Barreiras no acesso à Atenção Básica pela população LGBTQIA+: uma revisão integrativa / Barriers to access to Primary Care for the LGBTQIA+ population: an integrative review / Barreras de acceso a la Atención Primaria para la población LGBTQIA+: una revisión integradora

Introdução: A população LGBT constitui um grupo cujo acesso à saúde é historicamente limitado e ainda hoje é atravessado por questões complexas que envolvem desde a formação dos profissionais de saúde à própria estrutura organizacional do sistema assistencial. Apesar disso, a literatura científica acerca dos entraves que estes indivíduos enfrentam na Atenção Primária à Saúde (APS), porta de entrada e coordenadora do cuidado, é particularmente escassa. Objetivo: Caracterizar as barreiras envolvidas no acesso da população LGBTQIA+ à APS. Métodos: Trata-se de uma revisão integrativa de estudos científicos selecionados nas plataformas de busca PubMed e Portal Regional da Biblioteca Virtual em Saúde (BVS), sendo utilizados como descritores de busca os termos Minorias Sexuais e de Gênero, LGBTQIA+, APS e Acesso aos Serviços de Saúde. Foram incluídos artigos completos sem restrição de período nos idiomas inglês, português e espanhol. Foram excluídos textos do tipo: revisão bibliográfica; editorial; protocolos de estudo; opinião de especialistas e relato de experiência. Resultados: Foram selecionados 14 artigos, sendo seus conteúdos atribuídos a três eixos de discussão: barreiras físicas/organizacionais, barreiras sociais e barreiras relacionadas à educação/formação dos profissionais da saúde. Conclusões: É essencial expandir as discussões sociais acerca da temática de diversidade sexual e de gênero de modo a desconstruir os preconceitos instituídos; ademais, faz-se fundamental a revisão da estrutura física e organizacional ­ bem como da formação dos profissionais da saúde ­ para criar um ambiente assistencial inclusivo na atenção básica à população LGBTQIA+.

Introduction: The LGBT population is a group whose access to health care has historically been limited and is still crossed by complex issues ranging from the training of health professionals to the very organisational structure of the care system. Despite this, the scientific literature on the obstacles faced by these individuals in Primary Health Care, the gateway and coordinator of care, is particularly scarce. Objective: To characterize the barriers involved in the access of the LGBTQIA+ population to primary care. Methods: This is an integrative review of scientific studies selected from the PubMed and Virtual Health Library (VHL) Regional Portal search platforms, using as search descriptors the terms Sexual and Gender Minorities, LGBTQIA+, Primary Health Care, Health Services Accessibility. Complete articles were included without time restriction, in English, Portuguese and Spanish. Texts such as: literature reviews; editorials; study protocols; expert opinions and experience reports were excluded. Results: The review was composed by the selection of 14 studies, and their contents were assigned to three axes of discussion: physical/organizational barriers, social barriers, barriers related to education/training of health professionals. Conclusions: It is essential to expand the social discussions about the theme of sexual and gender diversity to deconstruct the established prejudices, moreover, it is essential to review the physical and organizational structure ­ as well as the training of health professionals ­ to create an inclusive care environment.

Introducción: La población LGTB es un colectivo cuyo acceso a la atención sanitaria ha estado históricamente limitado y sigue atravesado por complejas cuestiones que van desde la formación de los profesionales sanitarios hasta la propia estructura organizativa del sistema asistencial. A pesar de ello, la literatura científica sobre los obstáculos a los que se enfrentan estas personas en la Atención Primaria de Salud, puerta de entrada y coordinadora de la atención, es especialmente escasa. Objetivo: Caracterizar las barreras que supone el acceso de la población LGBT a la atención primaria. Métodos: Se trata de una revisión integradora de estudios científicos seleccionados de las plataformas de búsqueda PubMed y Portal Regional de la Biblioteca Virtual de Salud (BVS), utilizando como descriptores de búsqueda los términos Minorías Sexuales y de Género, LGBT, Atención Primaria de Salud, Accesibilidad a los Servicios de Salud. Se incluyeron artículos completos sin restriccíon de período, en inglés, portugués y español. Se excluyeron textos como revisiones bibliográficas, editoriales, protocolos de estudio, opiniones de expertos e informes de experiencias. Resultados: El corpus final de artículos se compuso de la selección de 14 artículos, y sus contenidos se asignaron a tres ejes de discusión: barreras físicas/organizativas, barreras sociales, barreras relacionadas con la educación/formación de los profesionales sanitarios. Conclusiones: Es esencial ampliar las discusiones sociales sobre el tema de la diversidad sexual y de género de manera que se deconstruyan los prejuicios institucionales, además, se hace fundamental la revisión de la estructura física y organizacional ­ así como la formación de los profesionales de la salud ­ para crear un ambiente asistencial inclusivo.

Accessibility in video games for the visually impaired population in Colombia / Accesibilidad en los videojuegos para población con discapacidad visual en colombia

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ABSTRACT In recent years, the change in the design of video games has become evident, one of them is accessibility for people with different disabilities, despite the laws, which are very limited, there are no standards that require companies, industries and producers from different sectors implement this resource in their projects. From this research, the objective is to investigate the importance that these inclusion games comply with the response to stimuli provided by the industry, in this field, and that the support that the country is giving to this need to be felt is also felt. this visually impaired population. Based on the mixed research methodology, different sources are investigated in order to demonstrate how necessary it is that there are models of inclusion in video games, both entertainment and educational (serious), thus reaching an identity model that. The lack of laws and resources that promote this industry is evidenced. The project made it possible to describe the main strategies and resources that have been proposed and/or implemented in terms of accessibility for people with visual disabilities in Colombia, investigating and comparing the information obtained from the state of the art, and in this way conclude with the impact of these development methods, in the visually impaired population. An important impact has been the technological evolution that other countries have managed to develop for this type of population. As a conclusion, a disparity was found in the development of this project, which is precisely the little accessibility that people with visual disabilities have to video games in Colombia, because beyond the interaction that exists with some, much more access is required. And above all more investment and enactment of laws that support this resource. Using the mixed research methodology, different sources are investigated in order to demonstrate how necessary it is that there are models of inclusion in video games, both entertainment and educational (serious), thus reaching an identity pattern that gives as shows the lack of laws and resources that promote this industry. From this type of research, it was concluded that the lack of resources has been a legible mark that passes through these industries that have the panorama quite compromised by the demands of the market, but that due to this lack of economic resources they cannot reach the levels of implementation. to its mission and vision. Observing what was said above, it becomes complex to be able to carry out a research that clearly defines the inclusion processes for this type of people with said disability in Colombia. Each model of each industry is defined in a different way, since not all of them have this offer in their services. Common to this type of population. What, then, allowed us to conclude this research, finding social differences in each production of a video game? The project allowed us to describe the main strategies that have been proposed and/or implemented in terms of accessibility for people with visual disabilities in Colombia, investigating and comparing the information obtained from the state of the art, as mentioned above. Thus, then, different responses were found to this inclusion, not only in entertainment games but also in educational ones, which in the end are also very important in the classroom, because not only should one think about the distraction game, but also about the playful nature of teaching, thus helping teachers in the development of their classes. In this way, we conclude with the impact of these development methods on the visually impaired population. Another important point that could be evidenced is the evolution of technology, which has brought haptic systems, immersive and dynamic audio, as well as braille itself in digital systems, this, of course, has allowed progress towards much more logical and dynamic resources, but they continue to be limited precisely because they cannot be implemented correctly, due to their high purchasing value. We must think not of people who suffer from visual disabilities, but rather we must think of all social strata with this type of disability who can, with their resources, access this type of technology. Each part of the intervention exercise with state and private companies led to results that concluded in the population with visual disabilities that does not have the possibility of accessing this exercise of inclusion, and beyond the common interest in popularizing these video games, the limitation of certain sectors is seen that do not find in this undertaking a great industry, since the majority assures that it is more lucrative to invest in video games for people without no limitation or disability than investing in this other type of video game In conclusion, the disabled population in Colombia is 3,134,037; this number is very high if we also consider the rural populations that live without any type of resource or technological reach; Due to their socioeconomic condition and location, they are people who have a deterioration in services, then what is the extent of the disabled population in these areas that do not have the support and resources to improve their quality of life? It is almost null, there is no possibility that in the most vulnerable places and far from the reach of the government, inclusion exercises will be carried out with the visually disabled population, because simply in the last population census that was carried out in Colombia in 2018, more than 50% of the population They do not access the Internet, this added to governments that waste state money, it could be said that the level exceeds that percentage. If so, it is very possible that the reach of this population to these technological resources is very bad. A lot of economic investment is required on the part of the state, and for the designers of these technologies to expand to cover their creative enterprises, to the entire population, without the right to exclusion. For this reason, in this project a disparity is evident, which is precisely the little accessibility that people with visual disabilities have to video games in Colombia, not only from entertainment, but from their spaces in the classroom, which is what many demands. academics for their models and resources to work with this population, because beyond the interaction that exists with some (very few), much more access is still required and above all more investment and enactment of laws that support said resource.

Implementación de un modelo de complementación público-privado (AMSJ - ASSE) de Asistencia Paliativa en el departamento de San José, Uruguay

Introducción: En inicios del año 2015 se implementa el convenio de complementación público-privado entre los dos principales prestadores del Departamento de San José - Uruguay: AMSJ y ASSE San José, conformándose así la Unidad Departamental de Medicina Paliativa de San José (UDMP). El convenio tiene como principal objetivo asegurar la asistencia paliativa a todos los usuarios de los prestadores involucrados con los principios fundamentales de calidad, equidad y accesibilidad, siguiendo los lineamientos del Plan Nacional de Cuidados Paliativos del Ministerio de Salud Pública de Uruguay. El objetivo es describir y analizar la experiencia de la implementación del primer modelo de complementación público-privado del país en Cuidados Paliativos (CP). Metodología: Estudio descriptivo analítico, retrospectivo que incluye datos de los primeros siete años de funcionamiento del convenio. Resultados: El convenio de complementación público-privado en el Departamento de San José, permitió la creación de un equipo interdisciplinario que asistió en forma continua a 1422 pacientes provenientes de zonas urbanas y rurales, portadores de diversas patologías. La cobertura departamental de CP aumentó de forma significativa, pasando de 24 % en 2014 a 57% en 2021. Estos resultados se lograron implementando un modelo de asistencia paliativa que asegura la continuidad asistencial en internación, consultorio y domicilio, que permitió respetar la autonomía del paciente, logrando el fallecimiento de 67% de los pacientes en su hogar. La satisfacción de usuarios y familiares de la asistencia brindada fue evaluada como muy buena. Conclusiones: El convenio de complementación resultó ser una herramienta eficiente para favorecer el acceso a CP, evitando la superposición de equipos en la asistencia domiciliaria en todo el departamento de San José.

Introduction: At the beginning of 2015, the public-private complementarity agreement was implemented between the two main providers of the Department of San José Uruguay: AMSJ and ASSE San José, thus forming the Departmental Unit of Palliative Medicine of San José (UDMP). The main objective of the agreement is to ensure palliative care to all users of the providers involved, with the fundamental principles of quality, equity and accessibility, following the guidelines of the National Palliative Care Plan of the Ministry of Public Health of Uruguay. The objective is describe and analyze the experience of implementing the country's first public-private complementation model in Palliative Care (PC). Methodology: Descriptive, analytical, retrospective study that includes data from the first seven years of operation of the agreement. Results: The public-private complementation agreement in the Department of San José allowed the creation of an interdisciplinary team that continuously assisted 1,422 patients from urban and rural areas, with various pathologies. Departmental CP coverage increased significantly, from 24% in 2014 to 57% in 2021. These results were achieved by implementing a palliative care model that ensures continuity of care in hospitalization, office and home, which allowed the patient's autonomy to be respected, achieving the death of 67% of patients at home. The satisfaction of users and family members with the assistance provided was evaluated as very good. Conclusions: The complementation agreement turned out to be an efficient tool to promote access to CP, avoiding the overlap of teams in home care throughout the department of San José.

Introdução: No início de 2015, foi implementado o acordo de complementaridade público-privado entre os dois principais prestadores do Departamento de San José Uruguai: AMSJ e ASSE San José, formando assim a Unidade Departamental de Medicina Paliativa de San José (UDMP). O principal objetivo do acordo é garantir cuidados paliativos a todos os usuários dos prestadores envolvidos, com os princípios fundamentais de qualidade, equidade e acessibilidade, seguindo as diretrizes do Plano Nacional de Cuidados Paliativos do Ministério de Saúde Pública do Uruguai. El objetivo es descrever e analisar a experiência de implementação do primeiro modelo de complementação público-privada em Cuidados Paliativos (CP) do país. Metodologia: Estudo descritivo, analítico, retrospectivo que inclui dados dos primeiros sete anos de vigência do convênio. Resultados: O acordo de complementação público-privada no Departamento de San José permitiu a criação de uma equipe interdisciplinar que atendeu continuamente 1.422 pacientes de áreas urbanas e rurais, com diversas patologias. A cobertura departamental do CP aumentou significativamente, de 24% em 2014 para 57% em 2021. Estes resultados foram alcançados através da implementação de um modelo de cuidados paliativos que garante a continuidade dos cuidados no internamento, no consultório e no domicílio, o que permitiu respeitar a autonomia do doente, atingindo a morte de 67% dos doentes no domicílio. A satisfação dos usuários e familiares com a assistência prestada foi avaliada como muito boa. Conclusões: O convênio de complementação revelou-se uma ferramenta eficiente para promover o acesso à CP, evitando a sobreposição de equipes na atenção domiciliar em todo o departamento de San José.

Efectos de la COVID-19 en la calidad de la atención de los servicios de salud en Colombia: Revisión de literatura / Effects of COVID-19 on the quality of health care services in Colombia: a literature review / Efeitos da covid-19 na qualidade dos serviços de saúde na colômbia: revisão da literatura

Introducción: La pandemia por COVID-19 ha afectado significativamente la calidad de los servicios de cuidado de la salud. Objetivo: Analizar los efectos en los atributos de la calidad en salud de los servicios de atención de enfermedades diferentes a la COVID-19 en Colombia, durante el periodo 2020-2022. Materiales y métodos: Se analizaron 24 artículos de alcance nacional y otros específicos de departamentos como Antioquia, Córdoba, Santander y Cundinamarca. Resultados: La pandemia por COVID-19 impactó la calidad de los servicios en la atención de enfermedades como cáncer, accidentes cerebrovasculares y de eventos como la interrupción voluntaria del embarazo. Conclusión: La calidad de la salud se vio afectada en todas sus dimensiones durante las fases de la pandemia, especialmente en la población con enfermedades crónicas y relacionadas con la salud infantil y materna. Además, se destacaron respuestas como el uso de la telemedicina y de la atención domiciliaria para contribuir a la calidad de la salud en Colombia.

Introduction: The COVID-19 pandemic has significantly affected the quality of health care services. Objective: To analyze the effects of COVID-19 on the quality of health care services focused on treating diseases other than COVID-19 in Colombia during the 2020-2022 period. Materials and methods: 24 articles were analyzed, which included some studies focused on national issues and others specific to the departments of Antioquia, Cordoba, Santander, and Cundinamarca. Results: The COVID-19 pandemic affected the quality of health services caring for diseases such as cancer, strokes, and critical circumstances like voluntary termination of pregnancy. Conclusion: All dimensions of health care were affected during the pandemic, especially impacting populations with chronic diseases and diseases related to child and maternal health. It is important to highlight that telemedicine and home care contributed to improving the quality of health in Colombia.

Introdução: A pandemia de COVID-19 afetou significativamente a qualidade dos serviços de saúde. Objetivo: Analisar os efeitos da COVID-19 nos atributos de qualidade em saúde dos serviços de atenção a outras doenças além da COVID-19 na Colômbia, durante o período 2020-2022. Materiais e métodos: foram analisados 24 artigos de âmbito nacional e outros específicos de departamentos como Antioquia, Córdoba, Santander e Cundinamarca. Resultados: A pandemia da COVID-19 impactou a qualidade dos serviços no cuidado de doenças como câncer, acidente vascular cerebral e eventos como a interrupção voluntária da gravidez. Conclusão: A qualidade da saúde foi afetada em todas as suas dimensões durante as fases da pandemia, especialmente na população com doenças crônicas e doenças relacionadas à saúde infantil e materna. Além disso, foram destacadas respostas como o uso da telemedicina e do atendimento domiciliar para contribuir para a qualidade da saúde na Colômbia.

Accessibility of reproductive health services among women living in the informal settlements of Mathare slums, Nairobi City County, Kenya

Background: This study sought to determine the health facility-related factors and social factors associated with the accessibility of reproductive health services (RHS) among women living in the informal settlements of Mathare slums, Nairobi City County, Kenya. Methods: This cross-sectional study focused on Nairobi County, Kenya, specifically targeting Mathare slums, known for poor reproductive health (PRH) indicators among women. Three hundred women were randomly recruited from four villages (Mathare 3B, Mathare 4A, Kosovo, and Mathare village 2). Results: The majority of respondents were aged 18-29 years (48.7%), had primary education (61.7%), were married (58.7%), and unemployed (69.3%). Significant associations were observed between accessibility and the woman's age (?2=83.013, df=1, p<0.001), education level (p<0.001), marital status (p<0.001), and employment status (?p<0.001). Significant health facility barriers to accessibility encompassed long distances to health facilities (p<0.001), transportation cost constraints (p<0.001), difficult terrain (p<0.001), cost of services (p<0.001), services provided by health facilities (p<0.001), and availability of required medications (p<0.001). Discouragement by friends or family (p<0.001), the perceived influence of age on RHS accessibility (p<0.001), the perceived influence of education level on RHS choices (p=0.014), and the perceived role of a spouse in influencing RHS (p=0.002) were all significant social factors associated with accessibility to RHS. Conclusions: Health facilities and social factors presented complex challenges, including geographical barriers, transportation costs, and medication availability, while spouse involvement, education's influence, and familial discussions positively impacted accessibility.

Acesso a serviço de saúde e reabilitação auditiva de adultos e idosos durante o período inicial da pandemia COVID-19 no Brasil / Access to health service and hearing rehabilitation for adult and older adults during the initial period of the COVID-19 pandemic in Brazil / Acceso a servicios de salud yrehabilitación auditiva para adultos y ancianos durante el período inicial de la pandemia COVID-19 en Brasil

Introdução: A perda auditiva é uma deficiência comum na população mundial e contribui para dificuldade na comunicação verbal e redução da qualidade de vida, evidenciando a importância da identificação precoce, reabilitação e acompanhamento audiológico dessa deficiência para mitigar suas consequências. Durante a pandemia da COVID-19, as medidas restritivas diminuíram a capacidade de atendimento dos serviços de saúde auditiva e dificultaram a busca de auxílio para resolver problemas relacionados à adaptação aos dispositivos eletrônicos de amplificação sonora (DAES), sendo uma barreira no processo de reabilitação da perda auditiva. Objetivo: Caracterizar os usuários de DEAS e o processo inicial de reabilitação auditiva de adultos e idosos e verificar fatores associados ao retorno para a consulta de monitoramento auditivo durante o período inicial da pandemia da COVID-19.Métodos: Estudo observacional transversal com usuários adultos e idosos de um serviço ambulatorial de saúde auditiva com retorno para consulta de monitoramento auditivo agendada no período inicial da implementação das medidas restritivas da pandemia da COVID-19 no Brasil. Resultados: A maioria dos participantes conseguiu retornou para a consulta de monitoramento auditivo, sendo eles em sua maioria idosos, do sexo feminino e vacinados contra a COVID-19. Houve maior prevalência de adaptação adequada aos DAES. Não houve associação estatística entre as variáveis relacionadas à adaptação aos DAES, COVID-19 e saúde mental e o retorno à consulta de monitoramento auditivo. Conclusão: Os fatores relacionados à adaptação aos DAES, à COVID-19 ou à saúde mental não influenciaram o retorno à consulta de monitoramento auditivo na presente pesquisa. (AU)

Introduction: Hearing loss is a common disability in the world population and contributes to difficulty in verbal communication and reduced quality of life, highlighting the importance of early identification, rehabilitation and audiological monitoring of this disability to mitigate its consequences. During the COVID-19 pandemic, restrictive measures reduced the service capacity of hearing health services and made it difficult to seek help to solve problems related to adaptation to personal sound amplification products (PSAPs), being a barrier in the rehabilitation process of hearing loss. Aim: To characterize PSAPs users and the initial hearing rehabilitation process for adults and elderly people and verify the factors associated with the return to hearing monitoring consultations in the initial period of the COVID-19 pandemic. Methods: Cross-sectional observational study with adults and elderly people: elderly users of an outpatient hearing health service who return for a scheduled hearing monitoring consultation in the initial period of the implementation of restrictive measures of the COVID-19 pandemic in Brazil. Results: Most participants were able to return to the hearing monitoring clinic, the majority of whom were elderly, female and vaccinated against COVID-19. There was a higher prevalence of adequate adaptation to the PSAPs. There was no statistical association between variables related to adaptation to PSAPs, COVID-19 and mental health and return to hearing monitoring consultation. Conclusion: Factors related to adaptation to PSAPs, COVID-19 or mental health did not influence the return to hearing monitoring consultation in the present investigation. (AU)

Introducción: La pérdida auditiva es una discapacidad común en la población mundial y contribuye a la dificultad en la comunicación verbal y a la reducción de la calidad de vida, destacando la importancia de la identificación temprana, rehabilitación y seguimiento audiológico de esta discapacidad para mitigar sus consecuencias. Durante la pandemia de COVID-19, las medidas restrictivas redujeron la capacidad de atención de los servicios de salud auditiva y dificultaron la búsqueda de ayuda para resolver problemas relacionados con la adaptación a dispositivos electrónicos de amplificación del sonido (DEAS), siendo una barrera en el proceso de rehabilitación de la pérdida auditiva. Objetivo: Caracterizar a los usuarios de DEAS y el proceso inicial de rehabilitación auditiva de adultos y ancianos y verificar los factores asociados al retorno a las consultas de monitorización auditiva en el período inicial de la pandemia COVID-19. Métodos: Estudio observacional transversal con adultos y ancianos: ancianos usuarios de un servicio ambulatorio de salud auditiva que regresan para consulta de monitorización auditiva programada en el período inicial de la implementación de medidas restrictivas de la pandemia de COVID-19 en Brasil. Resultados: La mayoría de los participantes pudieron regresar a la clínica de monitorización auditiva, la mayoría de los cuales eran ancianos, mujeres y estaban vacunados contra COVID-19. Hubo mayor prevalencia de adaptación adecuada a la DEAS. No hubo asociación estadística entre variables relacionadas con adaptación a DEAS, COVID-19 y salud mental y retorno a consulta de monitorización auditiva. Conclusión: Los factores relacionados con la adaptación a DEAS, el COVID-19 o la salud mental no influyeron en el retorno a la consulta de monitorización auditiva en la presente investigación. (AU)

Cuidado de enfermagem à pessoa com ferida naAtenção Primária à Saúde: desafios e potências / Nursing care for people with woundsin primary health care: Challenges and strengths / Atención de enfermería a personas conheridas en atención primaria de salud: desafíos y potencias

Objetivo: descrever fatores identificados pelos enfermeiros como desafios e potências no cuidado de enfermagem à pessoa com ferida na Atenção Primária à Saúde. Método: estudo exploratório, descritivo, de abordagem qualitativa, realizado de setembro a novembro de 2022, no Distrito Sanitário Centro de Florianópolis. Utilizou-se para a coleta de dados um questionário on-line, cujos resultados foram analisados com base na análise temática do conteúdo de Bardin. Resultados: o estudo contou com a participação de 29 enfermeiros, dos quais28 (97%) relataram enfrentar desafios, assim como identificaram potências no cotidiano de cuidado à pessoa com ferida. Com base na análise dos dados, emergiram três categorias: "Categoria 1 ­ Desafios e potências relacionadas ao processo de trabalho do enfermeiro"; "Categoria 2 ­ Desafios e potências relacionadas à pessoa com ferida"; e "Categoria 3 ­ Desafios e potências relacionados à infraestrutura e recursos tecnológicos e materiais disponíveis". Conclusão: Os fatores destacados pelos enfermeiros como potências e desafios estão relacionados ao trabalho do enfermeiro, ao indivíduo com ferida e à infraestrutura e recursos tecnológicos e materiais disponíveis. Conhecer esses fatores pode suscitar a implementação de ferramentas para superação dos desafios e promoção das potências, visando fomentar a qualidade dessa prática. (AU)

Objective: We aim to describe factors identified by nurses as challenges and strengths in nursing care for people with wounds in primary health care.Method: This is an exploratory, descriptive, qualitative study conducted from September to November 2022, in the Health District Center of the city of Florianópolis, state of Santa Catarina, Brazil. We used an online questionnaire for data collection, and the results were analyzed based on thematic content analysis according to Bardin. Results: A total of 29 nurses were included in the sample, of which 28 (97%) reported facing challenges as well as identifying strengths in the daily care of individuals with wounds. Based on data analysis, three categories emerged: "Category 1 ­ Challenges and strengths related to the nurse's work process"; "Category 2 ­ Challenges and strengths related to the individual with a wound"; and "Category 3 ­ Challenges and strengths related to available infrastructure, technological resources, and materials."Conclusions: The factors highlighted by nurses as strengths and challenges are related to nursing work focused on the person with a wound and to the available infrastructure, technological resources, and materials. Knowledge of these factors can lead to the implementation of tools to overcome challenges and promote strengths, with the aim of improving the quality of this practice. (AU)

Objetivo: Pretendemos describir los factores identificados por las enfermeras como desafíos y fortalezas en la atención de enfermería para personas con heridas en la atención primaria de salud.Método: Se trata de un estudio exploratorio, descriptivo y cualitativo realizado de septiembre a noviembre de 2022, en el Distrito de Salud Centro de la ciudad de Florianópolis, estado de Santa Catarina, Brasil. Utilizamos un cuestionario en línea para la recopilación de datos, y los resultados fueron analizados según el análisis de contenido temático de Bardin. Resultados: Un total de 29 enfermeras fueron incluidas en la muestra, de las cuales 28 (97%) informaron enfrentar desafíos y también identificar fortalezas en la atención diaria de individuos con heridas. Basándonos en el análisis de datos, surgieron tres categorías: "Categoría 1 ­ Desafíos y fortalezas relacionados con el proceso de trabajo de la enfermera"; "Categoría 2 ­ Desafíos y fortalezas relacionados con el individuo con una herida"; y "Categoría 3 ­ Desafíos y fortalezas relacionados con la infraestructura disponible, recursos tecnológicos y materiales".Conclusiones: Los factores destacados por las enfermeras como fortalezas y desafíos están relacionados con el trabajo de enfermería centrado en la persona con una herida y con la infraestructura disponible, recursos tecnológicos y materiales. El conocimiento de estos factores puede llevar a la implementación de herramientas para superar desafíos y promover fortalezas, con el objetivo de mejorar la calidad de esta práctica. (AU)

Efecto de COVID-19 en el tratamiento del cáncer cervicouterino: estudio antes/después / Effect of COVID-19 pandemics in treatment of cervical cancer: pre/post study

Resumen Introducción : Hay escasa evidencia sobre el impacto de la pandemia de COVID-19 en el cumplimiento del tratamiento de cáncer cervicouterino. Métodos : Se llevó a cabo un estudio poblacional de cohorte retrospectivo. -antes/después- de las pacientes con cáncer cervicouterino diagnosticadas en estable cimientos públicos de la provincia de Jujuy (n = 140), entre 2017 y 2020. Las pacientes diagnosticadas en 2020 se consideraron expuestas a la pandemia (n = 21). Utili zamos la regresión logística multivariada para analizar la asociación entre pandemia y cumplimiento del tra tamiento de cáncer. Además, se midió la duración del tratamiento en aquellas con indicación de braquiterapia y el tiempo hasta el inicio al tratamiento según estadio. Resultados : Comparadas con las mujeres diagnosti cadas en 2017-2019 el odds ratio de incumplimiento del tratamiento fue de 1.77 (IC95% 0.59-5.81; p = 0.32) para las diagnosticadas durante 2020. Se encontró un mayor riesgo de incumplimiento en pacientes con indicación de braquiterapia (OR 4.14; IC 95%:1.95-9.11; p < 0.001). La mediana de duración del tratamiento para aquellas con indicación de braquiterapia fue de 12.8 y 15.7 sema nas en 2017-2019 y 2020 respectivamente (p = 0.33). La mediana de tiempo hasta el inicio del tratamiento para pacientes con enfermedad en estadio temprano fue de 9 y 5 semanas durante 2017-2019 y 2020 respectivamente (p = 0.06), versus una mediana de 7.2 y 9 semanas en 2017-2019 y 2020 respectivamente (p=0.36) para las pa cientes con enfermedad en estadio IIB+. Conclusiones : El bajo acceso a la braquiterapia fue un factor determinante de incumplimiento de tratamiento de cáncer cervicouterino, independientemente del efecto de la pandemia.

Abstract Introduction : Little evidence exists on the impact of the COVID-19 pandemics on the compliance with cervi cal cancer treatment. Methods : We carried out a population-based, be fore-and-after retrospective cohort study of all cervical cancer patients diagnosed in the Jujuy province public health sector (n=140), Argentina, between 2017 and 2020. Patients diagnosed in 2020 were considered exposed to the COVID-19 pandemic (n=21). We used multivariable logistic regression to assess the relationship between the pandemics and compliance with treatment. We also measured treatment duration for women who were indicated brachytherapy and time to treatment initia tion by stage. Results : Compared with women diagnosed in 2017- 2019 the odds ratio of non-complying with treatment was 1.77 (95%CI 0.59-5.81; p = 0.32) for women diagnosed during 2020. An increased risk of non-compliance was found in patients with prescribed brachytherapy (OR 4.14. 95%CI 1.95-9.11; p < 0.001). Median treatment dura tion for women with prescribed brachytherapy was 12.8 and 15.7 weeks in 2017-2019 vs. 2020 (p = 0.33); median time to treatment initiation for women with early-stage disease was 9 and 5 weeks during 2017-2019 and 2020 respectively (p = 0.06), vs 7.2 and 9 weeks in 2017-2019 and 2020 respectively (p = 0.36) for patients with stages IIB+ disease. Conclusions : Low access to brachytherapy was a major determinant of non-compliance. irrespective of the effect of the pandemics.

Itinerários terapêuticos de pessoas hospitalizadas por covid-19 no SUS: um estudo quantiqualitativo no Distrito Federal / Therapeutic itineraries of people hospitalized for COVID-19 in the SUS: quantitative and qualitative study in the Federal District

RESUMO Os estudos sobre itinerários terapêuticos revelam modelos de cuidado e decisões tomadas pelas pessoas em situações de adoecimento e podem contribuir para o planejamento de políticas e serviços de saúde mais efetivos, especialmente em emergências como a pandemia de covid-19. O objetivo desta pesquisa foi descrever os itinerários terapêuticos de pacientes hospitalizados por covid-19 em um hospital público do Distrito Federal e explorar associações com determinantes sociais da saúde. Trata-se de um estudo de caso integrado, com triangulação de evidências quantitativas e qualitativas obtidas a partir da análise do banco de dados de um estudo observacional transversal com 233 adultos internados entre maio/2020 e dezembro/2021. A maioria homens, idosos, pretos ou pardos, com baixo nível de renda e escolaridade e múltiplas comorbidades, que procuraram atendimento na atenção especializada e conseguiram acesso rápido ao sistema de saúde. Os fatores que influenciaram a escolha do primeiro serviço foram: ocupação, região de moradia, classe econômica e escolaridade. Já os determinantes da facilidade de acesso foram: tipo de serviço buscado primeiro, gravidade do caso e contexto socioeconômico. Os resultados confirmam a influência de determinantes sociais nas experiências de adoecimento e podem subsidiar reflexões relacionadas à organização do acesso ao SUS em emergências sanitárias.

ABSTRACT Studies on therapeutic itineraries reveal models of care and decisions taken by people in situations of illness and can contribute to the planning of effective health policies and services, especially in emergencies such as the COVID-19 pandemic. The aim of this research was to describe the itineraries of patients hospitalized for COVID-19 in a public hospital in the Federal District and explore associations with social determinants of health. This is an integrated case study, with triangulation of quantitative and qualitative evidence obtained from the analysis of raw data from a cross-sectional observational study with 233 adults hospitalized between May/2020 and December/2021. The majority were men, elderly, black or brown, with low income and education levels and multiple comorbidities, who sought care in specialized care and obtained quick access to the health system. The factors that influenced the choice of the first service sought were: occupation, region of residence, economic class and education. The determinants of ease of access were: type of service first sought, severity of the case and socioeconomic context. The results confirm the influence of social determinants on illness experiences and can support reflections related to the organization of access to the SUS in health emergencies.

Nursing care for people with woundsin primary health care: Challenges and strengths / Cuidado de enfermagem à pessoa com feridana Atenção Primária à Saúde: desafios e potências / Atención de enfermería a personas conheridas en atención primaria de salud: desafíos y potencias

Objetivo: descrever fatores identificados pelos enfermeiros como desafios e potências no cuidado de enfermagem à pessoa com ferida na Atenção Primária à Saúde. Método: estudo exploratório, descritivo, de abordagem qualitativa, realizado de setembro a novembro de 2022, no Distrito Sanitário Centro de Florianópolis. Utilizou-se para a coleta de dados um questionário on-line, cujos resultados foram analisados com base na análise temática do conteúdo de Bardin. Resultados: o estudo contou com a participação de 29 enfermeiros, dos quais28 (97%) relataram enfrentar desafios, assim como identificaram potências no cotidiano de cuidado à pessoa com ferida. Com base na análise dos dados, emergiram três categorias: "Categoria 1 ­ Desafios e potências relacionadas ao processo de trabalho do enfermeiro"; "Categoria 2 ­ Desafios e potências relacionadas à pessoa com ferida"; e "Categoria 3 ­ Desafios e potências relacionados à infraestrutura e recursos tecnológicos e materiais disponíveis". Conclusão: Os fatores destacados pelos enfermeiros como potências e desafios estão relacionados ao trabalho do enfermeiro, ao indivíduo com ferida e à infraestrutura e recursos tecnológicos e materiais disponíveis. Conhecer esses fatores pode suscitar a implementação de ferramentas para superação dos desafios e promoção das potências, visando fomentar a qualidade dessa prática. (AU)

Objective: We aim to describe factors identified by nurses as challenges and strengths in nursing care for people with wounds in primary health care.Method: This is an exploratory, descriptive, qualitative study conducted from September to November 2022, in the Health District Center of the city of Florianópolis, state of Santa Catarina, Brazil. We used an online questionnaire for data collection, and the results were analyzed based on thematic content analysis according to Bardin. Results: A total of 29 nurses were included in the sample, of which 28 (97%) reported facing challenges as well as identifying strengths in the daily care of individuals with wounds. Based on data analysis, three categories emerged: "Category 1 ­ Challenges and strengths related to the nurse's work process"; "Category 2 ­ Challenges and strengths related to the individual with a wound"; and "Category 3 ­ Challenges and strengths related to available infrastructure, technological resources, and materials."Conclusions: The factors highlighted by nurses as strengths and challenges are related to nursing work focused on the person with a wound and to the available infrastructure, technological resources, and materials. Knowledge of these factors can lead to the implementation of tools to overcome challenges and promote strengths, with the aim of improving the quality of this practice. (AU)

Objetivo: Pretendemos describir los factores identificados por las enfermeras como desafíos y fortalezas en la atención de enfermería para personas con heridas en la atención primaria de salud.Método: Se trata de un estudio exploratorio, descriptivo y cualitativo realizado de septiembre a noviembre de 2022, en el Distrito de Salud Centro de la ciudad de Florianópolis, estado de Santa Catarina, Brasil. Utilizamos un cuestionario en línea para la recopilación de datos, y los resultados fueron analizados según el análisis de contenido temático de Bardin. Resultados: Un total de 29 enfermeras fueron incluidas en la muestra, de las cuales 28 (97%) informaron enfrentar desafíos y también identificar fortalezas en la atención diaria de individuos con heridas. Basándonos en el análisis de datos, surgieron tres categorías: "Categoría 1 ­ Desafíos y fortalezas relacionados con el proceso de trabajo de la enfermera"; "Categoría 2 ­ Desafíos y fortalezas relacionados con el individuo con una herida"; y "Categoría 3 ­ Desafíos y fortalezas relacionados con la infraestructura disponible, recursos tecnológicos y materiales".Conclusiones: Los factores destacados por las enfermeras como fortalezas y desafíos están relacionados con el trabajo de enfermería centrado en la persona con una herida y con la infraestructura disponible, recursos tecnológicos y materiales. El conocimiento de estos factores puede llevar a la implementación de herramientas para superar desafíos y promover fortalezas, con el objetivo de mejorar la calidad de esta práctica. (AU)

The access carried out in oral health services post-COVID-19 pandemic: a temporal analysis of the SIA-SUS in Jaboatão dos Guararapes

Background: Aim of the study was to evaluate the access provided, represented by the use of dental services, by users of the unified health system (SUS), in Jaboatão dos Guararapes (PE), during the COVID-19 pandemic. Methods: Time series analysis of data on dental activities and procedures carried out by dentists registered in the SUS ambulatory information system (SIA-SUS), between January and December, from 2013 to 2022, as a way of characterizing the access carried out, a characteristic of use of services. Results: The data reveal that there was a reduction in the supply of dental care in all categories during the COVID-19 pandemic, especially in the first two years: 2020 and 2021. Conclusions: The data analyzed corroborate the perception that the restrictions imposed on care dental services offered by the unified health system had a negative impact on health services in the municipality of Jaboatão dos Guararapes (PE).

Barreras de acceso a los servicios primarios de salud sexual y reproductiva en adolescentes, de una comunidad urbano marginal del Perú

Introducción: Las barreras de acceso a los servicios de salud primario conforman estructuras sociales que agravan la situación de salud de los adolescentes, impactando negativamente en el ejercicio pleno de la salud sexual reproductiva, situando a los adolescentes en una población de riesgo social. Objetivo: Determinar las barreras en el acceso a los servicios primarios de Salud Sexual y Reproductiva de atención diferenciada a los adolescentes del Centro de Salud I - 4 Pampa Grande Tumbes 2018. Metodología: Estudio analítico de caso control, se entrevistaron a 288 adolescentes del tercero, cuarto y quinto de secundaria de la institución educativa pública Túpac Amaru del centro poblado Pampa Grande de Tumbes en el año 2019, entre experimento y control con una razón de 1 a 1. Se aplicaron cuestionarios anónimos para evaluar las barreras de accesibilidad a los servicios primarios de salud. Se recogieron variables: características sociodemográficas y culturales que son consideradas, como barreras de acceso a los servicios de salud. Se realizó un análisis descriptivo e inferencial con el programa SPSS® v.23. Resultados: La edad, sexo e ingreso económico están directa y significativamente relacionadas con la accesibilidad a los servicios de salud sexual y reproductiva (p<0.01 IC 95 %); La disposición de recursos económicos para asumir los costos de traslado al centro de salud (OR = 4,23); la utilización del transporte público (OR = 1,58), el conocimiento de los servicios de salud sexual y reproductiva (OR = 1,15) incrementan la probabilidad de acceder a los servicios de salud sexual y reproductiva de los adolescentes. Discusión: Las barreras socioeconómicas a los servicios de salud sexual y reproductiva de los adolescentes son modificables y dependen de la gestión en salud pública.

Introduction: The barriers to access to primary health services make up social structures that aggravate the health situation of adolescents, negatively impacting the full exercise of reproductive sexual health, placing adolescents in a population at social risk. Objective: To determine the barriers in the access to the primary services of Sexual and Reproductive Health of differentiated attention to the adolescents of the Health Center I - 4 Pampa Grande Tumbes 2018. Methods: Analytical case control study, 288 adolescents from the third, fourth and fifth grade of secondary school of the public educational institution Túpac Amaru in the Pampa Grande de Tumbes town center were interviewed in 2019, between experiment and control with a ratio of 1 to 1. Anonymous questionnaires were applied to assess accessibility barriers to primary health services. Variables were collected: sociodemographic and cultural characteristics that are considered as barriers to access to health services. A descriptive and inferential analysis was carried out with the SPSS® v.23 program. Results: Age, sex and economic income are directly and significantly related to accessibility to sexual and reproductive health services (p<0.01 95% CI); The availability of economic resources to assume the costs of transportation to the health center (OR = 4.23); the use of public transport (OR = 1.58), knowledge of sexual and reproductive health services (OR = 1.15) increase the probability of accessing sexual and reproductive health services for adolescents. Discussion: Socioeconomic barriers to sexual and reproductive health services for adolescents are modifiable and depend on public health management.

Práticas de Enfermagem na Coordenação do Cuidado na Atenção Primária à Saúde / Nursing Practices In Coordination Care In Primary Health Care / Prácticas de Enfermería Coordinación Del Cuidado En La Atención Primaria da Salud

Objetivo: analisar as características das equipes e as práticas associadas ao acompanhamento e coordenação do cuidado no Pará e compreender como ocorre essa prática executada pelo enfermeiro como membro da equipe na Atenção Primária à Saúde. Métodos: estudo de métodos mistos. Os participantes foram enfermeiros da atenção básica do Pará. A coleta ocorreu entre novembro de 2019 a agosto de 2021, através de um formulário eletrônico e entrevista. A análise integrativa dos dados foi feita pela conexão dos métodos qualitativos e quantitativos. Resultados: A proporção de enfermeiros que acompanha e coordena os usuários que estão em uso de outros serviços foi de 50% (90/180). Houve associação significativa (p <0,05) entre o acompanhamento e coordenação do cuidado e o tipo de equipe, carga horária de trabalho, regulação das demandas locais na perspectiva da rede, articulação com profissionais de saúde de outros níveis de atenção, trabalhos com profissionais de outras formações e a condução da clínica ampliada/ matriciamento. As categorias temáticas "relação da Atenção Primária à Saúde com a rede de atenção" e "práticas de coordenação e continuidade do cuidado horizontal e vertical" apresentaram convergência com os dados quantitativos e a categoria temática "Práticas de coordenação do cuidado sob a forma do trabalho em equipe" converge com os dados quantitativos, mas divergem no apoio matricial. Conclusão: Os enfermeiros realizam o acompanhamento e coordenação do cuidado, porém enfrentam dificuldades que resultam em sobrecarga e realização de atribuições que não são da categoria profissional. (AU)

Objective: to analyze the characteristics of the teams and the practices associated with the monitoring and coordination of care in Pará and to understand how this practice is carried out by the nurse as a member of the team in Primary Health Care. Methods: study of mixed methods. The participants were primary care nurses in Pará. The collection took place between November 2019 and August 2021, through an electronic form and interview. The integrative data analysis was performed by connecting qualitative and quantitative methods. Results: The proportion of nurses who monitor and coordinate users who are using other services was 50% (90/180). There was a significant association (p <0.05) between monitoring and coordination of care and the type of team, workload, regulation of local demands from the perspective of the network, articulation with health professionals from other levels of care, work with professionals from other backgrounds and conducting the expanded clinic/matrix support. The thematic categories "relationship between Primary Health Care and the care network" and "practices of coordination and continuity of horizontal and vertical care" showed convergence with the quantitative data and the thematic category "Practices of coordination of care in the form of work in a team" converges with the quantitative data, but differs in matrix support. Conclusion: Nurses carry out monitoring and coordination of care, but they face difficulties that result in overload and carrying out tasks that are not of the professional category. (AU)

Objetivo: analizar las características de los equipos y las prácticas asociadas al seguimiento y coordinación del cuidado en Pará y comprender cómo esa práctica es realizada por el enfermero como miembro del equipo en la Atención Primaria de Salud. Métodos: estudio de métodos mixtos. Los participantes eran enfermeros de atención primaria de Pará. La recolección se realizó entre noviembre de 2019 y agosto de 2021, a través de formulario electrónico y entrevista. El análisis integrador de datos se realizó conectando métodos cualitativos y cuantitativos. Resultados: La proporción de enfermeros que acompañan y coordinan usuarios que utilizan otros servicios fue del 50% (90/180). Hubo asociación significativa (p<0,05) entre el seguimiento y coordinación de la atención y el tipo de equipo, carga de trabajo, regulación de las demandas locales desde la perspectiva de la red, articulación con profesionales de salud de otros niveles de atención, trabajo con profesionales de otros antecedentes y dirigiendo el apoyo clínico/matriz ampliado. Las categorías temáticas "relación entre la Atención Primaria de Salud y la red de atención" y "prácticas de coordinación y continuidad del cuidado horizontal y vertical" mostraron convergencia con los datos cuantitativos y la categoría temática "Prácticas de coordinación del cuidado en la forma de trabajo en un team" converge con los datos cuantitativos, pero difiere en el soporte de la matriz. Conclusión: Los enfermeros realizan seguimiento y coordinación de los cuidados, pero enfrentan dificultades que resultan en sobrecarga y realización de tareas que no son de categoría profesional. (AU)

Assessing accessibility of sexual reproductive health services among adolescents and young people living with HIV/AIDS in Kenya

Background: Sexual and reproductive health rights (SRHR) are fundamental human rights enshrined in national, regional, and international laws and agreements. This study aimed to determine the accessibility of SRHR services among young people living with HIV/AIDS in Kenya. Methods: The study was a cross-sectional study involving a sample of 224 adolescents and young people from Kenya. The study used both qualitative and quantitative methods of data collection and analysis. Before the study commenced, approvals were acquired from the Kenyatta University ethics and review committee, the National Commission for Science, Technology, and Innovation, County Governments, and selected county and sub-county health facilities in Kenya. Results: About 68.2% of adolescents and young people (AYP) living with HIV/AIDS accessed SRH services with a significant difference in proportion between study counties (Nairobi city and Homabay counties) in Kenya (?2=20.553; df=2; p<0.0001). Nevertheless, 33% of them reported that there were challenges that affected access to SRHR services and the unavailability of some services. Therefore, there is a need to ensure enough and constant supply of commodities and supplies for comprehensive care services. Conclusions: The study showed a statistically significant difference in the proportion of AYP living with HIV/AIDS who accessed SRH services in the study counties of Nairobi city and Homabay.

Estrategias usadas en la atención de la salud sexual de poblaciones rurales de bajos ingresos / Strategies Used in Sexual Health Care for Low-Income Rural Populations / Estratégias utilizadas na atenção à saúde sexual de populações rurais de baixa renda

Introducción: en la ejecución de políticas públicas de salud sexual, resultan cruciales las estrategias utiliza-das en la construcción de la relación agente de salud-usuario. En la literatura son pocos los artículos que exploran las estrategias que utilizan los agentes de salud para interactuar con pobladores rurales al abor-dar estas problemáticas. Este artículo se propone describir y comprender las estrategias que utilizan los agentes de salud en la atención de la salud sexual y reproductiva de pobladores rurales de bajos ingresos. Para ello, se conceptualiza la relación médico-paciente como una interfaz social, es decir, como un espacio de articulación entre los mundos de sentido de los actores involucrados. Materiales y métodos: se desarrolló un estudio de carácter exploratorio-descriptivo de tipo transversal. Se realizaron 21 entrevistas semiestruc-turadas a agentes del sistema de salud, y su análisis se hizo desde un enfoque cualitativo. Resultados: los agentes de salud utilizan un amplio repertorio de estrategias para abordar la salud sexual de los pobladores rurales. Se identificaron y caracterizaron dos tipos de estrategias (dialógicas y monológicas), con sus respectivos subtipos. Conclusión: el estudio visibiliza las estrategias dialógicas como modo alternativo de relación médico-paciente, en contraste con estrategias tradicionales, de tipo monológico. Además, contribuye a la formación de los agentes de salud, y en la conformación de los equipos que abordan la salud sexual y reproductiva en contextos rurales

Introduction: The strategies used for constructing health agent-user relationship are crucial for exe-cuting public policies on sexual health. In the literature, few articles explore the strategies used by health agents to interact with rural residents when addressing these problems. We aimed to describe and understand these strategies used by health agents for sexual health care in low-income rural resi-dents. To achieve this, the doctor­patient relationship is assumed to be a social interface and a space of articulation between the worlds of meaning of the actors involved. Materials and methods: An explor-atory, descriptive, and cross-sectional study was developed. Overall, 21 semistructured interviews were conducted with health agents, and the results were qualitatively analyzed. Results: Health agents use a wide repertoire of strategies to address the sexual health of rural residents. Two types of strategies (dia-logical and monological) and their respective subtypes were identified and characterized. Conclusion:Dialogic strategies are an alternative to the doctor­patient relationship and are contradictory to the traditional monological strategies. They impact the training of health agents and the formation of teams that address sexual and reproductive health in rural settings

Introdução: na execução das políticas públicas de saúde sexual, as estratégias utilizadas na construção da relação agente de saúde-usuário são cruciais. Na literatura são escassos os artigos que exploram as estratégias utilizadas pelos agentes de saúde para interagir com os moradores rurais na abordagem desses problemas. Este estudo se propõe a descrever e compreender as estratégias utilizadas pelos agen-tes de saúde na atenção à saúde sexual e reprodutiva de moradores rurais de baixa renda. Para isso, a relação médico-paciente é conceituada como interface social, ou seja, como espaço de articulação entre os mundos de sentido dos atores envolvidos. Materiais e métodos: foi desenvolvido um estudo transver-sal exploratório-descritivo. Foram realizadas 21 entrevistas semiestruturadas com agentes do sistema de saúde e sua análise foi feita a partir de uma abordagem qualitativa. Resultados: os agentes de saúde utilizam um amplo repertório de estratégias para abordar a saúde sexual dos residentes rurais. Dois tipos de estratégias (dialógicas e monológicas) foram identificadas e caracterizadas, com seus respecti-vos subtipos. Conclusão: este estudo torna visíveis as estratégias dialógicas como modo alternativo de relação médico-paciente, em contraste com as estratégias tradicionais de tipo monológico. Além disso, contribui para a formação de agentes de saúde e na formação de equipes que abordem saúde sexual e reprodutiva em contextos rurais.

Accessibility of soil-transmitted Helminthiasis control strategies in selected indigenous people communities in the Philippines

Background@#Indigenous peoples (IPs) remain vulnerable to soil-transmitted helminthiasis (STH) due to limited access to sanitary toilets, clean water, quality health education, and services. The World Health Organization recommends periodic mass drug administration (MDA) of anthelminthics, health education, and improvements in water, sanitation, and hygiene (WASH) as control strategies to reduce morbidities caused by STH in target populations such as schoolage children (SAC). This paper complements the published results of the parasitological survey (prevalence and intensity of STH) conducted in selected Aeta and Ata-Manobo communities. @*Objectives@#This study aimed to describe the accessibility of STH control strategies to respond to the needs of SAC in IP communities in Pampanga and Davao del Norte, the Philippines. It likewise intended to describe access of these IP communities to STH control strategies. @*Methods@#Data on accessibility of and access to STH control strategies were collected using key informant interviews (KIIs) and focus group discussions (FGDs). Eleven officials and workers from the departments of health and education, local government units, and two IP leaders were interviewed on the existing STH burden in SAC, implementation of STH control strategies, particularly of MDA, health education campaigns, and improvements in WASH including good practices and challenges in program implementation. Three FGDs with parents, elementary school teachers of IP schools, and rural health midwives were conducted separately. Guide questions focused on accessibility of and access to STH prevention and control strategies for SAC in IP communities. Informed consent to conduct and record KIIs and FGDs were obtained from participants prior to participation. Analysis of a multi-disciplinary team was based on the accessibility framework for IPs accessing indigenous primary health care services by Davy et al. (2016). @*Results@#The characteristics of the STH control strategies and the target populations are interrelated factors that influence accessibility. Challenges in the availability of the MDA program, particularly, inadequate staffing, drug shortages, and delays in delivery affect accessibility of and access to the free STH control strategies. Perceived harm, adverse events, stigma, beliefs, and practices likewise affect access. Lack of information on the similarity of treatment through community- and schoolbased MDA programs also affected engagement of SAC. IP communities are special settings where geographic isolation, peace and order situation as well as water supply need to be considered to help ensure access to STH control strategies, high MDA coverage, and improvements in WASH leading to desired outcomes. @*Conclusions@#Considering the context of IP communities and addressing the challenges in the accessibility of and access to STH control strategies are necessary to ensure successful implementation of an integrated approach in STH prevention and control strategies. Challenges in the accessibility of STH control strategies are inadequate staffing, poor inventory, and delays in the delivery of drugs, as well as poor sanitation and hygiene. Access of SAC is likewise affected by misconceptions on safety and efficacy of anthelminthics, including stigma and cultural practices. The similarity of the MDA programs based in school or community need to be disseminated.

Study on Drug List and Accessibility of Rare Diseases Based on the China′s Second List of Rare Diseases / 罕见病研究

Objective This study aims to sort out the rare disease drugs in the China′s Second List of Rare Diseases, to provide reference for the management of rare disease drug treatment. Methods Up to December 31, 2023, based on the China′s Second List of Rare Diseases, we sorted out the drugs approved in China with the drug label, or approved by the U.S. Food and Drug Administration(FDA) and the European Medicines Agency (EMA) for the treatment of the above diseases, and developed the second batch of rare disease drug catalog in China. The accessibility, localization and coverage of the national medical insurance were also analyzed. Results From the point of view of diseases, a total of 37 diseases in the China′s Second List of Rare Diseases have drug indications approved in China, and 10 diseases have drugs listed by the U.S. FDA/EMA and approved in China, but for off-label use. From the point of view of drugs, there are 55 drug indications approved for the treatment of the China′s Second List of Rare Diseases, and 22 drugs listed in the U.S. FDA/EMA and approved in the China, but for off-label use. Among the above-mentioned drugs with domestic approved rare disease indications or approved numbers, 39 drugs have at least one domestic approval number for a dosage form, covering 30 rare diseases; 37 drugs used for at least one rare disease are included in the national medical insurance catalog and are covered by reimbursement, covering 29 rare diseases. Conclusions The list of rare disease drugs in the China′s Second List of Rare Diseases was established. The number of rare disease drugs and covered diseases approved by China and the U.S. FDA/EMA has increased, and the number of rare disease drugs and covered diseases that are localized and included in the medical insurance catalog has also continued to increase.

A Comparative Study on Statistical Models for Evaluating the Spatial Accessibility to Healthcare Services / 中国卫生统计

Objective To compare the principles,methods and applications of provider-to-population ratios method,gravity-based model,two-step floating catchment area(2SFCA)method and improved two-step floating catchment area method for evaluating the spatial accessibility to healthcare services.Methods Taking the spatial accessibility to maternal and child healthcare services in Nanning prefecture for example,we collected data on vector map,transportation network,population size,and the number of health professionals in maternal and child health institutions.Provider-to-population ratios method,gravity-based model,2SFCA method and improved 2SFCA method were applied to evaluate the spatial accessibility to maternal and child healthcare services,on the scales of county level,township level and village level,respectively.Results The four models showed that the spatial heterogeneity of spatial accessibility to maternal and child health services was significant,and the spatial accessibility was gradually decreased from urban areas of Nanning to rural areas.However,regions with high spatial accessibility and regions with low spatial accessibility,decreasing trend in spatial accessibility across regions,the median and inter quartile range of spatial accessibility were different across the four models.Conclusion The practical significance in evaluating spatial accessibility to healthcare services for provider-to-population ratios method,gravity-based model,2SFCA method and improved 2SFCA method was different,yet the spatial accessibility varied somewhat across the four models.Thus,integrating findings of the four models based on multi space scales is strongly recommended to evaluate the spatial accessibility to healthcare services comprehensively and robustly.

Aspects that facilitate access to care for viral hepatitis: An evaluative research

ABSTRACT BACKGROUND: Viral hepatitis is a major public health concern worldwide. OBJECTIVES: This study aimed to analyze the factors that facilitate access to care for viral hepatitis. DESIGN AND SETTING: Using a sequential mixed method, this evaluation research was conducted in the state of Mato Grosso, Brazil. METHODS: Mapping of references and selection of regions were made based on the quantity and heterogeneity of services. The stakeholders, including the managers of the State Department of Health and professionals from reference services, were identified. Nine semi-structured interviews were conducted using content analysis and discussions guided by the dimensions of the analysis model of universal access to health services. RESULTS: In the political dimension, decentralizing services and adhering to the Intermunicipal Health Consortium are highly encouraged. In the economic-social dimension, a commitment exists to allocate public funds for the expansion of referral services and subsidies to support users in their travel for appointments, medications, and examinations. In the organizational dimension, the availability of inputs for testing, definition of user flow, ease of scheduling appointments, coordination by primary care in testing, collaboration following the guidelines and protocols, and engagement in extramural activities are guaranteed. In the technical dimension, professionals actively commit to the service and offer different opening hours, guarantee the presence of an infectious physician, expand training opportunities, and establish intersectoral partnerships. In the symbolic dimension, professionals actively listen to the experiences of users throughout their care trajectory and demonstrate empathy. CONCLUSIONS: The results are crucial for improving comprehensiveness, but necessitate managerial efforts to enhance regional governance.

"Nada sobre nós, sem nós": a surdez no ensino de história e na produção historiográfica, 2015-2022* / "Nothing about us without us": deafness in history teaching and historiography, 2015-2022

Resumo O texto aponta resultados parciais de uma pesquisa em andamento sobre a surdez no ensino de história e na produção historiográfica entre 2015 e 2022. O trabalho problematiza o lugar da pessoa com deficiência nos periódicos A1 e A2 e nos projetos pedagógicos de cursos de graduação em história (formação de professores e pesquisadores) da Universidade de São Paulo e da Universidade Estadual de Campinas, por conta de serem indicadas como as mais bem posicionadas no ranking de uma pesquisa realizada pela Folha de S.Paulo, levando-se em conta os critérios de articulação entre a Lei Brasileira de Inclusão, lei 13.146, de 6 de julho de 2015, e a formação inicial desses profissionais.

Abstract This text presents the partial results of ongoing research into deafness in history teaching and historiography between 2015 and 2022. The study problematizes the place of disabled people in top-ranking periodicals (the top two categories in Brazil) and in pedagogical projects on degree courses in history (with and without teacher-training certification) at the University of São Paulo and the State University of Campinas. These universities were chosen because they topped the ranking in a survey conducted by Folha de S.Paulo newspaper. The study observes how the Brazilian Inclusion Law (law 13.146, of July 6, 2015) is incorporated into the initial training of these professionals.