Invisibilização e preconceitos velados: barreiras para o acesso aos serviços de atenção básica pela população trans / Invisibilization and veiled prejudices: barriers to access to primary care services for the transgender population / Invisibilización y prejuicios velados: barreras para el acceso de la población trans a los servicios de atención primaria

Introdução: No processo de edificação da Política Nacional de Saúde Integral LGBT+, a Atenção Básica ganha importante destaque, pois deveria funcionar como o contato preferencial dos usuários transgênero (trans). Objetivo: Investigar quais as percepções dos profissionais da Atenção Básica quanto às situações de vulnerabilidade enfrentadas pelas pessoas trans, bem como pesquisar os impedimentos que eles consideram existir na busca dessa população por acesso a esses serviços. Métodos: Utilizou-se uma abordagem qualitativa por meio de entrevistas semiestruturadas com 38 profissionais de saúde atuantes das Estratégias Saúde da Família de dois municípios do interior do estado de São Paulo. O material obtido foi submetido à análise de conteúdo de Bardin. Resultados: Os resultados apontaram para o desconhecimento quanto aos reais empecilhos que dificultam o acesso e seguimento de pessoas trans nos serviços de saúde. Observou-se ainda a manutenção de preconceitos e ideias que reforçam estereótipos ligados ao tema e que se estendem ao exercício da profissão. Isso se relaciona diretamente com a falta da abordagem de assuntos relacionados à sexualidade humana na graduação desses profissionais, além da falta de atualização quanto ao tema, o que impacta a qualidade do serviço que é ofertado à população em estudo. Conclusões: As normativas e portarias já existentes precisam ser efetivamente postas em prática, fazendo-se imperativas a ampliação e difusão do conhecimento a respeito da temática trans no contexto dos serviços públicos de saúde, o que pode servir como base para subsidiar a formação dos profissionais que atuam nesse setor, bem como políticas públicas efetivas.

Introduction: In the process of creating the National LGBT+ Comprehensive Health Policy, primary care has important prominence as it must work as the preferential contact of transgender (trans) users. Objective: To investigate the perceptions of primary care professionals about the vulnerability situations faced by trans persons and also hindrances they consider existing in this population's search for access to these services. Methods: A qualitative approach was used through semi-structured interviews with 38 health care professionals working in the Family Health Strategy of two cities in the countryside of the state of São Paulo. The material obtained was submitted to analysis of Bardin content. Results: The results pointed to a lack of knowledge about real hindrances that obstruct the access to and follow-up by health services for trans persons. It was also observed the maintenance of prejudices and ideas that reinforce stereotypes connected to the matter and extend to the practice of professionals. It is directly related to the lack of approach of issues related to human sexuality in the education of those professionals, in addition to lack of update about it, which impacts the quality of service offered to the population under study. Conclusions: The standards and ordinances already existing need to be effectively practiced, being crucial the extension and spread of knowledge about trans matters in the context of public health services. It can be the basis for subsidizing the education of professionals who work in this field, as well as effective public policies.

Introducción: En el proceso de edificación de la Política Nacional de Salud Integral LGBT+, la Atención Básica tiene importante destaque, pues debería funcionar como contacto preferente de los usuarios transgénero (trans). Objetivo: Investigar las percepciones de los profesionales de Atención Básica sobre las situaciones de vulnerabilidad que enfrentan las personas trans, así como investigar los impedimentos que consideran que existe en la búsqueda de esta población por el acceso a estos servicios. Métodos: Se utilizó un abordaje cualitativo por medio de entrevistas semiestructuradas con 38 profesionales de salud actuantes de las Estrategias de Salud de la Familia de dos municipios del interior del estado de São Paulo. El material obtenido fue sometido a análisis de contenido de Bardin. Resultados: Los resultados apuntaron al desconocimiento sobre los reales obstáculos que dificultan el acceso de personas trans a los servicios, además del segmento de los cuidados en las unidades. Se observó además que se mantienen los prejuicios e ideas que refuerzan estereotipos vinculados al tema y que se extienden al ejercicio de la profesión. Esto se relaciona directamente a la falta da abordaje de asuntos relacionados a la sexualidad humana en la graduación de estos profesionales, además de la falta de actualización sobre el tema, lo que impacta en la calidad del servicio que se ofrece a la población en estudio. Conclusiones: Las normas y ordenanzas ya existentes deben ser efectivamente puestas en práctica, por lo que es imperativo ampliar y difundir el conocimiento sobre la temática trans en el contexto de los servicios públicos de salud, que pueda servir de base para apoyar la formación de profesionales que actúan en este sector, así como políticas públicas efectivas.

Loyola Generativity Scale e Generative Behavior Checklist: Um estudo psicométrico com idosos espanhóis LGBT+ / Loyola Generativity Scale and Generative Behavior Checklist: A Psychometric Study with Spanish LGBT+ Older Adults / Loyola Generativity Scale y Generative Behavior Checklist: Un estudio psicométrico con personas mayores españolas LGBT+

Resumo Enquadramento: A generatividade tem sido associada à resiliência e à satisfação com a vida na velhice, incluindo entre a população lésbica, gay, bissexual e transgénero (LGBT+) mais velha. Objetivo: Analisar as propriedades psicométricas da Loyola Generativity Scale (LGS) e da Generative Behavior Checklist (GBC) para idosos espanhóis LGBT + (com mais de 50 anos). Metodologia: Foi realizado um estudo psicométrico com 141 idosos espanhóis LGBT+ com o objetivo de examinar a validade de construto (análise fatorial exploratória), a validade convergente e a fiabilidade (consistência interna) da LGS e da GBC. Resultados: Os métodos de análise paralela e a análise fatorial exploratória sugeriram um modelo de dois fatores para ambos os instrumentos com boa adequação da amostra. A LGS explicou 45,1% da variância e apresentou uma consistência interna de 0,78. O GBC explicou 41,76% da variância e apresentou uma consistência interna de 0,879. Foi encontrada uma correlação positiva e estatisticamente significativa entre a satisfação com a vida e as escalas generativas. Foi também observada uma correlação positiva e significativa (rs = 0,310) entre os dois instrumentos. Conclusão: Ambos os instrumentos demonstraram ser válidos e fiáveis para medir a generatividade em idosos espanhóis LGBT+.

Abstract Background: Generativity has been associated with resilience and life satisfaction in older age, including among lesbian, gay, bisexual, and transgender (LGBT+) older adults. Objective: To examine the psychometric properties of the Loyola Generativity Scale (LGS) and Generative Behavior Checklist (GBC) for Spanish LGBT+ older adults (over the age of 50). Methodology: A psychometric study was conducted with 141 Spanish LGBT+ older adults to examine the construct validity (exploratory factor analysis), convergent validity, and reliability (internal consistency) of the LGS and the GBC. Results: Parallel and exploratory factor analyses suggested a two-factor model with good sample adequacy for both scales. The LGS explained 45.1% of the variance and had an internal consistency of 0.78. The GBC explained 41.76 % of the variance and had an internal consistency of 0.879. A positive and statistically significant correlation was found between life satisfaction and the generative scales. A positive and significant correlation (rs = 0.310) was also observed between both instruments. Conclusion: Both instruments proved valid and reliable for measuring generativity in Spanish LGBT+ older adults.

Resumen Marco contextual: La generatividad se asocia con la resiliencia y la satisfacción con la vida en la vejez, incluidas las de las personas adultas lesbianas, gays, bisexuales y transexuales (LGBT+). Objetivo: Examinar las propiedades psicométricas de la Loyola Generativity Scale (LGS) y la Generative Behavior Checklist (GBC) en adultos mayores LGBT+ españoles (mayores de 50 años). Metodología: Estudio psicométrico con 141 adultos mayores LGBT+. Se analizó la validez de constructo (análisis factorial exploratorio), la validez convergente y la consistencia interna de cada escala. Resultado: Los análisis factoriales paralelos y exploratorios sugieren un modelo bifactorial para ambas escalas con una buena adecuación a la muestra. La LGS explica el 45,1% de la varianza y tiene una consistencia interna de 0,78. La GBC explica el 41,76% de la varianza y tiene una consistencia interna de 0,879. Se encontró una correlación positiva estadísticamente significativa entre la satisfacción con la vida y las escalas de generatividad. Las dos escalas mostraron una correlación positiva y significativa (rs = 0,310). Conclusión: Ambas escalas han demostrado ser válidas y fiables para medir la generatividad en adultos mayores LGBT+ españoles.

[Coin tossing: Development of a computerized test to assess cognitive flexibility in older adults]. / Lanzando la moneda. Desarrollo de una prueba informática para evaluar la flexibilidad cognitiva en las personas mayores.

BACKGROUND: The aging population is increasing. Aging has been associated with some degree of cognitive decline, especially in functions such as cognitive flexibility. The voluntary task-switching paradigm is a novel model for studying this function. The aim of this work was to design and test a computerized instrument to assess cognitive flexibility with this paradigm. METHODS: A non-probabilistic and intentional sample of individuals aged 60 and above (N=57; M=70; SD=7.5), 72% of whom were women, was utilized. A general cognitive screening test (ACE III) and the "Coin Tossing" task, a computerized program consisting of four levels of complexity, were administered. RESULTS: A Wilcoxon test was used to contrast parity versus size responses (z(56)=-1.16, P=.24). To assess repetition bias, a Wilcoxon test was conducted between new and repeated responses (TR: z(56)=-1.81, P=.07 // Accuracy: z(56)=-6.33, P=.00). A repeated measures ANOVA was performed between reaction times before, during, and after a response change, F(1.02)=59.6, P<.01, η2=.937, B-1=1. And a repeated measures ANOVA between mean RTs per level, F(3)=7.92, P<.001, η2=.128, B-1=.98. CONCLUSIONS: The test was designed with a progressive structure across levels. The theoretical assumptions of the paradigm were partially demonstrated, showing its utility for the assessment and training of cognitive flexibility.

Injusticias epistémicas normalizadas y restricción de la agencia de las personas con discapacidad

Las injusticias epistémicas son aquellas formas de trato injusto que se relacionan con la producción, trasmisión o utilización del conocimiento por parte de los sujetos. El encuadre ético-epistémico y socio-epistémico proporcionado por estas injusticias se vincula con temas que atraviesan las principales tradiciones filosóficas como el pragmatismo, la fenomenología y la teoría crítica. Estas injusticias se interrelacionan, además, con movimientos sociales e intelectuales como el feminismo, la teoría crítica de la raza, los estudios críticos de la discapacidad y las epistemologías decolonizadoras. Sin embargo, existe un cuestionamiento a que las personas con discapacidad no han sido suficientemente abordadas. El presente artículo se posiciona en los debates actuales sobre las injusticias epistémicas y la discapacidad, y tiene como propósito aportar el concepto de "injusticias epistémicas normalizadas". Partiendo de la constatación de las formas en que se reconocen opresivamente los sujetos con discapacidad, como alejados de la "norma", establece que existen injusticias epistémicas asociadas con esta identificación. Propone que las injusticias epistémicas normalizadas ocurren en la intersección de dos ámbitos: un sistema hermenéutico capacitista y una agencia epistémica restringida en la que se producen al menos tres tipos de configuraciones: no agencia, agencias epistémicas disminuidas y agencias epistémicas en resistencia. Pensar las injusticias epistémicas considerando el peso de la "normalidad" en la constitución como sujetos de las personas con discapacidad permite reconocer una situación crítica de exclusión epistémica para algunas personas, mientras que otras resisten y luchan por ser comprendidas en los recursos hermenéuticos colectivos.

Epistemic injustices refer to those forms of unfair treatment that are related to the production, transmission, or use of knowledge by the subjects. The ethical-epistemic and socio-epistemic framework provided by these injustices is linked to themes that cross the main philosophical traditions such as pragmatism, phenomenology, and critical theory. These injustices are further intertwined with social and intellectual movements such as feminism, critical race theory, critical disability studies, and decolonizing epistemologies. However, there is a question that people with disabilities have not been sufficiently addressed. This article is positioned in the current debates on epistemic injustices and disability, and its purpose is to contribute the concept of "normalized epistemic injustices". Starting from the verification of the ways in which subjects with disabilities are oppressively recognized, as far from the "norm", it establishes that there are epistemic injustices associated with this identification. It proposes that normalized epistemic injustices occur at the intersection of two realms: a capacitist hermeneutic system and a constrained epistemic agency where at least three types of configurations are produced: non-agency; diminished epistemic agencies and epistemic agencies in resistance. Thinking about epistemic injustices considering the weight of "normality" in the constitution as subjects of people with disabilities allows us to recognize a critical situation of epistemic exclusion for some people, while others resist and fight to be understood in collective hermeneutical resources.

As injustiças epistêmicas referem-se àquelas formas de tratamento injusto que estão relacionadas à produção, transmissão ou uso do conhecimento pelos sujeitos. O enquadramento ético-epistêmico e socioepistêmico proporcionado por essas injustiças está vinculado a temas que atravessam as principais tradições filosóficas como o pragmatismo, a fenomenologia e a teoria crítica. Essas injustiças estão ainda mais entrelaçadas com movimentos sociais e intelectuais como o feminismo, a teoria crítica da raça, os estudos críticos da deficiência e as epistemologias descolonizadoras. No entanto, há uma questão de que as pessoas com deficiência não foram suficientemente abordadas. Este artigo se posiciona nos debates atuais sobre injustiças epistêmicas e deficiência, e seu objetivo é contribuir com o conceito de "injustiças epistêmicas normalizadas". A partir da verificação das formas como os sujeitos com deficiência são opressivamente reconhecidos, como distantes da "norma", constata-se que existem injustiças epistêmicas associadas a essa identificação. Propõe que injustiças epistêmicas normalizadas ocorrem na interseção de dois domínios: um sistema hermenêutico capacitista e uma agência epistêmica restrita onde pelo menos três tipos de configurações são produzidas: não-agência; agências epistêmicas diminuídas e agências epistêmicas em resistência. Pensar as injustiças epistêmicas considerando o peso da "normalidade" na constituição como sujeitos das pessoas com deficiência permite reconhecer uma situação crítica de exclusão epistêmica para algumas pessoas, enquanto outras resistem e lutam para serem compreendidas em recursos hermenêuticos coletivos.

Usefulness of the Mini Nutritional Assessment in the screening of sarcopenia in a sample of institutionalized older persons: A cross-sectional study / Utilidad del Mini Nutritional Assessment en el screening de sarcopenia en una muestra de personas mayores institucionalizadas: Un estudio transversal

Background: Sarcopenia is a disease associated with muscle changes during aging, and its detection remains a challenge outside specialized clinical units. Objective: To evaluate the utility of the Mini Nutritional Assessment (MNA) in detecting sarcopenia in institutionalized older persons. Materials and Methods: Cross-sectional study in adults aged 55 years and older from the city of Puebla. The MNA in its short form (SF) and full form (LF) were administered. The diagnosis of sarcopenia was made according to EWGSOP2. Points obtained from MNA-SF and MNA were plotted on a ROC curve. The odds ratio (OR) for presenting sarcopenia was evaluated according to recommended cutoff points with logistic regression models, adjusted for age and sex. Results: 162 participants were included, 64.1% were women, the mean age was 69.8 years (SD:5). The mean scores of MNA-SF and MNA-LF were 12.17 (SD:1.78), and 25.1 (SD:2.83), respectively. The prevalence of sarcopenia was 20.4%. The AUC of MNA-SF was 0.68 (95%CI:0.58-0.78) and for MNA-LF, 0.60 (95%CI:0.49-0.71). The OR for presenting sarcopenia with MNA-SF<12 was OR=2.87 (95%CI:1.31-6.29) and, after adjustment for age and sex, OR=2.47 (95%CI:1.10-5.54). Conclusions: According to AUC, MNA-SF may be useful in detecting sarcopenia in institutionalized older persons, while MNA-LF may have reduced utility in practice.

Antecedentes: la sarcopenia es una enfermedad asociada con cambios musculares durante el envejecimiento, y su detección sigue siendo un desafío fuera de las unidades clínicas especializadas. Objetivo: Evaluar la utilidad del Mini Nutritional Assessment (MNA) en la detección de sarcopenia en personas mayores institucionalizadas. Materiales y Métodos: Estudio transversal en adultos de 55 años y más de la ciudad de Puebla. Se administró el MNA en su forma corta (SF) y forma completa (LF). El diagnóstico de sarcopenia se realizó según EWGSOP2. Los puntos obtenidos de MNA-SF y MNA se representaron en una curva ROC. Se evaluó el odds ratio (OR) de presentar sarcopenia según puntos de corte recomendados con modelos de regresión logística, ajustados por edad y sexo. Resultados: Se incluyeron 162 participantes, el 64.1% fueron mujeres, la edad media fue 69.8 años (DE:5). Las puntuaciones medias de MNA-SF y MNA-LF fueron 12.17 (DE: 1.78) y 25.1 (DE: .,83), respectivamente. La prevalencia de sarcopenia fue del 20.4%. El AUC de MNA-SF fue 0,68 (IC 95%: 0.58-0.78) y para MNA-LF, 0.60 (IC 95%: 0.49-0.71). El OR de presentar sarcopenia con MNA-SF<12 fue OR=2.87 (IC95%:1.31-6.29) y, tras ajustar por edad y sexo, OR=2.47 (IC95%:1.10-5.54). Conclusiones: Según la AUC, MNA-SF puede ser útil para detectar sarcopenia en personas mayores institucionalizadas, mientras que MNA-LF puede tener una utilidad reducida en la práctica.

Pistas genealógicas de um Consultório na Rua: criminalização e assimilação / Genealogical clues from a Street Clinic: criminalization and assimilation / Pistas genealógicas de un Consultorio em la Calle: criminalización y asimilación

Este artigo, por meio de aproximação genealógica, buscou investigar o que chamaremos de pistas genealó-gicas do equipamento Consultório na Rua em município de médio porte no Sul do Brasil. Para o percurso da pesquisa, junto a uma vivência em um Consultório na Rua, nesse município do país, foram realizados entrevistas e levantamentos de documentos. Na investigação foi possível encontrar pistas que apontam para uma produção de criminalização e assimilação histórica dos viventes da rua pelo Estado brasileiro, de maneira que esses pontos precisam ser discutidos e problematizados para que tais regimes de verdade não sejam norteadores das políticas públicas para tais pessoas.

This article, employing a genealogical approach, aimed to examine the genealogical traces of the Street Clinic equipment in a medium-sized city in Brazil's southern region. In order to follow the path of the research, along with an experience in a Street Clinic in a Brazilian city, interviews and document surveys were conducted. In the investigation, it was possible to find elements of the production of criminalization and historical assimilation by the Brazilian State that need to be discussed and problematized so that such regimes of truth are not guiding the production of health care for people experiencing homelessness.

Este artículo, a través de un abordaje genealógico, buscó investigar pistas genealógicas del Consultorio en la Calle en una ciudad de tamaño medio en el sur de Brasil. Para el transcurso de la investigación, junto con una experiencia en un Consultorio en la Calle en un municipio de tamaño medio en el sur de Brasil, se efectuaron entrevistas y encuestas documentales. En la investigación, fue posible encontrar pistas que apuntan a una producción de criminalización y asimilación histórica de las personas en situación de calle por parte del Estado brasileño, por lo que estos puntos necesitan ser discutidos y problematizados para que tales regímenes de verdad no guíen políticas públicas para dicha población.

Prevalence of suspected abuse of non-institutionalized older people treated in primary care. PRESENCIA study.

OBJECTIVES: To determine the prevalence of suspected abuse of non-institutionalised elderly people and the associated variables. PATIENTS AND METHOD: Observational, descriptive, cross-sectional, multicentre study in patients aged 65 years or older, non-institutionalised, consecutively selected in primary care (PC). The EASI questionnaires (Suspected Elderly Abuse Index), the EAI questionnaire (Suspected Abuse Index in patients with cognitive impairment), the Barthel index, and the EUROQOL-5D questionnaire were used with patients, and the CASE questionnaire and the Zarit test were used with caregivers. Socio-demographic, health, and quality of life variables were analysed in all patients. RESULTS: Eight hundred four patients were included, mean age 78.9±7.9 years, 58.3% women. The prevalence of suspected abuse was 11.3% (95% CI: 9.1%-13.9%). Suspected abuse was more frequent in women than in men (14.4% vs. 7.1%; odds ratio (OR)=1.97; 95% CI=1.1-3.4; p=0.016) and in those who lived with two or more people compared to those who lived alone (18.4% vs. 7.3%; OR=2.42; 95% CI=1.1-5.0; p=0.017). Among older patients, the lower their dependency, the lower the prevalence of suspected abuse (30.0% in highly dependent vs. 8.7% in non-dependent: p-trend=0.006); and the better the perceived health status, the lower the prevalence of suspected abuse (29.6% in poor health status vs. 6.9% in optimal health status; p-trend=<0.001). Among caregivers, the prevalence of suspected abuse was 20.4% (95% CI=12.8%-28.0%). A trend of higher prevalence of suspected abuse could be observed with higher scores on the CASE questionnaire (56.3% at high risk and 9.6% with no risk of abuse; p-trend=0.007). In the case of the ZARIT questionnaire with scores below 47, the prevalence of suspected abuse was 9.1%, and for scores above 55, it was 52.6% (p-trend<0.001). CONCLUSIONS: The results of the PRESENCIA study show that approximately 1 in 10 patients aged ≥65 meet the criteria for suspected abuse. The probability of abuse increases in women, in patients with greater dependency and in patients with poorer perceived health status. Caregivers with greater overload and greater risk presented a greater suspicion of elder abuse.

Guía clínica para la atención integral en salud de las personas con VIH / Clinical guide for comprehensive health care for people with HIV

La presente guía clínica se constituye en la actualización de la Guía clínica de atención integral en salud de las personas con VIH, de diciembre de 2014, la cual se hace necesaria para contribuir a los objetivos del Plan Estratégico Nacional Multisectorial (PENM) cuya misión es la de conducir acciones en la repuesta nacional al VIH y las ITS, garantizando el acceso a la atención de las personas con VIH e ITS con estándares internacionales, previniendo nuevas infecciones; propiciando un entorno de respeto a los derechos humanos, equidad de género y la diversidad sexual, encaminada hacia la eliminación del VIH en El Salvador, reducción de nuevas infecciones de VIH, reducción de muertes relacionadas a sida y eliminación de la transmisión materno infantil. En el presente documento se incluyen las recomendaciones de la Organización Mundial de la Salud (OMS), sobre nuevos medicamentos antirretrovirales en tratamientos de primera, segunda y tercera línea, en todas las poblaciones incluidas, embarazadas y mujeres en edad fértil; se presentan diferentes esquemas de tratamiento, con el propósito de mejorar la calidad en la atención de la persona con VIH

This clinical guide is an update of the Clinical Guide for Comprehensive Health Care for People with HIV, dated December 2014, which is necessary to contribute to the objectives of the National Multisector Strategic Plan (PENM), whose mission is that of leading actions in the national response to HIV and STIs, guaranteeing access to care for people with HIV and STIs with international standards, preventing new infections; promoting an environment of respect for human rights, gender equality and sexual diversity, aimed at eliminating HIV in El Salvador, reducing new HIV infections, reducing AIDS-related deaths and eliminating mother-to-child transmission. This document includes the recommendations of the World Health Organization (WHO) on new antiretroviral drugs in first, second and third line treatments, in all populations included, pregnant women and women of childbearing age; Different treatment schemes are presented, with the purpose of improving the quality of care for people with HIV.

Vocal Approach to Transgender Individuals: The Journey Taken in Chile and Argentina

In recent years, there have been international references to the vocal approach for the specific group of transgender individuals, although the Latin American literature is still very timid on this matter. The purpose of this article is to identify the current norms, statistics, and vocal approach towards transgender individuals in Chile and Argentina, considering the experience of two speech and language pathologists with more than twenty years of experience on voice therapy. Reflections were made on the transgender reality in these countries, the limitations in the implementation of the depathologization of the transgender group were outlined, some current and unreliable statistics were presented, some innovative actions in the public system were highlighted, and the lack of knowledge about the benefits of vocal work for transgender men and women was discussed. The identified aspects could benefit from multicenter research that strengthens speech therapy actions with this group, contributing to depathologization and positive approach.

Desde los últimos años es posible encontrar referencias internacionales sobre el abordaje vocal al grupo específico de las personas transgénero, aunque la literatura latinoamericana sigue muy tímida en este asunto. La propuesta de este artículo es identificar las normas vigentes, estadísticas y abordaje vocal hacia las personas transgénero en Chile y Argentina, considerando la experiencia de dos fonoaudiólogas con más de veinte años de experiencia en terapia vocal. Se hicieron reflexiones sobre la realidad transgénero en los países citados, se delinearon las limitaciones en la puesta en práctica de la despatologización del grupo transgénero, se expusieron algunas estadísticas -vigentes y poco confiables-, se plasmaron algunas acciones novedosas en el sistema público y el desconocimiento sobre los beneficios del trabajo vocal en hombres y mujeres transgénero. Los aspectos detectados podrían beneficiarse de investigaciones multicéntricas que fortalezcan acciones fonoaudiológicas con este grupo, contribuyendo a la despatologización y el abordaje positivo.

User-centered development of an mHealth app for cardiovascular prevention.

Background: Mobile health (mHealth) apps can be used for cardiovascular disease (CVD) prevention. User-centered design, evidence-based content and user testing can be applied to ensure a high level of usability and adequate app access. Objective: To develop and evaluate an mHealth app (HerzFit) for CVD prevention. Methods: HerzFit´s development included a user-centered design approach and guideline-based content creation based on the identified requirements of the target group. Beta testing and a preliminary usability evaluation of the HerzFit prototype were performed. For evaluation, German versions of the System Usability Scale (SUS) and the mHealth App Usability Questionnaire (GER-MAUQ) as well as free text feedback were applied. Results: User-centered design thinking led to the definition of four personas. Based on their requirements, HerzFit enables users to individually assess, monitor, and optimize their cardiovascular risk profile. Users are also provided with a variety of evidence-based information on CVD and their risk factors. The user interface and system design followed the identified functional requirements. Beta-testers provided feedback on the structure and functionality and rated the usability of HerzFit´s prototype as slightly above average both in SUS and GER-MAUQ rating. Participants positively noted the variety of functions and information presented in HerzFit, while negative feedback mostly concerned wearable synchronization. Conclusions: The present study demonstrates the user-centered development of a guideline-based mHealth app for CVD prevention. Beta-testing and a preliminary usability study were used to further improve the HerzFit app until its official release.

Plan estratégico para el abordaje integral de las personas con epilepsia 2024-2031 / Strategic plan for the comprehensive approach to people with epilepsy 2024-2031

El presente Plan Estratégico para el abordaje integral de la persona con epilepsia 2024-2031 es la respuesta al compromiso del Plan Mundial para fortalecer la gobernanza para el abordaje integral de la persona en El Salvador, el Ministerio de Salud como rector ha elaborado con la participación de las Instituciones integrantes del Sistema Nacional Integrado de Salud. Dicho Plan integra el marco de referencia destacando el panorama mundial y nacional de la situación de las personas con epilepsia, estableciendo los principios rectores y enfoques para el abordaje integral, además las líneas estratégicas y actividades programadas

This Strategic Plan for the comprehensive approach to people with epilepsy 2024-2031 is the response to the commitment of the World Plan to strengthen governance for the comprehensive approach to the person in El Salvador, the Ministry of Health as rector has developed with the participation of the Institutions that make up the National Integrated Health System. This Plan integrates the reference framework highlighting the global and national panorama of the situation of people with epilepsy, establishing the guiding principles and approaches for a comprehensive approach, as well as the strategic lines and programmed activities

[Homelessness as a determinant of health and its impact on quality of life]. / Sinhogarismo como determinante de la salud y su impacto en la calidad de vida.

OBJECTIVE: To determine the health status of the homeless population who spend the night on the streets and in shelters (extreme residential exclusion), with reference to their quality of life, self-perceived health, comorbidity and access to health resources. METHOD: A cross-sectional descriptive study was carried out on a sample of 263 homeless people in the city of Valencia by means of a nocturnal count and using the EQ-5D-3L Health Related Quality of Life questionnaire and questions from the European Quality of Life Survey for Spain. RESULTS: Of the people who participated in the study, 129 of them slept outdoors, 49% (62.79% men, 19.37% women and 17.84% unidentified), while 134 slept in hostels, i.e. 51% (67.16% men and 32.84% women) with an estimated average age of 41.53 years and 55% had been living on the street for less than 12 months. People staying overnight on the streets presented worse quality of life and more than a quarter of the sample lacked a health card. CONCLUSIONS: There is a relationship between homelessness and poor health conditions in terms of quality of life, perceived health, comorbidity and accessibility to health to resources. The inverse care law is evidenced.

Incidence of Muscular Strength, Anthropometry, and Asymmetry in the General Index of Autonomy in Older Chilean Women

SUMMARY: Frailty affects the functional autonomy (FA) of older adults and could manifest itself in muscle imbalances in the limbs, resulting in a disparity in size and strength between them. In Chile, information on the relationship between muscle strength (MS) levels and FA asymmetries in older women is limited. This study related the levels of MS, anthropometric parameters, and asymmetries of the lower and upper limbs, with the FA of a group of older Chilean women. The study included 39 women who participated, and their FA was evaluated using the GDLAM index (IG). Based on the score obtained in the IG, they were classified by percentiles as Group 1 with favorable FA (P ≤ 50) and Group 2 with low FA (P > 50). Anthropometric parameters were BMI, fat percentage, bone mass, circumferences (arm, thigh, calf), diameters (humerus, femur) and upper/lower limb strength was evaluated to determine asymmetries. The differences between the covariates of both groups were evaluated using the student's t test and the Mann-Whitney test for independent samples. G1 presented less asymmetry (p > 0.05) in the lower limbs and greater calf circumference than G2 (p < 0.05). G1 presented greater bilateral strength (dominant and non-dominant limb) compared to G2 (p < 0.05). The covariates of age, anthropometry, MS, and lower/upper limb asymmetries influence FA in older women.

La fragilidad afecta la autonomía funcional (AF) de las personas mayores y podría manifestarse en desequilibrios musculares en los miembros, dando lugar a una disparidad de tamaño y fuerza entre ellos. En Chile, la información que relaciona los niveles de fuerza muscular (FM) y las asimetrías con la AF en mujeres mayores es limitada. Este estudio relacionó los niveles de FM, parámetros antropométricos y asimetrías de los miembros inferiores y superiores, con la AF de un grupo de mujeres mayores chilenas. Participaron 39 mujeres, cuya AF se evaluó mediante el índice GDLAM (IG). En función de la puntuación obtenida en el IG, se clasificaron por percentiles en Grupo 1 con AF favorable (P ≤ 50) y Grupo 2 con AF baja (P > 50). Los parámetros antropométricos fueron IMC, porcentaje de grasa, masa ósea, circunferencias (brazo, muslo, pantorrilla), diámetros (húmero, fémur) y se evaluó la fuerza de los miembros superiores/ inferiores para determinar asimetrías. Las diferencias entre las covariables de ambos grupos se evaluaron mediante la prueba t de student y la prueba de Mann-Whitney para muestras independientes. G1 presentó menor asimetría (p > 0,05) en los miembros inferiores y mayor perímetro de pantorrilla que G2 (p < 0,05). G1 presentó mayor fuerza bilateral (miembro dominante y no dominante) en comparación con G2 (p < 0,05). Las covariables de antropometría, FM y asimetrías de extremidades inferiores/superiores influyen en la AF en mujeres mayores.

User Personas for a "Better Design" of Nation-Wide EHRs Based on Thorough Expert Evaluation and Field Analysis: Modeling Users as Individuals Plus Family Members for an Enhanced Mapping of Healthcare Situations.

Electronic Health Records (EHRs) are pivotal in prevention, therapy, and care. Their design necessitates the representation of users, activities, context, and technology. Among various participative and ethnographic design methods, user personas are an effective tool for encapsulating users in the design process. Goals and methods: This research focused on the creation of user personas for the design of a nation-wide EHR, specifically the German "elektronische Patientenakte" (ePA). We employed qualitative methods, such as field analysis and expert workshops, to generate, assess, and refine a set of user personas that can cover the complexity of real-life familial care environments. We used an innovative bottom-up approach applying a whole new process for persona generation especially in the context of family management. Results: The research yielded an initial set of five personas that accurately represent fictional user types. Importantly, at least two of these personas encapsulate the unique challenges inherent in family care work. These results provide a foundation for future work, which can utilize these personas for EHR design, as well as for further evaluation and refinement.

Loneliness impact on healthcare utilization in primary care: A retrospective study.

BACKGROUND: An increased number of patients seek help for loneliness in primary care. OBJECTIVE: To analyze whether loneliness was associated with a higher utilization of healthcare facilities. METHODS: Observational, retrospective study based on the review of routinely coded data in the digital medical record system in a random sample of patients aged 65 or older, stratified by population size of their residence area. A minimum sample size was estimated at 892 medical records. Loneliness was defined as the negative feeling that arises when there is a mismatch between the quantity and quality of a person's social relationships and those, they desire. Thirty-three primary care nurses (30 females and 3 males) were reviewing the data. RESULTS: A total of 932 medical records of patients were reviewed (72% belonged to female patients). Of these, 657 individuals were living alone (71.9%). DeJong Scale average scores was 8.9 points (SD 3.1, 95CI 8.6-9.1). The average annual attendance to primary care ranged from 12.2 visits per year in the case of family practice, 10.7 nurse, 0.7 social workers. The average number of home visits was 3.2, and the urgent consultations attended at health centers were 1.5 per year. Higher feelings of loneliness were associated with extreme values in the frequency of healthcare resource usage. Compared to their peers of the same age, the additional healthcare resource consumption amounted to €802.18 per patient per year. CONCLUSION: Loneliness is linked to higher healthcare resource usage in primary care, with individuals experiencing poorer physical and mental health utilizing these resources up to twice as much as their peers of the same age.

[Recommendations for Primary Health Care for transgender people]. / Recomendaciones para la atención de la salud en Atención Primaria de las personas transgénero.

The WHO defines Primary Health Care as essential health care, based on practical, scientifically founded and socially acceptable methods and technologies, made available to all individuals and families in the community, through their full participation, and at a cost that the community and the country can bear, at each and every stage of their development, in a spirit of self-responsibility and self-determination. With the intention of fulfilling the basic objective of caring for and promoting health in all the groups that make up our current society, the need arises to focus on certain groups in which the actions of Primary Care are currently consensual or poorly protocolised, as is the case with the health care of transgender people.

Estado actual de la Enfermería en los Centros de Día Gerontológicos de Huelva / Estado atual da enfermagem nos Centros de Dia Gerontológicos de Huelva / Current state of Nursing in Gerontological Day Centers of Huelva

Introducción: El envejecimiento poblacional ha desplegadoun nuevo y amplio campo de estudio para la ciencia sanitariaen el que la enfermería debe investigar para garantizar laautonomía en salud de las personas mayores.Objetivo: Visibilizar los Centros de Día Gerontológicos(CDG) y las actividades de los profesionales de enfermeríaen dichos centros en Huelva.Metodología: Se ha realizado una investigación cualitativa apartir de cuestionarios y entrevistas dirigidas al personal dedirección y enfermería de varios Centros de Día de Huelvay provincia.Resultados: Los CDG son un recurso intermedio con múltiplesobjetivos y funciones, que ofrecen calidad de vida tantopara los mayores como para sus familiares. Se componende un equipo básico de profesionales que trabaja de formano permanente. La figura de la enfermería es esencial, perocuenta con una situación laboral muy deficiente.Conclusión: Estos centros proporcionan cuidados profesionalesy permiten la permanencia en los domicilios habitualesfavoreciendo la calidad de vida y autonomía de esta poblaciónmayor. La bibliografía sobre este tema es escasa, por lo quese considera necesario profundizar en su investigación juntocon la puesta en marcha de programas y propuestas de mejoraque den a conocer estos centros sociosanitarios.(AU)

Introduction: Population aging has opened up a newand broad field of study for health science in whichnursing must investigate to guarantee the healthautonomy of older people.Objective: To make visible the Gerontological DayCenters (CDG) and the activities of nursing professionalsin these centers in Huelva.Methodology: A qualitative investigation has beencarried out using questionnaires and interviews directedat the management and nursing staff of several DayCenters in Huelva and the province.Results: The CDG are an intermediate resource withmultiple objectives and functions, which offer qualityof life for both the elderly and their families. They aremade up of a basic team of professionals who workon a non-permanent basis. The role of nursing isessential, but it has a very poor employment situation.Conclusion: These centers provide professional careand allow them to remain in their usual homes,favoring the quality of life and autonomy of thisolder population. The bibliography on this topic isscarce, so it is considered necessary to deepen itsresearch along with the implementation of programsand improvement proposals that make these socio-health centers known.(AU)

Introdução: O envelhecimento populacional abriuum novo e amplo campo de estudo para as ciênciasda saúde no qual a enfermagem deve investigar paragarantir a autonomia de saúde dos idosos.Objectivo: Dar visibilidade aos Centros de DiaGerontológicos (CDG) e à actividade dos profissionaisde enfermagem destes centros de Huelva.Metodologia: Foi realizada uma investigação qualitativaatravés de questionários e entrevistas dirigidas aosdirigentes e pessoal de enfermagem de vários Centrosde Dia de Huelva e da província.Resultados: Os CDG são um recurso intermediáriocom múltiplos objetivos e funções, que oferecemqualidade de vida tanto para os idosos quanto paraseus familiares. São formados por uma equipe básicade profissionais que atuam de forma não permanente.O papel da enfermagem é essencial, mas tem umasituação laboral muito precária.Conclusão: Estes centros prestam cuidados profissionaise permitem a permanência nos seus domicílios habituais,favorecendo a qualidade de vida e a autonomia destapopulação idosa. A bibliografia sobre este tema éescassa, pelo que considera-se necessário aprofundara sua investigação juntamente com a implementaçãode programas e propostas de melhoria que dêem aconhecer estes centros sócio-sanitários.(AU)

First steps towards the deinstitutionalization of older adults: A protocol for the implementation of a complex intervention / Primeros pasos en la desinstitucionalización de adultos mayores: protocolo para la implementación de una intervención compleja

Background: Nursing homes are becoming increasingly important as end-of-life care facilities. However, many older adults want to stay in their homes as they age. Objective: To assess the feasibility of a deinstitutionalization process on selected institutionalized older adults who are willing to initiate the process. Methods: This study, divided into two phases, will be carried out over 15 months on 241 residents living in two nursing homes in Navarra (Spain). The first phase has a cross-sectional design. We will identify the factors and covariates associated with feasibility and willingness to participate in a deinstitutionalization process by bivariate analysis, essential resources for the process and residents to participate in the process. The second phase has a complex interventional design to implement a deinstitutionalization process. An exploratory descriptive and comparative analysis will be carried out to characterize the participants, prescribed services and the impact deinstitutionalization intervention will have over time (quality of life will be the main outcome; secondary variables will be health, psychosocial, and resource use variables). This study will be accompanied by a pseudo-qualitative and emergent sub-study to identify barriers and facilitators concerning the implementation of this process and understand how intervention components and context influence the outcomes of the main study. Intervention components and the way the intervention is implemented will be of great relevance in the analysis. Discussion: Alternatives to institutionalization with adapted accommodation and community support can allow people who wish to return to the community.(AU)

Introducción: Las residencias de personas mayores cobran cada vez más importancia como centros de atención al final de la vida. Sin embargo, muchos adultos mayores desean permanecer en sus casas mientras envejecen. Objetivo: Se pretende evaluar la viabilidad de un proceso de desinstitucionalización en adultos mayores seleccionados que viven en las residencias y que expresen la voluntad para iniciar el proceso. Métodos: Este estudio, dividido en dos fases, se llevará a cabo durante 15 meses en 241 sujetos que viven en dos residencias de personas mayores en Navarra (España). La primera fase tiene un diseño transversal en donde se identificarán los factores y covariables asociadas a la viabilidad y voluntad para participar en un proceso de desinstitucionalización a través de un análisis bivariante, los recursos imprescindibles para el proceso y los residentes que quieran participar en él. La segunda fase tiene un diseño de intervención compleja en la que se implementa un proceso de desinstitucionalización. Se realizará un análisis exploratorio descriptivo y comparativo para caracterizar a los participantes, los servicios prescritos y el efecto de la intervención de desinstitucionalización a lo largo del tiempo (la calidad de vida será la variable principal; las secundarias serán las referentes a la salud, las psicosociales y de uso de recursos). Este estudio irá acompañado de un subestudio pseudocualitativo y emergente para identificar las barreras y los elementos facilitadores relativos a la implementación de este proceso y comprender cómo los componentes de la intervención y el contexto influyen en los resultados del estudio principal. Los componentes de la intervención y su ejecución serán de gran relevancia en el análisis. Discusión: Las alternativas a la institucionalización con viviendas adaptadas y apoyos comunitarios pueden permitir a las personas que así lo desean el retorno a la comunidad.(AU)

Generating user-driven patient personas to support preventive health care activities of rural-living unattached patients.

Objective: This study created personas using quantitative segmentation and knowledge user enhancement to inform intervention and service design for rural patients to encourage preventive care uptake. Methods: This study comprised a cross-sectional survey of rural unattached patients and a co-design workshop for persona development. Cross-sectional survey data were analyzed for meaningful subgroups based on quartiles of preventive care completion. These quartiles informed "relevant user segments" grouped according to demographics (age, sex), length of unattachment, percentage of up-to-date preventive activities, health care visit frequency, preventive priorities, communication confidence with providers, and chronic health conditions, which were then used in the workshop to build the final personas. Results: 207 responses informed persona user segments, and five health care providers and 13 patients attended the workshop. The resulting four personas, included John (not up-to-date on preventive care activities), Terrance (few up-to-date preventive care activities), George (moderately up-to-date preventive care activities), and Anne (mostly up-to-date preventive care activities). Conclusion: Quantitative persona development with integrated knowledge user co-design/enhancement elevated and enriched final personas that achieved robust profiles for intervention design. Innovation: This project's use of a progressive methodology to build robust personas coupled with participant feedback on the co-design process offers a replicable approach for health researchers.