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ABSTRACT Objective To evaluate the food and nutrition insecurity of Brazilian families, according to indicators of food consumption and nutritional status, by location and situation of the households investigated using the 2008/2009 Household Budget Survey. Methods Inadequate consumption of macronutrients and nutritional dystrophies (underweight, short stature or overweight) in at least one family member were used as indicators, according to location and geographical situation of households. The prevalence of food and nutritional insecurity and their confidence intervals were calculated. Results Food consumption was assessed in a total of 13,569 households; a total of 67.55%, 43.96% and 6.85% revealed inadequacy for lipids, carbohydrates and proteins, respectively. Among the 53,640 households assessed by nutritional status, 15.10%, 35.15% and 45.50% had, at least one resident with low weight, short stature or overweight respectively. The Northeastern Region showed statistically higher prevalence than other Brazilian macro-regions for inadequate lipids (24.88%) and carbohydrates (15.32%), as well as for the presence of underweight (6.15%), overweight (14.77%) and short stature (15.17%), in at least one of the residents of the household. Conclusion Assessing the nutritional aspect of food insecurity allows for a better understanding of the dimensions of this situation by considering the effects of access and availability of food, as well as biological use and stability, based on indicators of inadequate food consumption and the presence of nutritional dystrophy. The results found in this study enhance the need to include nutritional indicators in the assessment of food security.

RESUMO Objetivo Avaliar a insegurança alimentar e nutricional de famílias brasileiras segundo indicadores de consumo alimentar e estado nutricional, por localização e situação dos domicílios investigados pela Pesquisa de Orçamento Familiar 2008/2009. Métodos Foram utilizados, como indicadores de insegurança alimentar e nutricional, o consumo inadequado de macronutrientes e distrofias nutricionais (baixo peso, baixa estatura ou excesso de peso) em pelo menos um membro da família, conforme localização e situação geográfica dos domicílios. Calculou-se a prevalência de insegurança alimentar e nutricional e seus intervalos de confiança. Resultados Foram avaliados 13.569 domicílios pelo consumo alimentar, sendo que 67,55%, 43,96% e 6,85% apresentaram inadequação para lipídios, carboidratos e proteínas, respectivamente. Entre os 53.640 domicílios avaliados pelo estado nutricional, 15,10%, 35,15% e 45,50% apresentam, respectivamente, pelo menos um morador com baixo peso, baixa estatura ou excesso de peso. O Nordeste apresentou prevalências estatisticamente maiores do que as demais macrorregiões para as inadequações de lipídios (24,88%) e de carboidratos (15,32%), bem como para presença de baixo peso (6,15%), excesso de peso (14,77%) e baixa estatura (15,17%), em pelo menos um dos moradores do domicílio. Conclusão Avaliar a vertente nutricional da insegurança alimentar permite maior compreensão das dimensões dessa situação por considerar os reflexos do acesso e disponibilidade de alimentos, bem como a utilização biológica e estabilidade, a partir dos indicadores de consumo alimentar inadequado e presença de distrofia nutricional. Os resultados encontrados reforçam a necessidade de incluir indicadores nutricionais na avaliação da segurança alimentar.

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Objetivo: identificar o papel da enfermagem em Cuidados Paliativos aos pacientes oncológicos em estado terminal, com base na literatura recente. Método: A revisão integrativa realizada neste trabalho visou efetuar uma análise do tema de interesse para a área de enfermagem. A partir das bases de dados da SciELO, LILACS e BVS. A busca foi realizada entre setembro de 2021 e maio de 2022, sendo selecionados os artigos disponíveis na íntegra, em português e formato original, o ano de publicação compreende os anos de 2014 a 2021. Resultados: Apontam os sentimentos vividos pela equipe de enfermagem e multidisciplinar bem como as dificuldades enfrentadas por esses profissionais, e a deficiência na formação desses profissionais além dos sentimentos envolvidos tanto na família como nos profissionais e como lidam com a terminalidade. Conclusão: Existe a necessidade de uma visão mais ampla sobre Cuidados Paliativos com início ainda na graduação até as atividades desenvolvidas nos Cuidados Paliativos, a sobrecarga de trabalho enfreada por esses profissionais, e o aspecto psicológico devido ao sentimento experimentado por eles no processo de morte.

Objective: to identify the role of nursing in palliative care for terminally ill cancer patients based on recent literature. Method: an integrative review carried out in this work aimed at an analysis of the topic of interest in the nursing area. From the SciELO, LILACS and BVS databases. The study was carried out between September 2021 and May 2022, with the selection of articles available in full, in Portuguese and in original format, the year of publication comprises the years of search from 2014 to 2021. Results: They point out the feelings experienced by the nursing team and multidisciplinary, as well as difficulties faced by these professionals, and deficient in the training of these professionals in addition to feelings involved both in the family and in the professionals and how they deal with terminality. Conclusion: There is a need for a broader view of Palliative Care starting at graduation until the activities developed in Palliative Care, the overload of work enfreada by these professionals, and the psychological aspect due to the feeling experienced by them in the process of death.

Objetivo: identificar el papel de la enfermería en los cuidados paliativos para pacientes con cáncer en estado terminal, a partir de la literatura reciente. Método: La revisión integradora realizada en este estudio tuvo como objetivo realizar un análisis del tema de interés para el área de enfermería. De las bases de datos de SciELO, LILACS y BVS. La búsqueda se realizó entre septiembre de 2021 y mayo de 2022, y se seleccionaron los artículos disponibles en su totalidad, en portugués y en formato original, el año de publicación comprende los años 2014 a 2021. Resultados: Indican los sentimientos experimentados por el equipo de enfermería y multidisciplinario, así como las dificultades a las que se enfrentan estos profesionales, y la deficiencia en la formación de estos profesionales, además de los sentimientos involucrados tanto en la familia como en los profesionales y cómo tratan la terminalidad. Conclusión: Existe la necesidad de una visión más amplia de los Cuidados Paliativos desde la graduación hasta las actividades desarrolladas en Cuidados Paliativos, la sobrecarga de trabajo enfreda por parte de estos profesionales, y el aspecto psicológico debido al sentimiento experimentado por ellos en el proceso de muerte.

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RESUMEN Introducción: La obesidad es un problema de salud asociado a una morbilidad variada y cada vez en edades más tempranas de la vida. El documento actual tiene como objetivo exponer resultados de un estudio acerca de los hábitos asociados a la obesidad infantil, en la medida, además, en que se evalúan las relaciones afectivas compensatorias y las actitudes generadoras de alteraciones psicológicas en la familia, en función de la presentación de elementos del programa de intervención psicológica dirigido al manejo de la obesidad en un grupo de niños obesos que constituyeron parte de la muestra. Método: La muestra estuvo constituida por 13 niños obesos y 21 familiares remitidos de la consulta de Pediatría del Centro de Investigaciones Médico-Quirúrgicas. La elaboración del programa intervención psicológica se realizó en el primer semestre de 2019 y la experiencia derivada su aplicación se extiende hasta el momento actual. Resultados: Se realiza un análisis cualitativo, en el que se exponen los resultados a partir de la observación de la tendencia de las variables en el grupo. Se aplicaron la entrevista al niño y a la familia, el análisis psicográfico y las Siete figuras de Collins. Se examinan variables psicológicas. Discusión: Se constata la influencia de las variables analizadas en la obesidad infantil, teniendo en cuenta la correspondencia con los estudios de investigadores de Cuba y el mundo, lo cual redunda en la validez y actualidad de los resultados, para la implementación del programa con sesiones dirigidas a los niños y familiares.

ABSTRACT Introduction: Obesity is a health problem associated with varied morbidity and increasingly at earlier ages of life. The current document aims to present the results of a study about the habits associated with childhood obesity, to the extent, in addition, that the compensatory affective relationships and the attitudes that generate psychological alterations in the family are evaluated, depending on the presentation. of elements of the psychological intervention program aimed at managing obesity in a group of obese children who were part of the sample. Method: The sample consisted of 13 obese children and 21 relatives referred from the Pediatric consultation of the Medical-Surgical Research Center. The elaboration of the psychological intervention program was carried out in the first semester of 2019 and the derived experience of its application extends until the current moment. Results: A qualitative analysis is carried out, in which the results are presented from the observation of the trend of the variables in the group. The interview with the child and the family, the psychographic analysis and the Seven figures of Collins were applied. Psychological variables are examined. Discussion: The influence of the variables analyzed on childhood obesity is verified, taking into account the correspondence with the studies of researchers from Cuba and the world, which results in the validity and timeliness of the results, for the implementation of the program with Sessions for children and families.

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Objetivo: Comprender las representaciones sociales de familiares de personas menores de edad en un Centro de Atención Psicosocial sobre este servicio. Método: Se trata de una investigación de enfoque cualitativo y exploratorio basada en el marco teórico-metodológico de representaciones sociales, desarrollada con 19 familiares en un servicio situado en el interior del Pernambuco, Brasil, después de la aprobación por el Comité de Ética (CAAE 66524717.2.0000.5196). Se utilizaron entrevistas semiestructuradas como técnica para la recolección de datos, procesadas por el software Iramuteq, con posterior análisis de contenido de Bardin para la interpretación de los datos, mostrándolos gráficamente a través del dendrograma. Resultados: Los familiares basan sus representaciones en la rutina establecida por el servicio, la cual se vuelve parte de su vida diaria y juega un papel importante en la interacción social de las personas participantes. Además, en las posibilidades que tanto la misma persona atendida como toda la familia desarrollan a través de la acogida y el acompañamiento. Por último, en los desafíos que aún quedan por delante para una atención más eficaz. Conclusión: Las personas participantes representaron al servicio como importante para establecer una rutina que, si bien modifica la vida diaria de todas las personas integrantes de la familia, juega un valioso papel en su interacción social.

Objetivo: Compreender as representações sociais de familiares das crianças e adolescentes acompanhados por um Centro de Atenção Psicossocial Infantojuvenil acerca deste serviço. Método: Trata-se de pesquisa de abordagem qualitativa e exploratória embasada no referencial teórico-metodológico das Representações Sociais, desenvolvida com 19 familiares das crianças e adolescentes em um serviço localizado no sertão médio de Pernambuco, Brasil, após aprovação pelo Comitê de Ética (CAAE 66524717.2.0000.5196). Foi utilizada como técnica para coleta de dados entrevistas semiestruturadas, processadas pelo software Iramuteq, com posterior Análise de Conteúdo de Bardin para interpretação dos dados, expondo-os graficamente através do dendrograma. Resultados: Os familiares pautaram suas representações na rotina estabelecida pelo serviço, que passa a fazer parte do seu cotidiano e desempenha importante função na interação social dos participantes; nas possibilidades que o mesmo desenvolve na criança/adolescente e em toda a família que frequenta o espaço através do acolhimento e acompanhamento; e nos desafios que ainda se colocam para o cuidado mais efetivo. Conclusão: Os participantes representaram o CAPSij como um serviço importante por estabelecer uma rotina que, embora modifique o cotidiano de todos os membros familiares, desempenha valorosa função na interação social dos usuários.

Objective: To understand the social representations of family members of children and adolescents with mental disorders about the Psychosocial Care Center. Method: This was a qualitative and exploratory research based on the theoretical and methodological Social Representations framework developed with 19 family members in a service located in the middle backlands of Pernambuco, Brazil; this happened after the Ethics Committee (CAAE 66524717.2.0000.5196) approval. The data were collected through semi-structured interviews processed by the Iramuteq software; they were later interpreted through the Bardin's Content Analysis, displaying them graphically through a dendrogram. Results: The family members base their representations on the routine established by the service, which becomes part of their daily lives and plays an important role in: the social interaction of the participants, the possibilities that the service develops for the child/adolescent and in the whole family that attends the space through welcoming and monitoring, and the challenges that are still faced for a more effective care. Conclusion: The participants represented the service as important for establishing a routine that, despite the fact that it modifies the daily life of all family members, plays a valuable function in the user's social interaction.

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The human brain is the most cognitively capable of mammalian brains, endowed as it is with an overdeveloped cerebral cortex that, in parallel, renders it vulnerable to mental disorders. Schizophrenia is the expression of the dysregulation of the neuronal activity of cortical and subcortical regions due to modifications in the levels of the various neurotransmitters, especially of dopamine, with a reciprocal, intimate relationship among genes with environmental and psychosocial factors. If the dopaminergic system increases the function prefrontal cortex will be reduced: this is the main reason of social, occupational and familiar disruption. The present article describes the function of the brain in schizophrenia and its relation with anatomical, physiological, and genetic changes, in addition to identifying, psychosocial and family factors that can be determinant in the functionality of the patient. A review of national and international bibliography was conducted bearing in mind the following variables: functioning at the cerebral level; psychosocial functioning, familial functioning, disability, and functionality in persons with schizophrenia. Due to the variety of the issues included in this review, it can be concluded that schizophrenia is the product of a complex array of symptoms, deficits and disabilities. It was identified that there is a reciprocal confluence of diverse genetic, psychosocial, familial, environmental, educative, and social factors which affect the functionality of persons with this disorder. The latter makes it necessary to study the patient taking into consideration all of these components in an integral manner.

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O objetivo deste estudo foi a adaptação e validação da entrevista Friends and Family Interview que avalia o estilo de apego e a função reflexiva de crianças e adolescentes. Para adaptação, foram avaliadas a equivalência semântica, idiomática, experiencial e conceitual entre a versão traduzida e o instrumento original. A versão final da entrevista foi aplicada a uma amostra clínica de jovens entre 9 e 17 anos (M=13,12; DP=2,72) do sul do Brasil. Constatou-se que a versão em português apresentou uma consistência interna alta (α=0,79), assim como uma boa concordância entre avaliadores (α=0,89). A análise fatorial exploratória revelou dois componentes principais que melhor explicaram os dados, denominados Segurança nos Relacionamentos e Funcionamento Reflexivo (α=0,95) e Insegurança do Apego (α=0,72). Os resultados apoiaram a validade de construto e de critério da FFI e forneceram evidências de sua utilidade na avaliação do apego e da função reflexiva na infância e adolescência. (AU)

The study aimed to adapt and validate the Friends and Family Interview that assesses the attachment style and the reflective function in children and adolescents. The semantic, idiomatic, experiential and conceptual equivalences between the original and the translated version were analyzed. Then the final version was applied in a clinic sample of young people ranging from 9 to 17 years of age (M=13.12 SD=2.72 years), of southern Brazil. The statistical tests showed a high internal consistency (α=.79), as well as a good inter-evaluators reliability (α=.89) in the Portuguese version of the FFI. Exploratory factor analysis yielded two main factors, Relationships Security and Reflective Functioning (α=.95) and Attachment Insecurity (α=.72). The data supported the construct and criterion validities of the Portuguese version of the interview protocol. The FFI is a useful tool for the evaluation of attachment and reflective function in children and adolescents. (AU)

El objetivo de este estudio fue la adaptación y la validación de la entrevista Friends and Family Interview (FFI) que evalúa el estilo de apego y la función reflexiva de niños y adolescentes. Para la adaptación se evaluó la equivalencia semántica, idiomática, experiencial y conceptual entre la versión traducida y el instrumento original. La versión final de la entrevista se aplicó a una muestra clínica de jóvenes entre 9 y 17 años (M=13,12; DS=2,72) del sur de Brasil. Se encontró que la versión portuguesa tenía una alta consistencia interna (α=0,79), así como una buena concordancia entre evaluadores (α=0,89). El análisis factorial exploratorio reveló dos componentes principales, denominados Seguridad en las Relaciones y Funcionamiento Reflexivo (α=0,95) e Inseguridad del Apego (α=0,72). Los resultados apoyaron la validez de criterio y constructo de la FFI y proporcionaron evidencias de su utilidad para evaluar el apego y la función reflexiva en la niñez y en la adolescencia. (AU)

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Multivariate twin and family studies are one of the most important tools to assess diseases inheritance as well as to study their genetic and environment interrelationship. The multivariate analysis of twin and family data is in general based on structural equation modelling or linear mixed models that essentially decomposes sources of covariation as originally suggested by  Fisher. In this paper, we propose a flexible and unified statistical modelling framework for analysing multivariate Gaussian and non-Gaussian twin and family data. The non-normality is taken into account by actually modelling the mean and variance relationship, while the covariance structure is modelled by means of a linear covariance model including the option to model the dispersion components as functions of known covariates in a regression model fashion. The marginal specification of our models allows us to extend classic models and biometric indices such as the bivariate heritability, genetic, environmental and phenotypic correlations to non-Gaussian data. We illustrate the proposed models through simulation studies and six data analyses and provide computational implementation in R through the package mglm4twin.

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RESUMEN: Objetivo: Determinar las características epidemiológicas, clínicas y familiares de los pacientes con trastornos mentales adscritos a una unidad de medicina familiar (UMF) mexicana. Material y métodos: Estudio prospectivo, transversal, observacional, descriptivo, sobre 164 pacientes adscritos a una UMF mexicana, elegidos por muestreo no probabilístico que cumplieron criterios de selección: mayores de 18 años, con trastorno mental, sin impedimento físico o cognitivo. Resultados: Se presentaron 51 hombres y 113 mujeres con edad promedio de 48,6 años; 57% con más de un trastorno mental; los más frecuentes fueron depresión y ansiedad. En escolaridad sobresale licenciatura; 16% reportaron intento de suicidio, 42% tiene más de 6 años diagnosticado. El 64,6% recibe psicoterapia y farmacología; el 18% fue hospitalizado a causa de sus trastornos, gran parte de ellos entre 1 y 4 semanas y 38% tiene algún familiar con algún trastorno mental, Las comorbilidades más frecuentes fueron Hipertensión, obesidad, diabetes mellitus, dislipidemia y artrosis. Los tipos de familia más frecuentes son: nuclear o nuclear simple, con núcleo integrado y núcleo no integrado; subsisten principalmente de los servicios; viven con niveles 1 y 2 de pobreza familiar; son modernas y urbanas en mayor número. Conclusiones: las características sociodemográficas, clínicas y familiares de los pacientes con trastornos mentales adscritos a una unidad de medicina familiar (UMF) mexicana son en su mayoría mujeres, en adultez media, que cursan con más de un trastorno mental (ansiedad y depresión), tratadas con fármacos y psicoterapia, además cursaban con hipertensión, y pertenecen a familias de tipo nuclear simple, de núcleo integrado y núcleo no; subsisten por servicios; viven con niveles 1 y 2 de pobreza familiar, son modernas y urbanas.

ABSTRACT: Objective: To determine the epidemiological, clinical and family characteristics of patients with mental disorders assigned to a Mexican family medicine unit (FMU). Material and methods: Prospective, cross-sectional, observational, descriptive study of 164 patients assigned to a Mexican FMU, chosen by non-probabilistic evidence that they met the selection criteria: older than 18 years, with mental disorder, without physical or cognitive impairment. Results: 51 men and 113 women with a mean age of 48.6 years were presented; 57% with more than one mental disorder; the most frequent were depression and anxiety. In schooling overselling bachelor's degree; 16% reported attempted suicide, 42% have been diagnosed for more than 6 years. 64.6% receive psychotherapy and pharmacology; 18% were hospitalized due to their disorders, most of them between 1 and 4 weeks and 38% have a family member with a mental disorder. The most frequent comorbidities were hypertension, obesity, diabetes mellitus, dyslipidemia and osteoarthritis. The most frequent types of family are: nuclear or simple nuclear, with integrated nucleus and non-integrated nucleus; they subsist mainly on services; they live with levels 1 and 2 of family poverty; are modern and urban in greater number. Conclusions: the epidemiological, clinical and family characteristics of patients with mental disorders assigned to a Mexican family medicine unit (FMU) are mostly women, in middle adulthood, who attend more than a mental disorder (anxiety and depression), treated with drugs and psychotherapy, also had hypertension, and belong to families of simple nuclear type and non-integrated nucleus; subsist on services; they live with levels 1 and 2 of family poverty, they are modern and urban.

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ADHD constitutes a developmental risk. The general aim was to identify social skills, behavior problems, academic performance and family resources of children with ADHD, with the specific aim being to compare students regarding indicators of ADHD and the use or not of medication. Participants were 43 Elementary Education I students (M=9.6 years, SD=1.5), 43 parents (M=39.1 years, SD=7.6) and 38 teachers (M=43.1 years, SD=8.4). The instruments used were the Inventory of Social Skills, Behavior Problems and Academic Competence (SSRS-BR), Conners' Scale and the Inventory of Family Resources. The collection was carried out in public schools. The results showed that the students had scores higher than the reference sample in Behavior Problems and Social Skills and lower in classes of social skills and Academic Competence; the presence of family resources; and grades above 5.0 as a school mean. We concluded that there is a need for interventions with the studied population. (AU)

TDAH constitui risco no desenvolvimento. Teve-se como objetivo geral identificar habilidades sociais, problemas de comportamento, desempenho acadêmico e recursos familiares de crianças com TDAH e, como específico, comparar alunos quanto a indicadores de TDAH e uso ou não de medicação. Participaram 43 estudantes (M = 9,6 anos, DP = 1,5) do Ensino Fundamental I, 43 responsáveis (M = 39,1 anos, DP = 7,6) e 38 professoras (M = 43,1 anos, DP = 8,4). Os instrumentos utilizados foram Inventário de Habilidades Sociais, Problemas de Comportamento e Competência Acadêmica (SSRS-BR), Escala de Conners e Inventário de Recursos Familiares. A coleta foi realizada em escolas públicas. Os resultados apontaram alunos com escores superiores à amostra de referência em Problemas de Comportamento e Habilidades Sociais, e inferiores em classes de Habilidades Sociais e Competência Acadêmica; recursos familiares presentes e; notas acima de 5,0 como média escolar. Conclui-se a necessidade de intervenções com a população estudada. (AU)

TDAH constituye riesgo de desarrollo. El objetivo general era identificar habilidades sociales, problemas de comportamiento, rendimiento académico y recursos familiares de niños con TDAH; qué tan específico es comparar estudiantes con respecto a los indicadores de TDAH y el uso de medicamentos. Participaron 43 estudiantes (M = 9.6 años, SD = 1.5) de la escuela primaria, 43 padres (M = 39.1 años, SD = 7.6) y 38 maestros (M = 43.1 años, SD = 8.4). Los instrumentos utilizados fueron: Inventario de Habilidades Sociales, Problemas de Comportamiento y Competencia Académica (SSRS-BR), Escala de Conners e Inventario de Recursos Familiares. La colección se realizó en escuelas públicas. Los resultados mostraron estudiantes con puntajes más altos que la referencia en Problemas de comportamiento y habilidades sociales y más bajos en clases de habilidades sociales y competencia académica; recursos familiares presentes; calificaciones promedio de la escuela superiores a 5.0. Concluye la necesidad de intervenciones. (AU)

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Two focus group interviews with eight low-income Mexican fathers in two communities in a rural Midwestern state explored fathers' perceptions, behaviors, and roles related to child and family food consumption, mealtimes, and physical activity. On average, fathers were 34 years of age, had 10 years of formal education, and annual household incomes ranged from $36,250 to $46,249. Findings include the identification of fifteen themes through the process of thematic analysis that are organized by five thematic areas of interest (family food patterns, strategies for healthy eating, family roles in food shopping and preparation, family mealtimes, physical activity among families). Findings revealed ways fathers contributed to their children's and families' health and well-being, and challenges they faced. Health promotion efforts aimed at rural, low-income Mexican immigrant families can benefit from embracing fathers' perspectives and how they influence the health and well-being of their children and families.

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Resumen Se investigó el desarrollo psicomotor temprano y si existían diferencias significativas en las diversas áreas de este desarrollo según la funcionalidad familiar (cohesión y adaptabilidad familiar) desde la percepción materna. Se trabajó con un diseño no experimental de alcance descriptivo. La muestra estuvo compuesta por 32 diadas madre- hijo de entre 12 y 27 meses de edad. Se administró el Instrumento de Observación del Desarrollo Infantil (IODI), la Prueba Nacional de Pesquisa (PRUNAPE) y FACES III. Se encontraron diversas diferencias significativas entre tipo de cohesión-adaptabilidad familiar y áreas de la PRUNAPE (p<.05) y del IODI (p<.05). Se observó un desarrollo infantil temprano más favorable en las áreas personal social, lenguaje y socioemocional, en aquellas familias conectadas y flexibles.

Abstract The early psychomotor development was investigated and whether there were significant differences in the various areas of this development according to the maternal perception of family functionality (family cohesion and adaptability). A non-experimental descriptive design was carried out. The sample was comprised of 32 mothers with their children between 12 and 27 months old. Data was collected regarding The Child Development Observation Instrument (IODI), The National Research Test (PRUNAPE) and FACES III. Significant differences between cohesion and adaptability types and areas of development from PRUNAPE (p <.05) and IODI (p <.05) were observed. A more favorable early childhood psychomotor development was observed in the personal social area, as well as in A more favorable early the language and socioemotional area, in those families connected and flexible.

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Resumen El uso de lenguajes sexistas y discriminatorios hacia la mujer, sobre todo en los roles desempeñados por el hombre y la mujer en el hogar, hacen parte de los imaginarios que en la comunidad de la Vereda Belén del municipio de Isnos (Huila) se evidencian sobre las violencias de género; además, se observó la emergencia de ciertos imagina rios radicales construidos desde la familia, a partir de experiencias y vivencias perso nales con sus padres como modelos de crianza.

Abstract: The use of sexist language, which is discriminatory towards women, especially in the roles played by men and women, at home, are part of the imaginaries that in the com munity of Belén Village, in the Municipality Isnos, Huila, about gender-based violence is made evident. Besides, the emergence of certain radical imaginaries built from the family, based on personal experiences, and experiences with their parents, as parenting models, was observed.

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Resumen La familia se ha configurado a lo largo de la historia de diferentes maneras, ha transitado desde una estructura nuclear hasta una que permite varias posibilidades de diversidad. Sin embargo, este tránsito ha requerido muchas veces de marcadas luchas sociales que aún hoy día generan controversia. Este trabajo muestra un análisis de dicho tránsito haciendo un recorrido desde lo global hasta lo local. Se analizan las definiciones de familia, su contexto en Latinoamérica y en Colombia, los cambios y nuevas formas de configuración y finalmente se cuestiona sobre la identidad de la familia y su papel como sujeto político que trasiende su carácter de institución.

Abstract Throughout history, the family has been configured in different ways. It has traveled from a nuclear structure to one, which allows various possibilities of diversity. However, this transit has often required marked social struggles, which still generate controversy today. This work shows an analysis of that transit, by going from the global to the local. It analyzes the definitions of family, its context in Latin America and Colombia, the changes and new forms of configuration, and finally, challenges the identity of the family and its role as a political subject, which transcends its character as an institution.

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A COVID-19 traz repercussões macroestruturais ao status econômico, social e laboral que podem impactar o funcionamento conjugal e familiar. Neste artigo, enfocamos os recursos e riscos familiares durante a pandemia da COVID-19. Por meio de uma revisão narrativa da literatura, que incluiu estudos nacionais e internacionais, abordamos (a) conjugalidade, (b) coparentalidade, (c) parentalidade e (d) implicações para a prática da terapia de casal e família nesse contexto. Terapeutas de casal e família devem atuar no sentido de promover a coesão, flexibilidade e comunicação. Destaca-se a importância da atribuição de significados à pandemia e às experiências vivenciadas, assim como da esperança na superação dos desafios, enquanto se encorajam divisões de tarefas domésticas mais igualitárias. Discutimos a relevância de investir em estratégias que otimizem processos protetivos das relações familiares.

The COVID-19 pandemic brings up macro-structural repercussions in economic, social, and work status, which may impact family and marital functioning. In the current paper, we focus on family resources and risks during the COVID-19 pandemic. Through a narrative review of the literature, considering Brazilian as well as international studies, we present (a) marital relations, (b) coparental relations, (c) parental relations, and (d) implications for the practice of marital and family therapy in this scenario. Family and couple therapists may work to strengthen aspects such as cohesion, flexibility, and communication. The importance of attributing meaning to the pandemic and the lived experiences as well as maintaining hope in the face of challenges are emphasized, whereas the establishment of a more equal division of household labor is encouraged. We discuss the relevance of enhancing strategies to optimize resources that promote healthy family relationships.

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OBJECTIVES: To convey advice from families whose children recently underwent spinal fusion to families whose children are under consideration for initial spinal fusion for neuromuscular scoliosis and to providers who counsel families on this decision. STUDY DESIGN: We interviewed 18 families of children who underwent spinal fusion between August 2017 and January 2019 at a freestanding children's hospital. We conducted phone interviews a median of 65 (IQR 51-77) days after surgery. We audio recorded, transcribed, and coded (line-by-line) interviews using grounded theory by 2 independent reviewers, and discussed among investigators to induce themes associated with surgical decision making and preparation. RESULTS: Six themes emerged about decision making and preparation for spinal fusion: (1) simplify risks and benefits; it is easy to get lost in the details; (2) families prolonging the decision whether or not to pursue spinal fusion surgery may not benefit the child; (3) anticipate anxiety and fear when making a decision about spinal fusion; (4) realize that your child might experience a large amount of pain; (5) anticipate a long recovery and healing process after spinal fusion; and (6) be engaged and advocate for your child throughout the perioperative spinal fusion process. CONCLUSIONS: Parents of children who had recently undergone spinal fusion had strong perceptions about what information to convey to families considering surgery, which may improve communication between future parents and physicians. Further investigation is needed to assess how best to incorporate the wisdom and experiences of parent peers into shared decision making and preparation for spinal fusion in children with neuromuscular scoliosis.

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Introdução: O Cuidado Centrado na Família surgiu do entendimento de que a família é fundamental no cuidado dos seus integrantes, assim a família deve ser considerada objeto do cuidado. A inexistência de consenso sobre a forma de envolvê-las no cuidado permite diferentes abordagens dos profissionais frente à participação da família, contribuindo para o aumento da angústia, medo e insegurança, possibilitando a ocorrência de experiência traumática para a criança e sua família. Objetivos: Analisar a percepção da equipe de enfermagem e da família acerca do Cuidado Centrado na Família (CCF), antes e após a implementação de um consenso para sistematizar a participação da família na assistência. Métodos: Estudo quase-experimental, realizado em 4 etapas metodológicas: Construção do consenso; Avaliação diagnóstica; Implementação do consenso e Avaliação final. O estudo foi realizado no Hospital Universitário da USP (HU-USP). A população consistiu em 79 profissionais da equipe de enfermagem e residentes de enfermagem e 122 familiares presentes na Clínica Pediátrica e Terapia Intensiva Pediátrica e Neonatal. Os dados foram coletados mediante a aplicação dos instrumentos Percepção do Cuidado Centrado na Família-Pais Versão Brasileira; Percepção do Cuidado Centrado na Família-Equipe - Versão Brasileira e do Guia para Atendimento das Famílias na Prática Clínica de Enfermagem. O consenso das especialistas sobre as práticas foi obtido pela Técnica de Grupo Nominal. As variáveis foram analisadas por frequência absoluta e relativa, associação estatística e aplicação dos testes: t pareado e teste t de Welch. Resultados: A percepção dos profissionais e da família respondeu positivamente na maioria das perguntas, apresentando discreto aumento da média dos escores na etapa pós-intervenção, com as médias dos profissionais de 1,86 pré- intervenção x 1,91 pós-intervenção e as médias das famílias de 2,26 pré-intervenção x 2,28 pós-intervenção. As famílias apresentaram maior percepção positiva sobre o CCF do que a equipe de enfermagem; houve aumento significativo da presença da família nos procedimentos invasivos após a implementação do consenso; as famílias participaram com maior frequência na realização dos cuidados de alimentação, higiene, conforto, oferecendo carinho e apoio à criança, inclusive em procedimentos invasivos; as famílias consideraram receber colaboração, apoio e suporte da equipe para a participação. Conclusão: A construção de um consenso fundamentado nas melhores evidências do CCF e o treinamento reflexivo para despertar a consciência da necessidade de avanços, foram fundamentais para os resultados deste estudo. Concluiu-se ser possível o envolvimento e participação das famílias nos ambientes de Clínica Pediátrica e Unidade de Terapia Intensiva Pediátrica e Neonatal. As recomendações enfatizaram a maneira da enfermeira relacionar-se com a família, compreender suas necessidades, estabelecer parcerias e dar autonomia para que a família decida, como e quando deseja participar da assistência, possibilitando que a mesma se torne mais segura e forte, minimizando o seu sofrimento e o da criança.

Introduction: Family-Centered Care emerged from the understanding that the family is fundamental in the care of its members, therefore the family should be considered the object of care, especially in neonatal and pediatric units. The lack of consensus on how to involve families in care, allows different approaches of professionals regarding family participation, contributing to the increase of distress, fear and insecurity, enabling the occurrence of traumatic experience for the child and his family. Objectives: The aim of this study is analyze the perception of nursing staff and family about family-centered care, before and after the implementation of a consensus to systematize family involvement in care. Methods: almost- experimental, carried out in 4 methodological steps: Consensus elaboration; Diagnostic evaluation; Consensus Implementation and Final Evaluation. The study was conducted at the University Hospital of USP (HU USP). The population consisted of 79 nursing staff professionals and nursing residents and 122 family members present at the Pediatric Clinic and Pediatric and Neonatal Intensive Care. The data were collected through the application of the instruments Perception of Family-Centered Care Parents - Brazilian Version; Perception of Family-Centered Care Staff - Brazilian Version of the Family Care Guide in Clinical Nursing Practice. The experts consensus on the practices was obtained by the Nominal Group Technique. The variables were analyzed by absolute and relative frequency, statistical association and tests application: paired t and Welch t test. Results: The perception of professionals and family answered positively on most questions, showed a slight increase in the mean scores in the post-intervention stage 1.86 pre-intervention x 1.91 post- intervention and the average of families 2.26 pre-intervention x 2.28 post-intervention. The data showed that the families had a higher perception of CCF than the nursing staff, and had a significant increase in the presence of family in invasive procedures after consensus implementation, and that families participated more frequently in the provision of food, hygiene, comfort care, providing high care and support to the child even in invasive procedures; families reported having obtained collaboration and support from professional team. Conclusion: The elaboration of consensus based on the best evidence of CCF and reflective training to raise awareness about the need to progress, were fundamental to the results of this study. It is concluded that it is possible for families to be involved in the pediatric clinic and neonatal and pediatric intensive care settings. The recommendations emphasized the nurse\'s way of relating to the family, understanding their needs, establishing partnerships and give autonomy for the family to decide how and when they want to participate in the care, enabling them to become safer and stronger, minimizing your suffering and the child.

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Introdução: Partindo-se do pressuposto que o Cuidado Centrado no Paciente e na Família é o modo mais humanizado de prestar cuidado em saúde, faz-se necessário refletir sobre a aplicabilidade dessa abordagem em unidades de emergência pediátrica. Uma possibilidade é o favorecimento da presença da família no atendimento de emergência. O uso de protocolo e o treinamento de profissionais de saúde são ferramentas que fortalecem a prática. Objetivos: elaborar e aplicar na prática clínica um protocolo brasileiro que inclui a família no atendimento de emergência pediátrica. Método: estudo piloto do tipo descritivo observacional, realizado em três etapas: 1) elaboração do protocolo; 2) treinamento de profissionais para a aplicação do protocolo. O treinamento foi realizado com 26 profissionais de enfermagem atuantes em uma unidade de emergência pediátrica de um hospital de ensino, localizado na cidade de São Paulo e 3) análise da aplicação do protocolo na prática assistencial. Para essa análise, foi investigada a dinâmica do atendimento de emergência focando os aspectos relacionados à presença da família; as perspectivas de profissionais de saúde em relação ao conteúdo do protocolo e as anotações de enfermagem no que tange a aplicação do protocolo. Resultados: Foram analisados 65 atendimentos de emergência com a aplicação do protocolo. Em 65,6% dos atendimentos, foi designado um profissional de suporte; 93.4% das famílias aceitaram o convite para presenciar o atendimento e não ocorreu interrupção do atendimento ao paciente em consequência da presença desta. Ao avaliar o protocolo, 85,7% dos profissionais referiram confiança em aplicá lo em sua prática profissional. As principais dificuldades percebidas pelos profissionais para aplicar o protocolo incluíram a falta de recursos humanos, a falta de treinamento de todos os profissionais e a falta de estrutura fisica para o acolhimento familiar. Em relação às facilidades, foram elencadas equipe sensibilizada à prática, suporte familiar, o CCPF como alicerce teórico e membros na equipe experientes sobre o tema. Em relação ao conteúdo, os profissionais consideraram o protocolo fácil e rápido de ser aplicado. Apenas em 50% das anotações de enfermagem foi registrado que a familia estava presente no atendimento. Conclusões: As ações promotoras para a adoção institucional do protocolo incluem a sensibilização dos profissionais para acolher as famílias no atendimento de emergência e treinamento para a aplicação do protocolo na prática assistencial. Além disso, as ações que facilitam a implantação do protocolo na prática assistencial incluem respaldo teórico na abordagem do CCPF, profissionais que atuem como referência sobre o tema para os demais membros da equipe e designação de um profissional de suporte.

Introduction: Based on the assumption that Patient and Family Centered Care (PFCC) is the most humanized way of providing health care, it is necessary to reflect on the applicability of this approach in pediatric emergency units. One possibility is to favor the presence of the family in emergency care. The use of protocol and the training of health professionals are tools that strengthen the practice. Objectives: To elaborate and apply in clinical practice a Brazilian protocol that includes the family in pediatric emergency care. Method: pilot study of descriptive observational type, carried out in three stages: 1) elaboration of the protocol; 2) professional training for the application of the protocol. The training was performed with 26 nursing professionals working in a pediatric emergency unit of a teaching hospital, located in the city of São Paulo; and 3) analysis of the application of the protocol in the practice of care. For this analysis, it was investigated the dynamics of emergency care focusing on the aspects related to family presence; the perspectives of health professionals regarding the content of the protocol and the nursing notes regarding the application of the protocol. Results: A total of 65 emergencies were analyzed using the protocol. In 65.6% of the attendances a support professional was assigned: 93.4% of the families accepted the invitation to attend the service and there was no interruption of the patient care due to the presence of the family. When evaluating the protocol, 85.7% of the professionals reported confidence in applying it to their professional practice. The main difficulties perceived by professionals to apply the protocol included lack of human resources, lack of training of all professionals and lack of physical structure for the family. Regarding the facilities, the team was sensitized to practice, family support, the PFCC as a theoretical foundation and have experienced team members on the topic. Regarding content, professionals considered the protocol easy and quick to apply. Only 50% of the nursing notes recorded that the family was present in the care. Conclusions: The actions promoting the institutional adoption of the protocol include raising the awareness of professionals to receive families in emergency care and training for the application of the protocol in the practice of care. In addition, actions that facilitate the implementation of the protocol in the practice of care include theoretical support in the approach of the PFCC, professionals who serve as reference on the theme for the other members of the team and appointment of a support professional.

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Objetiva-se com este trabalho discutir o uso do sonho do psicoterapeuta para o entendimento da dinâmica inconsciente familiar, quando este sonho está ligado com aspectos contratransferenciais. Por intermédio da análise de dois sonhos específicos da psicoterapeuta com os pacientes de um atendimento familiar, pretende-se demonstrar a relação entre os conteúdos oníricos do sonho e os elementos de origem transgeracional que a família herdou e foram captados pela mente da psicoterapeuta. Isto foi essencial para a compreensão do caso e dificilmente teria sido incorporado ao entendimento da organização da dinâmica familiar de outra maneira. Pensa-se, assim, que os sonhos do psicoterapeuta com seu paciente podem ser integrados à compreensão do caso, algo de relevância no setting psicanalítico familiar, haja vista a necessidade da elaboração de conteúdos inconscientes herdados psiquicamente de gerações anteriores.

The purpose of this study is to discuss the use of the psychotherapist's dream to understand the unconscious dynamics of the family, when this dream is related to aspects of countertransference. The author attempts to demonstrate, by using the analysis of two specific dreams (i.e. psychotherapist's dreams with her patients in family psychotherapy), the connection between the oneiric contents of the dream and the elements of transgenerational origin. These elements were both inherited by the family and captured by the psychotherapist's mind. They would have been hardly incorporated in any other way into the comprehension of how the family's dynamics have been organized. It was vital to the understanding of this case. The author thinks, therefore, that the psychotherapist's dreams with his patient may be included in the analysis of the case. Given the need to elaborate unconscious contents that were psychically inherited from previous generations, these dreams may play a relevant role in the setting of the family psychoanalysis.

El objetivo del siguiente trabajo es discutir el uso del sueño del psicoterapeuta para entender la dinámica inconsciente familiar y su relación con los aspectos contratransferenciales. Por medio del análisis de dos sueños específicos del psicoterapeuta con los pacientes de un acompañamiento familiar, se pretende demostrar la relación entre los contenidos oníricos del sueño y los elementos de origen transgeneracional que la familia heredó y fueron captados por la mente del psicoterapeuta. Esto fue esencial para comprender el caso, ya que, de otra manera, difícilmente habría podido ser incorporado para entender la organización de la dinámica familiar. Se considera, así, que los sueños del psicoterapeuta con su paciente pueden ser integrados para la comprensión del caso, pues cobran relevancia en el setting psicoanalítico familiar cuando surge la necesidad de elaborar contenidos inconscientes heredados psíquicamente de generaciones anteriores.

L'objectif de ce travail est de discuter l'utilisation du rêve du psychothérapeute pour la compréhension de la dynamique inconsciente familiale, lorsque ce rêve est lié à des phénomènes de contre-transferts. On a l'intention de démontrer la relation entre les contenus oniriques du rêve et les éléments d'origine transgénérationnel que la famille a hérité et qui sont captés par l'esprit de la psychothérapeute, par l'intermédiaire de l'analyse de deux rêves spécifiques de la psychothérapeute avec les patients d'une famille en cours d'analyse. Ce fait a été essentiel pour la compréhension du cas et ils ne seraient pas facilement incorporés à la compréhension de l'organisation de la dynamique familiale d'une autre manière. On croit ainsi que les rêves de la psychothérapeute avec son patient peuvent être intégrés à la compréhension du cas, ce qui est très important dans le setting analytique familial, étant donné le besoin de l'élaboration des contenus inconscients hérités psychiquement des générations précédentes.

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Species inhabiting drylands commonly depend on the surrounding vegetation for recruitment under stress, while competition may affect populations in moister environments. Our objective was to analyze how different climates and vegetation affect the fine-scale spatial genetic structure (SGS) of the columnar cactus Echinopsis terscheckii. At 4 sites, we estimated vegetation cover by digitized patches and the normalized difference vegetation index (NDVI). We mapped 30 individuals per population and collected tissue for isozyme electrophoresis using 15 putative loci. Spatial autocorrelation between all possible genotype pairs and the number of genetically homogeneous groups and families were calculated for each population. Greater cover (66%) and average NDVI values were detected in the most humid habitat that consisted of fewer, larger, and more dispersed vegetation patches. All populations were genetically diverse and showed significant SGS. Positive correlations were found between the distance at which maximum autocorrelation and kinship values were reached and vegetation area and patch size. Also higher NDVI values were associated with lower number of patches. Populations exposed to higher precipitation and vegetation cover consisted of sparse individuals that clustered at larger distances whereas vegetation patches in arid climates produced groups of closely related genotypes at small distances. These results support the stress-gradient genetic hypothesis. Under water stress, facilitation promotes establishment underneath patchy vegetation resulting in fine-scale family structure. In moister xerophilous forests, competition for resources, that is, light, results in sparse individuals and thus coarse-scale neighborhoods. This information can guide conservation and/or restoration efforts, such as the spatial scale to be considered in germplasm collection.

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BACKGROUND: This study aimed to assess the impact of comorbidities (CMs) on costs, utilities and health-related quality of life (HRQOL) among HIV patients in Colombia. METHODS: A cross-sectional study was conducted among 138 HIV patients at an outpatient clinic in Bogotá to assess their costs, utilities (EQ5D-5L) and HRQOL (EQ-VAS). CMs and other covariates were gathered from patient records. Multiple regression models were conducted to assess the impact of CMs. RESULTS: Of all patients, 72% experienced CMs; of these, half experienced ≥2 CMs (N = 49). CMs had a statistically significant impact on utilities when the EQ5D-5L (P = 0.022) was applied among patient with ≥2 CMs. No statistical significance was found for the impact of CMs on costs. CONCLUSION: This study suggests that having multiple CMs significantly influences utility, and CMs have some impact on HRQOL measured using the EQ-VAS but this effect is at the border of significance. No significant impact was observed on costs.

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