healthcare professionals to adhere to flu vaccination campaigns is crucial. Professionals who are asymptomatic carriers become sources of transmission. Annual vaccination, although safe and effective, faces variability due to antigenic concordance. In Portugal, educational and communication strategies are vital, highlighting the role of health professionals as models of preventive behavior. Easy access to medical consultations and Occupational Health recommendations is associated with greater adherence. In times of pandemic, the propensity for vaccination has increased, and it is important to promote this change. Strategies adapted to the cultural context are essential to boost adherence to Influenza vaccination among healthcare professionals. Conclusion: The approach to combating barriers and promoting vaccination among healthcare professionals must involve multiple areas and multiple levels, with communication targeted at specific groups, to increase its effectiveness. The message must be adapted to different population groups and different levels of health literacy. Knowing these behavioral determinants can help develop vaccination promotion campaigns from new perspectives and finding strategies to increase vaccination coverage is crucial for Occupational Health Services. Due to the ethical characteristics of the professions involved in providing direct care to patients, there is a need to reinforce the idea that vaccination among healthcare professionals is not only for their benefit, but above all for the protection of their patients.

RESUMO Introdução: A Gripe é uma ameaça global, com alto potencial epidémico e afeta anualmente entre 5 a 15% da população mundial. No ambiente hospitalar, a vacinação é crucial para proteger os Profissionais de Saúde. No entanto, apesar das recomendações internacionais, a adesão é baixa devido a preocupações de segurança e/ou desconfiança. Estudos mostram que os profissionais vacinados têm menores taxas de absentismo e, perante infeção pelo vírus, apresentam sintomatologia mais ligeira. Neste trabalho é realizado um estudo observacional transversal retrospetivo da taxa de vacinação contra esta doença numa população de trabalhadores de base hospitalar, no período de 2019 a 2023. Para compreender a importância da vacinação contra a Influenza nestes trabalhadores e quais os determinantes comportamentais que podem justificar esta evolução, realizou-se uma revisão dos desafios da vacinação entre Profissionais de Saúde, para identificar pontos chave e elaborar estratégias com o objetivo de promover a adesão às campanhas de vacinação. Metodologia: Para o estudo observacional da taxa de adesão à vacinação contra a Gripe num hospital periférico foram utilizados os dados de vacinação dos Profissionais de Saúde disponibilizados nos registos do Serviço de Saúde Ocupacional. A categoria profissional foi a única variável considerada. A análise dos dados foi realizada com o Microsoft® Excel®. Para a revisão recorreu-se às bases de dados Medline, Science Direct, Google Scholar; com as palavras-chave "Influenza vaccine”; “health professional” e “behaviour" e filtraram-se estudos de 2010 a 2024. Resultaram 1277 trabalhos e, após aplicar os critérios de exclusão, que incluíam vacinação para outras doenças e populações alvo que não os Profissionais de Saúde, foram selecionadas 22 fontes bibliográficas. Para espelhar a realidade nacional foram incluídos os artigos sobre o tema publicados pela Revista Portuguesa de Saúde Ocupacional Online, assim como estudos complementares e documentos de referência. Resultados: O estudo da adesão à vacinação contra a Gripe neste hospital periférico a Lisboa, entre 2019 e 2023, mostrou uma variação na adesão à vacinação, com uma média de 30%, valor abaixo dos valores reportados noutros países. As categorias com maior hesitação a esta vacina foram o Pessoal de Enfermagem e os Assistentes Técnicos. Na situação oposta estavam o Pessoal Médico e os Assistentes Técnicos. Durante a Pandemia COVID-19 existiu um número crescente de profissionais vacinados anualmente, tendo esta tendência invertido após o fim da emergência global desta doença. Da revisão da bibliografia sobre a hesitação vacinal destaca-se 8 dos 14 domínios comportamentais que representam as teorias de mudança comportamental que constituem fatores modificáveis que influenciam a atitude em relação à vacina. Abordou-se sobre esta perspetiva cada um deles, nomeadamente, o conhecimento; o contexto ambiental e recursos; influência social; crenças e conhecimento sobre consequências; bem como sobre a capacidade individual; identidade e papel social/profissional; reforço e emoção. Discussão: A hesitação vacinal contra a Gripe entre Profissionais de Saúde pode ser uma causa de morbilidade e mortalidade para os doentes. Compreender as barreiras e motivação para a adesão dos Profissionais de Saúde às campanhas de vacinação contra a Gripe é crucial. Profissionais portadores assintomáticos, tornam-se fontes de transmissão. A vacinação anual, embora segura e eficaz, enfrenta variabilidade devido à concordância antigénica. Em Portugal, estratégias educacionais e de comunicação são vitais, destacando o papel dos Profissionais de Saúde como modelos de comportamento preventivo. O acesso fácil a consultas médicas e tal ser recomendado pela Saúde Ocupacional é associado a maior adesão. Em tempos de pandemia, a propensão à vacinação aumentou, importando promover esta mudança. Estratégias adaptadas ao contexto cultural são essenciais para impulsionar a adesão à vacinação contra a Gripe entre Profissionais de Saúde. Conclusão: A abordagem para combater as barreiras e promover a vacinação nos Profissionais de Saúde deve envolver múltiplas áreas e vários níveis, com uma comunicação dirigida a grupos específicos, para aumentar a sua eficácia. Deve adaptar-se a mensagem aos diferentes grupos populacionais e aos diferentes níveis de literacia em saúde. Conhecer estes determinantes comportamentais pode ajudar a desenvolver campanhas de promoção da vacinação a partir de novas perspetivas e encontrar estratégias para aumentar a cobertura vacinal é crucial para os Serviços de Saúde Ocupacional. Pelas características éticas das profissões envolvidas na prestação de cuidados diretos aos doentes, existe a necessidade de reforçar a ideia de que a vacinação entre Profissionais de Saúde não é apenas para seu benefício mas, acima de tudo, para proteção dos seus doentes.

Abstract This article aims to map the global scientific production on social or cultural representations and breast cancer in Public Health and discuss how it is presented in the literature. We conducted a scoping review guided by the question: “How are cultural or social representations in the context of breast cancer described in the global scientific Public Health production?”. We searched for works in five scientific literature sources and included 45 studies. The analytical process followed the content analysis technique in the thematic modality. The analyzed collection can be thematized into the following categories: (1) Compromised body image and interactions, (2) Spirituality, (3) Loss of control over life, (4) Going on with life, and (5) Association with ethnic-racial issues. Despite advances in biomedicine, we observed that representations of breast cancer still have metaphors associated with cancer in the last century. We conclude that, among other aspects, care for women with breast cancer cannot be guided only by biomedical and epidemiological approaches since this disease is traversed by knowledge that competes with these approaches. question How production. . production?” 4 studies modality categories 1 (1 interactions 2 (2 Spirituality 3 (3 life (4 5 (5 ethnicracial ethnic racial issues biomedicine century aspects production? (

Resumo O objetivo deste artigo é mapear a produção científica global sobre representações sociais ou culturais e câncer de mama no campo da saúde coletiva e discutir como esse fenômeno se apresenta na literatura. Foi realizada uma revisão de escopo, tendo como norte a seguinte pergunta: “Como representações culturais ou sociais no contexto do câncer de mama são descritas na produção científica global no âmbito da saúde coletiva?”. As buscas foram realizadas em cinco fontes de literatura científica, sendo incluídos 45 estudos. O tratamento analítico seguiu a técnica de análise de conteúdo na modalidade temática. O acervo analisado pode ser tematizado nas seguintes categorias: (1) Comprometimento na imagem corporal e nas interações; (2) Espiritualidade; (3) Perda do controle da vida; (4) Seguir com a vida e (5) Associação a questões étnico-raciais. Apesar dos avanços da biomedicina, observa-se que nas representações do câncer de mama ainda permanecem metáforas associadas ao câncer no século passado. Conclui-se que, dentre outros aspectos, a atenção a mulheres com câncer de mama não pode ser pautada apenas pelas abordagens biomédica e epidemiológica, uma vez que essa doença é atravessada por saberes que competem com essas abordagens. escopo pergunta Como coletiva. . coletiva?” 4 estudos temática categorias 1 (1 interações 2 (2 Espiritualidade 3 (3 (4 5 (5 étnicoraciais. étnicoraciais étnico raciais. raciais étnico-raciais biomedicina observase observa passado Concluise Conclui aspectos epidemiológica coletiva? (

Resumo O objetivo deste artigo é mapear a produção científica global sobre representações sociais ou culturais e câncer de mama no campo da saúde coletiva e discutir como esse fenômeno se apresenta na literatura. Foi realizada uma revisão de escopo, tendo como norte a seguinte pergunta: “Como representações culturais ou sociais no contexto do câncer de mama são descritas na produção científica global no âmbito da saúde coletiva?”. As buscas foram realizadas em cinco fontes de literatura científica, sendo incluídos 45 estudos. O tratamento analítico seguiu a técnica de análise de conteúdo na modalidade temática. O acervo analisado pode ser tematizado nas seguintes categorias: (1) Comprometimento na imagem corporal e nas interações; (2) Espiritualidade; (3) Perda do controle da vida; (4) Seguir com a vida e (5) Associação a questões étnico-raciais. Apesar dos avanços da biomedicina, observa-se que nas representações do câncer de mama ainda permanecem metáforas associadas ao câncer no século passado. Conclui-se que, dentre outros aspectos, a atenção a mulheres com câncer de mama não pode ser pautada apenas pelas abordagens biomédica e epidemiológica, uma vez que essa doença é atravessada por saberes que competem com essas abordagens.

Abstract This article aims to map the global scientific production on social or cultural representations and breast cancer in Public Health and discuss how it is presented in the literature. We conducted a scoping review guided by the question: “How are cultural or social representations in the context of breast cancer described in the global scientific Public Health production?”. We searched for works in five scientific literature sources and included 45 studies. The analytical process followed the content analysis technique in the thematic modality. The analyzed collection can be thematized into the following categories: (1) Compromised body image and interactions, (2) Spirituality, (3) Loss of control over life, (4) Going on with life, and (5) Association with ethnic-racial issues. Despite advances in biomedicine, we observed that representations of breast cancer still have metaphors associated with cancer in the last century. We conclude that, among other aspects, care for women with breast cancer cannot be guided only by biomedical and epidemiological approaches since this disease is traversed by knowledge that competes with these approaches.

Resumo Introdução: O aborto espontâneo é muito comum e o seu impacto nas famílias, na sociedade e nos serviços de saúde é comprovado, mas subestimado. Este relato de caso pretende realçar a importância do acompanhamento após um aborto espontâneo, no luto, nos sintomas psicológicos associados à perda gestacional e na orientação holística do casal. Descrição do caso: Mulher de 37 anos, natural do Nepal, engravida espontaneamente após múltiplas tentativas sem sucesso. Sofre um aborto espontâneo às 10 semanas de gestação e é avaliada pela sua equipa de família, manifestando sentimentos de tristeza, solidão, ansiedade e medo, e desorientação face aos cuidados necessários. O acompanhamento centrou-se no esclarecimento de dúvidas e mitos, no reconhecimento dos sentimentos do casal, na exploração das formas de expressão do luto na cultura de origem, nos ensinos para estimular mudanças de comportamentos e na capacitação para o planeamento de uma nova gravidez. Comentário: Não existem intervenções farmacológicas eficazes para prevenir o aborto espontâneo; contudo, é uma oportunidade para intervir na adoção de hábitos de vida mais saudáveis. Apesar de frequentes, as consequências psicológicas e a psicopatologia associadas ao aborto espontâneo são muitas vezes esquecidas. A experiência do luto é individual e não se baseia necessariamente na idade gestacional, no nível socioeconómico ou educacional, ou no número de perdas ou de filhos vivos. Lidar com este caso exige à medicina geral e familiar avaliar a gestão do luto e o bem-estar físico e mental, despistando psicopatologia e acompanhando o planeamento de uma gravidez futura, atuando em cuidados transculturais e na dimensão social e familiar de cada um.

Abstract Introduction: Miscarriages are common and their impact on families, societies, and health services are proven, but yet underestimated. This case report intends to highlight the importance of follow-up after a miscarriage, especially concerning grief, psychological symptoms associated with pregnancy loss, and the holistic approach to the couple. Case report: A 37-year-old woman from Nepal becomes pregnant spontaneously after multiple unsuccessful attempts. She suffers a miscarriage at 10 weeks of gestation and she is seen by her family doctor and nurse. She expresses feelings of sadness, loneliness, anxiety and fear, and confusion regarding the follow-up care. The process of care focused on clarifying doubts and myths, recognizing the couple's feelings, exploring ways of expressing grief in their culture, encouraging changes in behavior, and helping to plan a new pregnancy. Discussion: There are no effective pharmacological interventions to prevent miscarriage, despite being an opportunity to promote the adoption of healthier lifestyle habits. Although frequent, the psychological consequences and psychopathology associated with miscarriage are often overlooked. The experience of bereavement is individual and it is not necessarily related to gestational age, socioeconomic or educational background, or the number of losses or living children. Dealing with a case of miscarriage requires family physicians to assess grief management and physical and mental well-being, screening for psychopathology and following the planning of a future pregnancy, acting on cross-cultural care and social and family dimensions of each person.

Summary Background and aims: The demand for native ornamentáis species has increased and the utilization of novel ornamental crops is a way of promoting their use and care by the community. Considering the high richness of the Tandilia hills, the objective of this study was to survey native plants with potential ornamental value and to propose suggestions for their use in landscaping. M&M: From the floristic survey carried out in a hill area of the south of Tandilia, a list of native species with potential ornamental value was made. For each species, it was recorded: growth habit; ornamental morphological attributes; flowering season and, depending on the environment's characteristics where they thrive, at least one suggestion for landscaping use was made. Results: A total of 47 species were proposed as ornamental, with predominance of perennial herbs (34), shrubs (11) and spring flowering. Foliage was the most frequent ornamental attribute. The main suggestion use category was: full-sun beds in shallow soils, followed in decreasing order by full-sun beds in deep soils; rock gardens, green roofs or full-sun vertical gardens; partial shadow beds in deep soils; partial shadow beds in shallow soils; shadow beds or shadow vertical gardens ponds. Conclusions: The southern hill areas of Tandilia have native flora of potential ornamental value that could be used in landscaping integrating different plantations, enhancing their cultural and patrimonial value.

Resumen Introducción y objetivos: La demanda de especies nativas con fines ornamentales ha aumentado y su uso representa una estrategia de valoración y conservación de las mismas por parte de la comunidad. Considerando la riqueza de las sierras de Tandilia, el objetivo de este trabajo fue relevar nativas de valor ornamental potencial y proponer sugerencias de uso de las mismas en espacios verdes. M&M: Del relevamiento florístico de un área del sur de Tandilia se elaboró un listado de especies nativas de uso ornamental potencial. Para cada especie se registró: hábito de crecimiento; atributos morfológicos ornamentales; época de floración y, según las características de los ambientales donde prosperan, se le adjudicó al menos una sugerencia de uso. Resultados: Se proponen 47 especies ornamentales, predominando las hierbas perennes (34) y los arbustos (11) y las floraciones primaverales. El follaje fue el atributo ornamental más frecuente. La principal sugerencia de uso fue la categoría macizos y/o canteros a pleno sol en suelos poco profundos, seguida de: macizos y/o canteros a pleno sol en suelos profundos; jardines de rocallas, techos verdes y/o jardines verticales a pleno sol; macizos y/o canteros a media sombra con suelos profundos; macizos y/o canteros a media sombra con suelos poco profundos; macizos, canteros y/o jardines verticales a la sombra; estanques. Conclusiones: Las áreas del sur de Tandilia poseen flora nativa de potencial valor ornamental que podrían emplearse en el diseño de espacios verdes integrando distintas plantaciones, realzando su valor cultural y patrimonial.

ABSTRACT Foundation: Skin cancer as a public health problem requires facing it through comprehensive, transversal and sustainable prevention strategies, based on the reality of the individual, family and community; where previous experiences, beliefs and customs are included, taking into account cultural diversity. Objective: Determine the intercultural practice of photoprotection in nursing students at the Chimborazo National University for the skin cancer prevention. Methods: Research with a qualitative-interpretive approach, considering narrative and experiential data supported for the in-depth description of the phenomenon. The studied subjects constituted 12 key informants who met the inclusion criteria. The data were collected through semi-structured interviews and self-reporting. The interviews were transcribed, categorized, interpreted and triangulated. Results: The intercultural practice of photoprotection in nursing students was related to three central categories: culture/health with cultural photoprotection care; environment with worldview and cultural environment; and promotion with learning and/or education needs on photoprotection respectively. Categories that are supported by the rising sun model proposed by Madeleine Leininger. Conclusions: Leininger's theory directs students and health professionals to be aware of cultural attitudes and work in collaboration with users, providing promotion and prevention strategies that are culturally appropriate and effective, where factors such as language, traditions and cultural norms are taking into account.

RESUMEN Fundamento: El cáncer de piel como problema de salud pública exige afrontarlo mediante estrategias integrales, transversales y sostenibles de prevención, basadas en la realidad del individuo, familia y comunidad, donde se incluyan experiencias previas, creencias y costumbres, tomando en cuenta la diversidad cultural. Objetivo: Determinar la práctica intercultural de fotoprotección en estudiantes de la carrera de Enfermería de la Universidad Nacional de Chimborazo para la prevención del cáncer de piel. Métodos: Investigación con enfoque cualitativo - interpretativo, considerando datos narrativos y vivenciales sustentados para la descripción profunda del fenómeno. Los sujetos de estudio constituyeron 12 informantes clave que cumplieron con los criterios de inclusión. Los datos fueron recolectados mediante la entrevista semiestructurada y el autorreportaje. Se realizó la transcripción de las entrevistas, categorización, interpretación y triangulación. Resultados: La práctica intercultural de fotoprotección en estudiantes de enfermería se relacionó con tres categorías centrales: cultura/salud con los cuidados culturales de fotoprotección; entorno con la visión del mundo y entorno cultural; y promoción con las necesidades de aprendizaje y/o educación sobre fotoprotección, respectivamente. Categorías que se respaldan con el modelo del sol naciente propuesto por Madeleine Leininger. Conclusiones: La teoría de Leininger direcciona a los estudiantes y profesionales de la salud para que sean conscientes de las actitudes culturales y trabajen en colaboración con los usuarios, brindando estrategias de promoción y prevención que sean culturalmente apropiadas y efectivas, en donde se consideren factores como el idioma, tradiciones y normas culturales.