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BACKGROUND: The Mapuche are a minority group living in small communities in southern Chile. Due to many variables, such as poverty and cultural factors, they are susceptible to inequalities in education and healthcare. PURPOSE: To describe nurse educators' experiences of caring for Mapuche people in primary care centers in Chile. METHODS: A descriptive qualitative study was performed with nine female nurse educators who supervised nursing students in clinical placement. Data were obtained through semi-structured interviews. Triangulation was achieved through consensus among the researchers. RESULTS: The analysis yielded two themes: Cultural sensitivity and Humanisation of care. Nurse educators respect Mapuche beliefs and practices about health and treatment and adapt clinical interventions accordingly. Nurse educators are committed to integrate Mapuche spiritual and cultural needs into the biomedical model, aiming to build a genuine person-centered relationship with patients and to promote transcultural nursing models with students. CONCLUSIONS: Culturally competent professionals are needed to train nurses about the demands of a globalized and culturally diverse world. Training is required in both humanized care competencies and cross-cultural nursing. Improving cultural competence among nurses and nurse educators would improve patients' health outcomes and would allow preventative intervention, therefore reducing treatment failures and further complications.

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BACKGROUND: To achieve an optimal quality of life through chronic disease management, people living with HIV (PLHIV) must adhere to antiretroviral therapy (ART). ART has been available throughout Peru since 2004 without cost in all regions; yet only 60% (43 200) of PLHIV receive ART and 32% are virally suppressed. Despite the low adherence, little is known about the experience of PLHIV with ART adherence in the context of Latin America. METHODS: A constructivist grounded theory design was used to understand the ART adherence experiences of PLHIV in Northern Peru. Unstructured interviews were conducted with 18 participants resulting in theoretical saturation. All interviews were recorded, immediately transcribed and analysed concurrently with data collection using constant comparative analysis with Atlas.ti (V.8) software. Rigour was maintained through openness, reflexivity, audit trail, memo writing, debriefings, member checks and positionality. RESULTS: The core category 'staying alive' emerged through the interaction of four categories, including: (1) overcoming barriers; (2) working with the healthcare team; (3) tailoring self-care strategies; and (4) appreciating antiretrovirals. Adherence is not a spontaneous outcome, instead, the surprise of HIV diagnosis transitions to living with HIV as a chronic disease. The healthcare team helps PLHIV realise ART is their life source by enhancing, supporting and facilitating self-care and overcoming barriers. CONCLUSION: Adherence emerges from experiential learning as PLHIV recognised ART as their life source in balance with their desire to continue living a normal life. Social support and healthcare team interventions help PLHIV implement tailored self-care strategies to overcome personal, social, and structural barriers to adherence. Healthcare professionals need to recognise the challenges confronted by PLHIV as they learn how to continue living while trying to stay alive.

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BACKGROUND: The Hospital Survey on Patient Safety Culture (HSOPSC) is widely utilized in multiple languages across the world. Despite culture and language variations, research studies from Latin America use the Spanish language HSOPSC validated for Spain and the United States. Yet, these studies fail to report the translation method, cultural adaptation process, and the equivalence assessment strategy. As such, the psychometric properties of the HSOPSC are not well demonstrated for cross-cultural research in Latin America, including Peru. The purpose of this study was to develop a target-language HSOPSC for cross-cultural research in Peru that asks the same questions, in the same manner, with the same intended meaning, as the source instrument. METHODS: This study used a mixed-methods approach adapted from the translation guideline recommended by Agency for Healthcare Research and Quality. The 3-phase, 7-step process incorporated translation techniques, pilot testing, cognitive interviews, clinical participant review, and subject matter expert evaluation. RESULTS: The instrument was translated and evaluated in 3 rounds of cognitive interview (CI). There were 37 problem items identified in round 1 (14 clarity, 12 cultural, 11 mixed); and resolved to 4 problems by round 3. The pilot-testing language clarity inter-rater reliability was S-CVI/Avg = 0.97 and S-CVI/UA = 0.86; and S-CVI/Avg = 0.96 and S-CVI/UA = 0.83 for cultural relevance. Subject matter expert agreement in matching items to the correct dimensions was substantially equivalent (Kappa = 0.72). Only 1 of 12 dimensions had a low Kappa (0.39), borderline fair to moderate. The remaining dimensions performed well (7 = almost perfect, 2 = substantial, and 2 = moderate). CONCLUSIONS: The HSOPSC instrument developed for Peru was markedly different from the other Spanish-language versions. The resulting items were equivalent in meaning to the source, despite the new language and different cultural context. The analysis identified negatively worded items were problematic for target-language translation. With the limited literature about negatively worded items in the context of cross-cultural research, further research is necessary to evaluate this finding and the recommendation to include negatively worded items in instruments. This study demonstrates cross-cultural research with translated instruments should adhere to established guidelines, with cognitive interviews, based on evidence-based strategies.

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Talking about sex with people living with HIV receives insufficient attention in health care. A cross-sectional and exploratory study describes the preferences of people living with HIV to talk about sex with specialized HIV physicians and nurses in a clinic in Barcelona (Spain). A 27-item self-administered questionnaire was used between June 2017 and May 2018. One hundred fourteen people agreed to participate. Data were analyzed using multivariate logistic regression. Most of the participants reported "never or almost never" having been asked about sex practices in visits with the HIV specialist physician (n = 65 [57.0%]) or nurse (n = 74 [64.9%]). Older participants stated that neither physicians nor nurses talked about sex during visits. Women felt that physicians hardly ever asked about their sexual practices. Men who had sex with other men indicated that their physicians always asked about their sex practices compared with heterosexuals living with HIV. Health professionals should reformulate how to talk about sex with people living with HIV to facilitate communication and provide adequate care.

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BACKGROUND: People living with HIV/AIDS (PLHIV) experience stigma and discrimination. Negative attitudes of nursing faculty about caring for PLHIV can adversely affect student perceptions and their nursing care. The study purpose was to describe nursing faculty attitudes and beliefs about caring for PLHIV. METHOD: The HPASS (Healthcare Provider HIV/AIDS Stigma Scale), Spanish version, was delivered to nursing faculty in Colombia and Peru. RESULTS: The HPASS was completed by 98 nursing faculty. The overall mean score was 2.41 (SD = 0.69), with subscale scores: stereotypes, 2.55 (SD = 0.84); discrimination, 2.28 (SD = 0.74); and prejudices, 2.41 (SD = 0.63). Peruvian faculty had the highest scores, statistically correlated with the importance of religion, whereas Colombia had the lowest. CONCLUSION: Nursing faculty attitudes toward PLHIV were slightly positive in Colombia to slightly negative in Peru; however, both countries had negative stereotypes. Knowledge deficiencies about HIV persist and attitudes appear to be influenced by culture and religion. [J Nurs Educ. 2019;58(12):712-717.].

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BACKGROUND: There are approximately 72,000 people living with HIV/AIDS (PLHIV) in Peru. Non-adherence to antiretroviral therapy (ART) is the most important factor for therapeutic failure and the development of resistance. Peru has achieved moderate progress in meeting the 90-90-90 targets, but only 60% of PLHIV receiving ART are virally suppressed. The purpose of this study was to understand ART adherence in the Peruvian context, including developing sociodemographic and clinical profiles, evaluating the clinical management strategies, and analyzing the relationships between the variables and adherence of PLHIV managed at a regional HIV clinic in Lambayeque Province (Northern Peru). METHODS: This was a cross-sectional study with 180 PLHIV adults, non-randomly but consecutively selected with self-reported ART compliance (78.2% of the eligible population). The PLHIV profile (PLHIV-Pro) and the Simplified Medication Adherence Questionnaire (SMAQ) were used to collect sociodemographic information, clinical variables, and data specific to ART adherence. Descriptive analysis of sociodemographic and clinical characteristics was performed. Bivariate analysis was performed with the Mann-Whitney test, Chi square test, and Yates correction. RESULTS: The 180 PLHIV sample included 78.9% men, 49.4% heterosexual, 45% with a detectable HIV-1 viral load less than 40 copies/ml, 58.3% not consistently adherent, and only 26.1% receiving Tenofovir + Lamivudine + Efavirenz. Risk factors significant for non-adherence included concurrent tuberculosis, discomfort with the ART regime, and previous pauses in ART. Multivariate analysis of nested models indicated having children is a protector factor for adherence. CONCLUSIONS: Self-reported adherence appeared to be low and the use of first-line therapy is not being prescribed homogeneously. Factors associated with nonadherence are both medical and behavioral, such as having tuberculosis, pausing ART, or experiencing discomfort with ART. The Peruvian government needs to update national technical standards, monitor medication availability, and provide education to health care professionals in alignment with evidence-based guidelines and international recommendations. Instruments to measure adherence need to be developed and evaluated for use in Latin America.

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INTRODUCTION: In Peru, people living with diabetes mellitus (PLDM) represent 7% of the adult population, each with a $54,000 lifetime cost. For Latinos, spirituality provides meaning and purpose of life while social support affects behavioral choices and adherence decisions. The purpose of this study was to determine the relationship between spirituality and social support for PLDM participating in a nurse-led diabetes management program in a public hospital in Lima, Peru. METHOD: This cross-sectional study included adult PLDM (N = 54). The instrument included demographic items and the Spanish versions of the social/vocational concern dimension of the Diabetes Quality of Life Questionnaire and the Reed's scale of spiritual perspective. RESULTS: There was an inverse relation between social support and spiritually practices (p = .020) and spiritual beliefs (p = .005). PLDM with 5 years or more in the program had significantly higher scores in social support (p = .020) and spiritual practices (p = .010). CONCLUSION: Spirituality and social support are important factors for managing PLDM. Nurse-led diabetes management programs with Latino participants should consider targeted spiritual and social support strategies to expand the holistic management. Future studies should explore the impact and effectiveness of spiritual and social support interventions on clinical outcomes.

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Maize (Zea mays L.) is a highly valuable crop in Argentina, frequently contaminated with the mycotoxins produced by Aspergillus flavus. Biocontrol products formulated with atoxigenic (nontoxic) strains of this fungal species are well known as an effective method to reduce this contamination. In the present study, 83 A. flavus isolates from two maize regions of Argentina were characterized and evaluated for their ability to produce or lack of producing mycotoxins in order to select atoxigenic strains to be used as potential biocontrol agents (BCA). All of the isolates were tested for aflatoxin and cyclopiazonic acid (CPA) production in maize kernels and a liquid culture medium. Genetic diversity of the nonaflatoxigenic isolates was evaluated by analysis of vegetative compatibility groups (VCG) and confirmation of deletions in the aflatoxin biosynthesis cluster. Eight atoxigenic isolates were compared for their ability to reduce aflatoxin and CPA contamination in maize kernels in coinoculation tests. The A. flavus population was composed of 32% aflatoxin and CPA producers and 52% CPA producers, and 16% was determined as atoxigenic. All of the aflatoxin producer isolates also produced CPA. Aflatoxin and CPA production was significantly higher in maize kernels than in liquid medium. The 57 nonaflatoxigenic strains formed six VCG, with AM1 and AM5 being the dominant groups, with a frequency of 58 and 35%, respectively. In coinoculation experiments, all of the atoxigenic strains reduced aflatoxin from 54 to 83% and CPA from 60 to 97%. Members of group AM1 showed a greater aflatoxin reduction than members of AM5 (72 versus 66%) but no differences were detected in CPA production. Here, we described for the first time atoxigenic isolates of A. flavus that show promise to be used as BCA in maize crops in Argentina. This innovating biological control approach should be considered, developed further, and used by the maize industry to preserve the quality properties and food safety of maize kernels in Argentina.

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Objetivo: las caídas y el miedo a caerse se relacionan entre sí, siendo cada uno de ellos factor de riesgo del otro. Este trabajo pretende analizar la efectividad de una intervención para reducir el miedo a caer y sus consecuencias dado que la aplicación de este tipo de tratamientos ha mostrado resultados satisfactorios. Método: mediante un diseño cuasi-experimental, con medidas pre-pos, se evaluó a 53 sujetos, con edades comprendidas entre 65 y 89 años y que habían sufrido una caída anterior. La muestra fue dividida en grupo control y tratamiento, poniéndose en marcha un método combinado de ejercicios y educación sanitaria para la prevención de caídas. Resultados: se obtuvieron resultados significativos en la calidad de vida relacionada con la salud, el equilibrio y el miedo a caer, observándose mejoras en el grupo tratamiento. Conclusión: la aplicación de intervenciones para la reducción del miedo a caerse en población anciana se plantea como un tratamiento cuyos efectos serían dobles, pues no solo se reduciría el propio miedo sino que, dada la asociación existente, se reduciría la posible caída por repetición.

Objective: Falling and the fear of falling are interrelated, with each being a risk factor of the other. This study is an attempt to analyze the effectiveness of an intervention to reduce the fear of falling and its consequences, since treatments of this type have demonstrated satisfactory results. Method: A quasi-experimental study with pre-post measurements was used to evaluate 53 subjects between the ages of 65 and 89 who had suffered a prior fall. The sample was divided into a control group and a treatment group. The latter was subject to treatment featuring a combination of exercises and health education to prevent falling. Results: The results obtained with respect to quality of life were significant for health, balance and fear of falling, with the treatment group showing progress. Conclusion: The application of interventions to reduce the fear of falling in the elderly population is proposed as a treatment with a twofold effect, not only on reducing fear itself, but also - given the association that exists - on reducing the potential for falling through repetition.

Objetivo: as quedas e o medo de cair se relacionam entre si, sendo cada um deles fator de risco do outro. Este trabalho pretende analisar a efetividade de uma intervenção para reduzir o medo de cair e suas consequências, já que a aplicação desse tipo de tratamentos vem mostrando resultados satisfatórios. Método: mediante um desenho quase experimental, com medidas pré e pós, avaliaram-se 53 sujeitos, na faixa de 65 a 89 anos, que sofreram uma queda. A amostra foi dividida em grupo controle e tratamento, iniciando-se um método combinado de exercícios e educação sanitária para a prevenção de quedas. Resultados: obtiveram-se resultados significativos na qualidade de vida relacionada com a saúde, o equilíbrio e o medo de cair, e observaram-se melhoras no grupo tratamento. Conclusão: a aplicação de intervenções para a redução do medo de cair em população idosa se propõe como tratamento cujos efeitos seriam duplos, uma vez que não só se reduziria o próprio medo, mas também, dada a associação existente, se reduziria a possível queda por repetição.

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Este trabajo presenta la comparación de las características de sujetos con alta y baja reserva cognitiva, y sujetos con baja reserva cognitiva y deterioro cognitivo, diferenciados a partir del desarrollo de una medida ponderada de reserva cognitiva. Mediante un diseño correlacional se evaluaron 200 personas con edad superior a 65 años, no institucionalizados. Los resultados mostraron, por un lado, que el grupo de alta reserva cognitiva obtuvo mejores puntuaciones tanto en el nivel de deterioro cognitivo como en la medida ponderada de reserva que el grupo de baja reserva cognitiva y, por otro lado, el grupo de baja reserva cognitiva mostró un perfil similar al del grupo de deterioro cognitivo, existiendo solamente diferencias en cuanto a la edad. Las diferencias observadas permiten plantear la medida como una variable que se debe tener en cuenta en el diagnóstico de enfermedades neurodegenerativas y su utilidad para establecer posibles tratamientos.

This paper presents the comparison of the characteristics of subjects with high and low cognitive reserve and subjects with low cognitive reserve and cognitive impairment, differentiated from the development of a weighted measure of cognitive reserve. Using a correlational design was evaluated 200 people aged over 65, not institutionalized. The results showed, firstly that high cognitive reserve group performed better on both the level of cognitive impairment as the weighted average of reserves that the group of low cognitive reserve and on the other hand the low cognitive reserve group showed a similar profile to the group of cognitive impairment, existing differences only in age. The observed differences would support the measure as a variable to be considered in the diagnosis of neurodegenerative diseases, and its usefulness to determine possible treatments.

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OBJETIVO: El envejecimiento con éxito es un concepto multidimensional que se puede evaluar a partir de componentes objetivos y subjetivos como el funcionamiento físico, psicológico y social. El objetivo de este trabajo es comparar el funcionamiento en variables relacionadas con el envejecimiento exitoso en ancianos institucionalizados y no institucionalizados. MÉTODO: Se realizó un diseño de dos grupos independientes, institucionalizados (N=242) y no institucionalizados (N=607), todos de más de 65 años, evaluándose sus actividades de la vida diaria (AVD) y el bienestar psicológico. RESULTADOS: El Índice de Barthel mostró diferencias significativas, siendo inferior la media de los institucionalizados que la de los no institucionalizados. En relación al bienestar, el MANOVA mostró diferencias entre grupos para todas las escalas. En los posteriores ANOVA's la variable crecimiento personal mostró las mayores diferencias y porcentaje de varianza explicada. Se obtuvieron correlaciones significativas de la edad con el Índice de Barthel, y con las siguientes escalas de bienestar psicológico de Ryff: autoaceptación, relaciones positivas con otros, dominio del ambiente y propósito en la vida. CONCLUSIONES: Los institucionalizados muestran puntuaciones significativamente inferiores en AVD y en bienestar psicológico, actuando como variable moderadora, que puede empeorar su situación. La edad afecta de forma más clara al bienestar de los institucionalizados, reafirmándose la necesidad de generar estrategias que mejoren la adaptación de las personas.

OBJECTIVES: Successful aging is a multidimensional concept that can be evaluated from objective and subjective components, such as physical, psychological and social functioning. This study aimed to compare the performance on variables related to successful aging in elderly institutionalized and non-institutionalized. METHODS: We conducted a design of two independent groups, institutionalized (N = 242) and non-institutionalized (N = 607), all aged over 65 years, evaluating their activities of daily living (ADL) and psychological well being. RESULTS: The Barthel index showed significant differences, being the mean of the institutionalized group lower than the mean of the non- institutionalized group. Regarding well-being, MANOVA showed differences between groups for all the scales. In subsequent ANOVA's, the variable personal growth showed the greatest differences and the percentage of explained variance. There were significant correlations between age and the Barthel Index, and the following scales Ryff's psychological well-being: self-acceptance, positive relations with others, environmental mastery and purpose in life. CONCLUSIONS: The institutionalized group has significantly lower scores in ADL and psychological well-being, and therefore living in nursing homes acts as a moderating variable that can worsen the situation. Additionally, age clearly affects the well-being of the institutionalized group, strengthening the need for generating strategies that improve the adaptation of the elderly.

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Los importantes cambios demográficos del último siglo han provocado un aumento de la longevidad y, por tanto, del número de adultos mayores, lo cual hay un incremento en la investigación con este grupo de edad y más concretamente en relación con el bienestar. Así, se ha podido constatar que en el envejecimiento, el bienestar subjetivo, compuesto por un componente cognitivo y otro afectivo tanto negativo como positivo, parece mantenerse estable y poco sujeto a cambiar con el tiempo. Por otra parte, en relación con el bienestar psicológico, estudiado a partir de las escalas de bienestar de Ryff, se ha observado, en diferentes trabajos, que las dimensiones crecimiento personal y propósito en la vida mantienen correlaciones negativas con le edad y, en consecuencia, experimenta más cambios.

Demographic changes in the last century have produced longer life expectancy and therefore there is a greater proportion of elderly in the population. As a consequence, there has been growing interest in research of elderly people, especially in terms of their well-being. There is research evidence that well-being in the elderly may be understood as a two-components construct: subjective well-being, that remains relatively stable during life span; and psychological well-being, that negatively changes with age, especially in the dimensions of personal growth and life purpose.

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INTRODUCTION: Well-being and its association with distinct factors have played a central role in the arena of psychogerontology research. Given the importance of this topic, the present study examined several factors that could influence well-being among the elderly of two countries. MATERIAL AND METHODS: This cross-cultural study was based on a survey of two samples of elderly people, one from the Dominican Republic (N=1,296) and another from Spain (N=476), sampled, respectively, by stratification and quota sampling. Analyses included descriptive statistics, correlations and a multivariate analysis of covariance. RESULTS: Overall, sociodemographic factors were found to affect well-being both in the univariate and multivariate analyses. Nevertheless, the effect sizes were, in general, rather low. These effects were basically due to main effects rather than interactions. Age was negatively related to well-being. Marriage was associated with the highest levels of some well-being dimensions. The highest educational levels were also associated with higher levels of some well-being dimensions. The largest effect was due to country, with Dominicans scoring lower on all well-being dimensions, even after statistically controlling for other factors. CONCLUSIONS: A main conclusion of this study was that sociodemographic factors did not differentially affect the two countries, given the rather low interaction effects. However, systematic effects were found for sociodemographic factors, independently of country. These effects were analyzed in light of the distinction between subjective and psychological well-being, and the data failed to support the idea of a different profile of results on these two types of well-being dimensions. Finally, given the large effect of country on all well-being dimensions, the relative importance of several sociopolitical and cultural factors was analyzed.

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OBJETIVO: Reconocer quiénes son las figuras suministradoras de apoyo, psicológico e instrumental, en la vejez, así como precisar si existen diferencias en función de la edad y el sexo. MATERIAL Y MÉTODOS: Se utilizó la entrevista Manheim de apoyo social y se recogieron las opiniones de 101 personas mayores (>65 años) de la provincia de Valencia (España), entre enero y mayo de 2006. RESULTADOS: Se han encontrado diferencias estadísticamente significativas en el apoyo psicológico y el instrumental y tanto en relación con la edad como con el sexo del entrevistado. CONCLUSIONES: Respecto del género, los datos muestran que los hombres reciben más apoyo de sus parejas, mientras que las mujeres tienden a priorizar a los hijos como suministradores de apoyo. Acerca de la edad, las parejas son más importantes en la primera de las franjas de edad consideradas (65-75 años) y a medida que la edad aumenta los hijos las reemplazan.

OBJECTIVE: To analyse who are the people giving psychological and instrumental support to the elderly, as well as potential differences among these caregivers according to age and/or sex of the elderly. MATERIAL AND METHODS: Manheim interview for social support was used to gather the opinions of 101 elder people (>65 years) living in Valencia (Spain), from January to May, 2006. RESULTS: Statistically significant differences were found on both psychological and instrumental support depending on age and sex of the interviewed elderly. CONCLUSIONS: With respect to sex differences old men seek for support mainly from their partners, while son and daughters are the main source of support for old women. With respect to age, there are changes in the figures giving support as age increases. Partners are the main figure to give support within the 65-75 years, but its importance decreases with age, while sons and daughters became more important as age of the elderly increases.

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OBJECTIVE: To analyse who are the people giving psychological and instrumental support to the elderly, as well as potential differences among these caregivers according to age and/or sex of the elderly. MATERIAL AND METHODS: Manheim interview for social support was used to gather the opinions of 101 elder people (>65 years) living in Valencia (Spain), from January to May, 2006. RESULTS: Statistically significant differences were found on both psychological and instrumental support depending on age and sex of the interviewed elderly. CONCLUSIONS: With respect to sex differences old men seek for support mainly from their partners, while son and daughters are the main source of support for old women. With respect to age, there are changes in the figures giving support as age increases. Partners are the main figure to give support within the 65-75 years, but its importance decreases with age, while sons and daughters became more important as age of the elderly increases.

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