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array:23 [ "pii" => "S1130862120304575" "issn" => "11308621" "doi" => "10.1016/j.enfcli.2020.07.008" "estado" => "S300" "fechaPublicacion" => "2020-12-01" "aid" => "1663" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2020" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Enferm Clin. 2020;30 Supl 7:38-41" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S1130862120304587" "issn" => "11308621" "doi" => "10.1016/j.enfcli.2020.07.009" "estado" => "S300" "fechaPublicacion" => "2020-12-01" "aid" => "1664" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Enferm Clin. 2020;30 Supl 7:42-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "titulo" => "Maternal depression and factors predicting depressive symptoms in adolescents in Bali, Indonesia" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "42" "paginaFinal" => "46" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Putu Ayu Emmy Savitri Karin, Nopporn Vongsirimas, Wimolnun Putdivarnichapong, Atittaya Pornchaikate Au Yeong" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Putu Ayu Emmy Savitri" "apellidos" => "Karin" ] 1 => array:2 [ "nombre" => "Nopporn" "apellidos" => "Vongsirimas" ] 2 => array:2 [ "nombre" => "Wimolnun" "apellidos" => "Putdivarnichapong" ] 3 => array:2 [ "nombre" => "Atittaya" "apellidos" => "Pornchaikate Au Yeong" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130862120304587?idApp=UINPBA00004N" "url" => "/11308621/00000030000000S7/v1_202012250829/S1130862120304587/v1_202012250829/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S1130862120304563" "issn" => "11308621" "doi" => "10.1016/j.enfcli.2020.07.007" "estado" => "S300" "fechaPublicacion" => "2020-12-01" "aid" => "1662" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Enferm Clin. 2020;30 Supl 7:34-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "titulo" => "Family support in improving quality of life of children with cancer undergoing chemotherapy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "34" "paginaFinal" => "37" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Kadek Cahya Utami, Luh Mira Puspita, Putu Ayu Emmy Savitri Karin" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Kadek Cahya" "apellidos" => "Utami" ] 1 => array:2 [ "nombre" => "Luh Mira" "apellidos" => "Puspita" ] 2 => array:2 [ "nombre" => "Putu Ayu Emmy Savitri" "apellidos" => "Karin" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130862120304563?idApp=UINPBA00004N" "url" => "/11308621/00000030000000S7/v1_202012250829/S1130862120304563/v1_202012250829/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "titulo" => "Coping with menopause – Measures that women can take" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "38" "paginaFinal" => "41" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Carlo Bryan C. Borrico, Corazon C. Borrico, Leonardo P. Borrico" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Carlo Bryan C." "apellidos" => "Borrico" "email" => array:2 [ 0 => "borrico.carlo@auf.edu.ph" 1 => "Seighart02@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0005" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Corazon C." "apellidos" => "Borrico" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Leonardo P." "apellidos" => "Borrico" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Assistant Professor, Angeles University Foundation, Angeles city, Pampanga, Philippines" "etiqueta" => "a" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Alumnus, Holy Angel University, Angeles city, Pampanga, Philippines" "etiqueta" => "b" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">According to the World Health Organization, the average age of menopause is 50 years. Menopausal symptoms affect 70% of women. During menopause, there is a hormonal imbalance that would lead to variety of menopausal symptoms such as hot flashes, weight gain, changes in the body shape, hair loss, hair becomes grayer and coarse, decreased elasticity of the skin, thinning of lining and dryness in the vagina, breast discomfort and urinary incontinence.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a> Menopausal woman have also increases the risks to certain medical condition such as osteoporosis, cardiovascular disease, diabetes and arthritis.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3,5–7</span></a> Some women view it as positive and some view it as negative.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> Some women feel a sense of loss because their reproductive years are ending. Some also feel very uncomfortable because of symptoms.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A woman can associate menopause positively by appreciating it as a period of reflection, a new beginning and a redirection of her life's goal. She may also depict that it is a sense of freedom from the responsibility of bearing and nurturing children. Consequently, a woman can relate menopause to sickness that must be heal, an alteration in her physical dimension, a period where more discomforts appear and regret over the loss of reproductive capacity and the end of sexual repression.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The changing demographics of a country's population are affecting how midlife is view. Experiences from limited opportunities for jobs, divorces, a period of aging and health concerns leaves little time for personal care and nurturing. Women's health and wellness often neglected due to multiple roles that needs attention. Women with higher level of education and those employed had higher quality of life and report to have fewer symptoms compare to younger women, low education, and overweight.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Understanding menopausal symptoms helps midlife women to cope and know how to deal it. Encouraging them to express their concerns and share their experience is essential.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> As nurse, we need to support these individual in their effort of coping these age related changes. Nurses are instrumental in offering holistic care and comprehensive support and providing them reliable up-to-date, evidenced-based information.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Hence, the purpose of the study is to extend knowledge regarding women's perception and outlook on their sense of body during their menopausal women years. This study can present an opportunity for personal introspection to assess a women's health status, identify certain health risk and acknowledge areas where there is a need for health promotion and disease prevention. It can help the women under this study to view midlife as a normal function of life and should be perceive in a positive way further enhance their confidence and well-being. It is also to explore how these women cope with these physiological and psychological changes.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">These symptoms are very crucial that must be aware because it can lead to negative attitude toward menopause.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> This study helps them identify the best coping strategy they can use to perceive these changes in a positive and productive ways.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">This study promotes better understanding to the women-experiencing menopause. It helps these women to gain more knowledge, identify best coping strategy and help them perceive these changes in a positive aspect.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–7</span></a> This phenomenological study aimed to describe the women's sense of body during their menopausal years at Angeles City. To gain an understanding of their common experience, the following broad questions asked:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">a.</span><p id="par0040" class="elsevierStylePara elsevierViewall">What are your experiences during midlife?</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">b.</span><p id="par0045" class="elsevierStylePara elsevierViewall">How did those experiences happen?</p></li></ul></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="par0050" class="elsevierStylePara elsevierViewall">Descriptive phenomenology is the qualitative research design chosen for the study to gain understanding of women experiencing menopausal symptoms. Purposive sampling was selected in which the researcher selects the informants who aged at least 50 years who currently experienced menopausal symptoms.</p><p id="par0055" class="elsevierStylePara elsevierViewall">At the vicinity of Mabalacat City, Philippines, the researcher employed Maximum variation sampling where the number of informants depends on the achievement of data saturation. When the information gathered, become repetitive and redundant, such that no new information can be get, data collection will stop.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Focus interviews chosen to explore the ideas and perception of women experiencing menopause. The researcher used an interview guide to ensure all question addressed. Interview data recorded on audio tape with the permission of the informants. As with observations, detailed recording is a necessary component of interviews since it forms the basis for analyzing the data. Informants asked to elaborate on any aspect that considered relevant to the general topic. Follow-up interviews done if the data gathered will not suffice since this study involves a whole inquiry of the lived experiences and the perceptions to which the topic gives rise.</p><p id="par0065" class="elsevierStylePara elsevierViewall">In addition, Moustaka method was adapted for chunking and managing the data collected since the study necessitates a structured guidance for the completion of this stage (Creswell, 1998). The data analyzed according to Moustakas’ Method (1994).</p><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Step 1</span>: Listing and preliminary grouping (horizonalization). The researcher used the verbatim transcripts from each interview and separates out each statement, which describes an element, or horizon, of the experience. The researcher names the horizons based on statements from the participants.</p><p id="par0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Step 2</span>: Reduction and elimination: Each horizon of the experience tested for two requirements: a) does it contain an element of the experience, which is necessary to understanding the experience? b) is it possible to separate it and label it? If the statement does not meet both these criteria, eliminated. Horizons that remain from this elimination process are the invariant constituents of the experience.</p><p id="par0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Step 3</span>: Clustering and thematizing the invariant constituents. The invariant constituents of the experiences grouped into similar themes, which develop from scrutiny of the horizons. These are then the core themes of the experience.</p><p id="par0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Step 4</span>: Final identification of the invariant constituents and themes by application: Validation. The invariant constituents and their themes checked against interview transcript to check for discrepancies and inconsistencies. Any horizons or themes, which are inconsistent with the participant's description of the experience, then deleted.</p><p id="par0090" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Step 5</span>: Construct an Individual Textural Description for each research participant. The Individual Textural Description allows for a description of “what” happened in the experience. In the textural description of an experience, nothing omitted; every dimension or phase granted equal attention and is included.</p><p id="par0095" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Step 6</span>: Construct an Individual Structural Description for each research participant. Shifting from the “what happened” emphasis of the textural description, the structural description describes how the event took place. In this step, the researcher uses reflection and imaginative variation to compose a description from a different point of view.</p><p id="par0100" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Step 7</span>: Construct a Textural-Structural Description of the meaning and essences of the experience for each of the research participants. This Textural-Structural Description relies on the preceding steps to create an individual description of the essences of the experience, which will serve to represent the whole.</p><p id="par0105" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Step 8</span>: Develop a Composite Description of the meanings and essences of the experience, which represents the group as a whole. The Composite Description, as the final step in the data analysis process, provides the culmination of the data analysis in a description of the shared essences of the experience.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Result</span><p id="par0110" class="elsevierStylePara elsevierViewall">After a thorough data collection, interviews were fully transcribed, word-for-word from the videotaped recorder. The raw data from the interview used as the basis for data analysis, thus the researchers arrived at an understanding of the essences of the experience since evidence from phenomenological research derived from first-person reports of life experiences (Marek, 1999). The data analyzed according to Moustakas modification of the van Kaam data analysis method.</p><p id="par0115" class="elsevierStylePara elsevierViewall">There are six key themes identified in the study:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">(1)</span><p id="par0120" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">“I’ve changed…”</span> This is the physical, emotional, social, psychological, and spiritual changes reported by informants.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">(2)</span><p id="par0125" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">“What is bothering me?”</span> This denotes the fears (fear that children will get married; fear of getting sick; fear of death; fear of losing her children) and problems (financial problem; problem on family; loss of love one; loss of self-worth due to retirement) currently experiences by informants.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">(3)</span><p id="par0130" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Looking back into the windows of the past</span>. This denotes Informants’ comparison before and during midlife (Comparison of Social life before and during menopause; things that she cannot do now but can do before), and regret of the things they did not do during earlier years.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">(4)</span><p id="par0135" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">My weapons for my battle.</span> Coping strategies the women do to combat menopausal symptoms (Religion as a coping strategy; support system from significant others; diversion activities).</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">(5)</span><p id="par0140" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Metamorphosis</span>: A new conquest. This involves menopausal women life realization, acceptance of being menopause, contentment in life, and giving advice to younger generation.</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">(6)</span><p id="par0145" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Dreams</span>: The paramount of my life. This involves menopausal women dream for oneself and their family, and giving wisdom to younger generation.</p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discussion</span><p id="par0150" class="elsevierStylePara elsevierViewall">Women have viewed this period of a life as a potential downward spiral of fading productivity, usefulness, influence, power, and beauty. Women must not view this as a stressor but rather turn this midlife crisis to an advantage. They can make this as a time for renewal of their body and mind rather to stand by helplessly. Each woman is unique and will have her own specific opinions, feelings and reactions about getting older.</p><p id="par0155" class="elsevierStylePara elsevierViewall">The menopausal experience provides an opening to psychological and spiritual growth that allows an individual to change their perception positively. However, they cannot take this journey without a certain amount of suffering. They must suffer the loss, change, and let go of what they bring into midlife. They think that it is a time to recapture lost youth. This is a common but a great misunderstanding. Information is need to enhance and understand more of what known about this major life transition.</p><p id="par0160" class="elsevierStylePara elsevierViewall">There are six key themes identified in the study: (1) “I’ve changed…” (2) “What is bothering me?” (3) Looking back into the windows of the past (4) my weapons for my battle (5) Metamorphosis: A new conquest (6) Dreams: The paramount of my life. These key themes developed from scrutiny of the horizons as well as the invariant constituents from the experience of the informants.</p><p id="par0165" class="elsevierStylePara elsevierViewall">Most of informants reported weight preoccupation and concern on their physical changes. Most of them experienced weight gain, fat distribution in their body especially in the abdomen, and reported decrease libido. In addition, most of the informants reported coping with illness of their love one, death of their husband, divorce, loss of self-worth due to retirement, and new role. Most of them reported religion; support system from significant others; diversion activities as their coping strategy. Lastly, most of them expressed they accepted of being menopause. They want to spend their remaining years giving advice and wisdom to younger generation to guide them.</p><p id="par0170" class="elsevierStylePara elsevierViewall">Thus, understanding these changes help midlife women to cope and know how to deal it. Encouraging them to express their concerns and share their experience is essential.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> As nurse, we need to support these individual in their effort of coping these age related changes. We need to provide health teaching and health promotion such as exercise, maintaining weight and good eating habit are essential to enhance their wellbeing.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclusion</span><p id="par0175" class="elsevierStylePara elsevierViewall">The study reflected the entirety of the participant's experiences. Understanding changes help midlife women to cope and know how to deal it. Encouraging them to express their concerns and share their experience is essential. As nurse, we need to support these individual in their effort of coping these age related changes. We need to provide health teaching and health promotion such as exercise, maintaining weight and good eating habit are essential to enhance their wellbeing.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflict of interest</span><p id="par0180" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1441029" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1315173" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Result" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-05-12" "fechaAceptado" => "2020-07-15" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1315173" "palabras" => array:3 [ 0 => "Menopause" 1 => "Age-related changes" 2 => "Midlife" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">During menopause, there is a hormonal imbalance that would lead to variety of menopausal symptoms such as hot flashes, weight gain, changes in the body shape, hair loss, hair becomes grayer and coarse, decreased elasticity of the skin, thinning of lining and dryness in the vagina, breast discomfort and urinary incontinence. These menopausal symptoms cause concern and discomfort for these women. It also affects their quality of life. The study aimed to explore the women's sense of body during their midlife years. A phenomenological-heuristic research design used in the study. Eight informants willingly participated in the study under an informal, semi-structured interview with the main question, “What are your experiences during midlife?” and “How did those experiences happened?” The transcribed verbatim were analyzed through the use of Moustakas method. The study revealed 7 main themes: (1) “I’ve changed…” (2) “What is bothering me?” (3) Looking back into the windows of the past (4) my weapons for my battle (5) Metamorphosis: A new conquest (6) Dreams: The paramount of my life. The study reflected the entirety of the participant's experiences. This study has shown that living the experience of wellness at menopause can accommodate the experience of change or symptoms. In this way the experience of menopausal change is not disruptive to the woman's continuity of experience, she continues to feel well and to do all the things she wants to do. Further recommendations are needed to enhance the understanding of the lived experience of women regarding their sense of body at midlife.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Peer-review under responsibility of the scientific committee of the International Nursing Research Conference of Udayana University. Full-text and the content of it is under responsibility of authors of the article.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Menopause sucks: what to do when hot flashes make you and everyone else miserable" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Kimes" 1 => "E. 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