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Resumen La desnutrición infantil constituye un desafío de gran importancia en el ámbito de la salud pública. El objetivo de la investigación fue evaluar la influencia de los factores sociales y culturales en el estado nutricional en niños menores ecuatorianos de 2 años, en la ciudad de Portoviejo, Provincia de Manabí, durante el año 2023. Se realizó una investigación prospectiva, descriptiva, transversal y observacional. La población pediátrica incluyó 169 menores de dos años, cuyas madres proporcionaron los datos pertinentes. Los factores sociales predominantes fue el nivel educativo del cuidador del niño comprendida entre 7 a 12 años de estudios con la presencia de casos de desnutrición crónica en un 83,9%; además, la limitada contribución financiera del progenitor para la alimentación del infante con casos de desnutrición aguda en un 88,6%. Dentro de los factores culturales, se encontró que los niños con esquema de vacunación incompleto presentaban desnutrición crónica con un 88,7%, la falta de los controles prenatales, al igual que la inasistencia al primer control prenatal antes del quinto mes con casos de desnutrición aguda en un 95,5%; además, se evidenció que la estimulación para la ingesta de alimentos y la falta de práctica de la lactancia materna exclusiva con la presencia de desnutrición crónica en los menores, con un 98,4% y un 96,8%, respectivamente. En este entorno, el estado nutricional de mayor tendencia fue la desnutrición crónica con un 34,3%. Además, se identificó una asociación significativa de relación de dependencia (p<0,05) entre los factores sociales, culturales y el estado nutricional.

Abstract Child malnutrition constitutes a challenge of great importance in the field of public health. The objective of the research was to evaluate the influence of social and cultural factors on the nutritional status in Ecuadorian children under 2 years of age in the city of Portoviejo, Province of Manabí, during the year 2023. A prospective, descriptive, crooss-sectional and observational research was carried. The pediatric population included 169 children under two years of age, whose mothers provided the relevant data. The predominant social factors were the educational level of the child's caregiver, ranging from 7 to 12 years of education, with the presence of cases of chronic malnutrition in 83.9%; in addition, the limited financial contribution of the parent to feeding the infant with cases of acute malnutrition in 88.6%. Within the cultural factors, it was found that children with an incomplete vaccination presented chronic malnutrition with 88.7%, the lack of prenatal check-ups, as well as non-attendance at the first prenatal check-up before the fifth month with cases of malnutrition acute in 95.5%; Furthermore, it was evidenced that the stimulation of food intake and the lack of practice of exclusive breastfeeding with the presence of chronic malnutrition in minors, with 98.4% and 96.8%, respectively. In this environment, the most trending nutritional status was chronic malnutrition with 34.3%. In addition, a significant association of dependency relationship (p<0.05) was identified between social and cultural factors and nutritional status.

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Abstract Objectives: identify the sociodemographic conditions of the community and determine the prevalence of the nutritional status of children under six years of age in the Nasa Paéz Indigenous Reserve, Rionegro-Huila, Colombia. Methods: cross-sectional descriptive study whose data was obtained from two databases, one of sociodemographic conditions and other anthropometric measurements of children under six years of age. The sample corresponded to the total population of less than six years. The data was analyzed using descriptive statistics using the R Studio 3.4 software. Results: 98.6% of the population is enrolled in the health system. Water consumption comes from 71.6% of non-potable sources. 25.5% of the population has access to wastewater disposal systems. Regarding nutritional status, the prevalence of delay in growth and risk of delay in growth is 43.3% in the population under six months and 69.4% in those aged between six months and six years. Furthermore, 34.3% of children under six months of age are at risk of being overweight. Conclusions: sociodemographic conditions are determined by different inequities, low education levels, inadequate housing, drinking water consumption, as well as a high prevalence of child malnutrition.

Resumen Objetivos: identificar las condiciones sociodemográficas de la comunidad y determinar la prevalencia del estado nutricional de niños menores de seis años en el Resguardo Indígena Nasa Paéz, Rionegro-Huila, Colombia. Métodos: estudio descriptivo transversal cuyos datos se obtuvieron de dos bases de datos, una de las condiciones sociodemográficas y otra de medidas antropométricas de niños menores de seis años. La muestra correspondió a la totalidad población menor seis años. Los datos se analizaron mediante estadística descriptiva utilizando el software R Studio 3.4. Resultados: el 98,6% de la población está inscrito en el sistema de salud. El consumo de agua proviene en un 71,6% de fuentes no potables. El 25,5% de la población tiene acceso a sistemas de eliminación de aguas residuales. En cuanto al estado nutricional, la prevalencia de retraso en el crecimiento y riesgo de retraso en el crecimiento es del 43,3% en la población menor de seis meses y del 69,4% en edad entre los seis meses a seis años. Además, el 34,3% de los niños menores de seis meses estaban en riesgo de tener sobrepeso. Conclusiones: las condiciones sociodemográficas están determinadas por diferentes inequidades, bajos niveles de educación, vivienda inadecuada, consumo de agua no potable, así como por una alta prevalencia de malnutrición infantil.

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Background: There are validated questionnaires in Spanish that evaluate the factors that influence organ donation, but they are not designed for the open population or do not delve into various aspects such as the one proposed. Objective: Validate an instrument to evaluate the factors that influence organ donation in Mexico. Material and methods: Phase 1: Development of the instrument. Translation into Spanish of the questionnaire "Factors Inffluencing Organ Donation in Qatar", adapted by experts in donation and clinimetry. Simultaneously, the definitive version of the questionnaire "Factors that Influence Organ Donation" (FIDO) and the questionnaire "International Donor Collaborative Project" were applied to patients, relatives and staff of a tertiary hospital in Puebla, Mexico. Mind a week after 200 respondents. Cronbach's Alpha (AC) (internal consistency), Intraclass Correlation Coefficient (ICC) (external consistency), and Phi (Phi) and Chi square Coefficient (concurrent validity in intention to donate) were obtained. Results: AC and ICC by domain: Knowledge 0.625 and 0.372; Attitudes 0.776 and 0.761; Beliefs 0.649 and 0.633; Intentions 0.126 and 0.123; Phi: 0.976, Chi square: 2.358 (p = 0.125). Conclusions: The FIDO questionnaire is valid and consistent to assess knowledge, attitudes, beliefs and intentions in organ donation in the general Mexican population.

Introducción: existen cuestionarios validados en español que evalúan los factores que influyen en la donación de órganos, pero no están diseñados para población abierta o no exploran aspectos diversos como el propuesto. Objetivo: validar un instrumento para evaluar los factores que influyen en la donación de órganos en México. Material y métodos: fase 1: Elaboración del instrumento. Traducción al español del cuestionario Factors Influencing Organ Donation in Qatar, adaptado por expertos en donación y clinimetría. Se realizaron pruebas piloto hasta lograr acuerdo en dos rondas consecutivas. Fase 2: Validez y consistencia. Simultáneamente se aplicó la versión definitiva del cuestionario Factores que Influyen en la Donación de Órganos (FIDO) y el cuestionario Proyecto Colaborativo Internacional Donante a pacientes, familiares y personal de un hospital de tercer nivel de Puebla, México. Se reaplicó telefónicamente una semana después a 200 respondientes. Se utilizó alfa de Cronbach (AC) (consistencia interna), coeficiente de correlación intraclase (CCI) (consistencia externa), y coeficiente de Phi (Phi) y Chi cuadrada (validez concurrente en intención de donar). Resultados: AC y CCI por dominio: Conocimiento 0.625 y 0.372; Actitudes 0.776 y 0.761; Creencias 0.649 y 0.633; Intenciones 0.126 y 0.123; Global 0.774 y 0.675, respectivamente (p = 0.000); Phi: 0.976, Chi cuadrada: 2.358 (p = 0.125). Conclusiones: el cuestionario FIDO es válido y consistente para explorar: conocimiento, actitudes, creencias e intenciones en donación de órganos en población general mexicana.

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BACKGROUND: Poor quality of care is a barrier to engagement in HIV care and treatment in low- and middle-income country settings. This study involved focus group discussions (FGD) with patients and health workers in two large urban hospitals to describe quality of patient education and psychosocial support services within Haiti's national HIV antiretroviral therapy (ART) program. The purpose of this qualitative study was to illuminate key gaps and salient "ingredients" for improving quality of care. METHODS: The study included 8 FGDs with a total of 26 male patients and 32 female patients and 15 smaller FGDs with 57 health workers. The analysis used a directed content analysis method, with the goal of extending existing conceptual frameworks on quality of care through rich description. RESULTS: Dimension of safety, patient-centeredness, accessibility, and equity were most salient. Patients noted risks to privacy with both clinic and community-based services as well as concerns with ART side effects, while health workers described risks to their own safety in providing community-based services. While patients cited examples of positive interactions with health workers that centered their needs and perspectives, they also noted concerns that inhibited trust and satisfaction with services. Health workers described difficult working conditions that challenged their ability to provide patient-centered services. Patients sought favored relationships with health workers to help them navigate the health care system, but this undermined the sense of fairness. Both patients and health workers described frustration with lack of resources to assist patients in dire poverty, and health workers described great pressure to help patients from their "own pockets." CONCLUSIONS: These concerns reflected the embeddedness of patient - provider interactions within a health system marked by scarcity, power dynamics between patients and health workers, and social stigma related to HIV. Reinforcing a respectful and welcoming atmosphere, timely service, privacy protection, and building patient perception of fairness in access to support could help to build patient satisfaction and care engagement in Haiti. Improving working conditions for health workers is also critical to achieving quality.

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Culture and culturally specific beliefs or practices may influence perceptions and decisions, potentially contributing to childhood obesity. The objective of this study is to identify the cultural factors (expressed through decisions, behaviors, individual experiences, perceptions, attitudes, or views) related to childhood and adolescent obesity in Mexico. Ten databases and one search engine were searched from 1995 onwards for qualitative studies. The Sunrise Enabler Model, described within the Cultural Care Theory, guided this review. Sample, the phenomenon of interest, study design, and evaluation data were extracted, and the Critical Appraisals Skills Programme tool was used to assess the quality of the included studies. Twenty-four studies were included. Of these, 12 studies included children or adolescents, 12 included parents, eight included schoolteachers, four included school staff (other than teachers), four included food vendors, and one included policymakers. Cultural values, beliefs, lifeways (especially food and food costumes), kinship, and social factors (particularly immediate and extended family) strongly influenced childhood and adolescent obesity-related lifestyles in Mexico. Most cultural factors related to childhood obesity in Mexico identified in this review may be modifiable and amenable to practical interventions.

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Este artículo se centra en la letra de la canción popular titulada "Baracunátana" para describir y analizar la cultura machista en las relaciones de género. La historia narrada en la canción, con su entramado machista, a un nivel microsocial, es el punto de partida de una exploración sobre los conflictos de género. A continuación, el artículo examina las consecuencias macrosociales de la cultura machista y, en especial, su influencia en la violencia de género. Esas problemáticas, micro y macro, son las bases para emprender una revisión crítica de las principales políticas y acciones de control penal desarrolladas para combatir la violencia en las relaciones de género en el sistema jurídico colombiano. Como resultado, se identifican varios nodos críticos que neutralizan e impiden un manejo adecuado de este tipo ascendente de violencia. Esto permite demostrar que las políticas en materia penal han derivado, con preocupante ineficacia, pese al sensacionalismo y la algarabía política que hacen, en un inoficioso populismo penal. En contraposición, el artículo propone dar prioridad al desarrollo de políticas sociales contra el machismo, cuyo objetivo sería afectar las disposiciones de poder, porque el problema de Baracunátana no es de amor, ni de celos, es una cuestión de poder.

This article focuses on the lyrics of the popular song "Baracunátana" to describe and analyze the machista culture in gender relations. The story narrated in the song, with its machista framework, at a micro-social level, is the starting point for an exploration of gender conflicts. The article then examines the macro-social consequences of macho culture and, in particular, its influence on gender violence. These micro and macro issues are the basis for a critical review of the main policies and criminal control actions developed to combat violence in gender relations in the Colombian legal system. As a result, several critical nodes are identified that neutralize and impede an adequate management of this ascending type of violence. This allows demonstrating that criminal policies have derived, with worrying ineffectiveness, despite the sensationalism and political hullabaloo they make, in an ineffective criminal populism. In contrast, the article proposes to give priority to the development of social policies against machismo, whose objective would be to affect the dispositions of power, because the problem of Baracunátana is not one of love or jealousy, it is a question of power.

Este artigo enfoca a letra da canção popular "Baracunátana" para descrever e analisar a cultura machista nas relações de gênero. A história contada na canção, com sua estrutura machista, em nível micro-social, é o ponto de partida para uma exploração dos conflitos de gênero. O artigo examina então as conseqüências macro-sociais da cultura machista e, em particular, sua influência sobre a violência baseada no gênero. Essas questões micro e macro são a base para uma revisão crítica das principais políticas e ações de controle penal desenvolvidas para combater a violência nas relações de gênero no sistema jurídico colombiano. Como resultado, são identificados vários nós críticos que neutralizam e impedem uma gestão adequada deste tipo de violência. Isto torna possível demonstrar que as políticas de justiça criminal se tornaram, com preocupante ineficácia, apesar do sensacionalismo e do alarido político que geram, um populismo criminoso ineficaz. Em contraste, o artigo propõe dar prioridade ao desenvolvimento de políticas sociais contra o machismo, cujo objetivo seria afetar as disposições de poder, pois o problema de Baracunátana não é de amor ou ciúme, é uma questão de poder.

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Access to the labor market by graduates of the National University of Moquegua is limited by a wide range of socioeconomic and cultural factors. The study aimed to develop a multivariate model to identify the socioeconomic and cultural factors that influence labor insertion of graduates of the National University of Moquegua, 2019. The type of research according to its purpose was basic and the non-experimental cross-sectional design, with a stratified random sample with proportional allocation with a significance level of 5% and a sampling error of 7%. The data collection technique was the survey and two validated and reliable instruments were applied. The population consisted of 537 graduates, with a sample of 121 graduates from six Professional Schools. The results of the application of logistic regression models indicate that the employment status (Wald = 21.179 and p-value = 0.000), basic electricity services (Wald = 4.567 and p-value = 0.033), the preference for movies (Wald = 6,136 and p-value = 0.013), and the communications media: TV and radio (Wald = 4.962 and p-value = 0.026) significantly influence the labor insertion of graduates of UNAM. It is concluded that both the working condition, electricity services, the preference for movies and communication media like TV and radio significantly influence the labor insertion of graduates of the National University of Moquegua.

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BACKGROUND: In some areas of the world, breast milk is seen as a potential source of child diarrhoea. While this belief has been explored in African and Southeast Asian countries, it remains vastly understudied in Latin American contexts. We investigate socio-cultural factors contributing to breastfeeding cessation in rural high-altitude populations of the Peruvian Andes. The role of socio- cultural factors in the local explanatory model of child diarrhoea, and whether these perceptions were integrated in the local healthcare system were assessed. METHODS: Within the framework of a randomised controlled trial, we conducted semi-structured interviews with 40 mothers and 15 health personnel from local healthcare centres involved in the trial. RESULTS: Cultural beliefs on breastfeeding cessation included the perception that breast milk turned into "blood" after six months and that breastfeeding caused child diarrhoea. We identified eight local types of child diarrhoea, and women linked six of them with breastfeeding practices. "Infection" was the only diarrhoea mothers linked to hygiene and the germ disease concept and perceived as treatable through drug therapy. Women believed that other types of diarrhoea could not be treated within the formal healthcare sector. Interviews with health personnel revealed no protocol for, or consensus about, the integration of the local explanatory model of child diarrhoea in local healthcare and service provision. CONCLUSIONS: The local explanatory model in rural Andean Peru connected breastfeeding with child diarrhoeas. Cultural beliefs regarding diarrhoea management may increase home treatments, even in cases of severe diarrhoeal episodes. Future national breastfeeding support programmes should promote peer-counselling approaches to reduce negative attitudes towards breastfeeding and health practitioners. Local explanatory models should be incorporated into provincial and regional strategies for child diarrhoea management to promote equity in health and improve provider-patient relationships.

RESUMEN: ANTECEDENTES: En diferentes partes del mundo, la leche materna es percibida como una fuente potencial de diarreas infantiles. Mientras que estas creencias se han estudiado en África o el Sudeste Asiático, su análisis en el contexto latinoamericano es limitado. Esta investigación se centra en el estudio de los factores culturales que contribuyen al cese de la lactancia materna en poblaciones rurales de los Andes peruanos. Al mismo tiempo, también se analiza el papel de estos factores culturales en el modelo explicativo local de diarreas infantiles y la integración de las creencias en los servicios locales de salud. MéTODOS: Dentro de un ensayo clínico aleatorizado, se llevaron a cabo entrevistas semi-estructuradas con 40 mujeres y 15 trabajadores de salud de centros participantes en el ensayo. RESULTADOS: Las creencias culturales en torno a la lactancia maternal incluían la percepción de que la leche materna se convierten en "sangre" a los seis meses del parto y que la leche materna causaba diarreas en los niños lactantes. Identificamos ocho tipos de diarreas locales, seis de las cuales fueron asociadas con la lactancia por las madres participantes. "Infección" resultó ser el único tipo de diarrea que las madres asociaron con los principios de la higiene y la teoría microbiana de la enfermedad y percibían como curable por medio de medicamentos. Las mujeres creían que el resto de diarreas locales no podían ser tratadas dentro del sistema de salud. Las entrevistas con el personal sanitario indicaron una falta de protocolos y consenso sobre cómo integrar el sistema de creencias locales en torno a las diarreas infantiles en los servicios de salud. CONCLUSIONES: El modelo explicativo local en zonas rurales de los Andes peruanos asocia la lactancia con las diarreas infantiles. Estas creencias culturales dan lugar a prácticas de manejo de diarreas infantiles que pueden incrementar los tratamientos domiciliarios, incluso en episodios de diarrea severos. Futuros programas nacionales de apoyo a la lactancia materna deben promover la consejería y apoyo de pares y profesionales de salud con la finalidad de reducir las actitudes negativas hacia la lactancia materna y el personal de salud. Los modelos explicativos locales de las diarreas infantiles deberían incorporarse a las estrategias provinciales y regionales con la finalidad de promover la equidad en salud y mejorar las relaciones médico-paciente.

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Background: The accurate diagnosis of neurocognitive disorders in illiterate Peruvian populations is challenging, largely owing to scarcity of brief cognitive screening tools (BCST) validated in these diverse populations. The Peruvian version of the Rowland Universal Dementia Assessment Scale (RUDAS-PE) is a BCST that relies minimally on educational attainment and has shown good diagnostic accuracy in an urban illiterate population in Peru, yet its psychometric properties in illiterate populations in rural settings of the country have not been previously investigated. Objectives: To establish the diagnostic accuracy of the RUDAS-PE compared to expert clinical diagnosis using the Clinical Dementia Rating (CDR) Scale in healthy and cognitively impaired illiterate persons living in two culturally and geographically distinct rural communities of Peru. Methods: A cross-sectional, population-based study of residents ≥ 50 years of age living in the Peruvian rural communities of Santa Clotilde and Chuquibambilla. A total of 129 subjects (76 from Santa Clotilde and 53 from Chuquibambilla) were included in this study. Gold standard diagnostic neurocognitive evaluation was based on expert neurological history and examination and administration of the CDR. Receiver operating characteristics, areas under the curve (AUC), and logistic regression analyses were conducted to determine the performance of RUDAS-PE compared to expert gold standard diagnosis. Results: Compared to gold standard diagnosis, the RUDAS-PE was better at correctly discriminating between MCI and dementia than discriminating between MCI and controls in both sites (97.0% vs. 76.2% correct classification in Chuquibambilla; 90.0% vs. 64.7% in Santa Clotilde). In Chuquibambilla, the area under the curve (AUC) of the RUDAS to discriminate between dementia and MCI was 99.4% (optimal cutoff at <18), whereas between MCI and controls it was 82.8% (optimal cutoff at <22). In Santa Clotilde, the area under the curve (AUC) of the RUDAS to discriminate between dementia and MCI was 99.1% (optimal cutoff at <17), whereas between MCI and controls it was 75.5% (optimal cutoff at <21). Conclusions: The RUDAS-PE has acceptable psychometric properties and performed well in its ability to discriminate MCI and dementia in two cohorts of illiterate older adults from two distinct rural Peruvian communities.

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RESUMEN Introducción: La psiquiatría cultural evalúa las manifestaciones, los síntomas de sufrimiento emocional o los trastornos mentales en los distintos contextos culturales; asimismo, aborda problemas sociales como la pobreza, la violencia y las desigualdades entre grupos o clases sociales. Objetivo: Presentar una revisión narrativa de los aspectos culturales más relevantes en el contexto de la práctica clínica en psiquiatría y proponer algunas alternativas para mejorar la competencia cultural de los profesionales de la salud. Métodos: Se llevó a cabo una revisión narrativa de los artículos más relevantes en el área. Resultados: Habitualmente se utiliza la perspectiva cultural para explicar diferencias en las prevalencias que se observan en algunos trastornos mentales según el sexo y la localización geográfica. Las diferencias culturales modifican la expresión de distress o sufrimiento emocional, y esto puede reducir la precisión y afectar a la confiabilidad de las clasificaciones y la validez de los diagnósticos actuales usados en psiquiatría. La Asociación Psiquiátrica Americana, en la clasificación más reciente, revisó los trastornos asociados con la cultura pero solo incluyó un reducido número de situaciones. La formación médica y la psiquiatría deben responder a las necesidades de comunidades diversas y proporcionar un cuidado de calidad mediante el desarrollo de competencias transculturales en los currículos. Conclusiones: Se debe considerar que las diferencias culturales modifican la expresión de distress y con ello se menoscaba la validez y la confiabilidad de los diagnósticos hegemónicos en distintos contextos culturales. En un mundo cada vez más globalizado, es posible que futuras clasificaciones diagnósticas omitan los «síndromes culturales¼.

ABSTRACT Background: Cultural psychiatry evaluates manifestations, symptoms of emotional distress and mental disorders in diverse cultural contexts; it also addresses social problems such as poverty, violence, inequalities between groups or social classes. Objective: To present a narrative review of the most relevant cultural aspects in the context of clinical practice in psychiatry and to suggest some alternatives to improve the cultural competence of health care professionals. Method: A narrative review was carried out of the most relevant articles in the area. Results: Usually, the cultural argument is used to explain differences in observed prevalences in some mental disorders according to gender and geographical location. Cultural differences modify the expression of emotional distress and this can reduce the accuracy and affect the reliability and validity of the current diagnostic classification used in psychiatry. The American Psychiatric Association, in the most recent classification, revised cultural syndromes but only included a limited number of situations. Consequently, medical education and psychiatry must respond to diverse populations and provide quality care through the development of trans-cultural competence in the curriculum. Conclusions: It should be considered that cultural differences modify the expression of distress and thereby undermine the validity and reliability for diagnoses in distinct cultural contexts. In an increasingly globalised world, future classifications may completely omit 'cultural syndromes'.

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INTRODUCTION: Cirrhosis of the liver is a serious public health problem worldwide, with regional variations determined by cultural factors and economic development. AIM: To know the characteristics of the social, cultural, and economic factors of the patients with cirrhosis of the liver in Veracruz. MATERIALS AND METHODS: A multicenter, retrolective, relational research study was conducted on patients with cirrhosis of the liver at five healthcare institutions in Veracruz. The variables analyzed were etiology, age, sex, civil status, educational level, occupation, and income. Descriptive and inferential statistics were utilized, and statistical significance was set at a P<.05. The Windows IBM-SPSS version 25.0 program was employed. RESULTS: A total of 182 case records of patients with cirrhosis of the liver were included. The etiologic factors were chronic alcohol consumption (47.8%), viral disease (28.5%), nonalcoholic fatty liver disease (NAFLD) (8.79%), autoimmune liver disease (4.4%), cholestasis (1.64%), and cryptogenic liver disease (8.8%). Mean patient age was 66.14±13.91, with a predominance of men (58.79%). In comparing the socioeconomic and cultural factors related to etiology, secondary and tertiary education and singleness were statistically significant in male alcoholics (P<.05), viral diseases and NAFLD were significantly associated with women with no income (P<.05), cryptogenic liver disease was significantly associated with women (P<.05), and cholestasis and autoimmune liver disease were not significantly associated with any of the factors. CONCLUSIONS: The study results revealed the influence of socioeconomic and cultural factors related to the different causes of cirrhosis of the liver in our environment.

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Zika virus infection during pregnancy is a cause of congenital brain abnormalities. Its consequences for pregnancies have made governments and both national and international agencies issue advice and recommendations to women. This study was designed to understand the impacts of Zika on women who were less directly affected and less vulnerable to Zika. Women were recruited from various locations in Brazil, Puerto Rico, and the United States. Data were collected through semi-structured interviews and analyzed using thematic analysis. Women perceived that public health systems placed an unfair responsibility for preventing health complications from Zika onto women who had limited ability to do so. They also stated that the measures recommended to them were invasive, while creating the perception that women were the sole determinant of whether they contracted Zika. The results indicate that women with higher levels of education understood the limitations of the information, government actions, and medical care they received, which ended up producing higher levels of anguish and worry. Gender inequality and discrimination must be recognized and rendered visible in the public health emergency response. The social effects of the epidemic affected women more than had been thought before and at deeper emotional levels.

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ABSTRACT Objectives: To conduct a systematic review and a meta-analysis of observational and experimental studies that explore the relation between asthma and cold exposure. Materials and methods: Systematic review of experimental and observational studies published up to August 2015 in Pubmed, Embase and Lilacs. Two researchers selected studies that measured the occurrence of asthma in individuals exposed to different environmental temperatures. A meta-analysis used RevMan 5.3's random effects model to calculate a summary weighted Odds Ratio with 95% confidence intervals, and a sensitivity analysis identified the influence of each study. Subsequent subgroup analyses identified summary measures by type of cold exposure and study design. Additional analysis measured heterogeneity and risk of bias. Results: We found 86 studies measuring the relation between cold exposure and asthma. We included 11.6% (10/86) of the studies in the meta-analysis and found an association between cold exposure and asthma with all the studies (ORw 2.0 95%CI 1.28-3.14), with the subgroup of experimental studies (ORw 3.8 IC95% 1.70-8.86), and with cold environmental air (ORw 1.59 IC95% 1.10-2.30). The studies had high risk of bias and statistical heterogeneity [I2: 63.1% (27%-81.4%)]. Conclusions: The results support the hypothesis of an association between asthma and cold exposure. This study encourages to explore the concepts proposed by traditional medicine to establish its benefits on prevention and care of respiratory diseases, such as asthma.

RESUMEN Objetivos: Realizar una revisión sistemática y meta-análisis de estudios observacionales y experimentales que exploren la relación entre asma y exposición al frío Materiales y Métodos: Revisión sistemática de estudios experimentales y observacionales publicados hasta agosto de 2015 en Pubmed, Embase y Lilacs. Dos investigadores seleccionaron estudios midiendo la ocurrencia de asma tras la exposición a diferentes temperaturas ambientales. Usando un modelo de efectos aleatorios en RevMan 5.3, un meta-análisis calculó un resumen de Odds Ratio ponderado con intervalos de confianza de 95%. Un análisis de sensibilidad identificó la influencia de cada estudio. Análisis de subgrupo identificaron las medidas de resumen de acuerdo a tipo de exposición al frío y diseño de estudio. Finalmente, medimos heterogeneidad y riesgo de sesgos. Resultados: Encontramos 86 estudios explorando la relación entre la exposición al frío y el asma. Incluimos 11.6% (10/86) de los estudios en el meta-análisis y encontramos una asociación entre la exposición al frío y asma en todos los estudios (ORw 2.0 95%CI 1.28-3.14), en el subgrupo de estudios experimentales (ORw 3.8 IC95% 1.70-8.86), y aire frío ambiental (ORw 1.59 IC95% 1.10-2.30). Los estudios tienen alto riesgo de sesgos y heterogeneidad [I2: 63.1% (27%-81.4%)]. Conclusiones: Los resultados apoyan la hipótesis de una asociación entre asma y exposición al frío. Este estudio invita a explorar los conceptos de la medicina tradicional para la prevención y cuidado de enfermedades respiratorias.

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Introduction: In the present study were determined the psychological, social and cultural factors that are related to organ donation in a Peruvian sample from the districts of San Isidro, Lince and San Juan de Lurigancho (Lima-Peru). Methods: Observational, retrospective, cross-sectional study controls that included adults between 18-60 years. Districts of Lima of different socioeconomic levels (A, B and C), A - San Isidro, B - Lince, and C - San Juan de Lurigancho were included. The questionnaire was administered to people who indicated they were donors and those who were not according to their district of domicile, with an equitable distribution of the surveyed population and the sectors of each district: San Isidro, Lince and San Juan de Lurigancho (5 sectors), 32 inhabitants for each sector of the district. Results: psychological factor was significantly associated with organ donation (OR = 6.407; p <0.001), altruism and fear of disfiguring the body being the ones with the greatest strength of association to organ donation. Social factors (OR = 0.879; p> 0.05) and cultural factors (OR = 0.659; p> 0.05) were not significantly associated. Major conclusion: The statistically significant associated factor to organ donation in the three districts of Lima was the psychological factor; the social and cultural factor did not show association in the districts evaluated.

Introducción: En el presente estudio se determinaron los factores psicológicos, sociales y culturales que se relacionan con la donación de órganos en una muestra peruana de los distritos de San Isidro, Lince y San Juan de Lurigancho (Lima-Perú). Métodos: Estudio observacional, retrospectivo, transversal que incluyó adultos entre 18-60 años. Se incluyó a tres distritos de Lima de diferentes niveles socioeconómicos (A, B y C), A - San Isidro, B-Lince, C-San Juan de Lurigancho. Se aplicó un cuestionario validado por juicio de expertos y confiabilidad por alfa de Cronbach, valor de 0.72. Se administró el cuestionario personas que indicaron ser donadores y aquellas que no lo fueron según su distrito de domicilio, realizándose una distribución equitativa de la población encuestada y los sectores de cada distrito: San Isidro, Lince y San Juan de Lurigancho (5 sectores), 32 habitantes por cada sector del distrito. Resultados: el factor psicológico se asoció significativamente a la donación de órganos (OR= 6.407; p<0.001) siendo el altruismo y el miedo a la desfiguración del cuerpo los que presentaron la mayor fuerza de asociación a la donación de órganos. Los factores sociales (OR= 0.879; p>0,05) y culturales (OR= 0.659; p>0.05) no se asociaron significativamente. Conclusión principal: El factor asociado estadísticamente significativo a la donación de órganos en los tres distritos de Lima, fue el factor psicológico; el factor social y cultural no presentaron asociación en los distritos evaluados. Resultados: el factor psicológico se asoció significativamente a la donación de órganos (OR= 6.407; p<0.001) siendo el altruismo y el miedo a la desfiguración del cuerpo los que presentaron la mayor fuerza de asociación a la donación de órganos. Los factores sociales (OR= 0.879; p>0,05) y culturales (OR= 0.659; p>0.05) no se asociaron significativamente. Conclusión principal: El factor asociado estadísticamente significativo a la donación de órganos en los tres distritos de Lima, fue el factor psicológico; el factor social y cultural no presentaron asociación en los distritos evaluados.

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La vasectomía es un procedimiento que genera mínimas complicaciones y ostenta una tasa de éxito del 99 %; además tiene menor costo que la esterilización femenina, por lo cual se debe tener en cuenta el rol que desempeña el hombre en el número de hijos que se proyecta tener. En esta revisión de tema se identificaron los factores que inciden en la aceptabilidad de la vasectomía. Se realizó la búsqueda de la literatura en las bases de datos de PubMed, ProQuest, BioMed Central, ScienceDirect y Clinical Key para el periodo 2008-2017. Se seleccionaron 39 artículos por haber cumplido los criterios de inclusión: (a) publicado entre el 2008 y el 2017, en inglés, español o portugués y b) reportar resultados afines al tema de interés con evidencia de calidad científica durante la aplicación de las listas de chequeo. La sistematización y análisis de la información permitió la construcción de tres categorías temáticas: Entorno cultural, Condiciones sociales y Educación e información. Sobre la temática se evidenció que los factores como las creencias, el entorno sociocultural y la educación e información que tienen los hombres y sus parejas sobre la vasectomía influyen en la decisión de realizarse o no este procedimiento. Un hallazgo novedoso fue que el sexo de la descendencia también incide en esta decisión. Se recomienda una educación masiva para aumentar el acceso y conocimiento de la vasectomía.

Vasectomy is a procedure that generates minimum complications and garners a success rate of 99 %; In addition, it is an inex-pensive procedure in comparison to female sterilization, consequently the role of men should be taken into account when considering family planning. In this review of the topic, the factors that currently affect the acceptability of vasectomy were identified. We searched PubMed, ProQuest, BioMed Central, ScienceDirect and Clinical Key databases for articles published between 2008-2017 in English, Spanish or Portuguese, and included articles that met the inclusion criteria and showed scien-tific quality during the application of checklists. A total of 39 articles were admitted into the topic review. The systematization and analysis of the information allowed the construction of three thematic categories: cultural-environment, social conditions, and education and information. In this review, it is evidenced that factors such as beliefs, socio-cultural environment, and education and information that men and their partners have about vasectomy influences the decision to undergo or avoid this procedure. The sex of the offspring was evidenced as a novel factor because the children's gender influenced the decision. Therefore, mass education to increase the access and knowledge about vasectomy is recommended

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Estudio analítico transversal, que tuvo por objetivo identificar los factores culturales y sociales asociados a la lactancia materna exclusiva en San Basilio de Palenque. La población estuvo constituida por 195 madres de niños menores de 2 años de la población de San Basilio de Palenque - Bolívar, muestra tipo censo. Los instrumentos utilizados fueron Manual CAP (2014), escala de IIFAS y creencias. Para estimar la asociación entre las variables se utilizó Odd Ratio. En los resultados la prevalencia de lactancia materna exclusiva fue del 50%. Los factores sociales que se asociaron fueron: el ser adolescente OR= 2,47 (IC=1,33- 4,58) y haber recibido apoyo de la familia en la lactancia materna OR= 2,21 (IC=1,12- 4,37). Los factores culturales: haber escuchado hablar de lactancia materna exclusiva OR= 4,31 (IC=1,89- 9,81), estar preparadas para dar de lactar a su bebe OR= 4,48 (IC=1,96- 10,27) y el empezar a trabajar es posible dar de lactar OR= 3,99 (IC=1,74- 9,14). El creer dar seno genera dependencia tiene menor probabilidad de lactar exclusivamente OR= 0,45 (IC=0,22- 0,94).Tener una actitud positiva hacia la lactancia materna se asocia significativamente con el amamantamiento OR=3,068 (IC=1,58-5,955). Se concluyó que la lactancia materna exclusiva en las madres resulto más baja respecto a las recomendaciones globales y nacionales. Los factores culturales mantuvieron mayor influencia en la práctica de lactancia.

Cross-sectional analytical study, which aimed to identify the cultural and social factors associated with exclusive breastfeeding in San Basilio de Palenque. The population was constituted by 195 mothers of children under 2 years old from the population of San Basilio de Palenque - Bolívar, sample type census. The instruments used were the CAP Manual (2014), IIFAS scale and beliefs. Odd Ratio was used to estimate the association between the variables. In the results, the prevalence of exclusive breastfeeding was 50%. The social factors that were associated were: the adolescent being OR = 2, 47 (CI = 1, 33 - 4, 58) and having received support from the family in breastfeeding OR = 2, 21 (CI = 1, 12 - 4, 37). Cultural factors: having heard about exclusive breastfeeding OR = 4, 31 (CI = 1, 89 - 9, 81), be prepared to breastfeed your baby OR = 4, 48 (CI = 1, 96 - 10, 27) and when starting to work it is possible to breastfeed OR = 3, 99 (CI = 1, 74 - 9, 14). Believing giving breast generates dependency is less likely to breastfeed exclusively OR = 0, 45 (CI = 0, 22- 0, 94). Having a positive attitude towards breastfeeding is significantly associated with breastfeeding OR = 3,068 (CI = 1, 58-5,955). It was concluded that exclusive breastfeeding in mothers was lower compared to global and national recommendations. The cultural factors maintained a greater influence in the practice of breastfeeding.

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Resumen Introducción Las enfermedades cardiovasculares se constituyen un problema de salud pública, dentro de este grupo, la enfermedad coronaria ha mostrado incrementos especialmente en la prevalencia para infarto agudo de miocardio en mujeres de 35-54 años. La organización mundial de la salud propone estudiar el problema desde las diferencias regionales para encontrar soluciones al asunto. Objetivo Analizar la asociación entre características socioculturales y de salud con la enfermedad coronaria en mujeres de Nariño. Materiales y Métodos: Estudio de casos (mujeres con enfermedad coronaria) y controles (mujeres sin enfermedad coronaria) atendidas en instituciones de referencia para el departamento de Nariño. La muestra estuvo conformada por 35 casos y 105 controles por muestreo no probabilístico. Resultados Características como: ser fumadora, hipertensa y vivir en el área urbana mostraron mayor asociación con la enfermedad coronaria: Odd ratios= 21,11; IC 95% 3,97-112,26 y Odd ratios= 9,47; IC 95% 2,87-31,23 respectivamente. Se destaca la proporción de mujeres con enfermedad coronaria que culturalmente se caracterizan por callar su enfermedad para no preocupar. Discusión Ser fumadora e hipertensa se constituyen en determinantes para desarrollar enfermedad coronaria, situaciones que pueden ser inducidas por situaciones familiares, sociales, culturales, ocupacionales que la mujer debe enfrentar. Conclusiones La mujer con enfermedad coronaria se caracterizó por ser fumadora, hipertensa y vivir en el área urbana, lo anterior muestra que es necesario generar estrategias específicas de prevención y control en la mujer.

Abstract Introduction Cardiovascular diseases are a public health problem. In this group, coronary artery disease has shown an increase, in particular, in the prevalence of acute myocardial infarction in 35-54-year-old women. The World Health Organization suggests studying this issue based on regional differences to find solutions. Objective To analyze socio-cultural and healthcare characteristics associated with coronary artery disease in women from Nariño. Materials and Methods: Case study (women with coronary artery disease) and controls (women without coronary artery disease) served in reference institutions of Nariño. The sample was made of 35 cases and 105 controls through non-probability sampling. Results Features such as being a smoker, hypertensive and living in an urban area showed greater association with coronary artery disease: Odd ratios= 21.11; CI 95% 3.97-112.26 and Odd ratios= 9.47; CI 95% 2.87-31.23, accordingly. A proportion of women with coronary artery disease stand out as culturally characterized by keeping their illness a secret not to worry others. Discussion Being a smoker and hypertensive are key factors to develop coronary heart disease; these situations can be induced by family, social, cultural and occupational issues faced by women. Conclusions Women with coronary artery disease were characterized as being smokers, hypertensive and living in an urban area; it is thus necessary to generate specific prevention and control strategies for women.

Resumo Introdução As doenças cardiovasculares são um problema de saúde pública e, dentro desse grupo, a doença coronariana tem apresentado um aumento, principalmente, na prevalência de infarto agudo do miocárdio em mulheres de 35 a 54 anos. A Organização Mundial da Saúde propõe estudar o problema a partir de diferenças regionais para encontrar soluções ao problema. Objetivo Analisar a associação entre características socioculturais e de saúde com doença coronariana em mulheres de Nariño. Materiais e Métodos: Estudo de casos (mulheres com doença coronariana) e controles (mulheres sem doença coronariana) tratadas em instituições de referência no departamento de Nariño. A amostra foi composta por 35 casos e 105 controles por amostragem não probabilística. Resultados Características como: ser fumante, hipertensa e moradora da área urbana apresentaram maior associação com a doença coronariana: razão de possibilidades = 21,11; IC95% 3,97-112,26 e razão de possibilidades = 9,47; IC 95% 2,87-31,23, respectivamente. Destaca-se o número de mulheres com doença coronariana que são culturalmente caracterizadas por silenciarem sua doença para não preocupar. Discussão Ser fumante e hipertensa são fatores determinantes para o desenvolvimento da doença coronariana, situações que podem ser induzidas por situações familiares, sociais, culturais, ocupacionais que a mulher deve enfrentar. Conclusões A mulher com doença coronariana se caracterizou por ser tabagista, hipertensa e por morar em uma área urbana, o exposto anteriormente demonstra que é necessário gerar estratégias específicas de prevenção e de controle nas mulheres.

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La sobrevaloración de la alimentación y de la saciedad en familias que viven en un medio influenciado por la globalización y desarrollo de la industria alimentaria, puede estar teniendo un efecto sinérgico en el desarrollo de la obesidad y sus comorbilidades en países de ingreso medio. El objetivo de este trabajo fue desarrollar y validar escalas para medir el valor otorgado a la alimentación y la saciedad en mujeres. Se desarrolló un instrumento y se aplicó en querétaro, México (n=243), se midieron variables socioeconómicas y de percepción de peso corporal. Se realizó análisis factorial explorato- rio, confirmatorio y ANOVA. Las escalas del valor que las mujeres dan a la alimentación como base del bienestar, a la saciedad y a la alimentación como base del bienestar del hijo, se validaron (α-Cronbach>0.66) y se confirmaron (CFI>0.98;RMSEA<0.05). Los puntajes de valor de la alimentación y de la saciedad se asociaron con un menor nivel socioeconómico y educativo, inseguridad alimentaria en el pasado, menor intención de perder peso y con percepción bajo peso en los hijos. En conclusión, las es- calas para medir el valor de la alimentación y la saciedad tienen validez para ser utilizadas en futuros estudios; su utilización puede contribuir a desarrollar estrategias que consideren la verdadera motivación de la alimentación en los segmentos poblacionales más desfavorecidos(AU)

The overvaluation of eating and satiation in families whose environment has been influenced by globalization and the food industry, could be inducing obesity and its co-morbidities in midd- le income countries. The objective was to develop and validate scales to measure women's eating and satiation values. A measurement instrument was developed and ad- ministered to women from querétaro, Mexico (n=243), it also measured socioeconomic (SE) and body weight per- ception variables. Analyses included exploratory and con- firmatory factorial analyses and ANOVA. The scales that represented the value of feeding as basis of wealth, the va- lue of satiation and the value of feeding a child as the basis of the child's wealth, were validated (Cronbach-α>0.66) and confirmed (CFI >0.98; RMSEA<0.05).The scores were associated with a lower SE status, lower education level, childhood food insecurity, low intention to lose weight and with an underweighted child perception. In conclusion, the scales that measure the value of eating and satiation have the validity to be used in future studies; its utilization can contribute to develop strategies to improve eating behavior of underprivileged population segments, that take into consideration the real motives of eating(AU)

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RESUMEN En este artículo se discute el rol de los factores socioculturales para el fortalecimiento de los sistemas de salud móvil integrados. Se enfatiza la importancia de que toda iniciativa en salud móvil integre el análisis de los factores socioculturales durante el proceso de diseño e implementación de programas e intervenciones de investigación. El enfoque sociocultural y sociotécnico consideran, además, el factor humano, así como los condicionantes del entorno y el contexto, más allá de los recursos tecnológicos del sistema de salud móvil y la infraestructura que lo acoge. Metodologías como estudios observacionales, grupos focales, y entrevistas a profundidad deberían ser incluidas, idealmente, en todo proyecto en salud móvil. Asimismo, se presenta un estudio de caso en la zona norte de Lima (Perú), adaptando la plataforma de investigación participativa basada en la comunidad (CBPR, por sus siglas en inglés) que se fundamenta en el enfoque sociotécnico y evalúa los factores socioculturales con el objetivo de optimizar el proceso de diagnóstico de la tuberculosis utilizando las tecnologías móviles en salud (salud móvil).

ABSTRACT This paper discusses the role of socio-cultural factors in strengthening integrated mobile health systems. Emphasis is placed on the importance that any initiative in mobile health should consider the analysis of socio-cultural factors during the process of the development and implementation of programs and research interventions. The socio-cultural and socio-technical approach also consider the human factor and considers the conditions of the environment and the context beyond the technological resources of the mobile health system and the infrastructure that supports it. Methodologies such as observational studies, focus groups, and in-depth interviews should be included ideally in any mobile health study. We also present a case study in the north area of Lima (Peru), adapting the Community-Based Participatory Research platform that is based on a socio-technical approach and evaluates the socio-cultural approach with the objective to optimize the diagnosis process of tuberculosis using mobile health.

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RESUMEN Desde un abordaje teórico-reflexivo, este artículo interconecta los resultados de diversas investigaciones cualitativas con teorías del conflicto social y de la antropología médica, para investigar cómo la alimentación puede ser una herramienta de transformación social, en términos de salud, pero también de diálogo, respeto y convivencia de personas, grupos y comunidades. En este sentido, se presenta una primera aproximación a un nuevo enfoque teórico-metodológico sobre educación alimentaria. En este enfoque, la alimentación incorpora una perspectiva política, sociocultural y participativa que nos acerca a una comprensión innovadora del fenómeno: la alimentación como herramienta de análisis y diagnóstico de realidades socioalimentarias, pero también como instrumento de intervención educativo-sanitaria en la resolución de conflictos y en el fomento de sociedades más saludables en términos globales: nutricionales y también de igualdad y cohesión social.

ABSTRACT Using a theoretical-reflexive approach, this article connects the results of various qualitative studies in social conflict and medical anthropology, in order to investigate how food can be a tool for social transformation in terms of health but also in terms of the dialogue, respect and coexistence among people, groups and communities. In this sense the article presents a first approximation to a new theoretical and methodological approach to food education. In this approach, food adopts a political, sociocultural and participatory perspective that brings us closer to an innovative understanding of the phenomenon of food: not only as an analytic and diagnostic tool, but also as an instrument for health education interventions toward conflict resolution and the promotion of healthier societies overall - nutritionally, but also in terms of equality and social cohesion.

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