Sentimentos da mulher frente a gestação de alto risco / Sentimientos de la mujer frente al embarazo de alto riesgo / Women's feelings facing High-Risk pregnancy

Resumo Introdução: A gestação configura-se como um acontecimento único e memorável para a vida de uma mulher. A gravidez de alto risco é uma experiência estressante em razão dos riscos a que estão submetidos a mãe e o bebê e devido às mudanças que afetam negativamente o seu equilíbrio emocional. Objetivo: Identificar os sentimentos vivenciados pela gestante frente à gravidez de alto risco. Método: Descritivo e exploratório com abordagem qualitativa, com amostra por conveniência composta por mulheres com gestação de alto risco, selecionadas de acordo com a disponibilidade do serviço de internamento, até a saturação das entrevistas. A coleta dos dados foi realizada em um período de dois meses através de entrevistas guiadas por um roteiro. Os dados foram analisados por meio da técnica de análise de conteúdo segundo Minayo. Resultados: Fizeram parte 37 mulheres. Os resultados foram oeganizados nas categorias: Como se deu o diagnóstico de alto risco; Sentimentos ao descobrir que a gestação é/era de risco; Sentimentos em relação ao apoio familiar acerca da gestação de alto risco. Os sentimentos relatados pelas gestantes e puérperas que conviveram com a gravidez de alto risco, deixam evidentes os impactos que este evento traz não somente na saúde física sobretudo para a emocional, deixando as gestantes fragilizadas. Conclusão: Assim, o estudo nos permitiu perceber que os sentimentos vivenciados nesse processo podem interfir na vida dessas mulheres, e de forma negativa. Mas, que apesar dessa situação, estas expressam sentimentos ambíguos, pois mesmo com o risco gestacional, muitas mostram-se felizes pela dádiva de ser mãe.

Resumen Introducción: El embarazo se considera un evento único y memorable en la vida de una mujer. El embarazo de alto riesgo es una experiencia estresante debido a los riesgos a los que están expuestas tanto la madre como su bebé y a los cambios que afectan negativamente su equilibrio emocional. Objetivo: Identificar los sentimientos experimentados por las mujeres embarazadas frente a un embarazo de alto riesgo. Metodología: Descriptivo y exploratorio con enfoque cualitativo, con una muestra a conveniencia compuesta por mujeres con embarazos de alto riesgo, seleccionadas según la disponibilidad del servicio de hospitalización, hasta la saturación de las entrevistas. La recopilación de datos se llevó a cabo durante un período de dos meses a través de entrevistas guiadas. Los datos fueron analizados utilizando la técnica de análisis de contenido según Minayo. Resultados: Participaron 37 mujeres y los resultados se organizaron en las siguientes categorías: cómo se realizó el diagnóstico de alto riesgo; sentimientos al descubrir que el embarazo era de riesgo; sentimientos con respecto al apoyo familiar en relación con el embarazo de alto riesgo. Los sentimientos relatados por las mujeres embarazadas y posparto que vivieron un embarazo de alto riesgo evidencian los impactos que tiene este evento no solo en la salud física sino, especialmente, en el bienestar emocional, pues deja a las mujeres embarazadas en un estado de vulnerabilidad. Conclusión: El estudio nos permitió darnos cuenta de que los sentimientos experimentados en este proceso pueden interferir en la vida de estas mujeres de manera negativa. Sin embargo, a pesar de esta situación, muchas de ellas expresan sentimientos ambiguos, porque, incluso con el riesgo gestacional, están agradecidas por el regalo de la maternidad.

Abstract Introduction: Pregnancy is considered a unique and memorable event in a woman's life. High-risk pregnancy is a stressful experience due to the risks to which the mother and the baby are exposed, and due to the changes that negatively affect their emotional balance. Objective: To identify the feelings experienced by pregnant women facing high-risk pregnancy. Method: Descriptive and exploratory, employing a qualitative approach, the study featured a convenience sample of women with high-risk pregnancies, selected based on inpatient service availability, until interview saturation was achieved. Data collection was conducted over a two-month period through scripted interviews. Data analysis was performed utilizing Minayo's content analysis technique. Results: Thirty-seven women participated in the study. The results were categorized as follows: How the high-risk diagnosis was determined; Feelings upon discovering the pregnancy was high-risk; Feelings regarding family support regarding the high-risk pregnancy. The feelings reported by pregnant and postpartum women who experienced high-risk pregnancies clearly reveal the impacts this event has, not only on physical health, but especially on emotional well-being, leaving the pregnant women in a vulnerable state. Conclusion: The study allowed us to realize that the feelings experienced in this process can negatively interfere in the lives of these women. However, despite this situation, many of them express mixed feelings, because even with the gestational risk, they are grateful for the gift of motherhood.

The use of complementary and alternative medicine and approaches to coping with stress in women with breast cancer: a cross-sectional study.

OBJECTIVE: The study aimed to reveal the approaches to coping with stress of women with breast cancer and the factors predicting these approaches, to determine the prevalence and characteristics of Complementary and Alternative Medicine (CAM), and to examine the relationship between use of CAM and approaches to coping with stress. METHODS: A descriptive and cross-sectional study was conducted among 328 women with breast cancer at a training and research hospital in Türkiye. Data were collected with the "Descriptive Information Form" and the "Stress Coping Styles Scale (SCSS)". RESULTS: Women's SCSS score was 47.26 ± 6.39 (effective) and 37.76 ± 6.33 (ineffective). The SCSS score were not significantly different between CAM users and non-CAM users (p > 0.05). The prevalence of CAM use was 36%, the most common types of CAM were herbal products (55.1%) and prayer (33.8%) and the reasons for using CAM were for relaxation (symptomatic) (43.2%). As a result of multivariate logistic regression analysis, level of income, working, number of living children, receiving chemotherapy, receiving surgery, having a family history of cancer, and the interest of their partner after the disease were associated with effective coping with stress (p < 0.05, adjusted R2 = 0.08, 0.05, and 0.33 respectively). Working, receiving chemotherapy, receiving surgery, stage of cancer, and having a history of cancer in a social environment were associated with ineffective coping with stress (p < 0.05, adjusted R2 = 0.14 and 0.11 respectively). CONCLUSIONS: One-third of women were using CAM and had a good level of approaches to coping with stress. Healthcare providers, especially gynecology-oncology nurses, should provide counseling on CAMs and develop strategies for coping with stress for women with breast cancer.

EPIDEMIOLOGY OF CONGENITAL ANOMALS IN A NATIONAL REFERENCE HOSPITAL IN ECUADOR / EPIDEMIOLOGÍA DE LAS ANOMALÍAS CONGÉNITAS EN UN HOSPITAL DE REFERENCIA NACIONAL EN ECUADOR / EPIDEMIOLOGIA DE ANOMALIAS CONGÊNITAS EM UM HOSPITAL DE REFERÊNCIA NACIONAL NO EQUADOR

Objective. To determine the prevalence, types, and associated risk factors of congenital anomalies in newborns admitted to Isidro Ayora Gynecological-Obstetric Hospital in Quito, Ecuador, between 2009-2022. Methods. Cross-sectional study, using retrospective data from the Perinatal Information System database. Chi-square tests and simple and multiple binary logistic regression models were employed. R programming language was utilized. Results. A total of 26,236 newborns were studied, of which 11.7% (3,075) were diagnosed with congenital anomalies. The most common were those related to the nervous system (25.6%), cardiorespiratory system (21.1%), and musculoskeletal system (16.1%). Maternal age over 35 years, pregnancy planning, and multiple pregnancies were associated with the presence of congenital anomalies. When analyzing risk factors by affected system, maternal age, maternal history of abortions and diabetes, folic acid consumption, and newborn's sex had both favorable and unfavorable effects on the development of congenital anomalies in a specific system. Conclusions. This study investigated the prevalence and most common types of congenital anomalies, along with their associated risk factors, in a reference hospital. These findings were compared with reports from other regions. The results provide significant data on the epidemiology of congenital anomalies in the studied population, which can guide the development of preventive strategies. The need for further comprehensive research on this topic in the region is emphasized.

Objetivo. Determinar la prevalencia, tipos y factores de riesgo asociados a anomalías congénitas en recién nacidos ingresados en el Hospital Gineco-Obstétrico Isidro Ayora de Quito, Ecuador, entre 2009-2022. Métodos. Estudio transversal, con datos retrospectivos de la base de datos del Sistema Informático Perinatal. Se emplearon pruebas de Chi cuadrado y modelos de regresión logística binaria simples y múltiples. Se utilizó el lenguaje de programación R.  Resultados. Se estudiaron 26 236 recién nacidos, el 11,7% (3 075) fueron diagnosticados con anomalías congénitas. Las más frecuentes fueron las relacionadas con el sistema nervioso (25,6%), las cardiorrespiratorias (21,1%) y las musculoesqueléticas (16,1%).  La edad materna superior a 35 años, la planificación del embarazo y los embarazos múltiples se asociaron con la presencia de anomalías congénitas. Al analizar los factores de riesgo en función del sistema afectado se encontró que la edad materna, los antecedentes maternos de abortos y diabetes, el consumo de ácido fólico y el sexo del recién nacido tenían efectos tanto favorables como desfavorables para el desarrollo de anomalías congénitas de un sistema específico. Conclusiones. Este estudio investigó la prevalencia y los tipos más comunes de anomalías congénitas, así como sus factores de riesgo asociados, en un hospital de referencia. Se compararon estos hallazgos con lo reportado en otras regiones. Los resultados obtenidos ofrecen datos significativos sobre la epidemiología de las anomalías congénitas en la población estudiada, lo que puede orientar el desarrollo de estrategias preventivas. Se destaca la necesidad de realizar investigaciones más exhaustivas sobre este tema en la región.

Objetivo. Determinar a prevalência, tipos e fatores de risco associados a anomalias congênitas em recém-nascidos admitidos no Hospital Gineco-Obstétrico Isidro Ayora de Quito, Equador, entre 2009-2022. Métodos. Estudo transversal, com dados retrospectivos da base de dados do Sistema Informático Perinatal. Foram utilizados testes de Qui-quadrado e modelos de regressão logística binária simples e múltiplos. A linguagem de programação R foi empregada. Resultados. Foram estudados 26.236 recém-nascidos, dos quais 11,7% (3.075) foram diagnosticados com anomalias congênitas. As mais frequentes foram as relacionadas ao sistema nervoso (25,6%), cardiorrespiratórias (21,1%) e musculoesqueléticas (16,1%). Idade materna acima de 35 anos, planejamento da gravidez e gestações múltiplas foram associados à presença de anomalias congênitas. Ao analisar os fatores de risco em relação ao sistema afetado, observou-se que a idade materna, antecedentes maternos de aborto e diabetes, consumo de ácido fólico e sexo do recém-nascido tiveram efeitos tanto favoráveis quanto desfavoráveis para o desenvolvimento de anomalias congênitas em um sistema específico. Conclusões. Este estudo investigou a prevalência e os tipos mais comuns de anomalias congênitas, bem como seus fatores de risco associados, em um hospital de referência. Esses achados foram comparados com o que é relatado em outras regiões. Os resultados obtidos fornecem dados significativos sobre a epidemiologia das anomalias congênitas na população estudada, o que pode orientar o desenvolvimento de estratégias preventivas. Destaca-se a necessidade de realizar pesquisas mais abrangentes sobre esse tema na região.

[Health consequences of violence against women by the couple]. / Consecuencias para la salud de la violencia contra la mujer por la pareja.

Intimate partner violence against women (IPV) has devastating effects on the healthcare and well-being of women and their children. Physical, psychological, and social consequences, a worse perception of their own health, and loss of quality of life are well-documented, while aftereffects persist in time even after the end of abuse. Psychological consequences of abuse last longer and are more serious. IPV also affects sons and daughters, disabled people, family, and the attacker himself. Many health problems, both physical and mental, that lead women to go to healthcare services in search of help have an origin in the violence they experience. Treatment of the symptoms without awareness of its relation to such violence favours medicalization, iatrogenesis, and chronification. Psychological violence poses a threat that is invisible, subtle, cumulative, and difficult to detect; it is, however, the most destructive.

Difficulties of gender affirming treatment in trans women with BRCA1+ mutation: A case report.

Gender affirming treatment in transgender women is based on a combination of antiandrogens and estrogens, with the latter maintained over the long term. When prescribing these treatments, we must consider the possibility of developing estrogen-dependent breast cancer. In transgender women, a breast cancer incidence of 4.1 per 100,000 has been estimated, which would increase the risk by 46% in relation to cisgender men but decrease it by 70% in relation to cisgender women. It is known that certain gene mutations such as BRCA1 imply an increased risk of breast cancer, but at present the risk in transgender women with BRCA1 treated with estrogens is not well established. We present the case of a transgender woman with a family history of breast cancer and BRCA1 mutation and the therapeutic decisions made in a multidisciplinary team. Following this case, we review and discuss the published literature.

Diabetes y mujer, ¿por qué somos diferentes? / Diabetes and women, why are we different?

La diabetes afecta de manera diferente a hombres y a mujeres, y la presunción equivocada de igualdad en su expresividad clínica puede tener como consecuencia errores y demoras en el proceso diagnóstico y en la estrategia terapéutica que se adopte. El objetivo del artículo es mostrar las diferencias de género que influyen en el abordaje de esta patología y cuál es el papel del médico de familia en el seguimiento de la mujer con diabetes. Es una revisión sobre el impacto de la diabetes en las distintas etapas de la vida de la mujer, cómo los cambios hormonales afectan al control glucémico, la diabetes gestacional, cómo afecta la diabetes al desarrollo de las complicaciones crónicas en la mujer y sus consecuencias, las diferencias existentes en el control de los factores de riesgo cardiovascular y los aspectos diferenciales por sexo de las distintas familias de fármacos utilizados en el tratamiento de la diabetes. (AU)

Diabetes affects men and women differently and the mistaken assumption of equality in its clinical expression can lead to errors and delays in the diagnostic process and the therapeutic strategy adopted. The objective is to show the gender differences that influence the approach to this pathology and what the role of the family doctor is in the monitoring of women with diabetes. It is a review of the impact of diabetes at different stages of a woman's life, how hormonal changes affect glycemic control, gestational diabetes, how diabetes affects the development of chronic complications in women and their consequences, the existing differences in the control of cardiovascular risk factors and the differential aspects by sex of the different families of drugs used in the treatment of diabetes. (AU)

Disfunción sexual en las mujeres con enfermedad pulmonar obstructiva crónica / Sexual dysfunction in women with chronic obstructive lung disease

Objetivo Determinar la prevalencia de la disfunción sexual en las mujeres con enfermedad pulmonar obstructiva crónica (EPOC) y los factores relacionados con su aparición. Métodos Se llevó a cabo un estudio observacional transversal a lo largo del año 2021, con inclusión de mujeres con EPOC diagnosticadas por espirometría mediante muestreo por conveniencia. Se recogieron datos de edad, tabaquismo, espirométricos, comorbilidades y fármacos utilizados, Además, se realizó un cuestionario de salud sexual. Resultados Se incluyeron 101 mujeres con edad media 59,7 (11,3) años. Todas ellas habían experimentado un cambio en su actividad sexual y 44% lo atribuyeron a la EPOC. Tenía disnea durante el coito 51,5%. La prevalencia de disfunción sexual fue de 52,5%. Las pacientes que experimentaron esto eran de más edad y tenían un índice de Tiffeneau más bajo. Asimismo, con más frecuencia consumían alcohol, tenían hipertensión arterial y enfermedad cerebrovascular, y con menos tenían diabetes e insuficiencia cardiaca. Sin embargo, puntuaban más bajo en el índice de Charlson corregido por edad. Aquellas con disfunción sexual utilizaban con menos regularidad la triple terapia inhalada. Conclusiones La disfunción sexual es frecuente en las mujeres con EPOC. Son necesarios más estudios que investiguen las causas, mecanismos y posibles tratamientos de la misma. (AU)

Objective To determine the prevalence of sexual dysfunction in women with COPD and the factors related to its presence. Methods Cross-sectional observational study during 2021, including women with COPD diagnosed by spirometry through convenience sampling. Data on age, smoking status, spirometric data, comorbidities and medications used were collected. A sexual health questionnaire was administered. Results The study included 101 women with a mean age of 59.7 (11.3) years. All had experienced a change in sexual activity, with 44% attributing it to COPD. Among them, 51.5% experienced dyspnea during coitus. The prevalence of sexual dysfunction was 52.5%. Women with sexual dysfunction were older and had a lower Tiffeneau index. Furthermore, they consumed alcohol more frequently and had hypertension and cerebrovascular disease, and less often, they had diabetes and heart failure. However, they scored lower on the Charlson index corrected for age. Patients with sexual dysfunction used inhaled triple therapy less frequently. Conclusions Sexual dysfunction is common in women with COPD. Further studies are needed to investigate its causes, mechanisms, and potential treatments. (AU)

Tratamiento de la informacion de violencia de género. Con aportaciones de la inteligencia artificial / Treatment of the information on gender-based violence. With contributions from artificial intelligence

Introducción/objetivos la violencia contra la mujer sigue siendo un grave problema social y de salud a pesar de las medidas puestas en marcha en los últimos años. La exploración de las víctimas por el médico forense en los juzgados es de gran interés puesto que recibe información relacionada no solo con la agresión, sino también de su entorno social, familiar y económico. El objetivo es utilizar dicha información para identificar grupos de riesgo y mejorar/obtener las medidas necesarias. Material y métodos en este trabajo, el forense ha recogido, durante 8 años, una toma abundante de datos sobre las víctimas exploradas en L’Hospitalet de Llobregat. La muestra incluye 1.622 casos de mujeres víctimas de violencia de género. Se realiza un estudio descriptivo poblacional y de las lesiones. Resultados se exponen las principales variables estudiadas tanto socioeconómicas como referentes a la agresión en sí. Se trabaja también con base en la reentrada de las víctimas o repetición de las agresiones (revictimización), que son el 10,9% de la muestra. Finalmente, se presentan los resultados obtenidos tras aplicar técnicas de inteligencia artificial, en este caso, árboles de clasificación CaRT. Conclusiones con los resultados obtenidos concluimos que el tratamiento de la información recogida y sistematizada de la intervención médico-forense permite una mejor comprensión de la violencia sobre la mujer, de la que podemos extraer sugerencias sobre la adopción de medidas de atención y soporte a las víctimas y a los colectivos más vulnerables, así como sobre los recursos administrativos y la optimización de programas de prevención. (AU)

Introduction/objectives Violence against women is still a serious social and health problem, despite the measures implemented in recent years. The examination of the victims by the forensic doctor in the courts is of great interest since it provides information related not only to the aggression, but also to their social, family and economic environment. The objective is to use this information to identify groups at risk and improve/implement the necessary measures. Material and methods In this work, the forensic has collected, for eight years, abundant data on the victims examined in L'Hospitalet de Llobregat. The sample includes 1,622 cases of women who have been victims of gender violence. A descriptive study of the population and of the lesions has been carried out. Results The paper presents the main variables studied, both socioeconomic and referring to the aggression itself. This study also analyzes the reentry of the victims, the repetition of aggressions (revictimization), which are 10.9% of the sample. Finally, the results obtained after applying artificial intelligence techniques -in this case, CaRT classification trees- are presented. Conclusions With the results obtained, we conclude that the treatment of the information collected and systematized from the medical-forensic intervention allows a better understanding of Violence Against Women, from which we can extract suggestions on the adoption of care and support measures for the victims and the most vulnerable groups, as well as administrative resources and the optimization of prevention programs. (AU)

Assistência de enfermagem à saúde da mulher na atenção primária à saúde / Nursing assistance to women's health in primary health care / Asistencia de enfermería a la salud de la mujer en la atención primaria de salud

Objetivo: Conhecer as práticas de cuidado de enfermeiros voltadas à saúde da mulher na APS. Métodos: Trata-se de uma pesquisa transversal de abordagem quanti-qualitativa, realizada com 24 enfermeiros da Atenção Primária a Saúde do estado de Sergipe. As entrevistas foram realizadas durante o período de dezembro de 2020 a abril de 2021, utilizando um roteiro semiestruturado. A análise dos dados quantitativos ocorreu de forma descritiva, a qualitativa ocorreu através da análise de conteúdo conforme Bardin. Resultados: As práticas mais citadas pelos entrevistados foram: consulta de enfermagem no pré-natal; exame Papanicolau e abordagem sindrômica das infecções sexualmente transmissíveis, exame clínico das mamas e solicitação da mamografia; no planejamento familiar, evidenciou-se a educação em saúde; no puerpério, comentaram sobre a avaliação clínica e obstétrica da mulher e as orientações. Conclusão: Os enfermeiros atuam, principalmente, como agentes fundamentais na promoção e prevenção da saúde da mulher, atuando em diversas fases da vida destas e auxiliando na manutenção da saúde e na prevenção de riscos e agravos. (AU)

Objective: to understand the care practices of nurses focused on women's health in PHC. Methods: This is cross-sectional research with a quantitative-qualitative approach, carried out with 24 nurses from Primary Health Care in the state of Sergipe. The interviews were conducted from December 2020 to April 2021, using a semistructured script. The analysis of the quantitative data occurred in a descriptive way, the qualitative one occurred through content analysis according to Bardin. Results: The practices most frequently mentioned by the interviewees were: prenatal nursing consultation; Pap smear and syndromic approach to sexually transmitted infections, clinical examination of the breasts and request for mammography; In family planning, health education was highlighted; In the postpartum period, they commented on the clinical and obstetric evaluation of the woman and the orientations. Conclusion: Nurses act mainly as fundamental agents in the promotion and prevention of women's health, acting in various phases of women's lives and assisting in the maintenance of health and in the prevention of risks and diseases. (AU)

Objetivo: comprender las prácticas asistenciales de los enfermeros enfocados en la salud de la mujer en la APS. Métodos: Se trata de una investigación transversal con abordaje cuantitativo-cualitativo, realizada con 24 enfermeros de la Atención Básica de Salud del estado de Sergipe. Las entrevistas se realizaron entre diciembre de 2020 y abril de 2021, utilizando un guión semiestructurado. El análisis de los datos cuantitativos ocurrió de forma descriptiva, el cualitativo ocurrió a través del análisis de contenido según Bardin. Resultados: Las prácticas más frecuentemente mencionadas por los entrevistados fueron: consulta de enfermería prenatal; Papanicolaou y abordaje sindrómico de las infecciones de transmisión sexual, examen clínico de las mamas y solicitud de mamografía; En cuanto a la planificación familiar, se destacó la educación para la salud; En el puerperio, comentaron sobre la evaluación clínica y obstétrica de la mujer y las orientaciones. Conclusión: Las enfermeras actúan principalmente como agentes fundamentales en la promoción y prevención de la salud de la mujer, actuando en diversas fases de la vida de la mujer y ayudando en el mantenimiento de la salud y en la prevención de riesgos y enfermedades. (AU)

Atenção à saúde da mulher na atenção primária: percepções sobre as práticas de enfermagem / Women's health care in primary care: perceptions about nursing practices / El cuidado de la salud de la mujer en la atención primaria: percepciones sobre las prácticas de enfermería

Objetivo: Identificar práticas de enfermagem direcionadas ao atendimento à saúde da mulher no âmbito da Atenção Primária à Saúde (APS), caracterizando-as pelo modo como ocorrem e lugar que ocupam no processo de trabalho dos Enfermeiros. Métodos: Trata-se de um estudo descritivo, exploratório e de natureza qualitativa. O material consta de 27 entrevistas com enfermeiros realizadas entre os meses de novembro de 2020 a março de 2021. Resultados: As ações de enfermagem direcionadas à saúde da mulher ocupam espaço representativo na agenda dos enfermeiros. As principais ações identificadas são voltadas à saúde materno-infantil. O planejamento familiar também foi identificado como medida educativa recorrente. Assistência às violências e ao climatério não foram mencionadas. Destacouse a autonomia dos enfermeiros na área de atuação em foco neste estudo como positiva no processo de trabalho. Conclusão: A prática do enfermeiro na APS privilegia a saúde no ciclo reprodutivo da mulher, principalmente no período pré-natal. Contudo, observam-se encaminhamentos na busca por uma prática integral, por meio da inclusão de ações mais humanizadas nos serviços. Ainda há a necessidade de se ampliar os focos de assistência à saúde da mulher na APS, e para isso é preciso fortalecer as discussões e estudos acerca dessas temáticas negligenciadas. (AU)

Objective: To identify nursing practices aimed at women's health care within the scope of Primary Health Care (PHC), characterizing them by the way they occur and the place they occupy in the nurses' work process. Methods: This is a descriptive, exploratory and qualitative study. The material consists of 27 interviews with nurses carried out between November 2020 and March 2021. Results: Nursing actions aimed at women's health occupy a representative space in the nurses' routine. The main actions identified are aimed at maternal and child health. Family planning was also identified as a recurrent educational action. Assistance to violence and climacteric were not mentioned. The nurses' autonomy in the area of expertise in focus in this study was highlighted as positive in the work process. Conclusion: The practice of nurses in PHC privileges health in the reproductive cycle of women, especially in the prenatal period. However, referrals are observed in the search for an integral practice, through the inclusion of more humanized actions in the services. There is still a need to expand the focus of women's health care in PHC, and for that it is necessary to strengthen the discussions and studies on these neglected themes. (AU)

Objetivo: Identificar las prácticas de enfermería dirigidas al cuidado de la salud de la mujer en el ámbito de la Atención Primaria de Salud (APS), caracterizándolos por la forma en que ocurren y el lugar que ocupan en el proceso de trabajo del enfermero. Métodos: Se trata de un estudio descriptivo, exploratorio y cualitativo. El material consta de 27 entrevistas a enfermeras realizadas entre noviembre de 2020 y marzo de 2021. Resultados: Las acciones de enfermería dirigidas a la salud de la mujer ocupan un espacio representativo en la agenda de los enfermeros. Las principales acciones identificadas están dirigidas a la salud maternoinfantil. La planificación familiar también fue identificada como una acción educativa recurrente. No se mencionaron la asistencia a la violencia y el climaterio. La autonomía de los enfermeros en el área de especialización en foco de este estudio fue destacada como positiva en el proceso de trabajo. Conclusión: La práctica del enfermero en la APS privilegia la salud en el ciclo reproductivo de la mujer, especialmente en el período prenatal. Sin embargo, se observan derivaciones en la búsqueda de una práctica integral, a través de la inclusión de acciones más humanizadas en los servicios. Aún existe la necesidad de ampliar el enfoque de la atención a la salud de la mujer en la APS, y para eso es necesario fortalecer las discusiones y estudios sobre estos temas desatendidos. (AU)

A pandemia de COVID-19 e casos de violência doméstica: percepções de profissionais da atenção primária à saúde no contexto de isolamento social / The COVID-19 pandemic and cases of domestic violence: perceptions of primary healthcare professionals in the context of social isolation / La pandemia de COVID-19 y la violencia doméstica: percepción de los profesionales de atención primaria de salud en el contexto del aislamiento social

Objetivo: analisar as percepções de profissionais da atenção primária à saúde de Paranaguá/PR sobre as relações entre a pandemia de COVID-19 e casos de violência doméstica em seus territórios adscritos, identificando desafios na abordagem, impactos nas famílias e manejo dos casos. Metodologia: pesquisa qualitativa com entrevistas semiestruturadas e grupos focais com 36 profissionais de duas unidades básicas de saúde de Paranaguá, litoral paranaense. Resultados: profissionais da atenção primária à saúde foram unânimes em relatar o aumento no número de casos de violência doméstica naquelas comunidades, com impactos tanto para mulheres, quanto para crianças e adolescentes, sendo o fechamento das escolas um fator agravante. Como principais desafios, foram reportados: a desestruturação da atenção primária à saúde durante o auge da pandemia com deslocamento de profissionais e recursos; desinformação sobre fluxos de encaminhamento nos casos de violência doméstica na rede intersetorial; medo dos profissionais, tanto da pandemia, quanto de denunciar casos de violência doméstica; e rotatividade de profissionais. Conclusão: o período de isolamento social causado pela pandemia intensificou os casos de violência doméstica segundo as percepções de profissionais da atenção primária à saúde de Paranaguá. O desmonte da rede intersetorial prejudicou ainda mais o cuidado de pessoas em situação de vulnerabilidade e/ou violência. A ausência de diretrizes nacionais do governo federal deixou municípios e profissionais da atenção primária à saúde à própria sorte para lidar com o problema.

Objective: to analyze the perceptions of primary health care professionals in Paranaguá/PR about the relationship between the COVID-19 pandemic and cases of domestic violence in their assigned territories, identifying challenges in the approach, impacts on families and case management. Methodology: qualitative research was conducted using semi-structured interviews and focus groups with 36 professionals from two primary health care units in Paranaguá, on the Paraná coast. Results: primary health care professionals unanimously reported an increase in the number of domestic violence cases in those communities, affecting women, children, and adolescents, with the closure of schools identified as an aggravating factor. The main challenges highlighted were the disruption of primary health care services during the peak of the pandemic due to the reallocation of professionals and resources; misinformation about referral processes for domestic violence cases within the intersectoral network; fear among professionals regarding the pandemic and reporting domestic violence cases; and high staff turnover. Conclusion: the period of social isolation caused by the pandemic intensified domestic violence cases, according to the perceptions of primary health care professionals in Paranaguá. The dismantling of the intersectoral network further compromised the care of individuals in situations of vulnerability and/or violence. The absence of national guidelines from the federal government left municipalities and primary health care professionals on their own to deal with the issue.

Objetivo: analizar las percepciones de los profesionales de la atención primaria de salud de Paranaguá/PR sobre las relaciones entre la pandemia de COVID-19 y los casos de violencia doméstica en sus territorios asignados, identificando desafíos en el abordaje, impactos en las familias y gestión de casos. Metodología: investigación cualitativa con entrevistas semiestructuradas y grupos focales con 36 profesionales de dos unidades básicas de salud de Paranaguá, en la costa de Paraná. Resultados: los profesionales de la atención primaria de salud fueron unánimes al reportar el aumento del número de casos de violencia doméstica en esas comunidades, con afectaciones tanto a mujeres, niños y adolescentes, siendo el cierre de escuelas un agravante. Se informaron los principales desafíos: la interrupción de la atención primaria de salud durante el apogeo de la pandemia con el desplazamiento de profesionales y recursos; desinformación sobre los flujos de derivación de casos de violencia doméstica en la red intersectorial; miedo entre los profesionales, tanto a la pandemia como a denunciar casos de violencia doméstica; y rotación profesional. Conclusión: el período de aislamiento social provocado por la pandemia intensificó los casos de violencia doméstica según la percepción de los profesionales de la atención primaria de salud en Paranaguá. El desmantelamiento de la red intersectorial perjudicó aún más la atención a personas en situación de vulnerabilidad y/o violencia. La ausencia de directrices nacionales por parte del gobierno federal dejó a los municipios y a los profesionales de atención primaria de salud a su suerte a la hora de abordar el problema.

Evaluation of the incorporation of an IOTA-ADNEX model in the discrimination of adnexal masses in our third-level hospital centre, taking into account the menopausal status of patients. Five years of experience / Evaluación de la incorporación del IOTA-ADNEX model en la discriminación de las masas anexiales en nuestro centro hospitalario de tercer nivel teniendo en cuenta el estado menopáusico en la predicción de malignidad. Cinco años de experiencia

Objective: The objectives were to estimate the performance of the IOTA-ADNEX model test after its incorporation into the ultrasound tests of our third-grade hospital gynecology service, as well as to assess whether its capacity of accuracy is modified when taking into account the patient's menopausal status. Methods: A cross-sectional study was conducted to clinically evaluate the diagnostic performance of the IOTA-ADNEX model test, which was performed between January 2016 and December 2021. The study included 573 women with an adnexal injury who underwent surgical excision within 180 days after ultrasound diagnosis and histological confirmation (gold standard). After the ultrasound exam, the injuries were classified using the ADNEX model. The study estimated the area under the receiver-operating-characteristics curve (AUC) of the ADNEX model for classifying between benign and malignant adnexal masses and compared the performance by menopausal state. Sensitivity and specificity were determined for different cut-off points. Results: Out of the 573 women, 183 (31.9%) had a malignant tumor. The AUC of the ADNEX model for differentiating between benign and malignant adnexal masses at the time of ultrasound examination was 0.92 and the best malignancy threshold, detected by Youden index, was 22.5%. At this cut-off, the sensitivity of the ADNEX model was 91.8% and the specificity was 76.4%. However, it varies according to menopausal status: in the group of pre-menopausal patient, sensitivity was 86.1% (95% CI, 85.4%–86.8%) and specificity was 81.3% (95% CI, 85.4%–86.8%). In the postmenopausal group, sensitivity was 96.1% (95% CI, 95.6%–96.7%) and specificity was 68.5% (95% CI, 68.1%–68.8%)...(AU)

Objetivo: Los objetivos eran estimar el rendimiento del test IOTA ADNEX model después de su incorporación en el estudio ecográfico en nuestro servicio de ginecología, en un hospital de tercer nivel, así como evaluar si su capacidad de precisión se modifica al tener en cuenta el estado menopáusico de la paciente. Método: Se llevó a cabo un estudio transversal para evaluar clínicamente el rendimiento diagnóstico del test IOTA ADNEX model, el cual se realizó entre enero de 2016 y diciembre de 2021. El estudio incluyó a 573 mujeres con una lesión anexial que se sometieron a tratamiento quirúrgico en un plazo de 180 días después del diagnóstico por ecografía y confirmación histológica (gold standard). Después de realizar la ecografía, las lesiones fueron clasificadas utilizando el modelo ADNEX. El estudio estimó el área bajo la curva (AUC) del modelo ADNEX para diferenciar entre masas anexiales benignas y malignas, y se comparó el rendimiento según el estado menopáusico. Se determinó la sensibilidad y la especificidad para diferentes puntos de corte. Resultados: De las 573 mujeres, 183 (31,9%) tenían un tumor maligno. El AUC del modelo ADNEX para diferenciar entre masas anexiales benignas y malignas en el momento del examen ecográfico fue de 0,92 y el umbral de malignidad óptimo, detectado por el índice de Youden, fue del 22,5%. Con este punto de corte, la sensibilidad (SE) del modelo ADNEX fue del 91,8% y la especificidad (SP) fue del 76,4%. Sin embargo, esto varía según el estado menopáusico: en el grupo de pacientes premenopáusicas, la sensibilidad fue del 86,1% (IC del 95%: 85,4-86,8%) y la especificidad fue del 813% (IC del 95%: 85,4-86,8%). En el grupo de pacientes posmenopáusicas, la sensibilidad fue del 96,1% (IC del 95%: 95,6-96,7%) y la especificidad fue del 68,5% (IC del 95%: 68,1-68,8%)...(AU)

Actualización del tratamiento de fisioterapia en el abordaje de la endometriosis. Una revisión sistemática / Update on physiotherapy treatment in endometriosis: A systematic review

La endometriosis es una patología ginecológica crónica e inflamatoria caracterizada por la presencia de tejido endometrial fuera del útero. Entre las manifestaciones clínicas están el dolor pélvico crónico, la fatiga, la dismenorrea, la dispareunia, la infertilidad, la disuria y la disquecia. La fisioterapia puede formar parte del tratamiento sintomático de la endometriosis, es por ello, que con esta revisión se pretende analizar la bibliografía científica para evaluar el efecto de la fisioterapia en este padecimiento. Se realizó una búsqueda bibliográfica durante las dos primeras semanas del mes de diciembre de 2022 en las bases de datos PubMed, Medline, Scopus, Web of Science, Physiotherapy Evidence Database (PEDro), Cumulative Index to Nursing and Allied Health Literature (CINAHL) y Enfermería-Fisioterapia-Podología (ENFISPO). Se emplearon los descriptores «Endometriosis» «Physical Therapy Modalities», «Physiotherapy», «Physiotherapist», «Physical therapy» y «Physical rehabilitation». Los resultados se limitaron a estudios clínicos aleatorizados publicados en inglés o español. Se obtuvieron un total de 943 artículos, de los cuales seis fueron seleccionados tras aplicar los criterios de elegibilidad. Las investigaciones seleccionadas desarrollaron diferentes intervenciones de fisioterapia con técnicas tales como la electroterapia con estimulación nerviosa transcutánea (TENS) y láser pulsado de alta intensidad (HILT), el entrenamiento de relajación muscular progresiva, la actividad física aeróbica, la terapia manual y el ejercicio terapéutico a través del yoga. La fisioterapia parece aportar beneficios en cuanto a la reducción del dolor pélvico y mejora de la calidad de vida en mujeres con endometriosis.(AU)

Endometriosis is a chronic, inflammatory gynecological pathology characterized by the presence of endometrial tissue outside the uterus. Clinical manifestations include chronic pelvic pain, fatigue, dysmenorrhea, dyspareunia, infertility, dysuria and dyschezia. Physical therapy can be part of the symptomatic treatment of endometriosis; therefore, this review aims to analyze the scientific literature to evaluate the effect of physical therapy in endometriosis. A bibliographic search was carried out during the first two weeks of December 2022 in the databases PubMed, Medline, Scopus, Web of Science, PEDro, CINAHL and ENFISPO. The descriptors “Endometriosis” “Physical Therapy Modalities”, “Physiotherapy”, “Physiotherapist”, “Physical therapy” and “Physical rehabilitation” were used. Results were limited to randomized clinical studies published in English or Spanish. A total of 943 results were obtained, of which 6 were selected after applying the eligibility criteria. The selected studies develop different physiotherapy interventions with techniques such as electrotherapy with TENS and high intensity pulsed laser, progressive muscle relaxation training, aerobic training, manual therapy, and therapeutic exercise through yoga. Physiotherapy appears to provide benefits in terms of reducing pelvic pain and improving quality of life in women with endometriosis.(AU)

Conocimiento y prevalencia de síntomas de disfunciones del suelo pélvico en mujeres nulíparas que practican deportes de alto impacto: estudio preliminar / Knowledge and prevalence of symptoms of pelvic floor dysfunctions in nulliparous women who practice high impact sports: Preliminary study

Objetivos Describir los conocimientos sobre el suelo pélvico (SP), las disfunciones del suelo pélvico (DSP), sus principales factores de riesgo y las estrategias preventivas y de tratamiento para las mismas, así como determinar la prevalencia de síntomas de DSP y el distrés que producen en mujeres nulíparas que practiquen baloncesto, fútbol o balonmano. Metodología Estudio descriptivo transversal, de base poblacional. Se incluyeron mujeres mayores de edad que practicasen baloncesto, fútbol o balonmano al menos tres horas semanales durante dos años. Se excluyeron mujeres embarazadas, con antecedentes gestacionales, con alteraciones cognitivas o visuales. Para llevar a cabo el estudio, se diseñó un cuestionario ad hoc en la plataforma de Google Forms, que se difundió mediante WhatsApp. Resultados Las participantes tenían mayor conocimiento sobre la incontinencia urinaria (10/12 puntos) que sobre los prolapsos de órganos pélvicos (6/12 puntos). A pesar de tener conocimientos sobre la localización del SP y sus funciones, no realizaban una contracción anticipada de esta musculatura antes de levantar peso. Se obtuvo una prevalencia de síntomas de DSP del 84,6%, destacando la incontinencia urinaria (82,9%). El distrés producido por estos síntomas fue leve (mediana: 11,97; RIC: 16,7). Conclusiones Las mujeres de la muestra tienen conocimientos elevados sobre el SP y las DSP; sin embargo, no utilizan la contracción anticipada de la musculatura del SP como estrategia de protección frente al incremento de presión intraabdominal durante la práctica deportiva. La prevalencia de síntomas de DSP es alta, aunque el distrés que estos síntomas les producen es leve. (AU)

Objectives To describe the knowledge about the pelvic floor (PF), pelvic floor dysfunctions (PFD), its main risk factors, and the preventive and treatment strategies for them, as well as to determine the prevalence of PFD symptoms and the distress produced in nulliparous women who play basketball, football or handball. Methodology Descriptive cross-sectional study, population-based. Women of legal age who practiced basketball, football or handball for at least 3hours a week for 2years were included. Pregnant women, with a history of pregnancy, with cognitive or visual alterations were excluded. To carry out the study, an ad hoc questionnaire was designed on the Google Forms platform, which was disseminated through WhatsApp. Results The participants had greater knowledge about urinary incontinence (10/12 points) than about pelvic organ prolapse (6/12 points). Despite having knowledge about the location of the PF and its functions, they did not perform an anticipated contraction of this muscle before lifting weights. A prevalence of PFD symptoms of 84.6% was obtained, highlighting urinary incontinence (82.9%). The distress produced by these symptoms was mild (median: 11.97; IQR: 16.7). Conclusions The women in the sample have high knowledge about the PF and the PFD, however, they do not use the anticipated contraction of the PF muscles as a protection strategy against the increase in intra-abdominal pressure during sports practice. The prevalence of PFD symptoms is high, although the distress that these symptoms cause them is mild. (AU)

[Impact of care for victims of gender violence on the health professionals]. / Impacto de la atención a las víctimas de violencia de género en los y las profesionales de la salud.

Professionals who work with women victims of gender violence face difficult emotional situations, and it is important to be aware of the emotions and feelings that the attitudes and behaviour of victims and aggressors generate in them. These emotions can become barriers to communication and seriously affect the professional's relationship with victims. Furthermore, they can generate situations of sustained stress, lead to emotional exhaustion, and affect their health, life, and work performance. We describe the consequences, risk factors and warning signs, as well as protective or resilience factors, that are important to know, and we list the current challenges and some recommendations for professionals and management in order to help prevent such effects and improve professional performance without health risks.

Sexual dysfunction in women with chronic obstructive lung disease.

OBJECTIVE: To determine the prevalence of sexual dysfunction in women with COPD and the factors related to its presence. METHODS: Cross-sectional observational study during 2021, including women with COPD diagnosed by spirometry through convenience sampling. Data on age, smoking status, spirometric data, comorbidities and medications used were collected. A sexual health questionnaire was administered. RESULTS: The study included 101 women with a mean age of 59.7 (11.3) years. All had experienced a change in sexual activity, with 44% attributing it to COPD. Among them, 51.5% experienced dyspnea during coitus. The prevalence of sexual dysfunction was 52.5%. Women with sexual dysfunction were older and had a lower Tiffeneau index. Furthermore, they consumed alcohol more frequently and had hypertension and cerebrovascular disease, and less often, they had diabetes and heart failure. However, they scored lower on the Charlson index corrected for age. Patients with sexual dysfunction used inhaled triple therapy less frequently. CONCLUSIONS: Sexual dysfunction is common in women with COPD. Further studies are needed to investigate its causes, mechanisms, and potential treatments.

Conocimiento y prevalencia de síntomas de disfunciones del suelo pélvico en mujeres nulíparas que practican deportes de alto impacto: estudio preliminar / Knowledge and prevalence of symptoms of pelvic floor dysfunctions in nulliparous women who practice high impact sports: Preliminary study

Objetivos Describir los conocimientos sobre el suelo pélvico (SP), las disfunciones del suelo pélvico (DSP), sus principales factores de riesgo y las estrategias preventivas y de tratamiento para las mismas, así como determinar la prevalencia de síntomas de DSP y el distrés que producen en mujeres nulíparas que practiquen baloncesto, fútbol o balonmano. Metodología Estudio descriptivo transversal, de base poblacional. Se incluyeron mujeres mayores de edad que practicasen baloncesto, fútbol o balonmano al menos tres horas semanales durante dos años. Se excluyeron mujeres embarazadas, con antecedentes gestacionales, con alteraciones cognitivas o visuales. Para llevar a cabo el estudio, se diseñó un cuestionario ad hoc en la plataforma de Google Forms, que se difundió mediante WhatsApp. Resultados Las participantes tenían mayor conocimiento sobre la incontinencia urinaria (10/12 puntos) que sobre los prolapsos de órganos pélvicos (6/12 puntos). A pesar de tener conocimientos sobre la localización del SP y sus funciones, no realizaban una contracción anticipada de esta musculatura antes de levantar peso. Se obtuvo una prevalencia de síntomas de DSP del 84,6%, destacando la incontinencia urinaria (82,9%). El distrés producido por estos síntomas fue leve (mediana: 11,97; RIC: 16,7). Conclusiones Las mujeres de la muestra tienen conocimientos elevados sobre el SP y las DSP; sin embargo, no utilizan la contracción anticipada de la musculatura del SP como estrategia de protección frente al incremento de presión intraabdominal durante la práctica deportiva. La prevalencia de síntomas de DSP es alta, aunque el distrés que estos síntomas les producen es leve. (AU)

Objectives To describe the knowledge about the pelvic floor (PF), pelvic floor dysfunctions (PFD), its main risk factors, and the preventive and treatment strategies for them, as well as to determine the prevalence of PFD symptoms and the distress produced in nulliparous women who play basketball, football or handball. Methodology Descriptive cross-sectional study, population-based. Women of legal age who practiced basketball, football or handball for at least 3hours a week for 2years were included. Pregnant women, with a history of pregnancy, with cognitive or visual alterations were excluded. To carry out the study, an ad hoc questionnaire was designed on the Google Forms platform, which was disseminated through WhatsApp. Results The participants had greater knowledge about urinary incontinence (10/12 points) than about pelvic organ prolapse (6/12 points). Despite having knowledge about the location of the PF and its functions, they did not perform an anticipated contraction of this muscle before lifting weights. A prevalence of PFD symptoms of 84.6% was obtained, highlighting urinary incontinence (82.9%). The distress produced by these symptoms was mild (median: 11.97; IQR: 16.7). Conclusions The women in the sample have high knowledge about the PF and the PFD, however, they do not use the anticipated contraction of the PF muscles as a protection strategy against the increase in intra-abdominal pressure during sports practice. The prevalence of PFD symptoms is high, although the distress that these symptoms cause them is mild. (AU)

Análisisdel Tiempo de Juego Efectivo y de la Posesión de Balón en el Fútbol Femenino Profesional / Análise do Tempo Efetivo de Jogo e Posse de Bola no Futebol Profissional Feminine / Analysis of Effective Playing Time and Possession of the Ball in Professional Female Footbal

Elobjetivo del presente estudio observacional fue describir el tiempo efectivo dejuego en el fútbol femenino profesional a partir de cómo se distribuyó la frecuencia y duración de la posesión de balón. Se analizaron ocho partidos de la Champions League femenina de la temporada 2021-22. El sistema de codificación estuvo compuesto por cuatro categorías: posesión de balón (dentro del balón en juego, BJ) y balón parado (BP), tanto del equipo de referencia como del oponente. Se implementaron un análisis descriptivo, una comparación de medias para las variables independientes (parte (primeray segunda) y lugar (casa y fuera) del partido) y un análisis de secuencialidad. Los resultados fueron que: 1) el BJ tuvo una mayor duración que el BP, en ambas partes y lugares; 2) el número de posesiones por cada BJ decreció a medida que aumentó el númerode posesiones consecutivas (desde 1 a 5 o más); 3) no existieron diferencias en la duración promedio de las posesiones, indistintamente a las partes y el lugar; y, 4) existióvariabilidad en las transiciones entre los BJ y BP con diferente duración. Estos hallazgos podrían ayudar a los cuerpos técnicos y, especialmente, a las/os preparadoras/es en el diseño de tareas que repliquen las dinámicas de juego en el fútbol femenino de élite.(AU)

This observational study aimed to describe the effective playing time based on how the frequency and duration of ball possession were distributed in professional women's football. Eight matches of the Women's Champions League of the 2021-22 season were analyzed. The coding system was made up of four categories: possession of the ball (within the ball in play, BJ) and set piece (BP), both the reference team and the opponent. A descriptive analysis, a comparison of means for the independent variables (half (first and second) and location (home and away) of the match), and a sequential analysis were implemented. The results were that: 1) the BJ had a longer duration than the BP, in both halves and location; 2) the number of possessions per BJ decreased as more consecutive possessions were accumulated (from 1 to 5 or more); 3) there were no differences in the average duration of the possessions, regardless of the havesand the location; and, 4) there was variability in the transitions between the BJ andBP withdifferent duration. These findings could help the coaching staff and, especially, coaches in the design of tasks that replicate the game dynamics in elite women's football.(AU)

O objetivo deste estudo observacional foi descrever o tempo efetivo de jogo a partir da distribuição da frequência e duração da posse de bola no futebol feminino profissional. Foram analisadas oito partidas da Liga dos Campeões Feminina da temporada 2021-22. O sistema de codificação foi composto por quatro categorias: posse de bola (dentro da bola em jogo, BJ) e bola parada (BP), tanto da equipa de referência quanto do adversário. Foram implementadas uma análise descritiva, uma comparação de médias para as variáveis independentes (primeira e segunda parte) e localização (casa e fora) da partida) e uma análise sequencial. Os resultados foram que: 1) o BJ teve uma duração maior que o BP, em ambos os trechos e localização; 2) o número de posses por BJ diminuiu à medida que mais posses consecutivas foram acumuladas (de 1 para 5 ou mais); 3) não houve diferenças na duração média das posses, independentemente das partes e do localização; e, 4) houve variabilidade nas transições entre o BJ e oBPcom diferentes durações. Esses achados podem auxiliar as equipes técnicas e, principalmente, os treinadores no desenho de tarefas que reproduzam a dinâmica do jogo no futebol feminino de elite.(AU)

Acolhimento da mulher migrante venezuelana na atenção básica: um ensaio teórico-reflexivo / Embracement of venezuelan migrant women in primary care: a theoretical-reflective essay / Acogida a la mujer migrante venezolana en la atención primaria: un ensayo teórico-reflexivo

Este ensaio emerge a partir de uma aposta científica que se propõe a produzir reflexões teorizadas sobre as práticas assistenciais de acolhimento produzidas pelos profissionais da saúde com mulheres migrantes venezuelanas na Atenção Básica. É um ensaio teórico-reflexivo. Salienta-se que, neste tipo de estudo, a produção de reflexões corre pela compreensão de um dado objeto sem que nele haja um sistema de compreensão rígido. As reflexões foram agrupadas em um núcleo teórico-reflexivo, intitulado: fundamentos para pensar o acolhimento à mulher migrante venezuelana na Atenção Básica. Nele, são encontrados conceitos e reflexões a respeito da Atenção Básica, migração, processos migratórios envolvendo mulheres venezuelanas e estratégias de acolhimento às suas necessidades em Unidades Básicas de Saúde. As (in)conclusões reflexivas para intensificar investigações perpassam por leituras do cotidiano no trabalho em saúde. Nesse sentido, é fundamental observar três rotas conceituais e reflexivas que fundamentalmente são necessárias para cuidar das migrantes venezuelanas de forma acolhedora na Atenção Básica ­ a saber: escuta qualificada, vínculo e clínica ampliada do sujeito ­ como forma de promover uma assistência alinhada aos princípios e diretrizes da política nacional de humanização.

This essay emerges from a scientific proposal to reflect on embracement care practices aimed at Venezuelan immigrant women in primary care. As a theoretical-reflective essay, the reflections produced on a given object disregard any rigid understanding system. Concepts and reflections on primary care, migration, migratory processes involving Venezuelan women, and embracement strategies were grouped into a theoretical-reflective nucleus entitled "foundations for discussing the embracement of Venezuelan immigrant women in primary care." Reflective (in)conclusions used to intensify investigations involve readings of everyday healthcare work. In this regard, three conceptual and reflective routes are essential to embrace Venezuelan immigrant women in in primary care­qualified listening, bond, and expanded clinical approach­to promote care aligned with the principles and guidelines of the national humanization policy.

Este ensayo propone producir reflexiones teorizadas sobre las prácticas asistenciales de acogida de los profesionales de la salud a las mujeres migrantes venezolanas en la atención primaria. Se trata de un ensayo teórico-reflexivo. En este tipo de estudio se destaca que la producción de reflexiones parte de la comprensión de un objeto dado sin que haya un sistema de comprensión rígido. Las reflexiones se agruparon en un núcleo teórico-reflexivo, titulado fundamentos para pensar en la acogida a la mujer migrante venezolana en la atención primaria. Se encuentran conceptos y reflexiones en torno a la atención primaria, migración, procesos migratorios que involucran a mujeres venezolanas y estrategias para acoger sus necesidades en unidades básicas de salud. Las (in)conclusiones reflexivas para intensificar las investigaciones pasan por lecturas de lo cotidiano en el trabajo en salud. En este sentido, es fundamental observar tres rutas conceptuales y reflexivas que fundamentalmente son necesarias para cuidar a la mujer migrante venezolana de forma acogedora en la atención primaria: escucha calificada, vínculo y clínica ampliada del sujeto; como forma de promover una asistencia alineada con los principios y directrices de la política nacional de humanización.

[The necessary response of health services to gender violence. Comprehensive care and provision of integrated services]. / La respuesta necesaria de los servicios de salud ante la violencia de género. Atención integral y prestación de servicios integrados.

Gender violence has multiple and serious consequences for the health of victims and their families, hence the reason for the important role that the health system plays in addressing it. Health professionals have a key role in the response, which must include early detection, care, and follow-up; actions in which primary care, because of its privileged position in the system, can play a fundamental part. This article establishes the necessary characteristics for the intervention to be effective: comprehensive care, multidisciplinary approach, intersectoral coordination, and integrated service provision; all of it community-oriented, person-centered, and adapted to its context (social factors and vulnerabilities) with an intersectional approach. The woman, her sons and daughters, and other cohabitants, as well as the perpetrator, are considered the object of intervention in the response, and specific guidelines for action are provided for detection, care, and follow-up. Reorientation of interventions, with emphasis on a community approach, is also proposed.