[Factors associated with inactivity during COVID-19 confinement among Latin American adults]. / Factores socio demográficos y de estilos de vida asociados a un bajo nivel de actividad física durante el confinamiento producto del COVID-19 en adultos latinoamericanos.

BACKGROUND: The confinement caused by the COVID-19 pandemic changed the lifestyles of the population affecting their levels of physical activity. AIM: To determine the factors associated with a low level of physical activity in adults during confinement during the COVID-19 pandemic. MATERIAL AND METHODS: Adults from Chile, Colombia, México and Perú were invited through social networks to answer an online survey. Questions about sociodemographic, health status and lifestyle variables were included. The level of physical activity and sedentary behavior were determined through the short version of the International Physical Activity Questionnaire (IPAQ). RESULTS: The survey was answered by 3,362 adults aged between 18 and 60 years. Respondents more likely to be inactive were women, those with less than eight years of education, those with overweight or obesity, those who smoked at least one cigarette a day, consumed alcohol four or more times a week, slept less than six hours per day and spent more than 6 hours per day in sedentary behaviors. CONCLUSIONS: These findings provide a sociodemographic and lifestyle profile associated with physical inactivity during the period of confinement in Latin American adults. The results confirm the need to promote healthy lifestyles in the population during periods of confinement.

Clinical and sociodemographic characterization of pregnant women hospitalized with COVID-19.

INTRODUCTION: In pregnant women, a higher risk for developing viral respiratory infections is identified. OBJECTIVE: To analyze sociodemographic characteristics, evolution, clinical manifestations, and complications of pregnant women hospitalized with COVID-19. METHODS: Study conducted at 11 public hospitals; sociodemographic variables, comorbidities, signs and symptoms, laboratory and imaging findings, pregnancy characteristics, treatment and pregnancy outcome were included for analysis. RESULTS: Age ranged between 15 and 40 years; 85.1% were at third trimester of pregnancy, 11.9% at second and 3% at first; 27% had any comorbidity such as obesity, hypertension or asthma; 89.5% had fever, 73.1% cough, 44.8% dyspnea, 43.3% headache and 35.8% myalgia. Diagnoses were mild disease (55.2%), mild pneumonia (26.9%), severe pneumonia (10.4%), severe pneumonia with acute respiratory distress syndrome (4.5%), and severe pneumonia with septic shock (3%); 76.2% had noninvasive oxygen support, and 9%, mechanical ventilation. Pregnancy was interrupted in 53.8%; 95.5% were discharged due to improvement of their condition and 4.5% died. CONCLUSIONS: Age range and symptoms are consistent with those previously reported. Evidence was found of an increase in cesarean section without a clear indication in women with COVID-19.

INTRODUCCIÓN: En las mujeres embarazadas se identifica mayor riesgo de desarrollar infecciones respiratorias virales. OBJETIVO: Analizar características sociodemográficas, evolución, manifestaciones clínicas y complicaciones en mujeres embarazadas con COVID-19 que fueron hospitalizadas. MÉTODOS: Estudio en 11 hospitales públicos; se incluyeron variables sociodemográficas, comorbilidades, síntomas y signos, hallazgos de laboratorio y gabinete, características del embarazo, tratamiento y desenlace de la gestación. RESULTADOS: La edad osciló entre 15 y 40 años; 85.1 % cursaba el tercer trimestre del embarazo, 11.9 % el segundo y 3 % el primero; 27 % presentó alguna comorbilidad como obesidad, hipertensión o asma; 89.5 % presentó fiebre, 73.1 % tos, 44.8 % disnea, 43.3 % cefalea y 35.8 % mialgias. Los diagnósticos fueron enfermedad leve (55.2 %), neumonía leve (26.9 %), neumonía severa (10.4 %), neumonía severa con síndrome de distrés respiratorio agudo (4.5 %) y neumonía severa con choque séptico (3 %); 76.2 % recibió soporte de oxígeno no invasivo y 9 %, ventilación mecánica. Se interrumpió el embarazo en 53.8 %; 95.5 % egresó por mejoría y 4.5 % falleció. CONCLUSIONES: El rango de edad y los síntomas coinciden con los señalados en la literatura especializada. En mujeres con COVID-19 se evidenció el incremento de la operación cesárea sin una indicación clara.

Health policy and systems research publications in Latin America warrant the launching of a new specialised regional journal.

BACKGROUND: Scientific journals play a critical role in research validation and dissemination and are increasingly vocal about the identification of research priorities and the targeting of research results to key audiences. No new journals specialising in health policy and systems research (HPSR) and focusing in the developing world or in a specific developing world region have been established since the early 1980s. This paper compares the growth of publications on HPSR across Latin America and the world and explores the potential, feasibility and challenges of innovative publication strategies. METHODS: A bibliometric analysis was undertaken using HPSR MeSH terms with journals indexed in Medline. A survey was undertaken among 2500 authors publishing on HPSR in Latin America (LA) through an online survey, with a 13.1% response rate. Aggregate indicators were constructed and validated, and two-way ANOVA tests were performed on key variables. RESULTS: HPSR publications on LA observed an average annual growth of 27.5% from the years 2000 to 2018, as against 11.4% worldwide and yet a lag on papers published per capita. A total of 48 journals with an Impact Factor publish HPSR on LA, of which 5 non-specialised journals are published in the region and are ranked in the bottom quintile of Impact Factor. While the majority of HPSR papers worldwide is published in specialised HPSR journals, in LA this is the minority. Very few researchers from LA sit in the Editorial Board of international journals. Researchers highly support strengthening quality HPSR publications through publishing in open access, on-line journals with a focus on the LA region and with peer reviewers specialized on the region. Researchers would support a new open access journal specializing in the LA region and in HPSR, publishing in English. Open access up-front costs and disincentives while waiting for an Impact Factor can be overcome. CONCLUSION: Researchers publishing on HPSR in LA widely support the launching of a new specialised journal for the region with a vigorous editorial policy focusing on regional and country priorities. Strategies should be in place to support English-language publishing and to develop a community of practice around the publication process. In the first years, special issues should be promoted through a priority-setting process to attract prominent authors, develop the audience and attain an Impact Factor.

Association of Co-Living and Age on the Type of Sports Practiced by Older People.

Introdution: The environment and the type of co-living of older people are crucial to understanding how the nature of their context influences a healthy lifestyle. However, no studies have investigated to what extent their type of co-living may be associated with the sports and the profile practice according to their age. Objective: This study aimed to assess the association between the types of co-living and the age of the physically active elderly and the sports they practice. Hypothesis: It is thought that the age, situation, and satisfaction with the way of living in physically active older people differ according to the type of sport they practice. Methods: Cross-sectional study. We included 358 individuals aged between 61 and 93 years old (M = 69.66, SD = 4.74). Type of co-living was classified as living alone or living with others. The sports activities evaluated were: gym, dance, water activities, and yoga/pilates. Differences in the type of co-living and sports practiced were evaluated by ANOVA or Chi2. Results: Among the elderly who practice gymnastics, most of them live alone and in a tight core (p < 0.001) (Phi = 0.244). Furthermore, those who practice aquatic activities are more frequently the youngest (p < 0.001) (Phi = 0.198). Conclusion: Older people who do gymnastics have smaller living groups, those under 69 opt for gymnastics and aquatic activities, while those aged 70 and over prefer dance, yoga, and pilates.

[Consumption of legal and illegal drugs and depressive symptoms in older adults during the SARS-CoV-2 pandemic in Mexico]. / Consumo de drogas legales e ilegales y síntomas de depresión en adultos mayores usuarios de Facebook durante la pandemia por SARS-CoV-2 en México.

BACKGROUND: The health risks faced by older adults are diverse; however, little has been explored about the use and abuse of psychoactive substances in this population. The seclusion imposed by the situation that prevails due to SARS-CoV-2 has increased the feelings of loneliness, isolation and sadness associated with this age, which makes them a risk factor for drug use. OBJECTIVE: To analyze the consumption of legal and illegal drugs in people over 60 years of age who are Facebook users and its relationship with symptoms of depression during the SARS-CoV-2 pandemic. MATERIAL AND METHODS: Study carried out on 380 elderly people, Facebook users, who answered a questionnaire published online, which inquired about: sociodemographic data, frequency and amount of legal and illegal drug use, and depressive symptomatology. RESULTS: 50.26% were women; the average age was 66.79 years (SD=5.81); 31.05% consumed alcohol in the last 30 days, 22.63% tobacco, tranquilizers without medical prescription 16.05% and marijuana 7.89%. The consumption of other illegal drugs did not exceed 2.6% of the population. When comparing between users and non-users, it turned out that consumption in the last 30 days was slightly higher in women, in single people and no differences were observed depending on the level of schooling. Mild and severe depressive symptoms were found to be associated with all drugs except tobacco and opiates. DISCUSSION AND CONCLUSIONS: The results obtained demonstrate the need to make drug use visible among older adults and to develop strategies that reduce the mood disorders they may be experiencing, such as fear, anguish and depression. When comparing between users and non-users, it turned out that consumption in the last 30 days was slightly higher in women, in single people and no differences were observed depending on the level of schooling.

An overview on the promotion on patient-centered care and shared decision-making in Mexico.

Mexico is a mid-income North American country. It strives to materialize the right to health in accordance with its laws. But the health system faces various problems: fragmentation, segmentation, limited funding, insufficient coverage, and low quality of health care. Mexico's population is aging, which has led to an increasing prevalence of chronic conditions. To overcome this issue, the goals have shifted towards free universal health coverage under equality, effectivity, and quality criteria focused on primary health care. Consequently, the health system has moved towards Patient-Centered Care (PCC), and an opportunity to promote Shared Decision-Making (SDM) during the clinical encounter to enhance patient and family involvement in their own health care. PCC and SDM are relatively new ideas in Mexico. The research agenda has focused on initiatives attempting to bring these concepts to clinical practice. This paper seeks to describe the local headway and the state of the art of PCC- and SDM-related strategies in the Mexican health system.

Pandemia COVID-19: consecuencias de la sobreexposición al uso de tecnologías de la Información y comunicación / COVID-19 pandemic: consequences of overexposure to the use of information and communication technologies

Resumen Objetivo: Establecer la asociación entre la sobreexposición al uso de las Tecnologías de la Información y la Comunicación (TIC) con la percepción sobre estilos de vida saludable y la salud mental, antes y durante la pandemia. Materiales y métodos: Estudio con abordaje cuantitativo, de tipo cohorte retrospectivo, realizado en estudiantes de tres preparatorias ubicadas en el golfo de México que aceptaron participar, mediante la aplicación de un cuestionario en línea Google Forms. Para analizar los resultados se utilizó estadística descriptiva como medidas de tendencia central y de dispersión, además se usaron técnicas estadísticas con muestras relacionadas para precisar cambios presentados antes y durante la pandemia; se calculó la razón de momios y sus intervalos de confianza al 95% para identificar la asociación entre la sobreexposición al uso de las TIC, con estilos de vida saludable y salud mental relacionados. Resultados: Participaron 432 estudiantes, la mayoría del sexo femenino (66.7%), del segundo semestre (62.7%), de entre 15 años (39.4%) y 16 años (35.6%). Con respecto al uso de las TIC, se encuentra que a la pandemia más del 50% de las respuestas obtenidas reflejaban un uso normal, sin embargo, durante el uso de los diversos dispositivos incrementó, con relación a la asociación entre la sobreexposición al uso de las TIC y la salud mental; para el caso de la depresión se encontró que antes de la pandemia los estudiantes tenían casi 2.9 veces posibilidades de presentar depresión si habían tenido sobrexposición al uso de las TIC, estas posibilidades se incrementaron casi 7.2 veces durante la pandemia. Conclusiones: En el contexto de la pandemia de COVID-19, la sobrexposición al uso de las TIC ha ocasionado cambios importantes en la salud mental de los adolescentes, sumados a los cambios propios de la etapa de desarrollo en que se encuentran.

Abstract Objective: We aimed to analyze the association between overexposure to the use of ICT with the perception on healthy lifestyles and mental health before and during the pandemic. Materials and methods: We conducted a quantitative and retrospective cohort study on students from 3 high schools, located in the Gulf of Mexico, who were surveyed using an online questionnaire. Descriptive statistics, such as measures of central tendency and dispersion, were used to analyze the results. Also, statistical techniques were used for related samples to specify changes occurred before and during the pandemic. The Odds Ratio and its 95% confidence intervals were calculated to identify the association between overexposure to the use of ICT with healthy lifestyles and mental health. Results: 432 students were included in our study. Most of them were female (66.7%), (62.7%) were studying the second semester, aged 15 (39.4%) to 16 (35.6%) years. Regarding the use of ICT, we found that before the pandemic more than 50% of the responses pointed out a normal use, but during the pandemic the use of various devices increased. Concerning the association between overexposure to the use of ICT and mental health, in this case depression, we found that before the pandemic students had almost 2.9 times the chance of developing depression if they had been overexposure to the use of ICT. These possibilities increased almost 7.2 times during the pandemic. Conclusions: Further research is mandatory to explore the mental health of adolescents, since during the COVID-19 pandemic important changes occurred, including those changes inherent to the stage they are undergoing.

Maltrato de personas mayores con multimorbilidad y su relación con la calidad de vida / Elder abuse with multimorbidity and its relationship with quality of life

Resumen Objetivo: Estimar la prevalencia del maltrato y de la multimorbilidad, así como, analizar si el maltrato con la presencia de multimorbilidad está asociado con la autopercepción de la calidad de vida relacionada con la salud en personas mayores de Xalapa, Veracruz. Material y métodos: Este es un estudio transversal a partir de datos recolectados en una encuesta representativa de las personas mayores (≥60 años) de Xalapa, Veracruz. La encuesta se realizó de septiembre de 2018 a enero de 2019 (n = 993). Se utilizó un cuestionario para recolectar datos demográficos, socioeconómicos y de salud. El maltrato se evalúo mediante la Escala Geriátrica de Maltrato (EGM-22 ítems) y la calidad de vida relacionada con la salud mediante el cuestionario de salud Short Form 36 (SF-36). Se realizaron análisis descriptivos para estimar las prevalencias y modelos de regresión logística para analizar la asociación. Resultados: La prevalencia del maltrato de personas mayores fue 16,2%. Los tipos de maltrato fueron: psicológico (13,6%), económico (4,8%), físico (3,2%), negligencia (2,3%) y abuso sexual (0,5%). La prevalencia de multimorbilidad fue 43.2%. Las personas mayores con maltrato y multimorbilidad presentaron menor calidad de vida en las dimensiones de rol físico (OR 2,362 IC: 1,254-4,452), dolor corporal (OR 2,278 IC: 1,277-4,065) y salud mental (OR 2,94 IC: 1,499-5,766). Conclusiones: El maltrato y la multimorbilidad son problemas comunes en las personas mayores de Xalapa, Veracruz, la presencia de estos dos eventos se asocia con una menor calidad de vida relacionada con la salud. La investigación futura debería concentrarse en mejorar la comprensión de las relaciones familiares de las personas mayores con multimorbilidad y, los servicios sociales y de atención médica deben tomar en cuenta estos hallazgos para atender el maltrato de personas mayores con multimorbilidad antes de que ocurran más situaciones adversas que impacten en su calidad de vida.

Abstract Objective: To estimate the prevalence of elder abuse and multimorbidity, as well as to analyze if elder abuse in the presence of multimorbidity is associated with self-perceived health-related quality of life in older adults from Xalapa, Veracruz. Material and methods: Material and methods: This is a cross-sectional study based on data collected in a representative survey of older people (≥60 years) from Xalapa, Veracruz. The survey was conducted from September 2018 to January 2019 (n = 993). A questionnaire was used to collect demographic, socioeconomic, and health data. Elder abuse was assessed using the Geriatric Mistreatment Scale (GMS-22 items) and health-related quality of life using the short form 36 health survey questionnaire (SF-36). Descriptive analyzes were performed to estimate the prevalence and logistic regression models to analyze the association. Results: The prevalence of elder abuse was 16.2%. The types of elder abuse were psychological (13.6%), economic (4.8%), physical (3.2%), neglect (2.3%) and sexual abuse (0.5%). The prevalence of multimorbidity was 43.2%. Older people with both elder abuse and multimorbidity presented lower health-related quality of life in the dimensions of physical role (OR 2,362 IC: 1,254-4,452), body pain (OR 2,278 IC: 1,277-4,065) and mental health (OR 2,94 IC: 1,499-5,766). Conclusions: Elder abuse and multimorbidity are common problems in the older population in Xalapa, Veracruz, Mexico; the presence of these two events is associated with lower health-related quality of life. Future research should focus on improving understanding of the family relationships of older people with multimorbidity, and health care and social services should take these findings into account to address the elder abuse with multimorbidity before further adverse situations occur that impact their health-related quality of life.

[Factors associated with hospitalization for injuries in patients treated in emergency departments]. / Factores asociados con la hospitalización por lesiones en pacientes atendidos en los servicios de urgencias.

OBJECTIVE: To identify factors associated with hospitalization for injuries in patients treated in the emergency departments of two hospitals. MATERIAL AND METHODS: Cross-sectional study on a sample of injured patients over the age of fifteen, who were treated in the emergency department of two hospitals in Xalapa, Veracruz, México. Bivariate analysis and logistic regression analysis were conducted to estimate the risks by odds ratio (OR) and to identify the factors associated with the likelihood of hospitalization. RESULTS: De los 505 lesionados, 10,7% requirieron ser hospitalizados. The risk of hospitalization was associated mainly to the male gender (OR=2.7, 95% CI 1.2-6.1), age 46 years or over (OR=2.3, 95% CI 1.2-4.5), drinking before the injury (OR = 2.3, 95% CI 1.2-4.6), and violence (OR=2.3, 95% CI 1.1-4.9). Regarding the type of injury, fractures showed the highest risk (OR=7.4, 95% CI 3.0-17.8). CONCLUSION: The results showed that some factors increased the risk of hospitalization for injuries. Such information can be used to propose strategies and develop interventions that may influence prevention of risk factors that result in serious injuries that lead to hospitalization.

OBJETIVO: Identificar los factores asociados con la hospitalización por lesiones en pacientes atendidos en el servicio de urgencias de dos hospitales. MÉTODOS: Estudio transversal, en lesionados mayores de 15 años que solicitaron atención en el servicio de urgencias de dos hospitales de Xalapa, Veracruz, México. Se realizó un análisis bivariado y un análisis de regresión logística para estimar los riesgos mediante Odds Ratio (OR) e identificar los factores asociados con la probabilidad de hospitalización. RESULTADOS: De los 505 lesionados, 10,7% requirieron ser hospitalizados. El riesgo de hospitalización se asoció con el sexo masculino (OR=2,7, IC95% 1,2-6,1), la edad de 46 años o más (OR=2,3, IC95% 1,2-4,5), el consumo de alcohol antes de la lesión (OR=2,3, IC95% 1,2-4,6), la violencia (OR=2,3, IC95% 1,1-4,9). En cuanto al tipo de lesión, mostraron mayor riesgo las fracturas (OR=7,4, IC95% 3,0-17,8). CONCLUSIÓN: Los resultados de esta investigación mostraron que algunos factores presentan mayor riesgo de hospitalización por lesiones. Dicha información puede utilizarse para proponer estrategias y desarrollar intervenciones que puedan incidir en la prevención de factores de riesgo que den como resultado lesiones graves que ameriten hospitalización.

Percepción de los estudiantes sobre el consumo de drogas psicoactivas en su universidad / Perception of Students Regarding Psychoactive Drug Use at Their University / Percepção de estudantes sobre o consumo de drogas psicoativas na universidade

entre los jóvenes universitarios se ha observado una tolerancia creciente hacia el consumo de drogas, debido ­entre otros factores­ a una reducción en la percepción de riesgo, que puede con-tribuir a la normalización del consumo. El objetivo fue analizar la percepción de los estudiantes de unauniversidad pública mexicana sobre la situación y la gravedad del consumo de drogas en su institución mediante diversos indicadores. Materiales y métodos: se analizó la base de datos derivada de la aplica-ción del Cuestionario sobre Consumo de Drogas en Estudiantes Universitarios (codeu-3), en el que partici-paron 19 815 estudiantes; se realizaron comparaciones según sexo y área académica utilizando pruebas de chi-cuadrado y el análisis post hoc de Bonferroni. Resultados: las mujeres indicaron tener una menor percepción de riesgo que los hombres sobre las variables analizadas (percepción de los participantes sobre el consumo de drogas en su facultad, venta y gravedad del consumo de drogas, según sexo y área académica y conductas de docentes y estudiantes que facilitan el consumo de alcohol y la postura de las autoridades universitarias ante estudiantes consumidores, según sexo y área académica). Conclusión: los resultados muestran diferencias en la percepción de hombres y mujeres, así como las diferencias asociadas con la adscripción de los estudiantes en las distintas áreas académicas, por lo que se sugiere profundizar el estudio de estos aspectos.

There is a growing tolerance toward drug use among university students due to a reduction in the perception of risk, which is considered as those judgments or intuitions held regarding the danger of a situation that can contribute to the normalization of consumption. This study aimed to analyze the perception of the students at a Mexican public university toward the situation and seriousness of drug use in the university using various indicators. Materials and methods: The database derived from the application of the Questionnaire on Drug Use in University Students (codeu-2 by its name in Spanish), in which 19,815 students from a Mexican public university participated, was analyzed, and comparisons were made according to gender and academic area using chi-squared tests and Bonferroni's post hocanalysis. Results: Women were reported to have a lower perception of risk than men on the variables analyzed (participants' perception of drug use in their faculty, sale and severity of drug use, according to gender and academic area, and behaviors of teachers and students that facilitate alcohol use and the position of university authorities towards student consumers, according to gender and academic area). Conclusion: The results indicated the importance of studying in greater depth the differences in the perception of men and women, as well as their affiliation in the different academic areas.

tem-se observado entre os jovens universitários uma crescente tolerância ao uso de dro-gas, devido à redução da percepção de risco, que é considerada como aqueles julgamentos ou intuições que se fazem sobre o perigo de uma situação, o que pode contribuir para a normalização do consumo. O objetivo do estudo foi analisar a percepção dos estudantes de uma universidade pública mexicana sobre a situação e a gravidade do uso de drogas em sua instituição por meio de vários indicadores. Materiais e métodos: analisou-se a base de dados derivada da aplicação do Questionário de Uso de Drogas em Estudantes Universitários (codeu-2), do qual participaram 19,815 estudantes; as comparações foram feitas de acordo com o gênero e a área acadêmica por meio de testes de qui-quadrado e análise post hoc de Bonferroni. Resultados: as mulheres relataram menor percepção de risco do que os homens nas variáveis analisadas (percepção dos participantes sobre o uso de drogas na faculdade, venda e gravidade do uso de drogas, por gênero e área acadêmica, e comportamentos de professores e alunos que facilitam o consumo de álcool e a atitude das autoridades universitárias perante estudantes consumidores, de acordo com o gênero e área acadêmica). Conclusão: os resultados mostram diferenças na percepção de homens e mulheres, bem como as diferenças associadas à inserção dos alunos nas diferentes áreas acadêmicas, para o que se sugere aprofundar o estudo desses aspectos.

Diseño y validez de contenido del cuestionario continuidad del cuidado entre niveles asistenciales / Design and content validity of the Continuity of Care Across Levels of Care Questionnaire

Introducción: La falta de continuidad del cuidado puede ocasionar omisiones o duplicaciones en las acciones dirigidas al cuidado de usuarios con Enfermedades Crónicas No Transmisibles (ECNT), generando un posible deterioro de su salud. Particularmente, en México y Colombia no existe un instrumento que evalúe la continuidad del cuidado que incluya sus tres elementos esenciales. Objetivos: Diseñar un instrumento que evalúe la continuidad del cuidado entre niveles asistenciales en usuarios con ECNT en México y Colombia; y validar el contenido del cuestionario por medio de un juicio de expertos en versiones adaptadas al contexto mexicano y colombiano. Materiales y Métodos: Se diseñó el cuestionario Continuidad del Cuidado entre Niveles Asistenciales. Se realizó el proceso de validación de contenido por expertos usando el método Delphi. Se seleccionaron 16 jueces expertos (8 por país). Los ítems del cuestionario fueron evaluados bajo cuatro categorías: suficiencia, claridad, coherencia y relevancia. Se realizaron dos rondas de evaluación para determinar el grado de concordancia entre jueces. Resultados: El cuestionario obtuvo un Coeficiente de Validez de Contenido General "Excelente" para ambos países (0,97). La versión final quedó conformada por 85 ítems divididos en tres secciones. Discusión: Este instrumento, a diferencia de otros, evalúa desde la experiencia de los usuarios con ECNT la continuidad del cuidado de forma multidisciplinaria en los tres niveles de atención. Conclusión: El cuestionario alcanzó una validez de contenido esperada usando el método Delphi, para evaluar la continuidad del cuidado entre niveles asistenciales en usuarios con ECNT según el contexto mexicano y colombiano.

Introduction: In the absence of continuity of care, actions aimed at the care of users with chronic non-communicable diseases (NCDs) may be omitted or duplicated, which can potentially worsen users' health. In Mexico and Colombia, in particular, there is no instrument for assessing continuity of care that includes its three essential elements. Objective: To develop an instrument to assess care continuity across levels of care for users with NCDs in Mexico and Colombia and validate the content of the questionnaire through expert judgment of versions adapted to the Mexican and Colombian contexts. Materials and Methods: The Continuity of Care across Levels of Care Questionnaire was designed. The content validation process was carried out by experts using the Delphi technique. Sixteen experts were selected (8 per country). Questionnaire items were assessed in four categories: sufficiency, clarity, coherence, and relevance. Two assessment rounds were conducted to determine the level of experts' agreement. Results: The questionnaire obtained an 'Excellent' overall Content Validity Coefficient in both countries (0.97). Discussion: This instrument, unlike others, assesses the continuity of care in a multidisciplinary manner across the three levels of care from the experience of users with NCDs. Conclusion: The questionnaire achieved the expected content validity using the Delphi technique to assess care continuity across levels of care for users with NCDs, according to the Mexican and Colombian contexts.

Introdução: A falta de continuidade do cuidado pode ocasionar omissões ou duplicidades nas ações voltadas para o atendimento aos usuários com Doenças Crônicas Não Transmissíveis (DCNT), gerando um possível agravamento de sua saúde. Particularmente, no México e na Colômbia não existe um instrumento que avalie a continuidade do cuidado que inclua seus três elementos essenciais. Objetivo: Desenhar um instrumento que avalie a continuidade do cuidado entre os níveis de atenção em usuários com DCNT no México e na Colômbia; e validar o conteúdo do questionário por meio de julgamento de especialistas em versões adaptadas ao contexto mexicano e colombiano. Materiais e Métodos: Foi elaborado o questionário de Continuidade de Cuidados entre os Níveis de Cuidados. O processo de validação de conteúdo foi realizado por especialistas por meio do método Delphi. Foram selecionados 16 juízes especialistas (8 por país). Os itens do questionário foram avaliados em quatro categorias: suficiência, clareza, coerência e relevância. Duas rodadas de avaliação foram realizadas para determinar o grau de concordância entre os juízes. Resultados: O questionário obteve um Coeficiente de Validade de Conteúdo Geral "Excelente" para ambos os países (0,97). A versão final foi composta por 85 itens divididos em três seções. Discussão: Este instrumento, diferente de outros, avalia a partir da experiência dos usuários com DCNT a continuidade do cuidado de forma multidisciplinar nos três níveis de atenção. Conclusão: O questionário atingiu a validade de conteúdo esperada usando o método Delphi, para avaliar a continuidade do cuidado entre níveis de atenção em usuários com DCNT de acordo com o contexto mexicano e colombiano.

Variables predictoras de la calidad de vida durante la pandemia de Covid-19 en adultos latinoamericanos

Objetivo: Evaluar las variables predictoras de la calidad de vida en población adulta latinoamericana en situación de pandemia durante la cuarentena por COVID-19. Métodos: Estudio descriptivo, trasversal. La muestra estuvo compuesta por 3101 habitantes adultos de Chile, Colombia, México y Perú. Los factores que aumentaron la probabilidad de tener una baja calidad de vida se identificaron mediante un análisis de regresión logística. Estos análisis fueron ajustados por estado nutricional, edad y procedencia geográfica. Resultados: Ser de género femenino (OR=1.73; p=0.001), físicamente inactivo/a (OR=1.85; p=0.001), consumir tabaco (OR=1.29; p=0,026), alcohol (OR=1.31; p=0,002) y comida chatarra (OR=2.04; p=0,001) aumentaron la probabilidad de tener una disminución en la dimensión salud general de la calidad de vida durante una cuarentena por Covid-19. Conclusiones: Los hallazgos en este estudio confirman la necesidad de promover hábitos y estilos de vida saludables en la población durante las cuarentenas en una pandemia como, por ejemplo, una dieta sana, practicar actividad física y evitar estar mucho tiempo sentado.

Objective: To evaluate the predictive variables of the quality of life in the Latin American adult population in a pandemic situation during the Covid-19 quarantine. Methods: Descriptive, cross-sectional study. The population was composed of 3,101 adult inhabitants of Chile, Colombia, Mexico and Peru. Factors that increased the likelihood of poor quality of life were identified using logistic regression analysis. These analyzes were adjusted for nutritional status, age, and geographic origin. Results: Being female (OR=1.73; p=0.001), physically inactive (OR=1.85; p=0.001), consuming tobacco (OR=1.29; p=0.026), alcohol (OR=1.31; p=0.002) and junk food (OR=2.04; p=0.001) increased the probability of having a decrease in the general health dimension of quality of life during a Covid-19 quarantine. Conclusions: The findings in this study confirm the need to promote healthy habits and lifestyles in the population during quarantines in a pandemic, such as a healthy diet, practicing physical activity and avoiding prolonged sitting.

[Out-of-pocket expenditure by elderly adults enrolled in a public health insurance programme in Mexico]. / Gasto de bolsillo en adultos mayores afiliados a un seguro público de salud en México.

OBJECTIVE: To identify the association between various sociodemographic variables and out-of-pocket expenditure on health by elderly people enrolled in Seguro Popular (SP). METHOD: Analytical cross-sectional study. An in-person survey was administered to users of three outpatient clinics in the state of Veracruz: a health centre (first level), regional hospital (second level) and highly specialised hospital. The out-of-pocket expenditure on health was analysed using a generalised linear model. RESULTS: The sample consisted of 1,049 beneficiaries of SP over age 60 with a response rate of 97.7%. The monthly out-of-pocket expenditure on health was $64.80 (95% confidence interval [95% CI]: 59.90-69.80). The highest expense category was drugs that are included in the SP ($28.80; 95% CI: 25.80-31.70) and drugs that are not covered by the SP ($8.00; 95% CI: 6.70-9.20). CONCLUSIONS: People over age 60 enrolled in SP pay out of their pocket to meet their health needs, despite having public health insurance. This represents an inequity in access, especially for the most vulnerable such as the rural population.

Factores socio demográficos y de estilos de vida asociados a un bajo nivel de actividad física durante el confinamiento producto del COVID-19 en adultos latinoamericanos / Factors associated with inactivity during COVID-19 confinement among Latin American adults

BACKGROUND: The confinement caused by the COVID-19 pandemic changed the lifestyles of the population affecting their levels of physical activity. AIM: To determine the factors associated with a low level of physical activity in adults during confinement during the COVID-19 pandemic. MATERIAL AND METHODS: Adults from Chile, Colombia, México and Perú were invited through social networks to answer an online survey. Questions about sociodemographic, health status and lifestyle variables were included. The level of physical activity and sedentary behavior were determined through the short version of the International Physical Activity Questionnaire (IPAQ). Results: The survey was answered by 3,362 adults aged between 18 and 60 years. Respondents more likely to be inactive were women, those with less than eight years of education, those with overweight or obesity, those who smoked at least one cigarette a day, consumed alcohol four or more times a week, slept less than six hours per day and spent more than 6 hours per day in sedentary behaviors. CONCLUSIONS: These findings provide a sociodemographic and lifestyle profile associated with physical inactivity during the period of confinement in Latin American adults. The results confirm the need to promote healthy lifestyles in the population during periods of confinement.

Caracterización clínica y sociodemográfica de mujeres embarazadas con COVID-19 hospitalizadas / Clinical and sociodemographic characterization of pregnant women hospitalized with COVID-19

Resumen Introducción: En las mujeres embarazadas se identifica mayor riesgo de desarrollar infecciones respiratorias virales. Objetivo: Analizar características sociodemográficas, evolución, manifestaciones clínicas y complicaciones en mujeres embarazadas con COVID-19 que fueron hospitalizadas. Métodos: Estudio en 11 hospitales públicos; se incluyeron variables sociodemográficas, comorbilidades, síntomas y signos, hallazgos de laboratorio y gabinete, características del embarazo, tratamiento y desenlace de la gestación. Resultados: La edad osciló entre 15 y 40 años; 85.1 % cursaba el tercer trimestre del embarazo, 11.9 % el segundo y 3 % el primero; 27 % presentó alguna comorbilidad como obesidad, hipertensión o asma; 89.5 % presentó fiebre, 73.1 % tos, 44.8 % disnea, 43.3 % cefalea y 35.8 % mialgias. Los diagnósticos fueron enfermedad leve (55.2 %), neumonía leve (26.9 %), neumonía severa (10.4 %), neumonía severa con síndrome de distrés respiratorio agudo (4.5 %) y neumonía severa con choque séptico (3 %); 76.2 % recibió soporte de oxígeno no invasivo y 9 %, ventilación mecánica. Se interrumpió el embarazo en 53.8 %; 95.5 % egresó por mejoría y 4.5 % falleció. Conclusiones: El rango de edad y los síntomas coinciden con los señalados en la literatura especializada. En mujeres con COVID-19 se evidenció el incremento de la operación cesárea sin una indicación clara.

Abstract Introduction: In pregnant women, a higher risk for developing viral respiratory infections is identified. Objective: To analyze sociodemographic characteristics, evolution, clinical manifestations, and complications of pregnant women hospitalized with COVID-19. Methods: Study conducted at 11 public hospitals; sociodemographic variables, comorbidities, signs and symptoms, laboratory and imaging findings, pregnancy characteristics, treatment and pregnancy outcome were included for analysis. Results: Age ranged between 15 and 40 years; 85.1% were at third trimester of pregnancy, 11.9% at second and 3% at first; 27% had any comorbidity such as obesity, hypertension or asthma; 89.5% had fever, 73.1% cough, 44.8% dyspnea, 43.3% headache and 35.8% myalgia. Diagnoses were mild disease (55.2%), mild pneumonia (26.9%), severe pneumonia (10.4%), severe pneumonia with acute respiratory distress syndrome (4.5%), and severe pneumonia with septic shock (3%); 76.2% had noninvasive oxygen support, and 9%, mechanical ventilation. Pregnancy was interrupted in 53.8%; 95.5% were discharged due to improvement of their condition and 4.5% died. Conclusions: Age range and symptoms are consistent with those previously reported. Evidence was found of an increase in cesarean section without a clear indication in women with COVID-19.

Edad de inicio y consumo de alcohol en pacientes lesionados atendidos en los Servicios de Urgencias en XALAPA, MÉXICO / Idade do início e consumo de álcool Em pacientes lesados atendidos nos Serviços de emergência em Xalapa, México / Onset age and alcohol intake in injured patients treated at emergency rooms in Xapala, México

Objetivo: Identificar la asociación entre la edad de inicio del consumo de alcohol con el patrón de consumo y el consumo problemático en pacientes lesionados. Método: Estudio transversal en lesionados atendidos en el servicio de urgencias de dos hospitales públicos y que reporta-ron consumo de alcohol alguna vez en la vida. Variables: sexo, edad de inicio, consumo de alcohol antes de la lesión, patrón de consumo en el último año y consumo problemático. Resultados: Se incluyeron 354 pacientes, la media de edad de inicio del consumo de alcohol fue 17±4 años. Se observaron diferencias significativas entre la edad de inicio con: sexo (p=0.006), consumo de alco-hol antes de la lesión(p=0.001) y consumo problemático (p=0.001). Conclusión: En el presente estudio se observó que a menor edad de inicio del consumo de alcohol ma-yor consumo problemático y un patrón de consumo alto y consuetudinario. Es necesario establecer estrategias es-pecíficas de intervención para la reducción del consumo de alcohol a edades tempranas.

Objective: To identify the association between alcohol consumption onset age with consumption pattern and troublesome consumption in injured patients. Method: Cross sectional study in injured patients treated in emergency rooms in two public hospitals who reported alcohol consumption at least once in their lives. Variables: sex; onset age, alcohol consumption before the lesion, consumption pattern in the last year and troublesome consumption. Results: 354 patients were included; average alcohol consumption onset age was 17±4. Significant differences were observed between onset age with: sex (p=0.006), alcohol consumption before the lesion (p=0.001) and troublesome consumption (p=0.001). Conclusion: In this study it was observed that younger consumption onset age was associated with more troublesome alcohol consumption and high and customary consumption pattern. It is necessary to establish specific intervention strategies to reduce alcohol intake at early ages.

Objetivo: Identificar a associação entre a idade de início do consumo de álcool e o padrão de consumo e consumo problemático em pacientes lesados. Método: Estudo transversal de pacientes lesados atendidos no pronto-socorro de dois hospitais públicos e que relataram consumo de álcool em algum momento de suas vidas. Variáveis: sexo, idade de início, consumo de álcool antes da lesão, padrão de consumo no último ano e consumo problemático. Resultados: 354 pacientes foram incluídos, a idade média de início do consumo de álcool foi de 17 ± 4 anos. Diferenças significativas foram observadas entre a idade de início com: sexo (p = 0,006), consumo de álcool antes da lesão (p = 0,001) e consumo problemático (p = 0,001). Conclusão: No presente estudo, observou-se que quanto menor a idade de início do consumo de álcool, maior o consumo problemático e um padrão de consumo alto e habitual. É necessário estabelecer estratégias de intervenção específicas para a redução do consumo de álcool em idade precoce.

Factores asociados con la hospitalización por lesiones en pacientes atendidos en los servicios de urgencias / Factors associated with hospitalization for injuries in patients treated in emergency departments

RESUMEN Objetivo Identificar los factores asociados con la hospitalización por lesiones en pacientes atendidos en el servicio de urgencias de dos hospitales. Métodos Estudio transversal, en lesionados mayores de 15 años que solicitaron atención en el servicio de urgencias de dos hospitales de Xalapa, Veracruz, México. Se realizó un análisis bivariado y un análisis de regresión logística para estimar los riesgos mediante Odds Ratio (OR) e identificar los factores asociados con la probabilidad de hospitalización. Resultados De los 505 lesionados, 10,7% requirieron ser hospitalizados. El riesgo de hospitalización se asoció con el sexo masculino (OR=2,7, IC95% 1,2-6,1), la edad de 46 años o más (OR=2,3, IC95% 1,2-4,5), el consumo de alcohol antes de la lesión (OR=2,3, IC95% 1,2-4,6), la violencia (OR=2,3, IC95% 1,1-4,9). En cuanto al tipo de lesión, mostraron mayor riesgo las fracturas (OR=7,4, IC95% 3,0-17,8). Conclusión Los resultados de esta investigación mostraron que algunos factores presentan mayor riesgo de hospitalización por lesiones. Dicha información puede utilizarse para proponer estrategias y desarrollar intervenciones que puedan incidir en la prevención de factores de riesgo que den como resultado lesiones graves que ameriten hospitalización.(AU)

ABSTRACT Objective To identify factors associated with hospitalization for injuries in patients treated in the emergency departments of two hospitals. Material and Methods Cross-sectional study on a sample of injured patients over the age of fifteen, who were treated in the emergency department of two hospitals in Xalapa, Veracruz, México. Bivariate analysis and logistic regression analysis were conducted to estimate the risks by odds ratio (OR) and to identify the factors associated with the likelihood of hospitalization. Results De los 505 lesionados, 10,7% requirieron ser hospitalizados. The risk of hospitalization was associated mainly to the male gender (OR=2.7, 95% CI 1.2-6.1), age 46 years or over (OR=2.3, 95% CI 1.2-4.5), drinking before the injury (OR = 2.3, 95% CI 1.2-4.6), and violence (OR=2.3, 95% CI 1.1-4.9). Regarding the type of injury, fractures showed the highest risk (OR=7.4, 95% CI 3.0-17.8). Conclusion The results showed that some factors increased the risk of hospitalization for injuries. Such information can be used to propose strategies and develop interventions that may influence prevention of risk factors that result in serious injuries that lead to hospitalization.(AU)

Consumo de drogas legales e ilegales y síntomas de depresión en adultos mayores usuarios de Facebook durante la pandemia por SARS-CoV-2 en México / Consumption of legal and illegal drugs and depressive symptoms in older adults during the SARS-CoV-2 pandemic in Mexico

Antecedentes: Los riesgos para la salud que enfrentan los adultos mayores son diversos; sin embargo, poco se ha explorado acerca del uso y abuso de sustancias psicoactivas en esta población. La reclusión impuesta por la situación que prevalece debido al SARS-CoV-2 ha incrementado los sentimientos de soledad, aislamiento y tristeza asociados a esta edad, que los convierte en un factor de riesgo para el consumo de drogas. Objetivo: Analizar el consumo de drogas legales e ilegales en el personas mayores de 60 años usuarios de Facebook®, y su relación con síntomas de depresión durante la pandemia por SARS-CoV-2.Material y métodosEstudio realizado a 380 personas mayores, usuarios de Facebook®, que respondieron un cuestionario publicado en línea, que indagó sobre: datos sociodemográficos, frecuencia y cantidad de consumo de drogas legales e ilegales y sintomatología depresiva. Resultados: El 50,26% fueron mujeres; la edad promedio fue de 6,79 años (DS=5,81); el 31,05% consumieron alcohol en los últimos 30 días, el 22,63% tabaco, tranquilizantes sin prescripción médica el 16,05% y mariguana el 7,89%. El consumo de otras drogas ilegales no superaron al 2,6% de la población. Al comparar entre consumidores y no consumidores, resultó que el consumo en los últimos 30 días fue ligeramente mayor en mujeres y en solteros, y no se observaron diferencias en función del nivel de escolaridad. Los síntomas de depresión leve y grave se encontró asociada con todas las drogas a excepción de tabaco y opiáceos. Discusión y conclusiones: Los resultados obtenidos demuestran la necesidad de visibilizar el consumo de drogas entre los adultos mayores, y de desarrollar estrategias que disminuyan las alteraciones anímicas que pueden estar experimentando, como el miedo, la angustia y la depresión. (AU)

Background: The health risks faced by older adults are diverse; however, little has been explored about the use and abuse of psychoactive substances in this population. The seclusion imposed by the situation that prevails due to SARS-CoV-2 has increased the feelings of loneliness, isolation and sadness associated with this age, which makes them a risk factor for drug use. Objective: To analyze the consumption of legal and illegal drugs in people over 60 years of age who are Facebook users and its relationship with symptoms of depression during the SARS-CoV-2 pandemic. Material and methods: Study carried out on 380 elderly people, Facebook users, who answered a questionnaire published online, which inquired about: sociodemographic data, frequency and amount of legal and illegal drug use, and depressive symptomatology. Results: 50.26% were women; the average age was 66.79 years (SD=5.81); 31.05% consumed alcohol in the last 30 days, 22.63% tobacco, tranquilizers without medical prescription 16.05% and marijuana 7.89%. The consumption of other illegal drugs did not exceed 2.6% of the population. When comparing between users and non-users, it turned out that consumption in the last 30 days was slightly higher in women, in single people and no differences were observed depending on the level of schooling. Mild and severe depressive symptoms were found to be associated with all drugs except tobacco and opiates. Discussion and conclusions: The results obtained demonstrate the need to make drug use visible among older adults and to develop strategies that reduce the mood disorders they may be experiencing, such as fear, anguish and depression. When comparing between users and non-users, it turned out that consumption in the last 30 days was slightly higher in women, in single people and no differences were observed depending on the level of schooling. (AU)

Gasto de bolsillo en adultos mayores afiliados a un seguro público de salud en México / Out-of-pocket expenditure by elderly adults enrolled in a public health insurance programme in Mexico

Objetivo: Identificar la asociación de distintas variables sociodemográficas con el gasto de bolsillo en servicios de salud en adultos de 60 años y más afiliados al Seguro Popular (SP). Método: Estudio transversal analítico. Se realizó una encuesta a través de una entrevista cara a cara a usuarios de la consulta externa de tres unidades médicas del estado de Veracruz: centro de salud (primer nivel), hospital regional (segundo nivel) y hospital de alta especialidad. El gasto de bolsillo en salud en el último año se analizó con el modelo lineal generalizado. Resultados La muestra fue de 1049 adultos de 60 años y más beneficiarios del SP y la tasa de respuesta fue del 97,7%. El gasto de bolsillo en salud mensual fue US$ 64,8 (intervalo de confianza del 95% [IC95%]: 59,9-69,8). El rubro con mayor gasto fueron los medicamentos incluidos en el SP (US$ 28,8; IC95%: 25,8-31,7) y los medicamentos que no cubre el SP (US$ 8; IC95%: 6,7-9,2). Conclusiones Los adultos de 60 años y más afiliados al SP pagan de su bolsillo para atender su salud, a pesar de contar con un seguro público de salud, lo que representa una inequidad en el acceso, principalmente para los más vulnerables, como son la población rural (AU)

Objective: To identify the association between various sociodemographic variables and out-of-pocket expenditure on health by elderly people enrolled in Seguro Popular (SP). Method: Analytical cross-sectional study. An in-person survey was administered to users of three outpatient clinics in the state of Veracruz: a health centre (first level), regional hospital (second level) and highly specialised hospital. The out-of-pocket expenditure on health was analysed using a generalised linear model. Results: The sample consisted of 1,049 beneficiaries of SP over age 60 with a response rate of 97.7%. The monthly out-of-pocket expenditure on health was $64.80 (95% confidence interval [95% CI]: 59.90–69.80). The highest expense category was drugs that are included in the SP ($28.80; 95% CI: 25.80–31.70) and drugs that are not covered by the SP ($8.00; 95% CI: 6.70–9.20). Conclusions: People over age 60 enrolled in SP pay out of their pocket to meet their health needs, despite having public health insurance. This represents an inequity in access, especially for the most vulnerable such as the rural population (AU)

Calidad de la atención desde la perspectiva del usuario en una comunidad terapéutica en Veracruz, México / Quality of care considering the user perspective in a therapeutic community in veracruz, Mexico

Introducción. En México, uno de los problemas de salud pública son las adicciones, las cuales constituyen un fenómeno social con graves secuelas sanitarias y socioeconómicas de dimensiones considerables. Objetivo. Evaluar la calidad de la atención desde la perspectiva del usuario, en una comuni-dad terapéutica del estado de Veracruz, México.Métodos. Estudio transversal y analítico; la población fueron usuarios de la comunidad. Se utilizaron las pruebas ro de Spearman, biserial puntual, tau c de Kendall y ji al cuadrado (p≤0,05). Resultados. Se incluyeron61 usuarios, con media de edad de 33 años y primer consumo entre los 8 y los 17 años. La mayor frecuencia de estancia fueron, cuatro meses (62,3 %). El 96,7 % estaba conforme con la ubicación de la comunidad terapéutica y, el 95,1 %, a gusto con los servicios disponibles. A mayor edad, más miembros de la comunidad consideraron: adecuadas la ubicación (rbp=0,25) y la distancia al núcleo urbano más próximo (rbp =0,27); suficiente el tratamiento psicológico individual (p=0,015; ro=0,311), y suficientes las salidas individuales durante el tratamiento (p=0,028; ro=0,281). A mayor tiempo en el centro, más miembros de la comunidad consideraron insuficientes (p=0,036; ro=-0,187) las salidas indi-viduales durante el tratamiento y suficiente la diversidad del grupo (p=0,031; ro=0,193). La mayoría de los residentes consideraron suficientes el tiempo en la comunidad, la formación profesional y la variedad de profesionales, y como muy bueno, el trato del personal. Conclusiones.Las variables e indicadores estudiados fueron evaluados satisfactoriamen-te. Sin embargo, es importante la evaluación permanente para detectar áreas que pueden mejorar y hacer la corrección oportuna, como una estrategia organizativa fundamental para fortalecer los indicadores de calidad en la prestación del servicio.

Introduction: Addictions are one of the public health problems in México. They establish a social phenomenon that leads to serious consequences on the sanitary and socioeconomic field. Objective: To evaluate the quality of care considering the user perspective in a therapeutic community located in Veracruz, México. Methods: Cross-sectional and analytic study. Population: Users of the Therapeutic Commu-nity. The following tests were applied: Spearman's rho, Point-biserial correlation, Kendall's Tau-c and Chi-squared (p≤ 0.05). Results: Sixty one users were included, average age 33 years, first drug use between 8 and 17 years; the highest frequency was 4 months (62.3%). 96.7% expressed agreement with the location of the T.C. and 95.1% were satisfied with the available services. The older members of the community considered more suitable the location of the facility (rbp =0.25), also the distance to the closest city (rbp =0.27). They considered adequate the amount of Individual psychological treatment (p=0.015, rho=0.311) as well as adequate, the reinser-tion activities during treatment (p= 0.028, rho=0.281). Those with higher inpatient stay considered that these reinsertion activities were not enough (p=0.036, rho=-0.187) and they estimated as adequate the diversity of the group (p= 0.031, rho=0.193). Most users considered that the time they spent in the therapeutic community, the professional training, and diversity of the staff members were adequate and the care staff behavior was conside-red as very good. Conclusion: The variables and indicators studied were successfully evaluated. However, it is important ongoing assessment in order to identify areas to improve and make the due co-rrection, as a key organizational strategy to strengthen the quality indicators in the service.