In-hospital stroke protocol outcomes before and after the implementation of neurological assessments by telemedicine: an observational case-control study.

Purpose: Stroke is the second leading cause of global adult mortality and the primary cause of disability. A rapid assessment by a neurologist for general and reperfusion treatments in ischemic strokes is linked to decreased mortality and disability. Telestroke assessment is a strategy that allows for neurological consultations with experienced professionals, even in remote emergency contexts. No randomized studies have compared face-to-face neurological care outcomes with telestroke care. Whether neurologists in an institution achieve better results remotely than in person is also unknown. This study aimed to compare mortality and other outcomes commonly measured in stroke protocols for stroke patients assessed by a neurologist via face-to-face evaluations and telestroke assessment. Methods: Observational single-center retrospective study from August/2009 to February/2022, enrolling 2,689 patients with ischemic stroke, subarachnoid hemorrhage, and intracerebral hemorrhage. Group 1 (G1) comprised 2,437 patients with in-person neurological assessments, and Telemedicine Group 2 (G2) included 252 patients. Results: The in-person group had higher admission NIHSS scores (G1, 3 (0; 36) vs. G2, 2 (0; 26), p < 0.001). The door-to-groin puncture time was lower in the in-person group than in the telestroke group (G1, 103 (42; 310) vs. G2, 151 (109; 340), p < 0.001). The telestroke group showed superior metrics for door-to-imaging time, symptomatic hemorrhagic transformation rate in ischemic stroke patients treated with intravenous thrombolysis, hospital stay duration, higher rates of intravenous thrombolysis and mechanical thrombectomy, and lower mortality. Symptomatic hemorrhagic transformation rate was smaller in the group evaluated via telestroke (G1, 5.1% vs. G2, 1.1%, p = 0.016). Intravenous thrombolysis and mechanical thrombectomy rates were significantly higher in telestroke group: (G1, 8.6% vs. G2, 18.2%, p < 0.001 and G1, 5.1% vs. G2, 10.4%, p = 0.002, respectively). Mortality was lower in the telestroke group than in the in-person group (G1, 11.1% vs. G2, 6.7%, p = 0.001). The percentage of patients with an mRS score of 0-2 at discharge was similar in both groups when adjusting for NIHSS score and age. Conclusion: The same neurological emergency team may assess stroke patients in-person or by telemedicine, with excellent outcome metrics. This study reaffirms telestroke as a safe tool in acute stroke care.

Knowledge about Breast Cancer and Barriers to Screening among Saudi Women in Al-Baha Region.

OBJECTIVE: The aim of this study was to measure the knowledge about breast cancer and to identify the barriers in screening among Saudi women in the Al-Baha region. To achieve this, a cross-sectional study was conducted, involving 468 women, to assess their understanding of breast cancer and to explore the obstacles they face in accessing breast cancer screening services. METHODS: The cross-sectional study included 468 women from Al Baha, Saudi Arabia, starting from May 17, 2022, to May 17, 2023. Participants were interviewed by well-trained team members of the research, and their responses were subsequently entered into a Google Form. This process aimed to evaluate their awareness, knowledge, and barriers to breast cancer screening. RESULTS: The majority of participants (48.9%) were in the 18-28 age group. The findings reveal a high level of awareness (96.4%) among participants regarding the significance of early breast cancer detection. For the effectiveness of breast cancer treatment, 59% believed there is an effective treatment, while 32.9% were uncertain or did not know. Knowledge about various risk factors for breast cancer varied. Smoking (73.5%), genetic factors (65.6%), and a family history of breast cancer (70.7%) were well-recognized as risk factors. Education and occupation significantly influenced knowledge about breast cancer (p-value of 0.000, and 0.035 respectively). CONCLUSION: this research highlights strong awareness of breast cancer's importance but gaps in knowledge regarding lesser-known factors. Education is crucial, requiring tailored campaigns and healthcare professional engagement.

Perceived barriers of access to health and nutrition services under drought and food insecurity emergency in north-east Uganda: a qualitative study.

BACKGROUND: In the face of drought and food insecurity emergency, evidence on access to health and nutrition services is important. Karamoja is one of the regions that have experienced extreme drought and food insecurity emergency in Uganda. As a part of the drought and food insecurity emergency response, World Health Organization (WHO) with Ministry of Health (MoH) has designed and implemented a qualitative study in 15 districts that have experienced drought and food insecurity emergency in north-east Uganda. Thus, we aimed to explore the barriers of access to health and nutrition services in drought and food insecurity emergency affected districts in north-east Uganda. METHODS: We employed a descriptive qualitative study design. We interviewed 30 patients and 20 Village Health Teams (VHT) from 15 districts. We employed an in-depth interview with semi-structured questions to collect data until information saturation reached. We used thematic data analysis approach by ATLAS.ti version 7.5.1.8 software. RESULTS: Of the 30 interviewed subjects, 15 were female, and the median age of the subjects was 29 years with interquartile range (IQR) of 23 to 37 years. Majority (68.8%) of subjects reported that access to health and nutrition services was harder to them. Four themes: sociocultural and economic; environmental; health system, and individual related factors were identified as the barriers of access to health and nutrition services. CONCLUSION: The present study identified several modifiable barriers that hinder access to health and nutrition services in drought and food insecurity affected districts. Comprehensive interventions aimed at addressing sociocultural, economic, environmental, health system and subject related challenges are required to improve access to health and nutrition services in drought and food insecurity affected setups.

The challenges faced by patients with hereditary myopathy during the COVID-19 pandemic.

BACKGROUND: Neuromuscular diseases are inherited and the prevalance of neuromuscular disease is estimated to be around 1:2000. METHODS: This cross-sectional research was conducted with a qualitative research model. Data were collected from patients with an online survey using the snowball sampling method. The study was conducted in accordance with the STROBE checklist methodology. Frequencies and percentages were used to analyse demographic data, and content analysis was used for qualitative opinions. RESULTS: Most of the participants were men and their education levels were low. Participants reported experiencing physical and socio-economic barriers to accessing healthcare. Participants also stated that these barriers have worsened since COVID-19. CONCLUSIONS: Patients with hereditary myopathy are stigmatised by society and face different problems depending on the type of disease and level of function. It is recommended that decision-makers enable patients with hereditary myopathy in exceptional situations to access healthcare services and take steps to resolve their problems.

Whoever wants better healthcare simply pays more: citizens' perception about voluntary private health insurance in Colombia.

OBJECTIVES: To explore the perceptions that Colombians have about voluntary private health insurance plans (VPHI) in the health system to identify the tensions that exist between the public and private systems. METHODS: A qualitative case study approach with 46 semi structured interviews of patients, healthcare workers, healthcare administrators, decision-makers, and citizens. Interviews were recorded, transcribed, anonymized, digitally stored, and analyzed following grounded theory guidelines. RESULTS: We developed a paradigmatic matrix that explores how, in a context mediated by both the commodification of health and social stratification, perceptions about the failures in the public health system related to lack of timely care, extensive administrative procedures, and the search for privileged care led to positioning VPHI as a solution to these failures. The interviewees identified three consequences of using VPHI: first, the worsening of problems of timely access to care in the public system; second, higher costs for citizens translated into double payment for technologies and services to which they are entitled; third, the widening of inequity gaps in access to health services between people with similar needs but different payment capacities. CONCLUSIONS: These findings can help decision makers to understand citizens´ perceptions about the implications that VPHI may have in worsening equity gaps in the Colombian health system. It also shows, how VPHI is perceived as a double payment for services covered within social security plans and suggests that the perceived lack of timely access to care in the public systems and the fear that citizens have for themselves or their family members when using suboptimal healthcare are important drivers to purchase these private insurances.

RESUMEN: OBJETIVOS: Explorar las percepciones que tienen los colombianos sobre los planes de seguro de salud privados voluntarios (VPHI) en el sistema de salud para identificar las tensiones que existen entre los sistemas público y privado. MéTODOS: Un estudio cualitativo de caso con 46 entrevistas semiestructuradas a pacientes, trabajadores de la salud, administradores de salud, tomadores de decisiones y ciudadanos. Las entrevistas se grabaron, transcribieron y almacenaron de manera anónima. El análisis se hizo siguiendo conceptos de la teoría fundamentada. RESULTADOS: Desarrollamos una matriz paradigmática que explora cómo, en un contexto mediado tanto por la mercantilización de la salud como por la estratificación social, las percepciones sobre las fallas en el sistema de salud público relacionadas con la falta de atención oportuna, procedimientos administrativos extensos y la búsqueda de atención privilegiada llevaron a posicionar los VPHI como una solución a estas fallas. Los entrevistados identificaron tres consecuencias del uso de los VPHI: primero, el empeoramiento de los problemas de acceso oportuno a la atención en el sistema público; segundo, mayores costos para los ciudadanos, traducidos en un pago doble por tecnologías y servicios a los que tienen derecho; tercero, el aumento de las brechas de equidad en el acceso a los servicios de salud entre personas con necesidades similares pero diferentes capacidades de pago. CONCLUSIONES: Estos hallazgos pueden ayudar a los tomadores de decisiones a comprender las percepciones de los ciudadanos sobre las implicaciones que el VPHI puede tener en el empeoramiento de las brechas de equidad en el sistema de salud colombiano. También muestra cómo el VPHI se percibe como un pago doble por servicios cubiertos dentro de los planes de seguridad social y sugiere que la falta percibida de acceso oportuno a la atención en los sistemas públicos y el miedo que los ciudadanos tienen por sí mismos o por sus familiares cuando utilizan una atención sanitaria subóptima son factores importantes para adquirir estos seguros privados.

Health care barriers and perceived mental health among adults in Canada during the COVID-19 pandemic: a population-based cross-sectional study. / Obstacles en matière de soins de santé et santé mentale perçue chez les adultes au Canada pendant la pandémie de COVID-19 : étude transversale fondée sur la population.

INTRODUCTION: The perceived mental health of individuals in Canada who faced health care barriers during the COVID-19 pandemic is underexplored. METHODS: We analyzed data collected March to June 2021 from adults who reported needing health care services within the past 12 months in the Survey on Access to Health Care and Pharmaceuticals during the Pandemic. Unadjusted and adjusted logistic regression analyses examined the associations between health care barriers (appointment scheduling problems, delaying contacting health care) and high self-rated mental health and perceived worsening mental health compared to before the pandemic, overall and stratified by gender, age group, number of chronic health conditions and household income tertile. RESULTS: Individuals who experienced pandemic-related appointment changes or had appointments not yet scheduled were less likely to have high self-rated mental health (aOR = 0.81 and 0.64, respectively) and more likely to have perceived worsening mental health (aOR = 1.50 and 1.94, respectively) than those with no scheduling problems. Adults who delayed contacting health care for pandemic-related reasons (e.g. fear of infection) or other reasons were less likely to have high self-rated mental health (aOR = 0.52 and 0.45, respectively) and more likely to have perceived worsening mental health (aOR = 2.31 and 2.43, respectively) than those who did not delay. Delaying contacting health care for pandemic-related reasons was associated with less favourable perceived mental health in all subgroups, while the association between perceived mental health and pandemic-related appointment changes was significant in some groups. CONCLUSION: Health care barriers during the pandemic were associated with less favourable perceived mental health. These findings could inform health care resource allocation and public health messaging.

Quality of life of women from a quilombola community in northeastern Brazil / Qualidade de vida de mulheres de uma comunidade quilombola do nordeste brasileiro

Abstract Quilombola communities are present in many Brazilian states living in precarious health conditions. This is due to geographic isolation, limitations to the access of the area in which they live in, and the lack of quality in the service when it is needed to be provided. Therefore, the aim of this study was to analyze the quality of life of women from a quilombola community in northeastern Brazil. It is an observational, cross-sectional and descriptive study. 160 adult women were first interviewed through a form to collect a profile and then it was applied the WHOQOL Quality of Life questionnaire - bref. It was observed that the women were on average 40.7 years old (±17.25), married, self-declared black, who did not finish elementary school, housewife, had no income, with their own masonry house, with up to 6 rooms, supplied by a box of community treated water. Quality of Life had median scores in the domains: physical (3.18), psychological (3.4), social relationships (3.45) and environment (2.59). With this research, it was possible to characterize the quilombola community of Santa Luzia do Norte-AL regarding the difficulties of access to health and income generation, issues that affect their health condition. The problems described in this study can contribute to health actions being planned and carried out in order to improve socioeconomic and health conditions in this community, considering the social, political and environmental context, valuing their traditional knowledge and practices.

Resumo As comunidades quilombolas, estão presentes em diversos estados brasileiros, vivendo em condições de saúde mais precárias. Isto ocorre por conta do isolamento geográfico, das limitações de acesso e da falta de qualidade no serviço quando este é prestado. Nesse sentido, o objetivo do estudo foi analisar a qualidade de vida de mulheres de uma comunidade quilombola do nordeste brasileiro. Estudo observacional, transversal e descritivo. Foram entrevistadas 160 mulheres adultas, através de um formulário para a coleta de perfil e do questionário de Qualidade de Vida WHOQOL - bref. Foi observado que as mulheres tinham em média 40,7 anos (±17,25), casadas, autodeclaradas negras, com fundamental incompleto, do lar, sem renda, com moradia de alvenaria, própria, com até 6 cômodos, abastecidas por caixa de água comunitária, tratada. A Qualidade de Vida, apresentou escores medianos nos domínios: físico (3,18), psicológico (3,4), relações sociais (3,45) e meio ambiente (2,59). Com a realização desta pesquisa foi possível caracterizar a comunidade quilombola de Santa Luzia do Norte-AL quanto as dificuldades de acesso a saúde e geração de renda, fatos que repercutem na sua condição de saúde. Os problemas descritos neste estudo podem contribuir para que ações de saúde sejam planejadas e efetivadas com o intuito de melhorar as condições socioeconômicas e de saúde nessa comunidade, considerando-se o contexto social, político e ambiental, valorizando seus saberes e práticas tradicionais.

Satisfação dos usuários de cadeiras de rodas da Região Metropolitana da Baixada Santista / Satisfaction of wheelchair users in the Baixada Santista Metropolitan Region

Resumo O objetivo deste artigo é identificar a satisfação dos usuários em relação às cadeiras de rodas e à prestação de serviços públicos e privados de saúde da Região Metropolitana da Baixada Santista. Estudo transversal com abordagem quantitativa. Os participantes responderam a um questionário sociodemográfico e à versão brasileira do Quebec Assistive Technology User Satisfaction Assessment. Os dados foram analisados utilizando a estatística descritiva e comparativa por meio do teste t de Student. Os tamanhos de efeito d de Cohen foram calculados. Os participantes (n = 42) estavam "mais ou menos satisfeitos" com as cadeiras de rodas e "pouco satisfeitos" com a prestação de serviços. Os usuários de cadeiras de rodas monobloco apresentaram satisfação significativamente maior com suas cadeiras em comparação com usuários de cadeiras de rodas acima de 90kg (p = 0,010, d = 1,04). Os usuários de serviços privados apresentaram satisfação significativamente maior com a prestação de serviço em comparação aos usuários de serviços públicos (p = 0,021, d = 0,75). Os usuários de cadeiras de rodas da Região Metropolitana da Baixada Santista estão mais satisfeitos com as cadeiras de rodas monobloco e menos satisfeitos com os serviços públicos.

Abstract This article seeks to identify user satisfaction in relation to wheelchairs and the provision of public and private health services in the Baixada Santista Metropolitan Region. It involved a cross-sectional study with a quantitative approach. Participants answered a sociodemographic questionnaire and the Brazilian version of the Quebec Assistive Technology User Satisfaction Assessment. Data were analyzed using descriptive and comparative statistics by means of Student's t test. Cohen's d effect sizes were also calculated. Participants (n = 42) were "more or less satisfied" with the wheelchairs and "quite satisfied" with the services provided. Rigid frame wheelchair users were significantly more satisfied with their wheelchairs compared to users of wheelchairs weighing over 198 lbs. (p = 0.010, d = 1.04). Users of private services showed significantly greater satisfaction with the provision of the service compared to public services users (p = 0.021, d = 0.75). Wheelchair users in the Baixada Santista Metropolitan Region are more satisfied with the rigid frame wheelchair and less satisfied with public services.

Social determinants and access to health services in patients with COVID-19: a cross-sectional study / Determinantes sociales y acceso a los servicios sanitarios en pacientes con COVID-19: un estudio transversal / Determinantes sociais e acesso aos serviços de saúde em pacientes com COVID-19: estudo seccional

ABSTRACT Objective: To verify the association between social determinants of health and access to health services for COVID-19 patients. Method: Analytical, cross-sectional study, carried out in three states in the Northeast of Brazil (Ceará, Maranhão and Pernambuco), with 968 patients, using questionnaires with sociodemographic data, determinants and the Primary Care Assessment Tool, adapted to the reality of COVID-19, with 58 items, classified as high (score ≥ 6.6) and low (score < 6.6), whose high value reveals better standards of access to health services. The Chi-square test was used for comparative analysis. Results: There was a significant difference (p < 0.05) between the domains of the instrument and the following determinants: age, skin color, body mass index, origin, schooling, employment, services close to home, first service, income and means of transport. Conclusion: Access to health services for people with COVID-19 was associated with various determinants, including individual, behavioural and social ones, correlated with the structural and organizational aspects of the health services offered by the three states of Northeastern Brazil.

RESUMEN Objetivo: Verificar la asociación de los determinantes sociales de la salud con el acceso de los pacientes con COVID-19 a los servicios de salud. Método: Estudio analítico, transversal, realizado en tres estados del Nordeste de Brasil (Ceará, Maranhão y Pernambuco), con 968 pacientes, utilizando cuestionarios con datos sociodemográficos, determinantes y la Herramienta de Evaluación de la Atención Primaria (PCATool), adaptada a la realidad de la COVID-19, con 58 ítems, clasificados en alto (puntuación ≥ 6,6) y bajo (puntuación < 6,6), cuyo valor alto revela mejores estándares de acceso a los servicios de salud. Se utilizó la prueba de chi-cuadrado para analizar las comparaciones. Resultados: Hubo diferencia significativa (p < 0,05) entre los dominios del instrumento y los siguientes determinantes: edad, color de piel, índice de masa corporal, origen, escolaridad, empleo, servicios cercanos al domicilio, primer servicio, ingreso y medio de transporte. Conclusión: El acceso a los servicios de salud de las personas con COVID-19 se asoció a diversos determinantes, entre ellos individuales, comportamentales y sociales, correlacionados con los aspectos estructurales y organizativos de los servicios de salud ofrecidos por los tres estados del nordeste de Brasil.

RESUMO Objetivo: Verificar a associação dos determinantes sociais da saúde com o acesso de pacientes com COVID-19 aos serviços de saúde. Método: Estudo analítico, transversal, desenvolvido em três estados do Nordeste brasileiro (Ceará, Maranhão e Pernambuco), com 968 pacientes, utilizando-se de questionários de dados sociodemográficos, determinantes e do Primary Care Assessment Tool, adaptado para realidade da COVID-19, com 58 itens, classificado em alto (escore ≥ 6,6) e baixo (escore < 6,6), cujo valor alto revela melhores padrões de acesso aos serviços de saúde. Para análise comparativa, empregou-se o teste do Qui-quadrado. Resultados: Verificou-se diferença significativa (p < 0,05) entre os domínios do instrumento e os seguintes determinantes: idade, cor da pele, índice de massa corporal, procedência, escolaridade, vínculo empregatício, serviços próximos à residência, primeiro serviço de atendimento, renda e meios de transporte. Conclusão: O acesso aos serviços de saúde de pessoas com COVID-19 esteve associado aos diversos determinantes, sendo estes individuais, comportamentais, sociais, correlacionados aos aspectos estruturais e organizacionais dos serviços de saúde ofertados pelos três estados do Nordeste brasileiro.

Oportunidades de abordagens sobre imunização durante o atendimento à demanda espontânea / Opportunities for immunization approaches when meeting spontaneous demand / Oportunidades para enfoques de inmunización al satisfacer la demanda espontánea

Tendo em vista o papel importante que os enfermeiros desempenham no processo de vacinação, o objetivo do presente estudo foi examinar a perspectiva desses profissionais em duas Unidades Básicas de Saúde (UBSs), que utilizam diferentes modelos de agendamento (Carve-Out e Acesso Avançado), com relação a como aproveitar as oportunidades de discutir a imunização durante o atendimento aos usuários que procuram ajuda sem agendamento prévio. Para realizar a comparação entre as unidades, foram utilizados dados secundários dos relatórios do Sistema de Informação do Programa Nacional de Imunizações e do e-SUS AB, no período de janeiro a dezembro de 2019. Foram realizadas entrevistas semiestruturadas com os enfermeiros dessas unidades sendo utilizada a Matriz SWOT para análise do ambiente interno. Com relação à escuta inicial, pode-se observar uma superioridade da UBS que segue o modelo de Acesso Avançado, porém não houve diferenças significativas quanto ao quantitativo de imunizações. A estratégia para diminuir as Oportunidades Perdidas de Vacinação (OPVs) mais citada, foi a abordagem do usuário no momento da procura na "demanda espontânea". No entanto, foi evidenciada como barreira a falta da caderneta de vacinação, já que o usuário não estaria na unidade para essa demanda e o pouco tempo disponível. Não houve diferenças significativas entre a percepção dos enfermeiros atuantes nos diferentes modelos de agendamento, Carve-Out e Acesso Avançado, no que se refere a oportunizar abordagens sobre imunização durante o atendimento à demanda espontânea.

Considering the important role that nurses play in the vaccination process, the objective of the present study was to examine the perspective of these professionals in two Basic Health Units (UBSs), which use different scheduling models (Carve-Out and Advanced Access), regarding how to take advantage of opportunities to discuss immunization during care for users who seek help without prior scheduling. To carry out the comparison between the units, secondary data from reports from the Information System of the National Immunization Program and e-SUS AB were used, from January to December 2019. Semi-structured interviews were carried out with nurses from these units. The SWOT Matrix for analyzing the internal environment. Regarding initial listening, we can observe the superiority of the UBS that follows the Advanced Access model, but there were no significant differences in terms of the number of immunizations. The most cited strategy to reduce Missed Vaccination Opportunities (OPVs) was the user approach when searching for "spontaneous demand". However, the lack of a vaccination booklet was highlighted as a barrier, as the user would not be at the unit for this demand and there was little time available. There were no significant differences between the perception of nurses working in the different scheduling models, Carve-Out and Advanced Access, with regard to providing opportunities for approaches to immunization when meeting spontaneous demand.

Considerando el importante papel que desempeña el enfermero en el proceso de vacunación, el objetivo del presente estudio fue examinar la perspectiva de estos profesionales en dos Unidades Básicas de Salud (UBS), que utilizan diferentes modelos de programación (Carve-Out y Acceso Avanzado), respecto a cómo aprovechar oportunidades para discutir sobre inmunización durante la atención a usuarios que buscan ayuda sin programación previa. Para realizar la comparación entre las unidades, se utilizaron datos secundarios de los informes del Sistema de Información del Programa Nacional de Inmunizaciones y del e-SUS AB, de enero a diciembre de 2019. Se realizaron entrevistas semiestructuradas a enfermeros de estas unidades. Matriz FODA para el análisis del entorno interno. En cuanto a la escucha inicial, se observa la superioridad de la UBS que sigue el modelo de Acceso Avanzado, pero no hubo diferencias significativas en cuanto al número de inmunizaciones. La estrategia más citada para reducir las Oportunidades de Vacunación Perdidas (OPV) fue el enfoque del usuario al buscar "demanda espontánea". Sin embargo, se destacó como una barrera la falta de cartilla de vacunación, ya que el usuario no estaría en la unidad para esta demanda y había poco tiempo disponible. No hubo diferencias significativas entre la percepción de las enfermeras que trabajan en los diferentes modelos de programación, Carve-Out y Advanced Access, con respecto a brindar oportunidades de enfoques de inmunización cuando se satisface la demanda espontánea.

Quality of life of women from a quilombola community in northeastern Brazil

Abstract Quilombola communities are present in many Brazilian states living in precarious health conditions. This is due to geographic isolation, limitations to the access of the area in which they live in, and the lack of quality in the service when it is needed to be provided. Therefore, the aim of this study was to analyze the quality of life of women from a quilombola community in northeastern Brazil. It is an observational, cross-sectional and descriptive study. 160 adult women were first interviewed through a form to collect a profile and then it was applied the WHOQOL Quality of Life questionnaire bref. It was observed that the women were on average 40.7 years old (±17.25), married, self-declared black, who did not finish elementary school, housewife, had no income, with their own masonry house, with up to 6 rooms, supplied by a box of community treated water. Quality of Life had median scores in the domains: physical (3.18), psychological (3.4), social relationships (3.45) and environment (2.59). With this research, it was possible to characterize the quilombola community of Santa Luzia do Norte-AL regarding the difficulties of access to health and income generation, issues that affect their health condition. The problems described in this study can contribute to health actions being planned and carried out in order to improve socioeconomic and health conditions in this community, considering the social, political and environmental context, valuing their traditional knowledge and practices.

Resumo As comunidades quilombolas, estão presentes em diversos estados brasileiros, vivendo em condições de saúde mais precárias. Isto ocorre por conta do isolamento geográfico, das limitações de acesso e da falta de qualidade no serviço quando este é prestado. Nesse sentido, o objetivo do estudo foi analisar a qualidade de vida de mulheres de uma comunidade quilombola do nordeste brasileiro. Estudo observacional, transversal e descritivo. Foram entrevistadas 160 mulheres adultas, através de um formulário para a coleta de perfil e do questionário de Qualidade de Vida WHOQOL bref. Foi observado que as mulheres tinham em média 40,7 anos (±17,25), casadas, autodeclaradas negras, com fundamental incompleto, do lar, sem renda, com moradia de alvenaria, própria, com até 6 cômodos, abastecidas por caixa de água comunitária, tratada. A Qualidade de Vida, apresentou escores medianos nos domínios: físico (3,18), psicológico (3,4), relações sociais (3,45) e meio ambiente (2,59). Com a realização desta pesquisa foi possível caracterizar a comunidade quilombola de Santa Luzia do Norte-AL quanto as dificuldades de acesso a saúde e geração de renda, fatos que repercutem na sua condição de saúde. Os problemas descritos neste estudo podem contribuir para que ações de saúde sejam planejadas e efetivadas com o intuito de melhorar as condições socioeconômicas e de saúde nessa comunidade, considerando-se o contexto social, político e ambiental, valorizando seus saberes e práticas tradicionais.

Experiencias en implementación de rutas integrales de atención en salud en Cauca. Un estudio cualitativo

Introducción: Las dinámicas poblacionales, la carga de enfermedad y los cambios estructurales político-económicos han impulsado al estado colombiano a buscar la integralidad en los procesos de atención en salud, en tal propósito definió la implementación de rutas integrales de atención en salud (RIAS). Objetivo: Comprender la percepción de la experiencia que tienen los líderes de proceso en entidades sanitarias referente a la implementación de las RIAS en Cauca, Colombia. Método: Estudio cualitativo, inductivo, con enfoque de fenomenología interpretativa. El grupo de estudio estuvo conformado por siete líderes de proceso de entidades sanitarias. Resultados: Los entrevistados sienten que la implementación es un proceso difícil, determinado por la voluntad y compromiso de los actores sanitarios. Los cambios de administración generan discontinuidades afectando avances en las rutas de la que ellos son responsables. Perciben desarticulación en la implementación, limitados recursos, deficiencia administrativa, de infraestructura y talento humano, principalmente especialistas en salud. Discusión: La percepción de las experiencias denota lo que varios autores han descrito en relación con tensiones en procesos de implementación y gestión en salud: inaccesibilidad, discontinuidad y fragmentación de servicios; débil autoridad sanitaria, enfoque curativo e intereses económicos. Conclusiones: Desde su experiencia, los líderes del proceso perciben las RIAS como un fundamento estratégico que favorece la atención integral en salud, sin embargo, existen vacíos en la implementación originados de procesos administrativos, financieros y del propio modelo de salud, restringiendo el cumplimiento del propósito para las cuales fueron creadas. A la vez, perciben sentimientos de impotencia y desesperanza, dificultades y tensiones en el ejercicio de la implementación.

Introduction: Population dynamics, disease burden and political-economic structural changes have prompted the Colombian state to seek comprehensiveness in health care processes, and to this end it defined the implementation of Integrated Health Care Routes (RIAS). Objective: To understand the perception of the experience of process leaders in health entities regarding the implementation of the RIAS in Cauca, Colombia. Method: Qualitative, inductive study with an interpretative phenomenology approach. The study group consisted of seven process leaders of health entities. Results: The interviewees feel that implementation is a difficult process, determined by the willingness and commitment of the health stakeholders. Changes in administration generate discontinuities affecting progress on the routes for which they are responsible. They perceive disarticulation in implementation, limited resources, administrative deficiencies, infrastructure and human talent, mainly health specialists. Discussion: The perception of the experiences denotes what several authors have described in relation to tensions in implementation and management processes in health: inaccessibility, discontinuity and fragmentation of services; weak health authority, curative approach and economic interests. Conclusions: From their experience, process leaders perceive the RIAS as a strategic foundation that favors comprehensive health care; however, there are gaps in the implementation caused by administrative and financial processes and the health model itself, restricting the fulfillment of the purpose for which they were created. At the same time, they perceive feelings of helplessness and hopelessness, difficulties and tensions in the implementation exercise.

Criterios de referencia y barreras para la atención de personas con baja visión en Santander

Objetivo: Identificar criterios de derivación y barreras percibidas por los optómetras para la rehabilitación de personas con baja visión en Santander. Métodos: Estudio de corte transversal que incluyó 82 optómetras de municipios de Santander, seleccionados mediante muestreo intencionado. Se diseñó un cuestionario con 36 preguntas para recolectar los datos que son reportados empleando estadística descriptiva. Resultados: El 47,5 % de los profesionales tiene claro el nivel de agudeza visual para clasificar a una persona con baja visión. Las principales barreras identificadas para el acceso a servicios de baja visión fueron: el proceso de derivación dentro del sistema de salud es engorroso (74,39 %), falta de servicios cerca (57,31 %) y considerar que los pacientes no pueden pagar las ayudas (48,78 %). Discusión: Es necesario fortalecer la formación de los optómetras para mejorar los procesos de identificación, atención y rehabilitación. Conclusiones: Es importante ubicar como prioritaria la discapacidad visual en Santander, para así robustecer la red de atención en salud.

Objective: To identify referral criteria and barriers perceived by optometrists for the rehabilitation of people with low vision in Santander. Methods: Cross-sectional study, which included 82 optometrists from municipalities of Santander, selected by purposive sampling. A questionnaire with 36 questions was designed to collect data that are reported using descriptive statistics. Results: A total of 47.5% of the professionals are clear about the level of visual acuity to classify a person with low vision. The main barriers identified for access to low vision services were: the referral process within the health system is cumbersome (74.39%), lack of services nearby (57.31%) and considering that patients cannot afford the aids (48.78%). Discussion: It is necessary to strengthen the training of optometrists to improve the processes of identification, care and rehabilitation. Conclusions: It is important to prioritize visual impairment in Santander in order to strengthen the health care network.

Healthcare bias and health inequalities towards displaced Syrians in Lebanon: a qualitative study.

Introduction: According to Lebanese official data, Lebanon hosts over 1.5 million displaced Syrians (DS). Research shows that migrants encounter barriers when accessing healthcare. The social determinants of health (SDOH) related to migration are an additional challenge for DS in Lebanon, though bias plays a significant factor in exacerbating health inequalities. This study aims to identify DS perception of healthcare biases in the Lebanese healthcare system, and its consequences on DS' accessing and receiving quality healthcare in Lebanon. Methods: A qualitative analysis using in-depth, semi-structured interviews was utilized. 28 semi-structured interviews were conducted with doctors (n = 12) and nurses (n = 16) in 2021. Six group interviews were conducted with DS (n = 22) in Lebanese healthcare facilities. The recruitment of participants relied on reasoned and targeted sampling. Thematic analysis was performed to identify common themes in participants' experiences with DS accessing Lebanese healthcare. Results: The findings indicated that there were barriers to accessing healthcare related to the SDOH, such as transportation and financial resources. The results also suggested that DS perceived health biases, including discriminatory behavior from Lebanese healthcare providers, stereotypes and racism leading to health inequalities. Conclusion: Based on the perceptions and experiences reported by participants, the underlying causes of biases are due to the fragility of the Lebanese healthcare system when facing a humanitarian crisis as well as a collapsing infrastructure torn by past wars and the current socio-political and financial crises in the country. Global initiatives are required to provide the necessary resources needed for offering equitable health services. Such initiatives involve addressing biases, health inequities, discrimination, and the lack of a Lebanese infrastructure system for the provision of healthcare. Addressing health inequalities remains a major health objective in achieving health equity on the micro level (cultural awareness and competencies) and macro level (equitable distribution of resources, implementation of a universal health coverage) in order to guarantee quality healthcare services to DS.

Hospitalizations for congenital syphilis in children under one year old in the state of Pará, Brazilian Amazon: ecological study.

BACKGROUND: The high incidence of congenital syphilis shows flaws in the resolution of primary health care, being a predictor of greater use of hospital services, whose regional differences in access to health actions and services may be reflected in health inequalities. OBJECTIVE: to investigate hospitalizations due to congenital syphilis in children under one year of age, in the state of Pará, Brazilian Amazon. METHODS: an ecological study was carried out, using hospitalization, lethality and mortality rates related to congenital syphilis in children under one year of age. Temporal analysis and mapping of hospitalization flows were carried out using Joinpoint®, version 4.7.0.0, Terraview 4.2.2, Tabwin 4.1.5. RESULTS: A total of 6,487 hospitalizations were recorded. For the ten years of the study period (2009 to 2018), the lethality rate showed a decreasing trend of - 13.5% (p = 0.01). The crude hospitalization rate showed an increasing trend of 12.8% (p < 0.000. The regression analysis demonstrated that there was a change point in the trend with a significant growth of 12.8% until 2016 (p = 0.0006). In the mortality rate the trend was stable (p = 0.56). The analysis of hospitalization care flows made it possible to identify that most hospitalizations due to congenital syphilis occurred in the municipalities of residence, but 1,378 (21.2%) had to move. Two large care gaps were highlighted in Metropolitan health regions II and III, belonging to macroregion II. The hospitalizations of residents of these regions were carried out by the assistance networks of Belém (capital) and Marituba, both of which are part of Metropolitana I. Residents of macroregions III and IV had the greatest distances traveled to access hospital care. CONCLUSIONS: The increase in the rate of hospitalizations with an increasing trend demonstrates the impact that syphilis still causes in Brazil, not being resolved even after national government interventions in primary health care, but there was a decreasing trend in the fatality rate. The results demonstrate a heterogeneous organization of health care networks in the state's health regions and macroregions.

Programa Médicos pelo Brasil: primeiros resultados / Doctors for Brazil Program: first results

Resumo O acesso ao cuidado médico é essencial para o alcance da atenção primária à saúde (APS) de qualidade. No Brasil, ainda persistem dificuldades de acesso. O Programa Médicos pelo Brasil (PMpB) pretende ampliar a oferta de serviços médicos em locais de difícil provimento ou alta vulnerabilidade. Traz como inovações a priorização das menores e mais isoladas cidades; a seleção de profissionais por processo isonômico; a formação em medicina de família e comunidade; e o fato de ser a primeira carreira médica federal na APS, com salários competitivos, progressão e incentivos financeiros que valorizam a longitudinalidade e o desempenho. O PMpB é executado pela Agência para o Desenvolvimento da Atenção Primária à Saúde (Adaps), o que permite mais eficiência na gestão da política pública. Os primeiros nove meses do programa mostram resultados promissores, com aproximadamente 23 mil médicos interessados em ingressar no programa por meio de seu processo seletivo, 97,1% de ocupação das vagas e 95,4% de permanência após o ingresso. Tais resultados sinalizam o avanço de qualidade do PMpB em relação às políticas anteriores, bem como a necessidade de continuar com sua implementação, a fim de que ela atinja todo o seu potencial de cobertura na APS do SUS.

Abstract Access to medical care is essential to achieve quality primary health care (PHC). In Brazil, access difficulties still persist. The Doctors for Brazil Program (PMpB in Portuguese) aims to expand the offer of medical services in places of difficult provision or high vulnerability. It innovates insofar as it prioritizes smaller and rather isolated cities, by selecting professionals through an isonomic process, offering them training in Family and Community Medicine and a chance to build their first federal medical career in PHC. The program offers competitive salaries, progression and financial incentives that value long-term commitment and performance. The PMpB is rolled out by the Agency for the Development of Primary Health Care (Adaps), which allows better management of public policies. The first nine months of the program showed promising results, as approximately 23,000 candidates seeking to join the program through its selection process, i.e., 97.1% vacancies were filled and retention rate after admittance was 95.4%. These results show to what extent PMpB has improved in quality compared to previous policies, as well as how essential it is to keep implementing the program so that it may reach its full PHC coverage potential within the Brazilian public health system.

CLINICAL AND HEALTHCARE IMPACTS OF PORTABLE ULTRASONOGRAPHY IN AMBULATORY CARE MUSCULOSKELETAL REHABILITATION CONSULTATIONS.

Objective: We evaluated the impact of Point-of-care ultrasound (POCUS) in musculoskeletal consultations out of hospital using a Philips Lumify portable ultrasound device. We aimed to determine the impact of POCUS on the number of hospital referrals for injections as well as on the number of injections performed in consultation. Design: Retrospective case study comparing 2 periods: June to September 2021 (pre-POCUS) and November 2021 to February 2022 (POCUS). Statistical comparisons were performed using the χ2. In both periods, 21 medical consultations were performed. In the pre-POCUS period, 470 patients were assessed, with an average of 1.29 hospital referrals made per day of consultation for hospital injections and an average of 2.05 injections performed per day of medical consultation. In the POCUS period, 589 patients were assessed, with an average of 0.1 hospital referrals per day (-92.6%; p < 0.00001) and an average of 2.76 injections performed per day (+34.9%; p < 0.00001). The introduction of POCUS at our practice reduced the number of hospital referrals made for injections and increased the number of injections performed every day of consultation. Conclusion: This suggests that POCUS is of great clinical value in out-of-hospital musculoskeletal rehabilitation consultations.

"It Is Definitely a Good Program for Everyone from Every Community": A Qualitative Study of Community Partner Perspectives on the Culturally and Linguistically Diverse (CALD) Mindfulness Program.

Meeting the health needs of migrant and refugee communities is crucial to successful settlement and integration. These communities are often under-served by mental health services. Previous research has demonstrated the effectiveness of a group mindfulness-based intervention tailored for Arabic and Bangla speakers living in Sydney, Australia. This study aimed to explore community partner perspectives on the program's impact, contributing factors and sustainability, and to elicit suggestions for future development. Data were collected via semi-structured telephone interviews with a purposively selected sample of 16 informants. Thematic analysis was conducted using the Rigorous and Accelerated Data Reduction (RADaR) technique. Community partners welcomed the emphasis on promoting wellbeing and reported that the community-based in-language intervention, in both face-to-face and online formats, overcame many of the barriers to timely mental health care for culturally and linguistically diverse (CALD) communities, with a beneficial impact on group participants, program providers, partner organisations and the broader community. Positive outcomes led to stronger community engagement and demand for more programs. For group mental health programs, both trust and safety are necessary. Relationships must be nurtured, diversity within CALD communities recognised, and projects adequately resourced to ensure partner organisations are not overburdened.

Non­urgent use of the emergency department: a qualitative semi­structured interview study, Vitória-ES, 2019. / Uso de serviço de emergência por motivos não urgentes: estudo qualitativo com usuários de um pronto-atendimento, Vitória-ES, 2019.

Introduction: The healthcare system is structured to prioritize Primary Health Care (PHC) as the main gateway for accessing care while reserving emergency services for situations requiring immediate attention. However, people's choices often deviate from what one would expect based on their health needs, leading to overburdened emergency services and reduced clinical care effectiveness and efficiency. Objective: This study aims to identify the motivations behind non-urgent health issues leading users to seek care at an emergency department. Method: A qualitative study involving semi-structured interviews was conducted in 2019 with users of an emergency department in Vitória-ES. The collected data underwent thematic analysis. Results: The study included 29 participants, predominantly women, of Black or mixed race, and under 30 years old, who reported issues related to pain or respiratory problems. Notably, participants perceived emergency services as places where they could readily obtain immediate and effective care. Accessing PHC was seen as challenging, and they anticipated that their needs (appointments, tests, medications) would not be promptly met within PHC. Conclusion: Utilizing emergency services for non-urgent concerns is a multifaceted and complex public health problem that extends beyond PHC access difficulties to encompass individual and collective understanding of PHC's role and emergency care. Merely expanding PHC is insufficient; reframing this level care is essential, particularly among younger individuals.

Introdução: o sistema de saúde é organizado de uma forma que prevê a Atenção Primária à Saúde (APS) como a porta de entrada preferencial para o cuidado, destinando-se os serviços de emergência para situações que exigem atendimento imediato. Contudo, o caminho percorrido pelas pessoas nem sempre reflete o que se esperaria pelo perfil de sua necessidade de saúde, resultando em sobrecarga e baixa efetividade e eficiência dos serviços de emergência. Objetivo: identificar motivações para uso pronto-atendimentos por problemas de saúde não urgentes em usuários deste serviço. Método: estudo qualitativo baseado em entrevistas semiestruturadas realizadas em 2019 com usuários de um pronto-atendimento do município de Vitória-ES. Os dados foram submetidos à análise temática derivada da análise de conteúdo. Resultados: Participaram 29 pessoas, sendo a maioria mulheres, negras ou pardas, com menos de 30 anos, queixando-se de dor ou problema respiratório. Observou-se, dentre outras coisas, que os entrevistados percebem os serviços urgência e emergência como aqueles onde obterão cuidados imediatos com maior facilidade e resolubilidade, já que é difícil acessar a APS e nela muito provavelmente não terão tudo aquilo que consideram necessário para manejar seu problema (consulta, exames e medicações) de uma maneira imediata, rápida e resolutiva. Conclusão: A utilização de pronto-atendimentos por motivos não urgentes é uma questão complexa. Envolve não apenas a dificuldade de acesso à APS, mas a própria compreensão individual e coletiva do papel da APS e do pronto-atendimento. Não basta, portanto, expandir a APS, mas é preciso também ressignificá-la, em especial junto aos mais jovens.

Acesso dos usuários do SUS à atenção psicossocial nos municípios brasileiros / Access of SUS users to psychosocial care in brazilian municipalities / Acceso de los usuarios del SUS a la atención psicosocial en los municipios brasileños

A criação do Sistema Único de Saúde (SUS) sob influência do movimento da Reforma Psiquiátrica propôs um novo modelo para a atenção à saúde mental focado na Atenção Primária em Saúde (APS). Porém, a mudança do modelo de atenção ainda possui algumas barreiras de acesso dos usuários aos serviços de saúde. Esta pesquisa busca analisar a produção científica sobre o acesso dos usuários do SUS à atenção psicossocial. Trata-se de uma revisão integrativa, na qual foram usados os descritores: "acesso aos serviços de saúde" "atenção primária à saúde", "serviços de saúde mental" nas bases de dados da SciELO, Medline/PubMed e Lilacs, resultando na inclusão de 13 estudos. Os dados foram analisados de acordo com a análise temática de conteúdo, constituída pela pré-análise, pela exploração do material e pelo tratamento dos resultados obtidos/interpretação. Os resultados evidenciaram como a APS tem articulado o acesso à atenção psicossocial, bem como as dificuldades que enfrenta no uso das tecnologias leves para o manejo de transtornos mentais e sofrimento psíquico. E, no campo da atenção secundária e no acesso aos serviços da atenção psicossocial, existem dificuldades estruturais, físicas e sociais. Além disso, evidenciam-se lacunas na produção acerca do acesso às diferentes modalidades dos Centros de Atenção Psicossocial e das residências terapêuticas. Assim, apesar do direito à saúde conquistado e da reorientação do modelo de atenção à saúde mental com foco na APS, esse nível de atenção ainda não consegue ser resolutivo.

Created under the influence of the Psychiatric Reform movement, the Unified Health System (SUS) proposed a new mental health care model focused on Primary Health Care (PHC). But this change still poses some barriers for user access to health services. Thus, this integrative review analyzes scientific production on the access of SUS users to psychosocial care. Bibliographic search was conducted on the SciELO, Medline/PubMed and Lilacs databases using the following descriptors: "access to health services," "primary health care," "mental health services," resulting in a sample of 13 studies. Data were explored by thematic content analysis, which consist of pre-analysis, exploration of the material, and treatment/interpretation of the results obtained. Results revealed that PHC has been an articulator of access to psychosocial care, and unveiled its difficulties in using light technologies to manage mental disorders and psychological distress. Secondary care and access to psychosocial care services face structural, physical, and social difficulties. The analysis also points to gaps in the literature regarding access to the different modalities of Psychosocial Care Centers and about therapeutic residences. Thus, despite the right to health achieved and reorientation of the mental health care model, now centered on PHC, this level of care remains not resolutive.

La creación del Sistema Único de Salud (SUS) bajo la influencia del movimiento de Reforma Psiquiátrica propuso un nuevo modelo para la atención de la salud mental, centrado en la Atención Primaria de Salud (APS). Sin embargo, el cambio en el modelo de atención todavía enfrenta algunas barreras relacionadas al acceso de los usuarios a los servicios de salud. Esta investigación pretende analizar la producción científica sobre el acceso de los usuarios del SUS a la Atención Psicosocial. Esta es una revisión integradora, en que se utilizaron los siguientes descriptores: "acceso a los servicios de salud", "atención primaria de salud", "servicios de salud mental" en las bases de datos de SciELO, Medline/PubMed y Lilacs; lo que resultó en la inclusión de 14 estudios. En los datos se aplicó el Análisis de Contenido Temático, consistente en preanálisis, exploración del material y tratamiento de los resultados obtenidos/interpretación. Los resultados mostraron cómo la APS ha sido un articulador del acceso a la atención psicosocial, así como las dificultades que se enfrentan en el uso de tecnologías blandas para manejar los trastornos mentales y la angustia psicológica. Y en el ámbito de la atención secundaria, en el acceso a los servicios de Atención Psicosocial, hay dificultades estructurales, físicas y sociales. Además, se destacan lagunas en la producción sobre el acceso a las diferentes modalidades de Centros de Atención Psicosocial y residencias terapéuticas. A pesar de la conquista del derecho a la salud y de la reorientación del modelo de atención a la salud mental con enfoque en la APS, este nivel de atención aún no llega a ser resolutivo.