Reported health and social consequences of the COVID-19 pandemic on vulnerable populations and implemented solutions in six West African countries: A media content analysis.

Coronavirus has spread worldwide with over 140 million cases and resulting in more than 3 million deaths between November 2019 to April 2021, threatening the socio-economic and psychosocial stability of many families and communities. There has been limited research to understand the consequences of COVID-19 on vulnerable populations in West Africa, and whether such consequences differ by countries' previous experience with Ebola. Using a media analysis of leading online news sources, this study identified the populations particularly vulnerable to the threats of the COVID-19 pandemic, described the consequences of COVID-19 experienced by these populations, and reported on the solutions to address them. All articles from the selected news sources published between January 1 and June 30, 2020 on 6 West African countries were imported into Dedoose. A total of 4,388 news articles were coded for excerpts on vulnerable populations, only 285 excerpts of which mentioned the existing effects of COVID-19 on vulnerable populations or implemented solutions. News articles from countries with past experience with Ebola were more likely to mention the pandemic's effects on vulnerable populations, especially on incarcerated people. Vulnerable groups were reported to have experienced a range of effects including economic disruptions, heightened domestic and sexual abuse, arbitrary arrests, health care inaccessibility, and educational challenges throughout the pandemic. With implications for the achievement of the Sustainable Development Goals (SDG) for 2030 in West Africa, these countries should consider and focus more strategic efforts on vulnerable populations to overcome their fight against the COVID-19 pandemic and to achieve the SDG for 2030.

Brief Report: Classifying Rates of Students with Autism and Intellectual Disability in North Carolina: Roles of Race and Economic Disadvantage.

We examined special education classifications among students aged 3-21 in North Carolina public schools, highlighting autism spectrum disorder (ASD) and intellectual disability (ID). Results revealed variability by county in ASD and ID prevalence, and in county-level ratios of ID vs. ASD classifications. Sociodemographic characteristics predicted proportion of ASD or ID within a county; correlations showed an association between race and ID, but not ASD. County's median household income predicted proportion of students classified as ASD and ID (opposite directions), controlling for number of students and gender. Variability was unlikely related to biological incidence, and more likely related to district/school practices, or differences in resources. Disparities warrant further examination to ensure that North Carolina's youth with disabilities access necessary, appropriate resources.

Vulnerability factors associated with HIV/AIDS hospitalizations: a case-control study.

OBJECTIVES: to identify the association between HIV/AIDS hospitalizations and factors that integrate individual, social, and programmatic vulnerabilities. METHODS: a case-control study conducted in 2014 in a municipality in the state of São Paulo. "Cases" included people living with HIV (PLHIV) hospitalized and "control" those who were outpatients. Interviews were conducted using a tool with sociodemographic variables, clinical characteristics and other vulnerabilities. Data were analyzed by conditional logistic regression. RESULTS: fifty-six cases and 112 control participated. Risk factors for HIV hospitalization were: unemployed and retired individuals; homeless people; non-antiretroviral users; individuals who did not regularly attend returns. Access to social workers was a protective factor for hospitalization. CONCLUSIONS: this research contributed to measure the social, individual and programmatic vulnerabilities that interfere with HIV worsening and, consequently, unfavorable outcome such as hospitalization.

Defining vulnerability in European pregnant women, a Delphi study.

OBJECTIVE: Vulnerability among pregnant women is an important and complex theme in the everyday practice of midwives. Exchanging knowledge and best practices about vulnerability between midwives in Europe can contribute to improving the knowledge and skills of midwives and as a result improve the care for vulnerable pregnant women. We therefore start a consortium with midwives, midwifery teachers, researchers and students from organizations of seven European cities with the aim to exchange knowledge and best practices concerning vulnerable pregnant women between midwives. To be able to effectively exchange knowledge and best practices, our consortium started with this study focuses on establishing a mutual definition of vulnerable pregnant women. Therefore, the aim of this study is to develop a mutual definition of vulnerable pregnant women and to identify aspects related to vulnerability. DESIGN: Delphi study with four rounds: (1) gathering existing knowledge from literature and definitions used by partners of the consortium, (2) and (3) two survey rounds and (4) an in-person consensus meeting. SETTING: Consortium of midwives, midwifery teachers, researchers and students from Antwerp (Belgium), Ghent (Belgium), Turku (Finland), Milan (Italy), Pila (Poland), Lisbon (Portugal) and Rotterdam (The Netherlands) PARTICIPANTS: We included all consortium members in the Delphi study. FINDINGS: Various aspects related to vulnerability and appropriate definitions were identified during the Delphi rounds. Consensus about the aspects related to vulnerability and the definition of vulnerable pregnant women was reached during the final consensus meeting. A vulnerable pregnant woman was defined as a woman who is threatened by physical, psychological, cognitive and/or social risk factors in combination with lack of adequate support and/or adequate coping skills. KEY CONCLUSION: We reached consensus about a mutual definition of vulnerable pregnant women and aspects related to vulnerability within this consortium. The Delphi approach led to interesting discussions and was a valuable method to define the concept of vulnerable pregnant women within our project . IMPLICATIONS FOR PRACTICE: In order to accomplish a project that aimed to improve care for vulnerable pregnant women it was important to first identify the population of vulnerable pregnant women with a mutual definition.

Uncovering Multidimensional Poverty Experiences in Shaping Children's Socioemotional Trajectories during the First 6 Years of Schooling.

The extant literature has attested to the importance of poverty on child well-being generally using a unidimensional approach. Researchers have yet to establish solid evidence on how multiple dimensions of poverty (e.g., depth, volatility, and spells of exposure) might be associated with children's socioemotional well-being during their early school years. Building upon Bronfenbrenner's bioecological systems theory, this study used latent class analysis to identify poverty patterns by incorporating multiple dimensions of poverty and investigated the relationship between multidimensional poverty patterns and children's socioemotional trajectories from kindergarten through fifth grade. Using the Early Childhood Longitudinal Study, Kindergarten Class of 1998-1999 (ECLS-K), a longitudinal dataset featuring a nationally representative cohort of children in the United States (N ≈ 20,090), the analysis identified seven poverty groups. Each group exhibited a unique poverty or economic pattern that incorporates the three poverty dimensions. Growth-curve results indicate that multidimensional poverty patterns were significantly associated with externalizing and internalizing behaviors both at kindergarten and over time by fifth grade. Children with the acutest form of economic deprivation-extreme poverty, volatile income, and multiple spells of poverty exposure-were reported to have the worst outcomes. The significant variations in children's socioemotional trajectories due to different poverty patterns highlight the importance of poverty reduction and prevention strategies corresponding to those patterns for optimal effect. This study suggests a focus not just on helping families exit poverty temporarily, but on improving their economic security as a way to nurture children's socioemotional well-being.

La bibliografía existente ha avalado la importancia de la pobreza en el bienestar de los niños, generalmente usando un enfoque unidimensional. Los investigadores aun tienen que demostrar con pruebas sólidas cómo las múltiples dimensiones de la pobreza (p. ej.: la profundidad, la volatilidad y los periodos de exposición) podrían estar asociadas con el bienestar socioemocional de los niños durante sus primeros años de escolarización. Basándose en la teoría bioecológica de sistemas de Bronfenbrenner, este estudio utilizó el análisis de clases latentes para identificar patrones de pobreza incorporando varias dimensiones de pobreza e investigó la relación entre los patrones multidimensionales de pobreza y las trayectorias socioemocionales de los niños desde el jardín de infantes hasta quinto grado. Utilizando el Estudio longitudinal de la primera infancia, promoción de jardín de infantes de 1998-99 (ECLS-K), un conjunto de datos longitudinales que presenta una cohorte de niños de los Estados Unidos representativa a nivel nacional (N ≈ 20,090), el análisis identificó siete grupos de pobreza. Cada grupo expuso un patrón económico o de pobreza único que incorporó las tres dimensiones de pobreza. Los resultados de la curva de crecimiento indican que los patrones multidimensionales de pobreza estuvieron asociados significativamente con conductas exteriorizadas e interiorizadas tanto en el jardín de infantes como en transcurso del tiempo hasta quinto grado. Se informó que los niños con la forma más aguda de privación económica-pobreza extrema, ingresos volátiles y varios periodos de exposición a la pobreza-tuvieron los peores resultados. Las variaciones significativas en las trayectorias socioemocionales de los niños debido a diferentes patrones de pobreza destacan la importancia de la reducción de la pobreza y de las estrategias de prevención correspondientes a esos patrones para lograr un efecto óptimo. Este estudio sugiere enfocarse no solo en ayudar a las familias a salir de la pobreza temporariamente, sino en mejorar su seguridad económica como forma de promover el bienestar socioemocional de los niños.

Implicaciones de la pandemia por COVID-19 para el paciente con insuficiencia cardiaca, trasplante cardiaco y asistencia ventricular. Recomendaciones de la Asociación de Insuficiencia Cardiaca de la Sociedad Española de Cardiología / COVID-19 pandemic implications for the patient with heart failure, heart transplant and ventricular assistance: Recommendations from the Heart Failure Association of the Spanish Society of Cardiology

La irrupción de la pandemia por COVID-19 está suponiendo un verdadero reto social y sanitario. Su rápida expansión hace que sean muchos los pacientes afectos que desarrollan clínica asociada, incluyendo síntomas cardiológicos. Los pacientes con afectación cardiaca son un grupo especialmente vulnerable, por su mayor riesgo de contagio y gravedad de la enfermedad. La insuficiencia cardiaca, incluyendo al trasplante cardiaco y las asistencias ventriculares, supone un grupo relevante dentro de los pacientes cardiológicos. Por ello, la Asociación de Insuficiencia Cardiaca de la Sociedad Española de Cardiología ha elaborado una serie de recomendaciones para el abordaje de estos pacientes, en los diferentes escenarios en los que se pueden encontrar: ambulatorio y hospitalizado, con y sin COVID-19

The outbreak of the COVID-19 pandemic is a real social and healthcare system challenge. Its rapid expansion implies that many affected patients develop associated symptoms, including cardiological symptoms. Patients with cardiological diseases are at increased risk of being infected and the severity of the disease. Heart failure, including heart transplantation and ventricular assist devices, is a relevant group within the cardiological patients. For this reason, the following text has been intended to give a series of recommendations for the management of these patients, in the different scenarios in which they can be found: outpatient and hospitalized, with and without COVID-19

Vulnerability factors associated with HIV/AIDS hospitalizations: a case-control study / Factores de vulnerabilidad asociados a la hospitalización del VIH/SIDA: estudio de control de casos / Fatores de vulnerabilidade associados às internações por HIV/aids: estudo caso controle

ABSTRACT Objectives: to identify the association between HIV/AIDS hospitalizations and factors that integrate individual, social, and programmatic vulnerabilities. Methods: a case-control study conducted in 2014 in a municipality in the state of São Paulo. "Cases" included people living with HIV (PLHIV) hospitalized and "control" those who were outpatients. Interviews were conducted using a tool with sociodemographic variables, clinical characteristics and other vulnerabilities. Data were analyzed by conditional logistic regression. Results: fifty-six cases and 112 control participated. Risk factors for HIV hospitalization were: unemployed and retired individuals; homeless people; non-antiretroviral users; individuals who did not regularly attend returns. Access to social workers was a protective factor for hospitalization. Conclusions: this research contributed to measure the social, individual and programmatic vulnerabilities that interfere with HIV worsening and, consequently, unfavorable outcome such as hospitalization.

RESUMEN Objetivos: identificar la asociación entre las hospitalizaciones por VIH/SIDA y los factores que integran las vulnerabilidades individuales, sociales y del programa. Métodos: estudio de casos y controles realizado en 2014 en un municipio del estado de São Paulo. Los "casos" incluyeron a personas que viven con VIH (PVVIH) hospitalizadas y "controla" a los pacientes ambulatorios. Las entrevistas se realizaron utilizando un instrumento con variables sociodemográficas, características clínicas y otras vulnerabilidades. Los datos fueron analizados por regresión logística condicional. Resultados: participaron 56 casos y 112 controles. Los factores de riesgo de hospitalización por VIH fueron: personas desempleadas y jubiladas; personas sin hogar; usuarios no antirretrovirales; individuos que no asistieron regularmente a las declaraciones. El acceso a los trabajadores sociales fue un factor protector para la hospitalización. Conclusiones: esta investigación contribuyó a medir las vulnerabilidades sociales, individuales y programáticas que interfieren con la agudización del VIH y, en consecuencia, el resultado desfavorable, como la hospitalización.

RESUMO Objetivos: identificar a associação entre as internações por HIV/aids e os fatores que integram as vulnerabilidades individuais, sociais e programáticas. Métodos: estudo caso-controle realizado em 2014 em um município do estado de São Paulo. "Casos" compreenderam pessoas que viviam com HIV (PVHIV) internadas e "controles" aquelas que faziam acompanhamento ambulatorial. Foram realizadas entrevistas utilizando um instrumento com variáveis sociodemográficas, características clínicas e outras vulnerabilidades. Os dados foram analisados por meio de regressão logística condicional. Resultados: participaram 56 casos e 112 controles. Constituíram fatores de risco para internação hospitalar por HIV: indivíduos desempregados e aposentados/do lar; pessoas em situação de rua; não usuários de antirretroviral; indivíduos que não compareciam regularmente aos retornos. Acesso à assistente social constituiu-se um fator de proteção para internação. Conclus ões: esta investigação contribuiu para mensurar as vulnerabilidades sociais, individuais e programáticas que interferem na agudização do HIV e, consequentemente, no desfecho desfavorável, como a internação hospitalar.

Adding Social Determinants in the Electronic Health Record in Clinical Care in Hawai'i: Supporting Community-Clinical Linkages in Patient Care.

Social and behavioral determinants of health, such as poverty, homelessness, and limited social support, account for an estimated 40% of health burdens and predict critical health outcomes. Many clinical-community linkages specifically focus on addressing such challenges. Given its distinctive history, culture, and location, Hawai'i has unique social factors impacting population health. Local health systems are striving to address these issues to meet their patients' health needs. Yet the evidence on precisely how health care systems and communities may work together to achieve these goals are limited both generally and specifically in the Hawai'i context. This article describes real-world efforts by 3 local health care delivery systems that integrate the identification of social needs into clinical care using the electronic health record (EHR). One health care system collects and assesses social challenges and interpersonal needs to improve the care for its frail seniors (aged 65 and older). Another system added key data fields around social support and inpatient mobility in the EHR to identify whether patients needed additional help during hospitalization and post-discharge. A third added a social needs screening tool (eg, housing instability, food insecurity, transportation needs) to its EHR to ensure that patient-specific needs can be appropriately addressed by the care team. Successful integration of this information into the EHR can identify, direct, and support clinical-community linkages and integrate such relationships into the care team. Many lessons can be learned from the implementation of these programs, including the importance of clinical relevance and ensuring capacity for social work liaisons trained for this work to address identified needs.

Implementation of Vulnerable Elders Survey-13 Frailty Tool to Identify At-Risk Geriatric Surgical Patients.

PURPOSE: The primary purpose of this project was to preoperatively identify frail and vulnerable geriatric patients aged 65 or older using the Vulnerable Elders Survey (VES-13) tool, and to use those scores to assist with perioperative decision-making. DESIGN: This feasibility study was implemented as a quality improvement initiative with a postimplementation group only. METHODS: The VES-13 was introduced to the perioperative nursing staff and anesthesia providers and then added to the traditional preoperative assessment. The VES-13 scores were correlated to hospital length of stay, postanesthesia care unit stay, altered mental status, and morbidity. FINDINGS: Increased identification of older adult surgical patients at risk for increased length of stay, altered mental status, and morbidity in the preoperative setting was not evident, although the VES-13 was effective in identifying functional deficits in the older adult surgical patient. CONCLUSIONS: A detailed and comprehensive preoperative assessment remains the most efficient way to identify frail geriatric surgical patients.

Intersectional decomposition analysis with differential exposure, effects, and construct.

In recent years a wide array of proposals for bringing intersectional perspectives into quantitative studies of health disparities have appeared, from studies of interaction, predictive discrimination, to mediation. Bauer and Scheim, in a companion set of articles, extend these proposals by developing new attribution-blind measures of perceived discrimination and using VanderWeele's 3-way decomposition to quantify its contribution to disparities through differential exposure and differential effects (sometimes called differential vulnerability or susceptibility). In this commentary, after providing an overview of causal inference interpretations with social characteristics, we provide a broad overview of old and new decomposition methods in the social sciences literature and contrast their strengths and weaknesses for studying intersectional inequalities. We then examine how different forms of differential effects can be expressed within these decompositions and discuss their utility for the purpose of informing interventions for reducing disparities. Last, we discuss the tension in social sciences research when prominent explanatory variables represent constructs that are only defined or exist for certain marginalized populations and may not neatly fit within the decomposition methods framework. Through these discussions, we aim to provide greater conceptual clarity for applied researchers who are interested in using decomposition methods and other approaches to advance intersectional equity.

Nursing diagnoses for elderly women vulnerable to HIV/AIDS.

OBJECTIVE: Classify the diagnoses in the conceptual framework of vulnerability of Ayres and in the Orem's self-care theory; Elaborate operational definitions of nursing diagnoses for elderly women vulnerable to HIV/AIDS. METHOD: A descriptive exploratory study, developed from March to December 2016 in the stages: 1. Classification of diagnoses in the conceptual framework of vulnerability of Ayres and in the Orem's self-care theory; 2. Operational definition of nursing diagnoses. RESULTS: 70 nursing diagnoses were classified in the conceptual framework of vulnerability of Ayres and Orem's self-care theory, and their operational definitions were constructed, where 75.7% of these were validated. FINAL CONSIDERATION: Diagnoses represent conditions that make older women vulnerable to HIV/AIDS and are linked to their self-care practices. Operational definitions contribute to a systematic approach to care and greater clarity in its implementation.

Identifying vulnerable populations to death and injuries from residential fires.

OBJECTIVE: This study proposes and evaluates the theory that people who are susceptible to injury in residential fires are not susceptible to death in residential fires and vice versa. It is proposed that the population vulnerable to death in residential fires can be proxied by 'frailty', which is measured as age-gender adjusted fatality rates due to natural causes. METHODS: This study uses an ecological approach and controls for exposure to estimate the vulnerability of different population groups to death and injury in residential fires. It allows fatalities and injuries to be estimated by different models. RESULTS: Frailty explains fire-related death in adults while not explaining injuries, which is consistent with the idea that deaths and injuries affect disjoint populations. CONCLUSIONS: Deaths and injuries in fire are drawn from different populations. People who are susceptible to dying in fires are unlikely to be injured in fires, and the people who are susceptible to injury are unlikely to die in fires.

Paciente preso: controversias en su abordaje como paciente pluripatológico y sistemas de clasificación según complejidad y severidad / No disponible

No disponible

Nursing diagnoses for elderly women vulnerable to HIV/AIDS / Diagnósticos de enfermería para mujeres mayores con vulnerabilidad al VIH/ SIDA / Diagnósticos de enfermagem para mulheres idosas com vulnerabilidade ao HIV/aids

ABSTRACT Objective: Classify the diagnoses in the conceptual framework of vulnerability of Ayres and in the Orem's self-care theory; Elaborate operational definitions of nursing diagnoses for elderly women vulnerable to HIV/AIDS. Method: A descriptive exploratory study, developed from March to December 2016 in the stages: 1. Classification of diagnoses in the conceptual framework of vulnerability of Ayres and in the Orem's self-care theory; 2. Operational definition of nursing diagnoses. Results: 70 nursing diagnoses were classified in the conceptual framework of vulnerability of Ayres and Orem's self-care theory, and their operational definitions were constructed, where 75.7% of these were validated. Final consideration: Diagnoses represent conditions that make older women vulnerable to HIV/AIDS and are linked to their self-care practices. Operational definitions contribute to a systematic approach to care and greater clarity in its implementation.

RESUMEN Objetivo: Clasificar los diagnósticos en el marco conceptual de vulnerabilidad de Ayres y en la teoría del autocuidado de Orem; establecer definiciones operativas de diagnósticos de enfermería para mujeres mayores con vulnerabilidad al VIH/ SIDA. Método: Estudio de carácter exploratorio descriptivo, desarrollado de marzo a diciembre de 2016 en las etapas: 1. Clasificar los diagnósticos en el marco conceptual de vulnerabilidad de Ayres y en la teoría del autocuidado de Orem; 2. Definición operacional de los diagnósticos de enfermería. Resultados: Se clasificaron 70 diagnósticos de enfermería en el marco conceptual de vulnerabilidad de Ayres y en la teoría del autocuidado de Orem, y se construyeron sus definiciones operativas, de las cuales el 75,7% fueron validadas. Consideraciones finales: Los diagnósticos representan condiciones que hacen mujeres mayores vulnerables al VIH/ SIDA y están interconectados a sus prácticas de autocuidado. Las definiciones operativas contribuyen a un enfoque sistemático del cuidado y una mayor claridad en su aplicación.

RESUMO Objetivo: Classificar os diagnósticos no quadro conceitual de vulnerabilidade de Ayres e na teoria do autocuidado de Orem; elaborar definições operacionais de diagnósticos de enfermagem para mulheres idosas com vulnerabilidade ao HIV/aids. Método: Estudo de natureza exploratória descritiva, desenvolvido de março a dezembro de 2016 nas etapas: 1) Classificação dos diagnósticos no quadro conceitual de vulnerabilidade de Ayres e na teoria do autocuidado de Orem; 2) Definição operacional dos diagnósticos de enfermagem. Resultados: Foram classificados 70 diagnósticos de enfermagem no quadro conceitual de vulnerabilidade de Ayres e na teoria do autocuidado de Orem, e foram construídas as suas definições operacionais, em que 75,7% destas foram validadas. Considerações finais: Os diagnósticos representam condições que vulnerabilizam mulheres idosas ao HIV/aids e estão interligados às suas práticas de autocuidado. As definições operacionais contribuem para uma abordagem sistemática do cuidado e maior clareza na sua implementação.

Analysis of population-level determinants of legionellosis: spatial and geovisual methods for enhancing classification of high-risk areas.

BACKGROUND: Although the incidence of legionellosis throughout North America and Europe continues to increase, public health investigations have not been able to identify a common exposure in most cases. Over 80% of cases are sporadic with no known source. To better understand the role of the macro-environment in legionellosis risk, a retrospective ecological study assessed associations between population-level measures of demographic, socioeconomic, and environmental factors and high-risk areas. METHODS: Geographic variability and clustering of legionellosis was explored in our study setting using the following methods: unadjusted and standardized incidence rate and SaTScan™ cluster detection methods using default scanning window of 1 and 50% as well as a reliability score methodology. Methods for classification of "high-risk" census tracts (areas roughly equivalent to a neighborhood with average population of 4000) for each of the spatial methods are presented. Univariate and multivariate logistic regression analyses were used to estimate associations with sociodemographic factors: population ≥ 65 years of age, non-white race, Hispanic ethnicity, poverty, less than or some high school education; housing factors: housing vacant, renter-occupied, and built pre-1950 and pre-1970; and whether drinking water is groundwater or surface water source. RESULTS: Census tracts with high percentages of poverty, Hispanic population, and non-white population were more likely to be classified as high-risk for legionellosis versus a low-risk census tract. Vacant housing, renter-occupied housing, and homes built pre-1970 were also important positively associated risk factors. Drinking water source was not found to be associated with legionellosis incidence. DISCUSSION: Census tract level demographic, socioeconomic, and environmental characteristics are important risk factors of legionellosis and add to our understanding of the macro-environment for legionellosis occurrence. Our findings can be used by public health professionals to target disease prevention communication to vulnerable populations. Future studies are needed to explore the exact mechanisms by which these risk factors may influence legionellosis clustering.

Experiences in the Family Health Strategy: demands and vulnerabilities in the territory.

OBJECTIVE:: To understand the daily demands of Family Health Strategy in clinical practice of the team and social vulnerabilities of community territory. METHOD:: Research with qualitative approach, in a critical-reflexive perspective, held with two teams of the Family Health Strategy, in the city of Fortaleza, State of Ceará, Brazil. The participants were 22 users and 19 health professionals from the basic health network. Data from the interviews and observation were analyzed under the assumptions of critical hermeneutics. RESULTS:: We highlight the unveiling of sufferings and daily clashes, the influence of social determinants on health and psychosocial demands, limits and possibilities of everyday clinical practice. CONCLUSION:: The clinic attention must recognize the perceptions and living conditions by listening and promoting health in the community. OBJETIVO:: Compreender as demandas cotidianas da Estratégia Saúde da Família na prática clínica da equipe e as vulnerabilidades sociais do território comunitário. MÉTODO:: Pesquisa com abordagem qualitativa, numa perspectiva crítico-reflexiva, realizada com duas equipes da Estratégia Saúde da Família, no município de Fortaleza, Estado do Ceará, Brasil. Os participantes foram 22 usuários e 19 profissionais de saúde da rede básica de saúde. Os dados das entrevistas e observação foram analisados sob os pressupostos da hermenêutica crítica. RESULTADOS:: Evidenciam-se o desvelamento de sofrimentos e enfrentamentos cotidianos, a influência dos determinantes sociais na saúde e as demandas psicossociais, limites e possibilidades da prática clínica cotidiana. CONCLUSÃO:: Considera-se que a atenção clínica deve reconhecer as percepções e condições de vida pela escuta e ações de promoção de saúde na comunidade.

The essence of care in health vulnerability: a Heideggerian construction.

OBJECTIVE:: Reflect on the essence of care in health vulnerability from the phenomenological perspective of Martin Heidegger. METHOD:: Theoretical-reflexive study, anchored in three essential parts: 1) Care in Heidegger; 2) The essence of care in health vulnerability; And 3) Nursing care actions on health vulnerability. RESULTS:: Vulnerability must be recognized as an indelible trait of the human condition and has its constituents in the human being, co-presence and care. Caring is an interactive process that reveals itself in the relationship with the other. Respecting the integrity of the Being in vulnerability must be a priority in nursing care, through behaviors that privilege the Being. CONCLUSION:: Understanding ontological care and its relation to vulnerability under Heidegger's phenomenological view allowed us to uncover the facets of care in health vulnerability by adding to the nursing knowledge body a comprehensive and reflective perspective. OBJETIVO:: Refletir sobre a essência do cuidado na vulnerabilidade em saúde sob a perspectiva fenomenológica de Martin Heidegger. MÉTODO:: Estudo teórico-reflexivo, ancorado em três partes essenciais: 1) O cuidado em Heidegger; 2) A essência do cuidado na vulnerabilidade em saúde; e 3) As ações do cuidar em enfermagem na vulnerabilidade em saúde. RESULTADOS:: A vulnerabilidade deve ser reconhecida como traço indelével da condição humana e tem seus constituintes na pessoa humana, co-presenças e cuidado. O cuidar é um processo interativo que se desvela na relação com o outro. Respeitar a integridade do Ser em vulnerabilidade deve ser prioridade no cuidar em enfermagem, por meio de comportamentos que privilegiem o Ser. CONCLUSÃO:: Compreender ontologicamente o cuidado e a sua relação com a vulnerabilidade sob o olhar fenomenológico de Heidegger permitiu desvelar as facetas do cuidado na vulnerabilidade em saúde, agregando ao corpo de conhecimento da Enfermagem uma perspectiva compreensiva e reflexiva.

Experiences in the Family Health Strategy: demands and vulnerabilities in the territory / Vivencias en la Estrategia de Salud Familiar: demandas y vulnerabilidades en la comunidad / Vivências na Estratégia Saúde da Família: demandas e vulnerabilidades no território

ABSTRACT Objective: To understand the daily demands of Family Health Strategy in clinical practice of the team and social vulnerabilities of community territory. Method: Research with qualitative approach, in a critical-reflexive perspective, held with two teams of the Family Health Strategy, in the city of Fortaleza, State of Ceará, Brazil. The participants were 22 users and 19 health professionals from the basic health network. Data from the interviews and observation were analyzed under the assumptions of critical hermeneutics. Results: We highlight the unveiling of sufferings and daily clashes, the influence of social determinants on health and psychosocial demands, limits and possibilities of everyday clinical practice. Conclusion: The clinic attention must recognize the perceptions and living conditions by listening and promoting health in the community.

RESUMEN Objetivo: Conocer las demandas diarias de la Estrategia de Salud Familiar en la práctica clínica del personal y las vulnerabilidades sociales en la comunidad. Método: Estudio cualitativo, bajo la perspectiva crítica y reflexiva, realizado con dos personales de la Estrategia de Salud Familiar en la municipalidad de Fortaleza, Brasil. Los participantes fueron 22 usuarios y 19 profesionales de salud en la red básica de salud. Tanto los datos de las entrevistas como los de la observación se los evaluaron bajo la hermenéutica crítica. Resultados: Fueron manifestados sufrimientos y enfrentamientos diarios, así como la influencia de los determinantes sociales en la salud y las demandas psicosociales, los límites y las posibilidades en la práctica clínica diaria. Conclusión: El cuidado clínico debe reconocer las percepciones y las condiciones de vida a través de la escucha y de acciones que promocionen la salud en la comunidad.

RESUMO Objetivo: Compreender as demandas cotidianas da Estratégia Saúde da Família na prática clínica da equipe e as vulnerabilidades sociais do território comunitário. Método: Pesquisa com abordagem qualitativa, numa perspectiva crítico-reflexiva, realizada com duas equipes da Estratégia Saúde da Família, no município de Fortaleza, Estado do Ceará, Brasil. Os participantes foram 22 usuários e 19 profissionais de saúde da rede básica de saúde. Os dados das entrevistas e observação foram analisados sob os pressupostos da hermenêutica crítica. Resultados: Evidenciam-se o desvelamento de sofrimentos e enfrentamentos cotidianos, a influência dos determinantes sociais na saúde e as demandas psicossociais, limites e possibilidades da prática clínica cotidiana. Conclusão: Considera-se que a atenção clínica deve reconhecer as percepções e condições de vida pela escuta e ações de promoção de saúde na comunidade.