Objetivo: O presente estudo teve como objetivo realizar a adaptação transcultural e verificar a confiabilidade, consistência interna, validade estrutural e a validade de construto do ProFiMap-neck em indivíduos com relato de dor cervical crônica. Método: Participaram deste estudo pacientes do sexo feminino com relato de dor cervical há mais de 3 meses durante o movimento ou repouso A amostra foi composta por 30 indivíduos (33,43±10,32 anos) para a etapa de teste da versão pré-final, 100 indivíduos (38,89±10,84 anos) para a confiabilidade e 180 indivíduos (37,49±11,86 anos) para a validadade de construto, para a análise da consistência interna e validade estrutural. O processo de tradução e retrotradução ocorreu em 5 etapas: 1) Tradução inicial para o português, 2) Síntese de traduções, 3) Retrotradução, 4) Comitê de especialistas, e 5) O teste da versão pré-final. Para validade de construto a pontuação do ProFitMap-neck foi correlacionada com a pontuação do Neck Disability Index (NDI), além disso, foram utilizados para fins de correlação a Escala de Ansiedade e Depressão Hospitalar (HADS-A e HADS-D), a Escala Tampa de Cinesiofobia e o Short Form - 36 (SF-36). Para a análise fatorial exploratória foi utilizada a Análise de Componentes Principais, o indice de Kaiser-Meyer-Olkin (KMO) e % de variância cumulativa. Para a análise da consistência interna foi utilizado o coeficiente de ? de Cronbach. Para a confiabilidade foi utilizando o Coeficiente de Correlação Intraclasse (CCI). O coeficiente de correlação de Pearson foi utilizado para verificação das correlações. A magnitude da correlação foi graduada da seguinte maneira: R<0,29: pobre; 0,3<R<0,69: moderada; R>0,7: forte. Resultados: Durante o processo de teste da versão pré-final não foram relatadas dúvidas pela amostra de pacientes ao responder o instrumento. Para a escala de Sintomas/Intensidade do ProFitMap-neck versão português brasileiro foram verificados dois domínios (Escala de Sintomas/Intensidade Geral e Escala de Sintomas/Intensidade Equilíbrio) com porcentagem de variância cumulativa de 57,33% e índice KMO=0,66. Para a escala de Sintomas/Frequência do ProFitMap-neck foi verificado apenas 1 domínio com porcentagem de variância cumulativa de 56,20% e KMO=0,84. Para a escala de Limitação Funcional do ProFitMap-neck foram verificados 2 domínios (Postura e AVDs e Movimento e Percepção de Saúde) com porcentagem de variância cumulativa de 56,28% e KMO=0,57. Todos os itens apresentaram carga fatorial superior a 0,2. A análise de consistência interna demonstrou valores de alpha de cronbach adequados (alpha>0.70) para todos os domínios do ProFitMap-neck. Na reprodutibilidade foram verificados valores de CCI excelentes para todos os domínios e escalas (ICC>0,75). Nossos achados demonstraram correlações moderadas/fortes e negativas entre a pontuação total do NDI e as pontuações dos domínios e escalas Sintomas/Intensidade, Sintomas/Frequencia e Limitação Funcional do ProFitMapneck (R=-0,65, R=-0,56 e R=-0,71, respectivamente). Foram verificadas correlações no geral moderadas/fortes e positivas entre os escores das ferramentas SF-36 e ProFitMap-neck. Para as correlações entre Ansiedade, Despressão e Cinesiofobia e as Escalas do ProFitMap-neck versão português brasileiro foram verificadas correlações em sua maioria moderadas e fortes (-0,32<R<-0,82). Conclusão: O ProFitMap-neck versão português-Brasil apresentou índices psicométricos adequados e, dessa forma, está disponível para ser empregado na prática clínica e pesquisa em pacientes com dor cervical crônica. / Objective: This study aimed to perform the cultural adaptation and verify the reliability, internal consistency, structural validity and construct validity of the Profile Fitness Mapping neck questionnaire (ProFiMap-neck) in individuals reporting chronic neck pain. Method: This study recruited female patients with neck pain for more than three months during motion or at rest The sample consisted of 30 individuals (33.43 ± 10.32 years) to test the pre-final version, 100 individuals (38.89 ± 10.84 years) for reliability and 180 individuals (37.49 ± 11.86 years) for construct validity, analysis of internal consistency and structural validity. The process of translation and back translation occurred in 5 steps: 1) Initial translation into Portuguese, 2) Summary of translations, 3) Back-translation, 4) Committee of Experts, and 5) The test of the pre-final version. Construct validity was verified correlating scores on ProFitMap-neck and Neck Disability Index (NDI), Hospital Anxiety Depression Scale (HADS-A and HADS-D), Tampa Scale of Kinesiophobia and the Short Form - 36 (SF-36). Exploratory factor analysis was perfomed considering Principal Component Analysis, the Kaiser-Meyer-Olkin index (KMO) and percentange of cumulative variance. For the analysis of internal consistenc, we used ? Cronbach and for reliability Intraclass Correlation Coefficient (ICC) was used. The Pearson correlation coefficient was used to investigate correlations and the strength was graded as follows: R <0.29: poor; 0.3 <R <0.69: moderate; R> 0.7: Strong. Results: During the test of the pre-final version, volunteers did no report doubts. Structural validity retained two domains for Symptoms/Intensity ProFitMap-neck Brazilian Portuguese version (General Symptoms Intensity and Symptoms Intensity/ Balance) with cumulative percentage of variance of 57.33% and KMO=0.66. For the Scale Symptoms/Frequency of ProFitMap-neck we identified one domain, with cumulative percentage of variance of 56.20% and KMO = 0.84. For Functional Limitation of the ProFitMap-neck, we identified two domains (Posture and Movement and Diary Life Activities and Health Perception) with cumulative percentage of variance of 56.28% and KMO = 0.57. All items had factors loadings greater than 0.2. The internal consistency analysis revealed adequate alpha Cronbach values (alpha>0.70) for all ProFitMap-neck domains. We obtained excellent ICC values for all domains and scales (ICC> 0.75). Our findings showed moderate/strong and negative correlations between the total score of the NDI and the scores of the domains and scales Symptoms/Intensity, Symptoms/Frequency and Functional Limitation of ProFitMap-neck brazilian portuguese version (R = -0.65, R = -0.56 and R = -0.71, respectively). Correlations between the scores of the SF-36 and ProFitMapneck tools were in the majority moderate/strong and positive. For correlations between anxiety, depression and kinesiophobia and the scales of the ProFitMap-neck brazilian portuguese version were observaded moderate and strong values (-0.32 <R <-0.82). Conclusion: ProFitMap-neck portuguese-Brazil version showed adequate psychometric indexes and, therefore, it\'s available to be apllied in clinical practice and research in patients with chronic neck pain.

Introduction The clinical community in Western society has long practised medicine as organized by "two dominant principles: 1) the principle of essentialism which states that there is a fixed "natural" border between disease and health, and 2) the principle of specific treatment which states that having revealed a disease, the doctor can, at least in principle, find the one, correct treatment. These principles have served as the legitimization of the traditional, hierarchical organization of health-care" (Jensen, 1987:19). A main feature of medical practices based on these principles has been to address specific kinds of problems impeding or decaying health. This research is centrally concerned with essentialism and the institutional fixation of problems as two important nodal points of Canada's biomedical value and belief system. More specifically, I hope to show in an organized way how these principles shape staff knowledge of client and culture in a community health centre (CHC) in Lethbridge, Alberta. My analysis is based on four guiding points: 1) that in our polyethnic society health care institutions are massively challenged with actual and perceived cultural diversity and cross cultural barriers to which their staff feel increasingly obliged to respond with their services; 2) while the client cultural diversity is "real", institutional responses depend primarily on how that diversity is imagined by staff -often as a threat to a health institution's sociocultural world; 3) that problem-specific, medicalized thinking is central in this community health centre, even though its mandate is health promotion and this problem orientation often combines with medical essentialism to reduce "culturally different" to a set of client labels, some of which are problematic; and 4) while a "lifestyle model" and other models for health promotion are at present widely advocated and are to be found centrally in this institution's (CHC) charter, they have led to little institutional accomodation to cultural diversity. In this thesis my aim is to present an ethnographic portrait of a community health centre, where emphasis is given to the distinctive formal and informal "formative processess" (Good 1994) of social construction of certain perceived common core challenges facing the Canadian biomedical community today - challenges concerning cultural difference and its incorporation into health care perception and practice. I am particularly interested in institutions subscribing to a "health promotion model" of health care, a term I have borrowed from Ewles and Simnett (1992). Ewles and Simnett descrive the meaning of "health promotion" as earlier defined by WHO (World Health Organization): this perspective is derived from a conception of "health" as the extent to which an individual or group is able, on the on hand, to realise aspirations and satisfy needs; and, on the other hand, to change or cope with the environment. Health is, therefore seen as a resource for everyday life, not the objective of living; it is a positive concept emphasising social and personal resources, as well as physical capacities (Ewles & Simnett, 1992:20) Health is therefore concerned with "a state of complete physical, mental and social wellbeing, and not merely the absence of disease and infirmity" (Ewles and Simnett, 1992:6), I am interested in determing how threats to this defintion prevail in a community health centre's ideology of preventive care, and how that ideology encodes dimensions of diversity. I, however, want to go much further than this by exploring everyday staff discourse and practice, to understand how client cultural diversity is formed and informed by what staff do and say. How, in short, do individuals based in a health promotion organization socially construct their clients as objects of institutional concern? We need, as Young (1982) suggest, "to examine the social condition of knowledge production" in an institutionalized health care service provision subculture. There are, I believe, also practical reasons for conducting this research. Over the past ten years the Canadian health care system increasingly has had to focus on two potentially contradictory goals: reducing costs, and lessening persistent inequalities in health status among key groups and categories of persons in the Canadian population. Many now argue that one of the most central dimensions of the latter - of perisistent health inequalities in Canada - is ethnocultural. Few would seriously argue, for example, that Canadian First Nation health statistics are anything but appalling. Moreover, radical changes in immigration patterns over the past three decades have greatly increased urban Canadian cultural diversity. Caring "at home" now assumes international dimensions (McAdoo, 1993; Butrin, 1992; Buchignani, 1991; Indra, 1991, 1987; Galanti, 1991; Dobson, 1991; Waxler-Morrison, 1990; Quereshi, 1989). A growing voiced desire to provide more pluralistic health care and health care promotion has become persistently heard throughout the clinical community in Canada (Krepps and Kunimoto, 1994; Masi, 1993). Even so, for many health professionals cultural difference evidently remians either irrelevant or a threat to the established order of things. Applied research on health care institutions undertaken to investigate how better to meet these challenges nevrtheless remains very incomplete and highly concentrated in two broad areas. One of these is structural factors within the institution that limit cross-cultural access (Herzfeld, 1992; Hanson, 1980). Some of these studies have shown the prevalence of a strictly conservative institutional culture that frequently makes frontline agency workers gate-keeprs, who actively (if unconsciously) maintain client-institution stratification (Ervin, 1993; Demain, 1989; Ng, 1987; Murphy, 1987; Foster-Carter, 1987; de Voe 1981). In addition, extensive research has been conducted on disempowered minority groups. This research has examined the frequency, effectiveness and manner with which ethnic and Native groups make use of medical services. Some institutional research on cross-cultral issues shows that under appropriate conditions health professional like nurses have responded effectively to client needs by establishing culturally sensitive hiring and training policies and by restructuring their health care organizations (Terman, 1993; Henderson, 1992; Davis, 1992; Henkle, 1990; Burner, 1990). Though promising, this research remains radically insufficient for learning purposes. In particular, little work has been done on how such institutions come to "think" (Douglas, 1986) about cultural difference, form mandates in response to pressure to better address culturally different populations and work them into the institution's extant sub-cultral ideas and practice (Habarad, 1987; Leininger, 1978), or on how helping instiutions categorize key populations such as "Indians" or "Vietnamese" as being culturally different, or assign to each a suite of institutionally meaningful cultural attributes (as what becomes the institution's working sense of what is, say, "Vietnamese culture"). This is so despite the existence of a long and fruitful ethnographic institutional research tradition, grounded initially in theories of status and role (Frankel, 1988; Taylor, 1970; Parson, 1951), symbolic ineractionism (Goffman, 1967, 1963, 1961), ethnomethodology (Garfinkle, 1975), and organizational subcultures (Douglas, 1992, 1986, 1982; Abegglen & Stalk, 1985; Ohnuki-Tierney, 1984; Teski, 1981; Blumers, 1969). More recent work on anthropological social exchange theory (Barth, 1981), on institutional and societal discipline (Herzfeld, 1992; Foucault, 1984, 1977), on the institution-client interface (Shield, 1988; Schwartzman, 1987, Ashworth, 1977, 1976, 1975), and on framing the client (Hazan, 1994; Denzin, 1992; Howard, 1991; Goffman, 1974). I also hope that this study makes a contribution to the study of health care and diversity in southern Alberta. Small city ethnic relations in Canada have been almost systematically ignored by researchers, and similar research has not been conducted in this part of Alberta. Local diversity is significant: three very large Indian reserves are nearby, and the city itself has a diverse ethnic, linguistic and ethno-religious population. Also, significant province wide restructuring of health care delivery was and is ongoing, offering both the pitfalls and potentials of quick institutional change. Perhaps some of the findings can contribute to making the future system more responsive to diversity than the present one. / 202 p. ; 29 cm.

Made available in DSpace on 2011-05-04T12:36:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2010 / Em todo mundo há mudança no perfil epidemiológico da população no sentidode aumento da prevalência de doenças crônico-degenerativas. No Brasil, a hipertensão arterial (HTA) e diabetes mellitus (DM) estão entre os agravos cuja prevalência tem aumentado além de serem fatores de risco para doenças cerebrovasculares e doenças cardíacas isquêmicas, que são as principais causas de mortalidade na população. Por serem tratamentos longos e que, em geral, uma vez instaurados, persistem por toda avida do paciente, a adesão ao tratamento é imprescindível para que o indivíduo mantenha a qualidade de vida e evite ou adie as complicações da doença. Entretanto, a não adesão ao tratamento de doenças crônicas é um problema de saúde pública de extensão mundial, acarretando impactos negativos na saúde do indivíduo e problemas econômicos para o sistema de saúde, pois em muitos casos, a pouca adesão resultará em maiores custos com hospitalizações, que incluem o tratamento de complicações de longo prazo. Desta forma, na avaliação dos programas de saúde pública, é conveniente examinar a adesão ao tratamento que é oferecido pela rede assistencial. Por isso, um dos objetivos da pesquisa de avaliação do programa Remédio em Casa da Prefeitura do Rio de Janeiro era avaliar o nível de adesão ao tratamento de hipertensos e diabéticos. Para tanto, procurou-se utilizar um questionário que avaliasse a adesão sob a perspectiva da OMS, a qual considera limitado restringir a adesão ao grau de seguimento das instruções médicas e que defende o papel ativo do indivíduo no seu tratamento. Como o questionário cubano MBG desenvolvido e validado por Alfonso et al. (2008) atende essas considerações, decidiu-se traduzi-lo para o português através de um processo formal de adaptação transcultural com vistas a ser utilizado na pesquisa de avaliação do programa Remédio em Casa da Prefeitura do Rio de Janeiro. Este processo seguiu a proposta de operacionalização de Reichenheim e Moraes (2007), cujas etapas são baseadas na avaliação de algum tipo de equivalência. Assim, foram feitos pré-testes e um piloto com a versão traduzida do instrumento. Com os resultados do piloto, foram analisadas as características psicométrica de confiabilidade do instrumento, através da investigação da consistência interna e da estabilidade teste-reteste. Com alfa de Cronbach do instrumento superior a 0,70 (0,78 no teste e 0,79 no re-teste) e um coeficiente de correlação intraclasse para o total do instrumento de 0,81 (indicando oncordância quase perfeita ), é possível afirmar que bons níveis de confiabilidade foram obtidos e que o instrumento é capaz de medir de modo reprodutível a adesão ao tratamento. / Everywhere there is change in the epidemiological pattern of the population towards an increased prevalence of chronic degenerative diseases. In Brazil, arterial hypertension (HT) and diabetes mellitus (DM) are among the diseases whose prevalence has increased, besides they are risk factors for cerebrovascular disease and ischemic heart diseases, which are the main causes of mortality. Because of their long treatments that, in general, once initiated, persist throughout the patient's life, treatment adherence is essential for individuals to maintain their quality of life and avoid or delay the complications of the diseases. However, non-adherence to treatment of chronic diseases is a public health problem of global extent, causing negative impacts on individuals’ health and economic problems for the health system, because in many cases, noncompliance will result in higher costs with hospitalizations, which include the treatment of long-term complications. Thus, in assessing public health programs, it is necessary to examine adherence to the treatment offered by health care network. Therefore, one objective of the “Remédio em Casa” program evaluation in the district of Rio de Janeiro was to assess the level of adherence to treatment of arterial hypertension or diabetes mellitus. We looked for a questionnaire to assess adherence from the perspective of WHO, which considers limited defining adherence as “the extent to which the patient follows medical instructions”, and defends the individual's active role in your treatment. As the Cuban MBG questionnaire developed and validated by Alfonso et al. (2008) addresses these considerations, we decided to translate it into Portuguese through a formal process of cultural adaptation in order to be used in the research “Remédio em Casa” program evaluation in the district of Rio de Janeiro. This process has followed the Reichenheim and Moraes’ (2007) operational framework, whose steps are based on the evaluation of some kind of equivalence. Thus, pre-tests and a pilot study with the translated version of the instrument were made. We analyzed the psychometric reliability of the instrument with the results of the pilot study through investigation of internal consistency and test-retest stability. The alpha Cronbach instrument exceeded 0.70 (0.78 and 0.79 in the test re-test) and the intraclass correlation coefficient for the total instrument was 0.81 (indicating agreement "almost perfect"), so it’s possible to say that good levels of reliability were obtained and that the instrument is able to measure reproducibly adherence to treatment.

Objetivo: O presente estudo teve como objetivo realizar a adaptação transcultural e verificar a confiabilidade, consistência interna, validade estrutural e a validade de construto do ProFiMap-neck em indivíduos com relato de dor cervical crônica. Método: Participaram deste estudo pacientes do sexo feminino com relato de dor cervical há mais de 3 meses durante o movimento ou repouso A amostra foi composta por 30 indivíduos (33,43±10,32 anos) para a etapa de teste da versão pré-final, 100 indivíduos (38,89±10,84 anos) para a confiabilidade e 180 indivíduos (37,49±11,86 anos) para a validadade de construto, para a análise da consistência interna e validade estrutural. O processo de tradução e retrotradução ocorreu em 5 etapas: 1) Tradução inicial para o português, 2) Síntese de traduções, 3) Retrotradução, 4) Comitê de especialistas, e 5) O teste da versão pré-final. Para validade de construto a pontuação do ProFitMap-neck foi correlacionada com a pontuação do Neck Disability Index (NDI), além disso, foram utilizados para fins de correlação a Escala de Ansiedade e Depressão Hospitalar (HADS-A e HADS-D), a Escala Tampa de Cinesiofobia e o Short Form - 36 (SF-36). Para a análise fatorial exploratória foi utilizada a Análise de Componentes Principais, o indice de Kaiser-Meyer-Olkin (KMO) e % de variância cumulativa. Para a análise da consistência interna foi utilizado o coeficiente de ? de Cronbach. Para a confiabilidade foi utilizando o Coeficiente de Correlação Intraclasse (CCI). O coeficiente de correlação de Pearson foi utilizado para verificação das correlações. A magnitude da correlação foi graduada da seguinte maneira: R<0,29: pobre; 0,3<R<0,69: moderada; R>0,7: forte. Resultados: Durante o processo de teste da versão pré-final não foram relatadas dúvidas pela amostra de pacientes ao responder o instrumento. Para a escala de Sintomas/Intensidade do ProFitMap-neck versão português brasileiro foram verificados dois domínios (Escala de Sintomas/Intensidade Geral e Escala de Sintomas/Intensidade Equilíbrio) com porcentagem de variância cumulativa de 57,33% e índice KMO=0,66. Para a escala de Sintomas/Frequência do ProFitMap-neck foi verificado apenas 1 domínio com porcentagem de variância cumulativa de 56,20% e KMO=0,84. Para a escala de Limitação Funcional do ProFitMap-neck foram verificados 2 domínios (Postura e AVDs e Movimento e Percepção de Saúde) com porcentagem de variância cumulativa de 56,28% e KMO=0,57. Todos os itens apresentaram carga fatorial superior a 0,2. A análise de consistência interna demonstrou valores de alpha de cronbach adequados (alpha>0.70) para todos os domínios do ProFitMap-neck. Na reprodutibilidade foram verificados valores de CCI excelentes para todos os domínios e escalas (ICC>0,75). Nossos achados demonstraram correlações moderadas/fortes e negativas entre a pontuação total do NDI e as pontuações dos domínios e escalas Sintomas/Intensidade, Sintomas/Frequencia e Limitação Funcional do ProFitMapneck (R=-0,65, R=-0,56 e R=-0,71, respectivamente). Foram verificadas correlações no geral moderadas/fortes e positivas entre os escores das ferramentas SF-36 e ProFitMap-neck. Para as correlações entre Ansiedade, Despressão e Cinesiofobia e as Escalas do ProFitMap-neck versão português brasileiro foram verificadas correlações em sua maioria moderadas e fortes (-0,32<R<-0,82). Conclusão: O ProFitMap-neck versão português-Brasil apresentou índices psicométricos adequados e, dessa forma, está disponível para ser empregado na prática clínica e pesquisa em pacientes com dor cervical crônica. / Objective: This study aimed to perform the cultural adaptation and verify the reliability, internal consistency, structural validity and construct validity of the Profile Fitness Mapping neck questionnaire (ProFiMap-neck) in individuals reporting chronic neck pain. Method: This study recruited female patients with neck pain for more than three months during motion or at rest The sample consisted of 30 individuals (33.43 ± 10.32 years) to test the pre-final version, 100 individuals (38.89 ± 10.84 years) for reliability and 180 individuals (37.49 ± 11.86 years) for construct validity, analysis of internal consistency and structural validity. The process of translation and back translation occurred in 5 steps: 1) Initial translation into Portuguese, 2) Summary of translations, 3) Back-translation, 4) Committee of Experts, and 5) The test of the pre-final version. Construct validity was verified correlating scores on ProFitMap-neck and Neck Disability Index (NDI), Hospital Anxiety Depression Scale (HADS-A and HADS-D), Tampa Scale of Kinesiophobia and the Short Form - 36 (SF-36). Exploratory factor analysis was perfomed considering Principal Component Analysis, the Kaiser-Meyer-Olkin index (KMO) and percentange of cumulative variance. For the analysis of internal consistenc, we used ? Cronbach and for reliability Intraclass Correlation Coefficient (ICC) was used. The Pearson correlation coefficient was used to investigate correlations and the strength was graded as follows: R <0.29: poor; 0.3 <R <0.69: moderate; R> 0.7: Strong. Results: During the test of the pre-final version, volunteers did no report doubts. Structural validity retained two domains for Symptoms/Intensity ProFitMap-neck Brazilian Portuguese version (General Symptoms Intensity and Symptoms Intensity/ Balance) with cumulative percentage of variance of 57.33% and KMO=0.66. For the Scale Symptoms/Frequency of ProFitMap-neck we identified one domain, with cumulative percentage of variance of 56.20% and KMO = 0.84. For Functional Limitation of the ProFitMap-neck, we identified two domains (Posture and Movement and Diary Life Activities and Health Perception) with cumulative percentage of variance of 56.28% and KMO = 0.57. All items had factors loadings greater than 0.2. The internal consistency analysis revealed adequate alpha Cronbach values (alpha>0.70) for all ProFitMap-neck domains. We obtained excellent ICC values for all domains and scales (ICC> 0.75). Our findings showed moderate/strong and negative correlations between the total score of the NDI and the scores of the domains and scales Symptoms/Intensity, Symptoms/Frequency and Functional Limitation of ProFitMap-neck brazilian portuguese version (R = -0.65, R = -0.56 and R = -0.71, respectively). Correlations between the scores of the SF-36 and ProFitMapneck tools were in the majority moderate/strong and positive. For correlations between anxiety, depression and kinesiophobia and the scales of the ProFitMap-neck brazilian portuguese version were observaded moderate and strong values (-0.32 <R <-0.82). Conclusion: ProFitMap-neck portuguese-Brazil version showed adequate psychometric indexes and, therefore, it\'s available to be apllied in clinical practice and research in patients with chronic neck pain.

[pt] O objetivo desta tese é avaliar as semelhanças e diferenças das motivações para a parentalidade (MP) em uma amostra de homens e mulheres adultos dos países do Brasil e do Peru. Especificamente, os objetivos foram investigar as relações do MP com variáveis biosociodemográficas (ex. Sexo, idade, inserção no trabalho, estado civil, número de irmãos, cuidado de irmãos mais novos na infância ou adolescência), psicológicas (positividade, religiosidade, personalidade), relacional (ajustamento diádico e suporte familiar) e reprodutivo (desejos reprodutivos). A amostra total foi de 4014 indivíduos; 2029 peruanos (68,1 porcento mulheres) de 22 departamentos do país e 1985 brasileiros (83,6 porcento mulheres) de 27 estados diferentes. O objetivo do Capítulo I é descrever o estado da arte no estudo das MP por meio de uma revisão sistemática e duas revisões teóricas que visam descrever as principais teorias que explicam as MP, as evidências empíricas que as sustentam e a descrição do modelo Trait-Desires-Intenção-Behaviour utilizado como base teórica para esta tese. O capítulo II, composto por três artigos psicométricos, descreve a adaptação e análise de validade do Childbearing Motivation Questionnaire (CBQ) (Miller, 1995) para seu uso no Brasil e no Peru e testa a possibilidade de uso dessa escala para estudos transculturais nos dois países. O capítulo III, composto por dois artigos empíricos, analisa as motivações positivas (MPP) e negativas (MPN) para a parentalidade na população brasileira e peruana respectivamente, analisando suas relações com variáveis sociodemográficas, relacionadas à infância, características pessoais e relacionamento. Finalmente, o capítulo IV, por meio de três artigos transculturais, fornece dados sobre as diferenças e semelhanças das MPP e seus variáveis preditivas e também a relação do MPP com os desejos reprodutivos no Brasil e no Peru. Notamos a necessidade de continuidade dos estudos sobre o assunto. Esta tese tem como objetivo contribuir para a área da psicologia reprodutiva ao fornecer um instrumento de mensuração das MP para uso no contexto peruano e brasileiro e por apresentar resultados nunca antes discutidos na literatura latino-americana da área. / [en] The objective of this thesis is to evaluate the similarities and differences of the childbearing motivations (CM) in a sample of adult men and women from the countries of Brazil and Peru. Specifically, the objectives were to investigate the relationships of the CM with biosociodemographic variables (ex. Sex, age, work, marital status, number of siblings, care of younger siblings in childhood or adolescence), psychological (positivity, religiosity, personality), relational (dyadic adjustment and family support) and reproductive (reproductive desires).The total sample was 4014 subjects; 2029 Peruvians (68.1 percent women) from 22 departments of the country and 1985 Brazilians (83.6 percent women) from 27 different states. Chapter I aims to describe the state of the art in the study of CM through a systematic review and two theoretical reviews that aim to describe the main theories that explain CM, the empirical evidence that supports them and the description of the model Trait - Desires-Intentions-Behaviors used as the theoretical basis of this thesis. Chapter II, composed of three psychometric articles, describes the adaptation and validity analysis of the Childbearing Motivation Questionnaire (CBQ) (Miller, 1995) for use in Brazil and Peru and tests the possibility of using this scale for cross-cultural studies in both countries. Chapter III, composed of two empirical articles, analyzes the positive (PCM) and negative (NCM) childbearing motivations for parenting in the Brazilian and Peruvian population respectively, analyzing their relationships with sociodemographic variables, related to childhood, personal characteristics and couple relationship. Finally, chapter IV, through three cross-cultural articles, provides data on the differences and similarities of PCM and predictor variables of PCM and as well as the relationship of PCM with reproductive desires in Brazil and Peru. We note the need for continuity of studies on this subject. This thesis aims to contribute to the area of reproductive psychology by providing an instrument to measure CM for use in the Peruvian and Brazilian context and by presenting results never before discussed in the Latin American literature in this field. / [es] La presente tesis tiene como objetivo evaluar las semejanzas y diferencias de las motivaciones para la parentalidad (MP) en una muestra de hombres y mujeres adultos de los países de Brasil y Perú. Específicamente, los objetivos fueron investigar las relaciones de las MP con variables biosociodemográficas (ex. sexo, edad, inserción en el estado de trabajo, estado civil, número de hermanos, cuidado de hermanos menores en la infancia o adolescencia), psicológicas (positividad, religiosidad, personalidad), relacionales (ajustamiento diádico y soporte familiar) y reproductivos (deseos reproductivos). La muestra total fue de 4014 sujetos; 2029 peruanos (68.1 por ciento mujeres) de 22 departamentos del país y 1985 brasileros (83.6 por ciento mujeres) de 27 diferentes estados. El capítulo I tiene por objetivo describir el estado del arte del estudio de las MP por medio de una revisión sistemática y dos revisiones teóricas que apuntan a describir las principales teorías que explican las MP, las evidencias empíricas que las sustentan y la descripción del modelo Trait-Desires- Intentions-Behaviors usado como base teórica de la presente tesis. El capítulo II, compuesto por tres artículos psicométricos, describe la adaptación y análisis de validez del Childbearing Motivation Questionnaire (CBQ) (Miller, 1995) para su uso en Brasil y Perú y testa la posibilidad de utilizar esta escala para estudios transculturales en ambos países. El capítulo III, compuesto por dos artículos empíricos, hace un análisis de las motivacines para la parentalidad positivas (MPP) y negativas (MPN), en la población brasilera y peruana respectivamente, analizando sus relaciones con variables sociodemográficas, relacionadas a infancia, características personales y relación de pareja. Finalmente el capítulo IV, a través de tres artículos transculturales, brinda datos sobre las diferencias y semejanzas de las MPP y variables predictoras de las MPP y así como de la relación de las MPP con los deseos reproductivos en Brasil y Perú. Apuntamos la necesidad de continuidad de los estudios sobre esta temática. Esta tesis pretende contribuir al área de la psicología reproductiva proporcionando un instrumento de medida de las MP para su uso en el contexto peruano y brasilero y al presentar resultados nunca antes discutidos en la literatura latino-americana en este campo.

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Bakgrund: En individanpassning efter kulturella referensramar förutsätter personcentrerad vård i transkulturella vårdmöten. Att omvårdnaden är kulturell kompetent är meningsfullt för att säkerställa jämlik och effektiv vård för alla patienter, oavsett deras kulturella bakgrunder. Med ett mångkulturellt samhälle som bakgrund och jämlik vård som mål inom hälso- och sjukvården, blir betydelsen av ökad kulturell kompetens alltmer accentuerad. Syfte: Att belysa sjuksköterskors upplevelser av transkulturella vårdmöten i Skandinavien. Metod: En litteraturstudie baserad på 12 kvalitativa vetenskapliga artiklar. Resultat: Fyra kategorier och 13 underkategorier identifierades. Kategorierna var: Upplevelser av utmaningar i transkulturella vårdmöten, Upplevelser av osäkerhet i transkulturella vårdmöten, Upplevelser av otillräcklighet i transkulturella vårdmöten, Upplevelser av svårigheter i transkulturella kommunikationen. Konklusion: Trots utmaningar i transkulturella vårdmöten visade sjuksköterskorna en god kulturell medvetenhet, en vilja att förvärva kulturell kunskap samt en adekvat kulturell sensitivitet, vilket bekräftade möjligheten till att utveckla kulturella kompetenser och ge kulturkongruent omvårdnad. / Background: An individual adaptation based on cultural frameworks presupposes person-centered care in transcultural care encounters. Ensuring cultural competence in care is meaningful to achieve equitable and effective healthcare for all patients, regardless of their cultural backgrounds. With a multicultural society as the backdrop and equitable care as the goal in healthcare, the importance of increased cultural competence becomes increasingly emphasized. Aim: To illustrate nurses' experiences of transcultural care encounters in Scandinavia. Method: A literature review based on 12 qualitative scientific articles. Results: Four categories and 13 subcategories were identified. The categories were: Experiences of challenges in transcultural care encounters, Experiences of uncertainty in transcultural care encounters, Experiences of inadequacy in transcultural care encounters, Experiences of difficulties in transcultural communication. Conclusion: Despite experiences of negative elements, nurses demonstrated good cultural awareness, a willingness to acquire cultural knowledge, and adequate cultural sensitivity, confirming their potential to develop cultural competencies and provide culturally congruent care.

Bakgrund: Generellt betraktas flyktingar, asylsökande och papperslösa ingå i en sårbar population. Med hänsyn till det ökande antalet asylsökande i Sverige det senaste decenniet, kommer de flesta som arbetar inom hälso- och sjukvård troligen att möta patienter som har en flyktingbakgrund. Många yrkesgrupper i vården saknar däremot kunskaper om migrationens påverkan och vilka rättigheter patienten har. Sjuksköterskor måste ha förmågan att tillgodose patientens såväl fysiska, psykiska, sociala, andliga som kulturella behov, och göra detta på ett kulturellt känsligt sätt. Syfte: Syftet var att belysa sjuksköterskors erfarenheter av att vårda flyktingar, asylsökande och papperslösa. Metod: En litteraturöversikt enligt Fribergs metod genomfördes. Arbetet baseras på tolv vetenskapliga artiklar av både kvalitativ och kvantitativ metod från databaserna CINAHL och PubMed. Efter analys av materialet utkristalliserades teman och subteman. Resultat: Resultatet redogörs i form av två huvudteman med tillhörande subteman. Det första huvudtemat Erfarenheter av hinder i vårdmötet behandlar de olika hindrande faktorer för sjuksköterskan i mötet med patienter som är flyktingar, asylsökande och papperslösa. Det andra huvudtemat Sjuksköterskors känslomässiga reaktioner behandlar de subjektiva känslorna som väckts hos sjuksköterskorna i arbetet med denna patientgrupp. Diskussion: Resultatet tyder på att sjuksköterskorna erfor svårigheter i kommunikationen, samt svårigheter i att vårda på grund av olika syn på hälsa. Stereotypbilder och föreställningar om patienter kunde även förekomma, vilket påverkade vårdandet negativt. Dessa betydande fynd diskuteras i relation till Leiningers teori om transkulturell omvårdnad. / Background: In general, refugees, asylum seekers and undocumented migrants are considered to be a vulnerable population. With regards to the increasing number of asylum applicants during the last decade in Sweden, health care staff is likely to encounter individuals with a refugee background. Although, many working in health care have limited knowledge about the effects of migration and legal rights. Nurses are required to have the ability to meet patients’ physical, psychological, social, spiritual as well as cultural needs, and to deliver the care in a culturally sensible way. Aim: The aim of this bachelor’s thesis was to illustrate nurses’ experiences of caring for refugees, asylum seekers and undocumented migrants. Method: A literature review according to Friberg’s method was conducted. Twelve scientific articles of both qualitative and quantitative design are the foundation of this paper. Data was collected from the databases CINAHL and PubMed. Themes and subthemes were then formed after analyses of the material. Results: The results are presented in two main themes along with their subthemes. The first main theme Experiences of obstacles in caring describes various difficulties the nurses encountered while caring for patients who are refugees, asylum seekers and undocumented migrants. The second main theme The nurses’ emotional reactions describes subjective feelings the nurses expressed while working with patients who have this background. Discussion: The results show that nurses experienced difficulties in the communication and difficulties giving care related to different cultural views on health. Stereotyping and bias of patients could also occur among nurses, which affected the care negatively. These consequential findings are discussed in relation to Leininger’s theory of transcultural nursing.

Diabetes, speciellt typ 2, är ett växande globalt hälsoproblem. Idag är det cirka 220 miljoner människor i världen som är drabbade av diabetes och siffran uppskattas stiga till 366 miljoner fram till år 2030. Sverige är ett mångkulturellt samhälle, vilket ställer högre krav på att hälso- och sjukvård ska anpassa omvårdnaden till varje enskild patient med diabetes. Syftet med studien var att belysa uppfattningar om egenvård vid diabetessjukdom hos personer med olika kulturella/etniska ursprung. Studien genomfördes som en allmän litteraturstudie där tio kvalitativa forskningsartiklar analyserades. En modell för Transkulturell Kompetens har använts som teoretisk referensram. Resultat av denna studie visar att det finns kulturella/etniska skillnader vad gäller uppfattning om egenvård vid diabetessjukdom, framförallt vad gäller kunskap om diabetes, faktorer som påverkar livsstilsförändringar och egenvårdsinsatser, religion/tro samt stöd/brist på stöd i olika relationer. Vårdpersonalens förmåga att hantera kulturella olikheter och bedriva transkulturell omvårdnad ställer krav på att vårdgivare har kunskap om hur kulturella/etniskt ursprung kan påverka synen på egenvård vid diabetes. Ökad kunskap kan ge vårdpersonalen trygghet i sitt arbete, vilket bidrar till en mera individanpassad och säkrare omvårdnad. / Diabetes, especially type 2, is a growing global health problem. Today there is about 220 million people worldwide suffering from diabetes and this figure is estimated to rise to 366 million by the year 2030. Sweden is a multicultural society, which places greater demands for health care to adapt to each individual patient with diabetes. The purpose of this study was to illuminate the perceptions of self-care in diabetes disease in people with different cultural / ethnic origin. The study was conducted as a literature review and ten qualitative research articles were analyzed. The Model for Development of Transcultural Competence was used as a theoretical framework. Results of this study indicate that there are cultural / ethnic differences in perception of self-care in diabetes, particularly in terms of knowledge of diabetes, factors that influence lifestyle changes and self-care activities, religion / faith and the support / lack of support in different relationships. Health professionals' ability to manage cultural differences and maintain transcultural nursing requires that healthcare providers have knowledge of how cultural / ethnic origin may influence the perception of self-care in diabetes. Increased knowledge can provide health care providers safety in their profession, which contributes to a more individualized and safer care.

Li Zehou 李泽厚 (1930 - ) est l’une des plus importantes figures de la philosophie chinoise contemporaine. A l’issue d’un itinéraire philosophique qui le conduit de Changsha à Beijing, puis aux Etats-Unis, où il enseigne à Colorado College, Li Zehou œuvre à la création d’une philosophie chinoise, réactualisant l’héritage traditionnel chinois par l’intégration de la philosophie. Lors de ce parcours, il étudie l’histoire de la pensée chinoise, devient le plus éminent spécialiste de l’esthétique chinoise, et s'attelle à la critique de la Critique de Kant. Depuis les années 2000, son travail se concentre sur le champ de l’ontologie, au sein duquel il propose sa propre théorie, “L’ontologie anthropologico-historique”.Cette étude est une exploration de l’ontologie de Li Zehou, mais dans une perspective qui dépasse les affirmations de son auteur. Grâce à une méthode multi-focale, nous travaillons à décrire, le plus précisément possible, quels sont les engagements ontologiques réels de Li Zehou. D’abord, à partir de son traitement des philosophies de Marx, Kant et Dewey, quelles sont les options ontologiques propres à la philosophie qu’il admet, et quelles sont celles qu’il rejette? Ensuite, quelles créations ontologiques découvrons-nous en parcourant ses textes, et en offrant une voix philosophique française à ce philosophie chinois ? Enfin, comment l’ontologie, et plus généralement la philosophie de Li Zehou, se situe-t-elle sur le plan philosophique, dans le monde du “sens philosophique” ? Quelles cohérences, quelles résonances, quelles différences, faut-il identifier par rapport aux enseignements chinois et aux courants philosophiques ? / Li Zehou 李泽厚 (1930 - ) is one of the foremost figure of contemporary Chinese philosophy. He is at the end of a philosophical path that lead him from Changsha to Beijing and to the United States of America, where he teaches at Colorado College, and is working on the creation of a Chinese philosophy, reactualizing the Chinese traditional legacy through the integration of philosophy. Simultaneously, he studied the history of Chinese philosophy, became the most eminent specialist of Chinese aesthetics and criticized Kant’s Critique. Since the 2000s, he has focused his work on the field of ontology, in which he has proposed his own theory, “The anthropologico-historical ontology”.This study is an exploration of Li Zehou’s ontology, but in a perspective that exceeds the assertions of the author. Thanks to a multi-focal methodology, we will describe as thoroughly as possible what Li Zehou’s real ontological commitments are. At first, starting from his study of Marx, Kant, and Dewey’s philosophies, we’ll seek to identify which ontological options he admits and which he rejects, among the traditional philosophical ones. Then, we’ll focus on his own ontological creations, by analyzing his texts and giving him a French philosophical voice. Finally, we will situate his ontology and his philosophy in the philosophical plan, within the world of “philosophical meaning”. What consistencies, resonances and differences should we identify as regards the Chinese teachings and philosophical movements?