Evaluation of health status of transgender sex workers in Turkey: A qualitative study.

OBJECTIVE: Sex workers can be disadvantaged in terms of overall health due to challenging living and working conditions. This research aimed to evaluate the health status and experiences related to sexually transmitted infections (STDs) of unregistered transgender sex workers in Turkey. DESIGN: It employed a phenomenological qualitative research design. SITE: Data were collected in Istanbul between March 2021 and November 2021. PARTICIPANTS: Data were collected through in-depth interviews involving 24 people (19 sex workers and 5 physicians). METHODS: Key statements were listed during data analysis, and clusters of meanings were formed based on these statements. The participants' statements were used for contextual and structural descriptions. RESULTS: Sex workers suffer from chronic illnesses such as asthma, chronic obstructive pulmonary disease (COPD), diabetes, allergic diseases, and neurological disorders. Among the health issues affecting them, the most notable ones are STDs, psychological problems, and the risk of suicide. Sex workers also face a dilemma between choosing public hospitals and private hospitals. Majority of sex workers undergo regular testing for STDs, with the frequency varying from person to person. Reasons for not undergoing regular testing include lack of social security coverage, financial constraints, lack of information, and feeling undervalued. Some individuals are being subjected to mandatory testing. CONCLUSIONS: It is recommended that sex workers who seek and request healthcare services should be provided with detailed information and education, particularly regarding psychological problems and STDs.

Evaluación quinquenal de los ejes sanitarios de un programa nacional de Atención Primaria de la Salud / Five-year evaluation of the sanitary axes of a national program of Primary Health Care

Se realizó una evaluación quinquenal de los ejes sanitarios (que dan lugar a objetivos estratégicos con sus correspondientes metas e indicadores, áreas de intervención y líneas de acción) dentro del marco de la gestión sanitaria de uno de los 10 principales agentes de la seguridad social argentinos quien implementaba desde hacía 20 años un Programa Nacional de Atención Primaria de la Salud (PNAPS). El mismo promedió alrededor de 800 mil beneficiarios anuales dentro de una red asistencial nacional propia en el primer nivel de atención compuesta por 45 Centros de Atención Primaria (CAPs). Se implementó una investigación evaluativa que incluyó un trazado de línea de base con la valoración de cinco Ejes Sanitarios (ES). Se trata de un diseño de corte transversal de un periodo de 5 años. Se definieron metas, indicadores y recomendaciones para cada uno de los ES, recopilando información de fuentes diferentes y complementarias para su análisis. Los resultados mostraron una evolución favorable en el período evaluado, aunque el cumplimiento de las metas estuvo bastante alejado de lo propuesto de manera teórica. Conclusiones: este trabajo aporta información valiosa y original para subsidiar la toma de decisiones e incentivar la investigación en el ámbito de la APS, buscando reformular los actuales modelos de gestión y de atención de la salud (AU)

A five-year evaluation of the health axes (which give rise to strategic objectives with their corresponding goals and indicators, areas of intervention and lines of action) was carried out within the framework of health management of one of the 10 main argentine social security agents who had been implementing a National Primary Health Care Program (PNAPS) for 20 years. It averaged around 800,000 annual beneficiaries within its own national care network at the first level of care made up of 45 Primary Care Centers (CAPs). An evaluative investigation was implemented that included a baseline drawing with the assessment of five Sanitary Axis (ES). It is a cross-sectional design of a period of 5 years. Goals, indicators and recommendations were defined for each of the ES, collecting information from different and complementary sources for analysis. Results: they showed a favorable evolution in the period evaluated, although the fulfillment of the goals was quite far from what was theoretically proposed. The results of this work provides valuable and original information to support decision-making and encourage research in the field of PHC, seeking to reformulate current management and health care models (AU)

¿Cuáles son las brechas de conocimiento y qué priorizar en investigación en salud mental del adulto mayor? Estudio cuali-cuantitativo utilizando la matriz de estrategias combinadas para Argentina (MECA).

INTRODUCCIÓN: el envejecimiento poblacional es un fenómeno mundial. Los problemas de salud mental, altamente prevalentes en este grupo, impactan en la vida de los individuos, sus familias y la sociedad en su conjunto. OBJETIVO: identificar brechas de conocimiento y prioridades de investigación en salud mental del adulto mayor en Argentina. MATERIAL Y MÉTODOS: diseño cuali-cuantitativo, en tres etapas: (1) diagnóstico de situación, (2) evaluación global de necesidades de investigación y (3) ejercicio de priorización basado en la Matriz de Estrategias Combinadas validada para Argentina (MECA). RESULTADOS: con base en las primeras dos etapas del estudio se identificaron dos áreas temáticas investigar en el país y dimensiones priorizadas: (a) soledad-aislamiento y (b) deterioro cognitivo y demencia. Como resultado del ejercicio de priorización surgieron las siguientes dimensiones: en relación con soledad-aislamiento: 1. efecto de los programas, 2. falta de acceso a los recursos, 3. capacidad de adaptación a los contextos locales (integración social del adulto mayor) y 4. calidad de servicios. En relación con deterioro cognitivo y demencia: 1. impacto cuidadores y entorno, 2. barreras para la implementación de guías y capacitación, 3. estudios de costo-efectividad sobre intervenciones y calidad de vida, y 4. recolección y publicación de datos epidemiológicos. CONCLUSIÓN: se debe enfatizar la importancia de fortalecer la investigación en Argentina sobre la implementación y difusión de intervenciones de promoción, prevención y prestación de servicios en la salud mental del adulto mayor.

Mortalidade por suicídio na 5a mesorregião de perícia Santa Catarina: Análise dos casos / Mortalidad por suicidio en el mesoregion experto de la 5a fronteira de Santa Catarina / Mortality by suicide in the 5th fronteira de Santa Catarina expert mesoregion

Objetivo: analisar o perfil dos óbitos por suicídio necropsiados pelo Instituto Geral de Perícias/Chapecó, entre janeiro 2007 e dezembro 2016. Método: estudo exploratório descritivo retrospectivo, obteve aprovação ética do Comitê de Ética em Pesquisa com Seres Humanos (CEP/UFFS) sob parecer no 1.826.221. Dados obtidos nos registros de necropsia e declarações de óbito de mortes por suicídio, organizados em planilhas eletrônicas, analisados pelo teste qui quadrado, e discutidos com base na literatura. Resultados: analisados 335 óbitos. À análise estatística univariada, significância para sexo, faixa etária, escolaridade e situação conjugal. Análise de tendência temporal apontou incremento nas taxas entre 30-39 anos e acima de 60 anos. Conclusão: o fortalecimento de políticas públicas voltadas à saúde mental é necessário.(AU)

Objective: to analyze the profile of deaths by suicide autopsied by the Instituto Geral de Perícias/Chapecó, between January 2007 and December 2016. Method: a retrospective descriptive exploratory study, which obtained ethical approval from the Ethics Committee for Research with Human Beings (CEP/UFFS) under opinion No. 1,826,221. Data obtained from autopsy records and death certificates of deaths by suicide, organized in electronic spreadsheets, analyzed by the chi-square test, and discussed based on the literature. Results: analyzed 335 deaths. Univariate statistical analysis revealed significance for sex, age group, education and marital status. Time trend analysis showed an increase in rates between 30-39 years and over 60 years. Conclusion: the strengthening of public policies aimed at mental health is necessary.(AU)

Objetivo: analizar el perfil de las muertes por suicidio autopsiadas por el Instituto Geral de Perícias/Chapecó, entre enero de 2007 y diciembre de 2016. Método: estudio exploratorio descriptivo retrospectivo, obtuvo aprobación ética del Comité de Ética en Investigación con Seres Humanos (CEP/ UFFS) bajo dictamen N° 1.826.221. Datos obtenidos de autopsias y certificados de defunción de muertes por suicidio, organizados en hojas de cálculo electrónicas, analizados por la prueba de chi-cuadrado y discutidos con base en la literatura. Resultados: se analizaron 335 defunciones. El análisis estadístico univariado reveló significancia para sexo, grupo de edad, educación y estado civil. El análisis de tendencia temporal mostró un aumento en las tasas entre 30-39 años y mayores de 60 años. Conclusión: es necesario el fortalecimiento de las políticas públicas dirigidas a la salud mental.(AU)

Perioperative management of non-deferrable oncologic surgeries during COVID-19 pandemic in Madrid, Spain. Is it safe?

INTRODUCTION: Surgical treatment during Covid-19 pandemic is controversial. Currently, most clinical guidelines advise to defer surgical patients during the Covid-19 pandemic, although the supporting data is sparse. We assumed that a Covid-19-free hospital, on the back of strong isolation measures and targeted screening, could reduce complications and enable us to continue treating high-risk patients. METHODS: Prospective study with retrospective analysis of 355 patients who had undergone nondeferrable oncological surgery between March 16th, 2020, and April 14th, 2020, at our institution. The aim of the study was to assess the hospital restructuring and surgical protocols to be able to safely handle non-deferrable surgeries during the first wave of the Covid-19 pandemic. We implemented structural changes and an updated surgical-anesthetic protocol in order to isolate Covid-19 patients from other surgical patients. Comprehensive targeted screening for Covid-19 patients was made. PCR tests were requested for suspected Covid-19 patients. We analyzed mortality and complications related to both surgery and Covid-19 during hospital admission and also 15 and 30 days after surgery. We compared it with a sample of similar patients in the pre-pandemic period. RESULTS: Of the 355 patients enrolled in our study, 21 were removed due to Covid-19 infection, leaving a total of 334 patients in our final analysis. Post-operative complications were found in 37 patients (11.07%). Two patients died after surgery (0.6%). At the end of the study, Covid-19-related adverse outcomes were detected in six patients (1.79%). When comparing the complications of our original sample with the complications that occurred in the pre-covid era, we found no statistically significant differences. CONCLUSIONS: Our results show that the surgical treatment of oncologic patients during the Covid-19 pandemic is safe, as long as the hospital performs surgeries under strict isolation measures and a robust screening method. It is necessary to select Covid-19 free hospitals for this matter in this and future pandemics.

Manejo perioperatorio de cirugías oncológicas no diferibles durante la pandemia de covid-19 en Madrid, España ¿Es seguro? / Perioperative management of non-deferrable oncologic surgeries during COVID-19 pandemic in Madrid, Spain. Is it safe?

Introducción: El tratamiento quirúrgico durante la pandemia de COVID-19 es controvertido. Actualmente, la mayoría de las guías clínicas recomiendan posponer la cirugía a los pacientes durante la pandemia de COVID-19, aunque los datos de apoyo son escasos. Asumimos que un hospital sin COVID-19, apoyado en fuertes medidas de aislamiento y exámenes de detección específicos, podría reducir las complicaciones y nos permitiría continuar tratando a pacientes de alto riesgo. Métodos: Estudio prospectivo con análisis retrospectivo de 355 pacientes sometidos a cirugía oncológica no diferible entre el 16 de marzo de 2020 y el 14 de abril de 2020 en nuestra institución. El objetivo del estudio fue valorar la reestructuración hospitalaria y de los protocolos quirúrgicos para poder manejar con seguridad las cirugías no diferibles durante la primera ola de pandemia por COVID-19. Implementamos cambios estructurales y un protocolo anestésico-quirúrgico actualizado para aislar a los pacientes con COVID-19 de otros pacientes quirúrgicos. Se realizó una evaluación exhaustiva dirigida a detectar pacientes con COVID-19. Se solicitaron pruebas de PCR para pacientes sospechosos de COVID-19. Analizamos la mortalidad y las complicaciones relacionadas tanto con la cirugía como con la COVID-19 durante el ingreso hospitalario y también a los 15 días y al mes de la cirugía. Comparamos nuestros resultados con una muestra de pacientes similar en el periodo pre-pandemia. Resultados: De los 355 pacientes incluidos en nuestro estudio, 21 fueron eliminados debido a la infección por COVID-19, lo que deja un total de 334 pacientes en nuestro análisis final. Se encontraron complicaciones postoperatorias en 37 pacientes (11,07%). Dos pacientes fallecieron tras la cirugía (0,6%).(AU)

Introduction: Surgical treatment during COVID-19 pandemic is controversial. Currently, most clinical guidelines advise to defer surgical patients during the COVID-19 pandemic, although the supporting data is sparse. We assumed that a COVID-19-free hospital, on the back of strong isolation measures and targeted screening, could reduce complications and enable us to continue treating high-risk patients. Methods: Prospective study with retrospective analysis of 355 patients who had undergone nondeferrable oncological surgery between March 16th, 2020, and April 14th, 2020, at our institution. The aim of the study was to assess the hospital restructuring and surgical protocols to be able to safely handle non-deferrable surgeries during the first wave of the COVID-19 pandemic. We implemented structural changes and an updated surgical-anesthetic protocol in order to isolate COVID-19 patients from other surgical patients. Comprehensive targeted screening for COVID-19 patients was made. PCR tests were requested for suspected COVID-19 patients. We analyzed mortality and complications related to both surgery and COVID-19 during hospital admission and also 15 and 30 days after surgery. We compared it with a sample of similar patients in the pre-pandemic period. Results: Of the 355 patients enrolled in our study, 21 were removed due to COVID-19 infection, leaving a total of 334 patients in our final analysis. Post-operative complications were found in 37 patients (11.07%). Two patients died after surgery (0.6%). At the end of the study, COVID-19-related adverse outcomes were detected in six patients (1.79%). When comparing the complications of our original sample with the complications that occurred in the pre-COVID era, we found no statistically significant differences.(AU)

Construction and Validation of a Questionnaire to Assess the Physician-Patient Relationship and its Association with Bioethical Principles / Construcción y validación de un cuestionario para evaluar la relación médico-paciente y su asociación con los principios bioéticos / Construção e validação de um questionário para avaliar a relação médico-paciente e sua associação com os princípios bioéticos

Abstract Physician-patient relationship (PPR) is a professional-interpersonal relationship that serves as the basis for health management. We aimed to develop an instrument for patients to assess the medical attention received in the outpatient clinic. A 21 question instrument was administered to evaluate its reliability and consistency. The intraclass correlation coefficient was 0.81 (p < 0.05); to fulfill the bioethical principles, the intraclass correlation coefficient was 0.740 (p < 0.05), allowing us to get familiar with the perception of patients who attended the Nephrology Service. The survey showed autonomy as the most reported principle (69 %), followed by dignity (67 %) and justice (60 %). Courtesy, punctuality, and respect make the disease and its treatment more bearable, in addition to promoting the ethics of third parties.

Resumen La relación médico-paciente (RMP) es una relación profesional-interpersonal base para la gestión de la salud. Nuestro objetivo fue desarrollar un instrumento que permitiera evaluar la presencia de los principios bioéticos en la atención médica recibida en la consulta externa de una institución hospitalaria. El instrumento quedó constituido por 21 reactivos para evaluar su confiabilidad y consistencia. El coeficiente de correlación intraclase fue de 0,81 (p < 0,05); para el cumplimiento de los principios bioéticos, fue de 0,740 (p < 0,05). El cuestionario mostró que la autonomía fue el principio más reportado (69 %), después la dignidad (67 %) y justicia (60 %). La presencia de los principios de la bioética ampliados hace más llevadera la enfermedad.

Resumo A relação médico-paciente é uma relação profissional interpessoal, base para a gestão da saúde. Nosso objetivo foi desenvolver um instrumento que permitisse avaliar a presença dos princípios bioéticos na atenção médica recebida na consulta de uma instituição hospitalar. O instrumento foi constituído de 21 reativos para avaliar sua confiabilidade e consistência. O coeficiente de correlação intraclasse foi de 0,81 (p < 0,05); para o cumprimento dos princípios bioéticos, foi de 0,740 (p < 0,05). O questionário mostrou que a autonomia foi o princípio mais relatado (69%), depois da dignidade (67%) e da justiça (60%). A presença dos princípios da bioética ampliados torna a doença mais suportável.

Perfil de ganadores de la convocatoria a Becas "Salud Investiga" 2021-2022 del Ministerio de Salud de la Nación, Argentina / Profile of winners of "Salud Investiga" grants 2021-2022 awarded by the Argentine Ministry of Health

Entre junio y noviembre de 2021 la Dirección de Investigación en Salud del Ministerio de Salud de la Nación realizó la Convocatoria a Becas Salud Investiga 2021-2022. Su objetivo fue promover investigaciones en salud sobre lineamientos y temas priorizados en la Agenda Nacional de Investigación en Salud Pública. La particularidad de este llamado fue incorporar un grupo de becas de Estudios de Múltiples Investigadores (EMI) y EMI en Hospitales Nacionales en el marco del Plan Nacional de Investigación Traslacional en Salud para la Red de Hospitales. Se otorgaron 47 becas para Estudios Individuales (EI), 221 para EMI y 32 para EMI en Hospitales Nacionales. El lineamiento con más proyectos ganadores (14) fue el de impacto sanitario/social/económico de la pandemia COVID-19 en poblaciones vulnerables (pueblos originarios, pobreza estructural, inmigrantes, trabajo informal). El 68% de los becarios de EI y el 83% de los becarios de EMI y EMI en Hospitales Nacionales provenían de instituciones públicas, mayormente establecimientos hospitalarios. Las formaciones disciplinares predominantes fueron las Ciencias de la Salud y las Ciencias Sociales y Humanidades. Los ganadores residían mayormente en la Ciudad Autónoma de Buenos Aires (40% EI y 29% EMI y EMI Hospitales) y en la Provincia de Buenos Aires (17% EI y 36% EMI y EMI Hospitales). Las mujeres de entre 30 y 39 años fueron el subgrupo con mayor representación entre los ganadores de ambos tipos de beca.

Care continuity across levels of care perceived by patients with chronic conditions in six Latin-American countries / La continuidad de la atención entre niveles percibida por pacientes con enfermedades crónicas en seis países latinoamericanos

Objective: To analyse the care continuity across levels of care perceived by patients with chronic conditions in public healthcare networks in six Latin American countries (Argentina, Brazil, Chile, Colombia, Mexico and Uruguay), and to explore associated factors. Method: Cross-sectional study by means of a survey conducted to a random sample of chronic patients in primary care centres of the study networks (784 per country) using the questionnaire Cuestionario de Continuidad Asistencial Entre Niveles de Atención (CCAENA)©. Patients had at least one chronic condition and had used two levels of care in the 6 months prior to the survey for the same medical condition. Descriptive analysis and multivariable logistic regression were carried out. Results: Although there are notable differences between the networks analysed, the results show that chronic patients perceive significant discontinuities in the exchange of clinical information between primary care and secondary care doctors and in access to secondary care following a referral; as well as, to a lesser degree, regarding clinical coherence across levels. Relational continuity with primary care and secondary care doctors and information transfer are positively associated with care continuity across levels; no individual factor is systematically associated with care continuity. Conclusions: Main perceived discontinuities relate to information transfer and access to secondary care after a referral. The study indicates the importance of organisational factors to improve chronic patients' quality of care. (AU)

Objetivo: Analizar la continuidad asistencial entre niveles de atención percibida por pacientes con enfermedades crónicas en redes sanitarias públicas de seis países latinoamericanos (Argentina, Brasil, Chile, Colombia, México y Uruguay) y explorar los factores asociados. Método: Estudio transversal mediante una encuesta realizada a una muestra aleatoria de pacientes crónicos en los centros de atención primaria de las redes de estudio (784 por país) utilizando el Cuestionario de Continuidad Asistencial Entre Niveles de Atención (CCAENA©). Los pacientes presentaban al menos una afección crónica y habían utilizado dos niveles de atención en los 6 meses anteriores a la encuesta por el mismo motivo. Se realizaron un análisis descriptivo y una regresión logística multivariante. Resultados: Aunque existen diferencias notables entre las redes analizadas, los resultados muestran que los pacientes crónicos perciben discontinuidades significativas en el intercambio de información clínica entre médicos de atención primaria y secundaria, y en el acceso a la atención secundaria tras una derivación, así como, en menor medida, en la coherencia clínica entre niveles. La continuidad de relación con los médicos de atención primaria y secundaria, y la transferencia de información, se asocian de manera positiva con la continuidad asistencial en ambos niveles; ningún factor individual se asocia sistemáticamente con la continuidad asistencial. Conclusiones: Las principales discontinuidades percibidas se relacionan con la transferencia de información y el acceso a la atención secundaria después de una derivación. El estudio indica la importancia de los factores organizativos para mejorar la calidad de la atención de los pacientes crónicos. (AU)

Perioperative management of non-deferrable oncologic surgeries during COVID-19 pandemic in Madrid, Spain. Is it safe? / Manejo perioperatorio de cirugías oncológicas no diferibles durante la pandemia de covid-19 en Madrid, España ¿Es seguro?

INTRODUCTION: Surgical treatment during COVID-19 pandemic is controversial. Currently, most clinical guidelines advise to defer surgical patients during the COVID-19 pandemic, although the supporting data is sparse. We assumed that a COVID-19-free hospital, on the back of strong isolation measures and targeted screening, could reduce complications and enable us to continue treating high-risk patients. METHODS: Prospective study with retrospective analysis of 355 patients who had undergone nondeferrable oncological surgery between March 16th, 2020, and April 14th, 2020, at our institution. The aim of the study was to assess the hospital restructuring and surgical protocols to be able to safely handle non-deferrable surgeries during the first wave of the COVID-19 pandemic. We implemented structural changes and an updated surgical-anesthetic protocol in order to isolate COVID-19 patients from other surgical patients. Comprehensive targeted screening for COVID-19 patients was made. PCR tests were requested for suspected COVID-19 patients. We analyzed mortality and complications related to both surgery and COVID-19 during hospital admission and also 15 and 30 days after surgery. We compared it with a sample of similar patients in the pre-pandemic period. RESULTS: Of the 355 patients enrolled in our study, 21 were removed due to COVID-19 infection, leaving a total of 334 patients in our final analysis. Post-operative complications were found in 37 patients (11.07%). Two patients died after surgery (0.6%). At the end of the study, COVID-19-related adverse outcomes were detected in six patients (1.79%). When comparing the complications of our original sample with the complications that occurred in the pre-COVID era, we found no statistically significant differences. CONCLUSIONS: Our results show that the surgical treatment of oncologic patients during the COVID-19 pandemic is safe, as long as the hospital performs surgeries under strict isolation measures and a robust screening method. It is necessary to select COVID-19 free hospitals for this matter in this and future pandemics.

Perfil epidemiológico de pacientes atendidos en policlínico de dolor crónico no oncológico (DCNO), Hospital Hernán Henríquez Aravena (HHHA). Servicio de Salud Araucanía Sur, Región de la Araucanía / Epidemiological profile of patients served in chronic non-oncological pain polyclinic (DCNO), Hernán Henríquez Aravena Hospital (HHHA). Health Service Araucanía Sur, Region of la Araucanía

Introducción: El dolor crónico no oncológico (DCNO) es un tema de salud pública con alta prevalencia en Chile. Existe evidencia sobre la necesidad de abordaje multidisciplinario por profesionales capacitados. El año 2013 se crea el policlínico de DCNO por la especialidad de fisiatría, coordinando atención con anestesista para intervencionismo. El Objetivo de este trabajo es conocer las características clínicas de los usuarios en control en policlínico de DCNO. Material y Método: Estudio retrospectivo, descriptivo, observacional. Desde la base de datos de usuarios atendidos entre inicios del 2013 y mayo 2018 de policlínico DCNO del Servicio de Medicina Física y Rehabilitación del HHHA; se recogen variables como: sexo, edad, etnia, previsión, ruralidad, diagnóstico ingreso, intensidad dolor (según NRS), tratamiento farmacológico, entre otras. Para manejo estadístico se utiliza planilla Excel, con pruebas paramétricas (promedio, mínimo, máximo), tablas y gráficos. Resultados: Los usuarios en control en el periodo fueron 125, con un 67,2% de mujeres y una mediana de edad de 55,5 años (mínimo 12, máximo 88). El 58,4% tenía como previsión Fonasa B, 83.2% presenta domicilio urbano, 16% etnia mapuche. El mayor número de ingresos ocurrió el año 2017. Las derivaciones provienen de especialidades médicas (25,6%), quirúrgicas (29,6%), fisiatría (24,8%). Según tipo de dolor, el 49,6% es nociceptivo, 32% neuropático y 18,4% mixto. Al ingreso, la intensidad fue 90% severa y 10% moderada (según NRS). Los principales diagnósticos de ingreso fueron 44,8% patología de columna, 27,2% patología neurológica, 12,8% fibromialgia y 15,2% otras. Al ingreso mayoría de los usuarios usaba paracetamol, tramadol gotas o comprimidos; actualmente 23% recibe metadona, 8% parches buprenorfina, 20% paracetamol, 27,2% tramadol en gotas/comprimidos y 23,2% pregabalina/ gabapentina. En el 51,2% se requirió cambio de terapia; en el 79,7% por analgesia insuficiente y 20,3% por reacción adversa a medicamentos. Se realizó derivación a intervencionismo en 21 usuarios. 15 usuarios fueron dados de alta de policlínico DCNO (12%). Conclusiones: Estos datos servirán para futuras investigaciones y medir impacto de nuestras intervenciones. Se presenta como desafío aumentar recursos de la unidad, demostrar beneficio de atención interdisciplinaria y bajar costos para la institución.

Introduction: Non-oncological chronic pain (NOCP) is a public health issue with high prevalence in Chile. There is evidence of the need for a multidisciplinary approach by trained professionals. In 2013, the NOCP polyclinic was created for the specialty of physiatry, coordinating care with anesthesiologist for interventionism. The objective of this work is to know the clinical characteristics of users in control in NOCP polyclinic. Material and Methods: Retrospective, descriptive, observational study. From the database of users attended between the beginning of 2013 and May 2018, from the NOCP polyclinic of the Physical Medicine and Rehabilitation Service of the HHHA; variables such as: sex, age, ethnicity, foresight, rurality, income diagnosis, pain intensity (according to NRS), and pharmacological treatment, among others are collected. For statistical management Excel spreadsheet isused, with parametric tests (average, minimum, maximum), tables and graphs. Results: The users in control in the period were 125, with 67.2% of women, a median age of 55.5 years (minimum 12, maximum 88). 58.4% had Fonasa B as a forecast, 83.2% have an urban address, 16% Mapuche ethnicity. The highest number of admissions occurred in 2017. The referrals come from medical specialties (25.6%), surgical specialties (29.6%), and physiatry (24.8%). According to type of pain, 49.6% is nociceptive, 32% neuropathic and 18.4% mixed. At admission, the intensity was 90% severe and 10% moderate (according to NRS). The main diagnoses of admission were 44.8% spinal pathology, 27.2% neurological pathology, 12.8% fibromyalgia and 15.2% others. On admission, most users used paracetamol, tramadol drops or tablets; currently 23% receive methadone, 8% patches buprenorphine, 20% paracetamol, 27.2% tramadol in drops / tablets and 23.2% pregabalin / gabapentin. In 51.2%, therapy change was required; in 79.7% due to insufficient analgesia and 20.3% due to adverse drug reaction. A derivation to interventionism was carried out in 21 users. 15 users were discharged from polyclinic DCNO (12%). Conclusions: These data will serve for future research and measure the impact of our interventions. It is a challenge to increase the resources of the unit, demonstrate the benefit of interdisciplinary attention and lower costs for the institution.

Care continuity across levels of care perceived by patients with chronic conditions in six Latin-American countries.

OBJECTIVE: To analyse the care continuity across levels of care perceived by patients with chronic conditions in public healthcare networks in six Latin American countries (Argentina, Brazil, Chile, Colombia, Mexico and Uruguay), and to explore associated factors. METHOD: Cross-sectional study by means of a survey conducted to a random sample of chronic patients in primary care centres of the study networks (784 per country) using the questionnaire Cuestionario de Continuidad Asistencial Entre Niveles de Atención (CCAENA)©. Patients had at least one chronic condition and had used two levels of care in the 6 months prior to the survey for the same medical condition. Descriptive analysis and multivariable logistic regression were carried out. RESULTS: Although there are notable differences between the networks analysed, the results show that chronic patients perceive significant discontinuities in the exchange of clinical information between primary care and secondary care doctors and in access to secondary care following a referral; as well as, to a lesser degree, regarding clinical coherence across levels. Relational continuity with primary care and secondary care doctors and information transfer are positively associated with care continuity across levels; no individual factor is systematically associated with care continuity. CONCLUSIONS: Main perceived discontinuities relate to information transfer and access to secondary care after a referral. The study indicates the importance of organisational factors to improve chronic patients' quality of care.

Convergent care research and its qualification as scientific research / Investigación convergente asistencial y su calificación como investigación científica / Pesquisa convergente assistencial e sua qualificação como investigação científica

ABSTRACT Objectives: to highlight the main attributes of Convergent Care Research that ratify it as a method of scientific research. Methods: it is a theoretical-reflective study on Convergent Care Research's theoretical-methodological assumptions. Development: Convergent Care Research is compatible with the Social Constructionism paradigm. Convergent Care Research projects have two approaches: practical and conceptual. The Convergent Care Research process corpus contains five phases: conception; instrumentation; scrutiny; analysis and theorizing. Final Considerations: Convergent Care Research rigor encompasses the relationship between research and care practice, and this corresponds to the convergence of these two dimensions. Due to its theoretical foundation and criteria of methodological rigor, Convergent Care Research is aligned with scientific research methods.

RESUMEN Objetivos: destacar los principales atributos de la Investigación Convergente Asistencial que la ratifican como método de investigación científica. Métodos: estudio teórico-reflexivo sobre supuestos teórico-metodológicos del Investigación Convergente Asistencial Desarrollo: el Investigación Convergente Asistencial es compatible con el paradigma del Construccionismo Social. Los proyectos de Investigación Convergente Asistencial asumen dos enfoques: práctico y conceptual. El corpus del proceso Investigación Convergente Asistencial consta de cinco fases: concepción, instrumentación, investigación, análisis y teorización. Consideraciones Finales: el rigor de la Investigación Convergente Asistencial comprende la relación entre la investigación y la práctica asistencial, y esto corresponde a la convergencia de estas dos dimensiones. Por su fundamento teórico y criterios de rigor metodológico, el Investigación Convergente Asistencial se alinea con los métodos de investigación científica.

RESUMO Objetivos: destacar os principais atributos da Pesquisa Convergente Assistencial que a ratificam como um método de pesquisa científica. Métodos: estudo teórico-reflexivo sobre pressupostos teórico-metodológicos da Pesquisa Convergente Assistencial. Desenvolvimento: a Pesquisa Convergente Assistencial se compatibiliza com o paradigma do Construcionismo Social. Projetos de Pesquisa Convergente Assistencial supõem dois enfoques: prático e conceptual. O corpus do processo em Pesquisa Convergente Assistencial contém cinco fases: concepção, instrumentação, perscrutação, análise e teorização. Considerações Finais: o rigor em Pesquisa Convergente Assistencial compreende as relações entre pesquisa e prática assistencial, e isso corresponde à convergência dessas duas dimensões. Por sua fundamentação teórica e critérios de rigor metodológico que comporta, a Pesquisa Convergente Assistencial se coloca em alinhamento com métodos de pesquisa científica.

Experiencias y desafíos para la inclusión profesional en la atención primaria de salud en Brasil / Experiences and challenges for the professional inclusion in Primary Health Care in Brazil

Introducción: En Brasil se incluyeron profesionales expertos en la atención primaria de salud como recurso para aumentar la resolución de casos y el alcance de las acciones. Objetivo: Analizar las contribuciones de los núcleos de apoyo a la salud de la familia para ampliar la capacidad de respuesta de la atención primaria de salud. Métodos: Estudio de casos múltiples con abordaje cualitativo, realizado en seis municipios del estado de Bahía, Brasil. Se utilizó una matriz analítica desarrollada a partir de atributos de la atención primaria: acceso, longitudinalidad de la atención, coordinación del cuidado y orientación para la comunidad. Los datos fueron obtenidos por medio de entrevistas semiestructuradas con 83 profesionales de la atención primaria y observaciones de campo. Los datos se organizaron y categorizaron según la técnica de análisis temático. Resultados: Los núcleos de apoyo no contribuyeron mucho a ampliar la resolución de casos. El acceso a los servicios de los expertos profesionales fue limitado y los núcleos raramente ofrecían atención continua. La actuación en la coordinación del cuidado también fue insatisfactoria. Se evidenció incipiente reducción de la demanda para los otros niveles y frágil interacción con la red de atención. La actuación orientada a la comunidad ocurría de forma parcial. Conclusiones: El trabajo de los núcleos de apoyo muestra poca contextualización con los atributos de la atención primaria, de ahí la necesidad de superar los obstáculos estructurales y organizativos que comprometen el trabajo de los nuevos profesionales en este nivel básico del sistema de salud(AU)

Introduction: In Brazil, experts in primary health care were included as a resource to increase cases resolution and the scope of actions. Objective: To analyze the contributions of the groups for family health´s support in expanding the response capacity of primary health care. Methods: Multiple cases study with a qualitative approach carried out in six municipalities in Bahia state, Brazil. It was used an analytics matrix developed from primary care attributes like: access, care longitudinality, coordination of care and guidance for the community. The data were obtained by means of semi-structured interviews with 83 primary health care professionals and field observations. The data were organized and categorized according to the technique of thematic analysis. Results: The support groups did not contributed much to expand the cases resolution. The access to the professional experts´ services was limited and the groups rarely offered continuous attention. Performance in the coordination of care was also unsatisfactory. It was shown incipient reduction of demand for the other levels and fragile interaction with the care network. The community-oriented performance occurred partially. Conclusions: The work of the support groups shows little contextualization with the attributes of primary care, hence the need to overcome structural and organizational obstacles that involve the work of the new professionals in this basic level of the health system(AU)

10 anos de um CAPSi: percepções dos profissionais acerca do trabalho em saúde mental infantojuvenil / 10 años de un CAPSi: percepciones de los profesionales acerca del trabajo en salud mental de niños y adolescentes / 10 years of a CAPSi: professionals' perceptions about work in children's mental health

Objetivou-se identificar as percepções de profissionais trabalhadores de um CAPSi acerca do trabalho em saúde mental da criança e do adolescente, bem como descrever os impasses e desafios vividos pelo serviço em seu décimo ano de funcionamento. Os dados foram analisados por meio da Classificação Hierárquica Descendente (CHD), possibilitada pelo software IRaMuTeQ. A CHD formou cinco classes: 1- "A clínica no CAPSi", classe que compreende as interrogações dos profissionais acerca da dimensão clínica do CAPSi, especialmente no que se refere às condutas a serem adotadas para o cuidado de usuários com autismo; 2- "Articulação com a Rede", sendo situados os desafios relacionados à efetivação da política intersetorial; 3- "Imaginário do serviço", que ilustra o entendimento da população e demais serviços da rede acerca do CAPSi, frequentemente visto como um serviço clínico-ambulatorial centrado na especialidade psiquiátrica. 4- "Perfil dos usuários globais", que remonta a lógica histórica de ações dedicadas à crianças e adolescentes considerados "desviantes", condição que contribui para a prevalência de usuários provenientes de famílias com baixa renda e em vulnerabilidade social no CAPSi; 5- "O Cuidado de Usuários AD", que denota a dificuldade da equipe do CAPSi constituir um lugar possível para cuidado de usuários com necessidades decorrentes do uso de álcool e outras drogas.

Este estudio tuvo como objetivo identificar las percepciones de los profesionales que trabajan en un CAPSi sobre el trabajo sobre salud mental de niños y adolescentes (SMNA), especialmente para describir los obstáculos y los desafíos que enfrenta el servicio en su décimo año de operación... Quince profesionales del servicio fueron entrevistados. Los datos se analizaron a través de la Clasificación Jerárquica Descendente (CJD), posible por el software IRaMuTeQ. El CJD formó cinco clases: 1- "La clínica en el CAPSi", una clase que comprende las preguntas de los profesionales acerca de la dimensión clínica del CAPSi, que conduce a una mirada dentro del servicio, especialmente con respecto a los protocolos que deben adoptarse para el cuidado de los usuarios con autismo; 2- "Articulación con la Red", donde existen desafíos relacionados con la implementación de la política intersectorial; 3 - "Imaginario del servicio", que comprende los cruces históricos de la salud mental brasileña, especialmente marcados por el modelo biomédico, que aún atraviesa los dispositivos de atención como el CAPSi, a veces entendido como un servicio clínico-ambulatorio centrado en la especialidad psiquiátrica. 4- "Perfil de usuarios globales", que se remonta la lógica histórica de las acciones dedicadas a niños y adolescentes consideradas "desviadas", una condición que contribuye a la prevalencia de usuarios de familias con bajos ingresos y vulnerabilidad social en CAPSi; 5 - "El cuidado de los usuarios de AD", que denota la dificultad del equipo CAPS ser un lugar posible para atender a los usuarios con necesidades de consumo de alcohol y drogas, y por lo tanto, el frecuente "no lugar" de estos usuarios en el servicio.

This study aimed to identify the perceptions of working professionals of a CAPSi about the work on mental health of children and adolescents (CAMH), especially in order to describe the impasses and challenges faced by the service in its tenth year of operation. Fifteen service professionals were interviewed. The data were analyzed through the Descending Hierarchical Classification (DHC), possibled by the IRaMuTeQ software. The DHC formed five classes: 1- "The clinic in the CAPSi", a class that understands the professionals' questions about the CAPSi's clinical dimension, which leads to a look inside the service, especially regarding the protocols to be adopted for the care of users with autism; 2- "Articulation with the Network", where there are challenges related to the implementation of intersectoral policy; 3 - "Imaginary of the service", which comprises the historical crossings of Brazilian mental health, especially marked by the biomedical model, that still crosses the attention devices like the CAPSi, sometimes understood as a clinical-ambulatory service centered in the psychiatric specialty. 4- "Profile of global users", which goes back to the historical logic of actions dedicated to children and adolescents considered "deviant", a condition that contributes to the prevalence of users from families with low income and social vulnerability in CAPSi; 5 - "The Care of AD Users", which denotes the CAPSi team difficulty being a possible place for caring for users with alcohol and drug use needs, and therefore, the frequent "non-place" of these users in the service.

[Gender inequalities in authorship of the main Spanish medical journals in 2017]. / Desigualdades de género en la autoría de las principales revistas médicas españolas durante el año 2017.

INTRODUCTION: Some studies have shown a lower female participation in scientific publications. The objective of this study is to analyse the gender inequalities in the main Spanish journals of medical publications. MATERIAL AND METHOD: Cross-sectional study of the main Spanish medical journals classified by SCImago Journal & Country Ranking (n=24) and their publications (n=3.375), during the year 2017. Women/men ratio in authorship was calculated for all journals and types of papers. Bivariate analyses were developed with the type of article as the dependent variable, and gender, institution, and country of the first and last authors as the independent variables. Logistic regression models were performed to calculate adjusted odds ratios (aOR) and their 95% confidence intervals (95% CI) of the types of papers according to authorship gender, institution, and country. The statistical program used was R. RESULTS: The total number of authors was 16,252 (44.2% women, 53.9% men, and 1.9% non-identified gender). Women represented 46% of the first authors and 33.5% of the last ones. Women were the first authors of Editorials less often than men (aOR 0.39; 95% CI 0.30-0.51), but more often in Originals (aOR 1.55; 95% CI 1.33-1.80). Women were the last authors with less frequency in all types of papers, especially in Editorials (aOR 0.50; 95% CI 0.35-0.70). The women/men ratio in authorship was less than 0.80 in 10 of 26 journals analysed (41.7%). CONCLUSIONS: These results show the gender inequalities in the authorship of the main Spanish medical journals in 2017, especially as first authors and Editorials.

Reproducibilidad y validez del Picker Patient Experience (versión con 26 ítems) en participantes de investigaciones en Medellín, Colombia, en 2018 / Reproducibility and validity of the Picker Patient Experience (26-item version) in research participants in Medellin, Colombia, in 2018 / Reprodutibilidade e validade da Picker Patient Experience (versão com 26 itens) em participantes da pesquisa em Medellín, Colômbia, em 2018

Resumen Objetivo: Evaluar la reproducibilidad y validez del Picker Patient Experience versión con 26 ítems, en participantes de investigaciones de una institución de alta complejidad de Medellín, Colombia, en 2018. Metodología: Evaluación psicométrica en 241 sujetos, mediante fiabilidad con el alfa de Cronbach, consistencia interna con correlaciones de Spearman, validez de apariencia, contenido y predictiva con análisis factorial. Resultados: Más del 90% de los participantes calificó positivamente la claridad de la información, relación con personal asistencial y la atención. El alfa de Cronbach fue 0,70 (intervalo de confianza -IC- 95%=0,64-0,76); las correlaciones en la consistencia interna fueron mayores que 0,30 en la mitad de los ítems; en la validez de contenido, el porcentaje de éxito fue mayor al 90%; la validez predictiva fue moderada, con una proporción de la varianza explicada del 55%. En una escala de cero (peor resultado) a cien (mejor), el 50% de los valores centrales del Picker Patient Experience osciló entre 80,8 y 92,3, con rango entre 62 y 98, lo que demuestra la excelente percepción de calidad en el grupo de estudio, sin diferencias estadísticas según la edad, el número de hijos, la escolaridad, el estrato socioeconómico de la vivienda, el estado civil, ni la ocupación. Solo se halló asociación estadística con el sexo, siendo menor la mediana del puntaje en las mujeres (Me=85; rango intercuartil -RI-=81-92) en comparación con los hombres (Me=87; RI=83-94). Conclusión: Se dispone de una escala reproducible, válida y útil para la percepción de calidad en investigaciones con 26 ítems, correspondiente a una modificación de la versión en español del Picker Patient Experience versión con 33 ítems. Esto es de gran relevancia, al considerar que la calidad asistencial requiere la inclusión de la perspectiva del paciente con constructos psicométricamente robustos.

Abstract Objective: To evaluate the reproducibility and validity of the 26-item Picker Patient Experience, in research participants of a high complexity institution in Medellin, Colombia, in 2018. Methodology: Psychometric evaluation in 241 subjects, through reliability with Cronbach's alpha, internal consistency with Spearman correlations, appearance, content and predictive validity with factor analysis. Results: Over 90% of participants positively rated the clarity of the information, relationship with care staff and care. Cronbach's alpha was 0.70 (confidence interval - CI - 95% = 0.64-0.76); the correlations in internal consistency were greater than 0.30 in half of the items; in the content validity, the success rate was greater than 90%; predictive validity was moderate, with a proportion of variance explained of 55%. On a scale of zero (worst result) to one hundred (best), 50% of the central values of the Picker Patient Experience ranged between 80.8 and 92.3, with a range between 62 and 98, demonstrating the excellent perception of quality in the study group, with no statistical differences according to age, number of children, schooling, socioeconomic status of housing, marital status, or occupation. The only statistical association was found with sex, the median score being lower in women (Me = 85; interquartile range —IR— = 81-92) compared to men (Me = 87; IR = 83-94). Conclusion: There is a reproducible, valid and useful scale for the perception of quality in research with 26 items, corresponding to a modification of the Spanish version of the 33-item Picker Patient Experience. This is of great relevance, considering that the quality of care requires the inclusion of the patient's perspective with psychometrically robust constructs.

Resumo Objetivo: Avaliar a reprodutibilidade e a validade do Picker Patient Experience versão com 26 itens, em participantes de pesquisas de uma instituição altamente complexa em Medellín, na Colômbia, em 2018. Metodologia: Avaliação psicométrica em 241 sujeitos, através da confiabilidade com o alfa de Cronbach, consistência interna com correlações de Spearman, validade de aparência, conteúdo e preditiva com análise fatorial. Resultados: Mais de 90% dos participantes qualificaram positivamente a clareza das informações, o relacionamento com a equipe de assistência e o atendimento. O alfa de Cronbach foi de 0,70 (intervalo de confiança —ic— 95 % = 0,64-0,76); as correlações na consistência interna foram superiores a 0,30 na metade dos itens; na validade do conteúdo, a percentagem de sucesso foi superior a 90 %; a validade preditiva foi moderada, com proporção da variância explicada de 55 %. Em uma escala de zero (pior resultado) a cem (o melhor), 50 % dos valores centrais da Paciente Picker Experience oscilou entre 80,8 e 92,3, com um intervalo entre 62 e 98, demonstrando a excelente percepção de qualidade no grupo de estudo, sem diferenças estatísticas segundo a idade, o número de filhos, a escolaridade, a condição socioeconômica da moradia, o estado civil nem a ocupação. Somente foi achada associação estatística com o sexo, sendo mais baixa a mediana dos pontos nas mulheres (Me = 85; intervalo interquartil —RI— = 81-92) em comparação aos homens (Me = 87; ri = 83-94). Conclusão: Existe uma escala reproduzível, válida e útil para a percepção de qualidade em pesquisas com 26 itens, correspondendo a uma modificação da versão em espanhol da versão Picker Patient Experience com 33 itens. Isso é de grande relevância, considerando que a qualidade da assistência requer a inclusão da perspectiva do paciente em constructos psicometricamente robustos.

Analysis of records by nursing technicians and nurses in medical records / Análisis de los registros médicos de técnicos de enfermería y de enfermeros / Análise dos registros de técnicos de enfermagem e enfermeiros em prontuários

ABSTRACT Objectives: to analyze the main non-conformities of the nursing records of a public hospital in Natal, Brazil. Methods: this is a descriptive, cross-sectional study, with a quantitative approach. This study was conducted in nursing departments of medical and surgical wards. The sample was composed of 120 medical records of inpatients between October and December 2016. The obtained data were tabulated and analyzed by simple statistics in absolute and relative frequency using the 2013 Microsoft Excel software. The Pareto Diagram was used to evaluate the non-conformities of the records. Results: the main problems in the nursing records were the absence of the professional category and the nursing council number, responsible for 41.8% of the non-conformities in the records of nursing technicians; for nurses' records, the main non-conformities were the absence of time and the illegible handwriting, with 61.2%. Conclusions: the study showed that nursing professionals perform their records incompletely and often do not document the care provided.

RESUMEN Objetivos: evaluar las no conformidades principales de los registros de enfermería de un hospital público del Nordeste en la ciudad de Natal (Brasil). Métodos: estudio descriptivo, transversal, de enfoque cuantitativo. Se llevó a cabo en enfermerías médicas y quirúrgicas. La muestra constó de 120 registros médicos de pacientes hospitalizados entre octubre y diciembre de 2016. Los datos obtenidos fueron tabulados y analizados por estadística simple en frecuencias absoluta y relativa con el software Microsoft Excel 2013. Se utilizó el Diagrama de Pareto en la evaluación de las no conformidades de los registros. Resultados: entre los principales problemas en los registros de enfermería, se destacó la ausencia de la categoría profesional y del número de la comisión, responsables de un 41,8% de las no conformidades en los registros de técnicos de enfermería, mientras que en las anotaciones de los enfermeros se sobresalió la ausencia de hora y caligrafía ilegible, con un 61,2%. Conclusiones: el estudio demostró que los profesionales de enfermería hacen sus registros de forma incompleta y que muchas veces no documentan el cuidado ofertado.

RESUMO Objetivos: analisar as principais não conformidades dos registros de enfermagem de um hospital público do Nordeste na cidade de Natal. Métodos: estudo descritivo, transversal, abordagem quantitativa. Realizado em enfermarias médicas e cirúrgicas. Amostra composta de 120 prontuários de pacientes internados entre outubro e dezembro de 2016. Os dados obtidos foram tabulados e analisados por estatística simples em frequência absoluta e relativa com o software Microsoft Excel 2013. Para avaliar as não conformidades dos registros, usou-se o Diagrama de Pareto. Resultados: como principais problemas nos registros de enfermagem, destacou-se a ausência da categoria profissional e número do conselho, responsáveis por 41,8% das não conformidades nos registros de técnicos de enfermagem, enquanto nas anotações dos enfermeiros foram a ausência de hora e as letras ilegíveis, com 61,2%. Conclusões: o estudo evidenciou que os profissionais de enfermagem realizam seus registros de forma incompleta e que muitas vezes não documentam o cuidado prestado.