Análisis Crítico del Documento (borrador): Plan Nacional de Rehabilitación 2021-2030 / Critical Analysis of the Document (draft): National Rehabilitation Plan 2021-2030

Introducción. El 01 marzo de 2022 y con la presencia la subsecretaria de Salud Pública se llevó a cabo la oficialización del Plan Nacional de Rehabilitación 2021-2030 del Departamento de Rehabilitación y Discapacidad del Ministerio de Salud de Chile (MINSAL). Mediante esta iniciativa, el MINSAL buscó proporcionar una guía para la organización de los servicios de rehabilitación en toda la red asistencial a través de la regulación y administración de "Servicios de Medicina Física y Rehabilitación", desconociendo otras formas de organización y las intervenciones orientadas hacia la recuperación funcional de los usuarios realizadas por los profesionales de salud que no están integrados en dichos servicios. Ante las protestas de nuestro gremio, el ministerio decidió someter a consulta pública el mencionado documento. En este artículo se deja de manifiesto la visión parcial de conceptos respecto de discapacidad, rehabilitación e inclusión y se señalan algunas imprecisiones contenidas en este documento. Además, resulta evidente el marcado enfoque biomédico del plan propuesto, que se centra en el médico fisiatra, sin reconocer otras formas de organización por parte de los profesionales del equipo multidisciplinario en rehabilitación, especialmente los kinesiólogos. Finalmente, en opinión de los autores, la implementación de una política pública como la que se pretende imponer con el plan nacional, podría generar nuevas barreras de acceso a los servicios profesionales de los miembros del equipo de rehabilitación, en vez de organizar adecuadamente los recursos ya existentes en la red pública.

Introduction. On March 1, 2022, in the presence of the Sub-secretary of Public Health, the official launch of the National Rehabilitation Plan 2021-2030 was held by the Department of Rehabilitation and Disability of the Ministry of Health of Chile (MINSAL). Through this initiative, MINSAL aimed to guide the organization of rehabilitation services throughout the healthcare network, through the regulation and administration of "Physical Medicine and Rehabilitation Services," disregarding other forms of organization and interventions focused on the functional recovery of users carried out by healthcare professionals who are not integrated into these services. In response to the protests from our professional community, the ministry has decided to subject the mentioned document to public consultation. This article highlights the partial understanding of concepts related to disability, rehabilitation, and inclusion, and identifies certain inaccuracies contained in this document. Furthermore, the pronounced biomedical approach of the proposed plan is evident, focuses on physiatrists, neglecting to recognize other forms of organization by professionals in the multidisciplinary rehabilitation team, particularly physical therapists. Finally, in the authors' opinion, the implementation of a public policy such as the one intended to be imposed with the national plan may create new barriers to accessing professional services provided by members of the rehabilitation team, instead of adequately organizing the existing resources in the public network.

Predictors of Mental Health Outcomes in Grocery Store Workers amid the COVID-19 Pandemic and Implications for Workplace Safety and Moral Injury.

Limited research exists on the mental health (MH) of grocery store workers (GSWs), who have been on the frontlines throughout the COVID-19 pandemic. A disaster MH conceptual model incorporating demographics, disaster exposure and threat (COVID-19 fear and workplace threat perception), perceived stress, and social support (lack of from family and friends) was utilized to predict MH outcomes (anxiety, depression, and post-traumatic stress symptoms; PTSS) of GSWs. GSWs (n = 842) were recruited through a regional union in California. The participants were diverse (62.1% female) and were 18-69 years of age (M = 41.5, SD = 13.9). They completed an online survey regarding COVID-19 fear, workplace threat perception, perceived stress, lack of social support, and workplace needs/recommendations for support. Three hierarchical linear regression models were run assessing each MH outcome. Thematic analysis coding and an inductive approach were utilized for analyzing open-ended responses of workplace needs/recommendations. Females and younger GSWs (ages 18-29 years old) on average, reported higher MH symptoms than males and older age groups, respectively. COVID-19 fear and perceived stress were significant predictors of anxiety, while COVID-19 fear, workplace threat perception, and perceived stress significantly predicted depression and PTSS, explaining almost half of the variance for each model. Social support and demographics were not predictive of MH outcomes. Almost half of GSWs (40%) requested increased safety protections in the workplace. Feelings of fear of COVID-19, threat in the workplace, and overall perceived stress are predictive of GSWs' MH outcomes. Increasing feelings of safety in the workplace and reducing stress may lessen MH symptoms.

Exploratory factor analysis and validity of the virtual reality symptom questionnaire and computer use survey.

The widespread use of virtual reality head-mounted-displays (HMDs) calls for a re-examination of the impact of prolonged exposure to fixed visual displays at close ocular proximity. The purpose of this study is to validate the Virtual Reality Symptoms Questionnaire (VRSQ), created to understand symptoms of prolonged HMDs use, and Computer Use Survey (CUS), created to assess general physical and visual discomfort symptoms. Participants (N = 100) recorded their general discomfort symptoms using the CUS, performed an interactive task using a HMD for thirty minutes, and then answered the CUS again along with the VRSQ. VRSQ, analysed using an exploratory factor analysis, indicated a clear two-factor solution, and demonstrated very good internal consistency (α = 0.873). The CUS, also analysed using an exploratory factor analysis, indicated a four-factor solution, and demonstrated good internal consistency (α = 0.838). Practitioner Summary: A quantitative-experimental study was conducted to explore the factor structure and validate both the Virtual Reality Symptoms Questionnaire (VRSQ), and the Computer Use Survey (CUS). Findings indicate the VRSQ and CUS are precise and accurate survey instruments for evaluating discomfort after VR-HMD use and the latter for computer use. Abbreviations: VRSQ: virtual reality symptom questionnaire; CUS: computer use survey; OLED: organic light-emitting diode; MSQ: pensacola motion symptom questionnaire; SSQ: simulator sickness questionnaire; 3 D: three-dimensional computer generated space; VR: virtual reality; VR-HMD: virtual reality head-mounted-display; HMDs: head-mounted-displays; EFA: exploratory factor analysis.

Avoiding the Banality of Evil in Times of COVID-19: Thinking Differently with a Biopsychosocial Perspective for Future Health and Social Policies Development.

The COVID-19 pandemic provides the opportunity to re-think health policies and health systems approaches by the adoption of a biopsychosocial perspective, thus acting on environmental factors so as to increase facilitators and diminish barriers. Specifically, vulnerable people should not face discrimination because of their vulnerability in the allocation of care or life-sustaining treatments. Adoption of biopsychosocial model helps to identify key elements where to act to diminish effects of the pandemics. The pandemic showed us that barriers in health care organization affect mostly those that are vulnerable and can suffer discrimination not because of severity of diseases but just because of their vulnerability, be this age or disability and this can be avoided by biopsychosocial planning in health and social policies. It is possible to avoid the banality of evil, intended as lack of thinking on what we do when we do, by using the emergence of the emergency of COVID-19 as a Trojan horse to achieve some of the sustainable development goals such as universal health coverage and equity in access, thus acting on environmental factors is the key for global health improvement.

Proposta de gestão integrada das águas urbanas como estratégia de promoção da segurança hídrica: o caso de Fortaleza / Proposal of integrated urban waters management as a strategy to promote water security: the Fortaleza case

RESUMO O estudo propõe a utilização de modelos de gestão integrada de águas urbanas como estratégia para a promoção da segurança hídrica e de preparação às secas. Ele foi construído em duas etapas: avaliação da vulnerabilidade do sistema hídrico; e proposição do modelo de gestão integrada de águas urbanas. Na primeira etapa, utilizou-se um modelo de rede de fluxo para a simulação do sistema hídrico. Na segunda etapa, aplicou-se o método indutivo após a realização de pesquisa exploratória. A avaliação das vulnerabilidades hídricas revelou déficit de atendimento de Fortaleza em 2,56% do período simulado e o esvaziamento completo do reservatório Castanhão em 6,52% dos meses. O modelo de gestão integrada de águas urbanas é pautado na gestão da oferta e da demanda hídricas. No primeiro caso, propõe-se que o sistema de abastecimento de Fortaleza seja constituído por fontes hídricas convencionais (águas superficiais) e por mananciais alternativos (águas subterrâneas, águas pluviais, dessalinização de água do mar). Para a gestão da demanda, aponta-se a utilização de aparelhos sanitários economizadores e de mecanismos financeiros. Esse modelo apresenta uma matriz de fontes de abastecimento mais robusta, o que possibilita o aumento da segurança hídrica de centros urbanos.

ABSTRACT The study proposes the use of integrated urban water-management models as a strategy to promote water security and drought preparedness. It was developed in two stages: assessment of water system's vulnerability; proposition of the integrated urban water management model. In the first step, a flow network model was used to simulate the water system. In the second stage, the inductive method was applied after conducting an exploratory research. The assessment of the water vulnerabilities revealed a deficit in Fortaleza's water supply in 2.56% of the simulated period and the complete emptying of Castanhão's reservoir in 6.52% of the months. The integrated urban water management model is based on the management of water supply and water demand. In the first case, it is proposed that Fortaleza's supply system be constituted by conventional water sources (surface waters) and by alternative sources (groundwater, rainwater, desalination of sea water). For the management of demand, it is pointed out the use of water saving plumbing fixtures and financial mechanisms. This model presents a more robust matrix of water supply sources, which increases the water security of urban centers.