As dobras do origami: reflexões sobre a implicação em pesquisa / The origami's folds: reflections about the implication in research / Los pliegues del origami: reflexiones sobre la implicación en investigación

INTRODUÇÃO: A análise da implicação na pesquisa se opõe a uma suposta neutralidade resultante do afastamento do objeto, porque o/a pesquisador/a coloca a sua subjetividade em análise, o contexto histórico-social da pesquisa, assim como, a intersubjetividade de todos os envolvidos nela. A implicação integra o processo de construção do conhecimento na busca de maior compreensão dos fenômenos, sendo um dos conceitos fundamentais da psicossociologia. OBJETIVO: O presente estudo objetiva apresentar um relato de experiência sobre a análise da implicação em uma pesquisa clínico-qualitativa respaldada teórico-metodologicamente pela psicossociologia francesa e psicodinâmica do trabalho. Essa investigação ocorreu entre 2018 e 2022, tendo se dado parcialmente no período da pandemia da COVID-19. METODOLOGIA: Empregaram-se os seguintes dispositivos como método de análise da implicação: os diários de campo, as supervisões, as reuniões de equipe, a participação em um grupo de convivência e a psicoterapia individual. Assim, a pesquisadora procurou abordar os seus afetos e sentimentos envolvidos ao longo das etapas da pesquisa. RESULTADOS E DISCUSSÃO: Foi possível, pois, evidenciar a implicação como fonte, paradoxalmente, de processos criativos e, em alguns casos, também de alienação. CONCLUSÃO: Apesar da identificação de alguns destes aspectos negativos da implicação da pesquisadora, se pode ampliar o conhecimento sobre o objeto da pesquisa.

INTRODUCTION: The implication analysis is opposed to a supposed neutrality because the researcher analyzes his own subjectivity, his historical and social context, as well as the intersubjectivity of the actors involved in a research. Implication analysis is one of the fundamental concepts of psychosociology. It enables one to understand phenomena and builds knowledge. OBJECTIVE: The present study aims to present an experience report about an implication analysis of a clinical-qualitative research that was based on French psychosociology and psychodynamics of work theory and methodology. This investigation happened from 2018 to 2022, partially carried out during the COVID-19 pandemic. METHOD: There were used the following resources to access the implication analysis: dailies, supervisions, team meetings, participation in a reflection group, and individual psychotherapy. Thus, the researcher related feelings and affections involved in each one of the research stages. RESULTS AND DISCUSSION: This study highlighted the implication as a source that paradoxically allows creative processes but also, in some cases, alienation. CONCLUSION: Despite some negative aspects of the implication researcher, it was possible to expand the knowledge about the research object.

INTRODUCCIÓN: El análisis de la implicación en la investigación se opone a una supuesta neutralidad resultante de la distancia del objeto porque el investigador analiza su propia subjetividad, el contexto histórico-social de la investigación, así como la intersubjetividad de todos los involucrados en la investigación. La implicación forma parte del proceso de construcción del conocimiento en la búsqueda de una mejor comprensión de los fenómenos, siendo uno de los conceptos fundamentales de la psicosociología. OBJETIVO: Este estudio tiene como objetivo presentar un relato de experiencia sobre el análisis de la implicación en una investigación clínico-cualitativa sustentada teórica y metodológicamente por la psicossociologia francesa y la psicodinámica del trabajo. Esta investigación se llevó a cabo entre 2018 y 2022, habiéndose realizado parcialmente durante el período de la pandemia de COVID-19. MÉTODO: Se utilizaron como método de análisis de la implicación los siguientes dispositivos: diarios de campo, supervisiones, reuniones de equipo, participación en un grupo de convivencia y psicoterapia individual. Así, la investigadora buscó abordar sus afectos y sentimientos involucrados a lo largo de las etapas de la investigación. RESULTADOS Y DISCUSIÓN: Este estudio destacó la implicación como fuente, paradójicamente, de procesos creativos y, en algunos casos, alienación. CONCLUSIÓN: A pesar de la identificación de algunos de estos aspectos negativos de la implicación de la investigadora, se logró ampliar el conocimiento sobre el objeto de investigación.

An obscured obstacle—Prevalence and nature of micro aggressions amongst healthcare professionals / Un obstáculo oscurecido. Prevalencia y naturaleza de las microagresiones entre los profesionales de la salud

Introduction: Microaggressions create negative consequences on the mental health of individuals who experience them, such as feelings of alienation, frustration and low self-esteem. Physicians worldwide are negatively impacted by the detrimental effects of microaggressions and implicit bias. It is imperative to establish the prevalence specificity of the problem hence the aim of this study is to determine the prevalence, nature and determinants of microaggressions amongst healthcare professionals. Method: The study used an online anonymous survey to collect data including demographics, awareness of the term, experience of microaggression, acts and response. The research findings were analyzed using univariate and multivariate analyses using Chi-square test and binary logistic regression respectively. Result: A total of 443 participants (40.9% males, 59.1% females) included 403 physicians (91%), 21 dentists (4.7%), 15 nurses (3.4%) and 4 pharmacists (0.9%). More than half of the participants (59.8%) were aware of the term micro-aggression. The percentage was significantly higher among respondents from the western region of Saudi Arabia than the Gulf/Middle Eastern countries. Approximately 38.1% of the participants experienced microaggression and more than half (55.62%) did not report experiencing microaggression. The most common form of microaggression was passive-aggressive behavior (80.5%) followed by invalidation of an opinion (73.4%). Among those who experienced microaggression, (12.9%) reported anger as the most predominant emotional response. Conclusion: Microaggression is a universal phenomenon. Further research is necessary to determine its prevalence in other countries to establish a comprehensive understanding of its cultural context.(AU)

Introducción: Las microagresiones crean consecuencias negativas en la salud mental de las personas que las experimentan, como sentimientos de alienación, frustración y baja autoestima. Los médicos de todo el mundo se ven afectados negativamente por los efectos perjudiciales de las microagresiones y el sesgo implícito. Es imperativo establecer la especificidad de prevalencia del problema, por lo que el objetivo de este estudio es determinar la prevalencia, la naturaleza y los determinantes de las microagresiones entre los profesionales de la salud. Método: El estudio utilizó una encuesta anónima en línea para recopilar datos demográficos, conocimiento del término, experiencia de microagresión, actos y respuesta. Los resultados de la investigación se analizaron mediante análisis univariados y multivariados mediante la prueba de Chi-cuadrado y la regresión logística binaria, respectivamente. Resultado: Un total de 443 participantes (40,9% hombres, 59,1% mujeres) incluyeron 403 médicos (91%), 21 dentistas (4,7%), 15 enfermeras (3,4%) y 4 farmacéuticos (0,9%). Más de la mitad de los participantes (59,8%) conocían el término microagresión. El porcentaje fue significativamente mayor entre los encuestados de la región occidental de Arabia Saudita que entre los países del Golfo/Medio Oriente. Aproximadamente el 38,1% de los participantes experimentaron microagresión y más de la mitad (55,62%) informaron no haber experimentado microagresión. La forma más común de microagresión fue el comportamiento pasivo-agresivo (80,5%), seguido de la invalidación de una opinión (73,4%). Entre quienes experimentaron microagresión, 12,9% reportaron ira como la respuesta emocional predominante. Conclusión: La microagresión es un fenómeno universal. Se necesita más investigación para determinar su prevalencia en otros países a fin de establecer una comprensión integral de su contexto cultural.(AU)

Enfermedad mental entre los profesionales de la salud durante la pandemia de COVID-19 / Mental illness among health professionals during the COVID-19 pandemic

Introducción: La enfermedad mental se ha convertido en objeto de estudios científicos de actualidad en detrimento de las consecuencias de la reciente pandemia del nuevo coronavirus, especialmente entre los profesionales de la salud, debido a su intrínseca relación en la asistencia a las víctimas de covid-19 y la sobrecarga de trabajo en ese período. Objetivo:Investigar la enfermedad mental entre los profesionales de la salud durante la pandemia por covid-19. Materiales y Método: Se trata de un estudio transversal, descriptivo con enfoque cuantitativo, realizado en municipio de Paraíba, con 126 profesionales de la salud de diferentes servicios en el municipio. Se utilizó un cuestionario sociodemográfico con 10 preguntas y dos instrumentos validados, el Maslach Burnout Inventory y el Depression, Anxiety and Stress Scale. Resultados: La mayoría es mujer (n=105), edad entre 26 y 36 años (n=49), con nivel técnico (n=37), agentes comunitarios de salud (n=39), trabajaban desde hace más de 10 años (n=62), con carga horaria de hasta 48 horas semanales (n=95), no hacían uso de medicamentos psicotrópicos (n=109) o terapia (n=115) en los últimos 12 meses. Se encontró que 30,96% tenían algún grado de depresión, 39,68% sufrían con algún grado de ansiedad y 38,88% sufrían de estrés. Se identificó Burnout moderado (n=86), y la mayoría se encontraba en la fase de despersonalización. Conclusión: Considerando los agravios psíquicos a la salud mental de los profesionales de la salud, como la ansiedad, la depresión, el estrés y el síndrome de Burnout, los resultados de este estudio son importantes, ya que permiten la elaboración de medidas, protocolos y asistencia psicológica a los profesionales de la salud (AU)

Introdução: O adoecimento mental se tornou alvo de estudos científicos da atualidade em detrimento das consequências da recente pandemia do novo coronavírus, especialmente entre os profissionais de saúde devido sua intrínseca relação na assistência as vítimas da COVID-19 e a sobrecarga de trabalho nesse período.Objetivo: Investigar o adoecimento mental entre os profissionais de saúde durante a pandemia pela COVID-19.Materiais e Método: Trata-se de estudo transversal, descritivo com abordagem quantitativa, realizado em município paraibano, com 126 profissionais da saúde de diferentes serviços no município. Utilizou-se um questionário sociodemográfico com 10 questões e dois instrumentos validados, o Maslach Burnout Inventory e o Depression, Anxiety and Stress Scale. Resultados: A maioria são mulheres (n=105), idade entre 26 a 36 anos (n=49), com nível técnico (n=37), agentes comunitários de saúde (n=39), trabalhavam há mais de 10 anos (n=62), com carga horária de até 48 horas semanais (n=95), não faziam uso de medicamentos psicotrópicos (n=109) ou terapia (n=115) nos últimos 12 meses. Verificou-se que 30,96% tinham algum grau de depressão, 39,68% sofriam com algum grau de ansiedade e 38,88% sofriam com estresse. Foi identificado burnout moderado (n=86), e a maioria encontrava-se na fase da despersonalização.Conclusão: Considerando os agravos psíquicos à saúde mental dos profissionais de saúde, a exemplo da ansiedade, depressão, estresse e a síndrome de burnout, os achados deste estudo são importantes, uma vez que permitem a elaboração de medidas, protocolos e assistência à saúde psicológica aos profissionais de saúde (AU)

Introduction: Mental illness has become the target of current scientific studies to the detriment of the consequences of the recent pandemic of the new coronavirus, especially among health professionals due to its intrinsic relationship in the care of victims of covid-19 and the work overload in this period. Objective: To investigate mental illness among health professionals during the covid-19 pandemic. Materials and Method: This is a cross-sectional, descriptive study with a quantitative approach, conducted in a municipality of Paraíba, with 126 health professionals from different services in the city. A sociodemographic questionnaire with 10 questions was used, in addition to two validated instruments, the Maslach Burnout Inventory and the Depression, Anxiety and Stress Scale. Results: The majority is woman (n=105), aged between 26 and 36 years (n=49), with technical level (n=37), community health agents (n=39), worked for more than 10 years (n=62), had a workload of up to 48 hours per week (n=95), did not use psychotropic drugs (n=109) or therapy (n=115) in the last 12 months. It was found that 30.96% had some degree of depression, 39.68% suffered with some degree of anxiety and 38.88% suffered with stress. Moderate Burnout was identified (n=86), and most were in the depersonalization phase. Conclusion: Considering the mental health problems of health professionals, such as anxiety, depression, stress and Burnout syndrome, the findings of this study are important, since they allow the development of measures, psychological health care to health professionals (AU)

An obscured obstacle-Prevalence and nature of micro aggressions amongst healthcare professionals.

INTRODUCTION: Microaggressions create negative consequences on the mental health of individuals who experience them, such as feelings of alienation, frustration and low self-esteem. Physicians worldwide are negatively impacted by the detrimental effects of microaggressions and implicit bias. It is imperative to establish the prevalence specificity of the problem hence the aim of this study is to determine the prevalence, nature and determinants of microaggressions amongst healthcare professionals. METHOD: The study used an online anonymous survey to collect data including demographics, awareness of the term, experience of microaggression, acts and response. The research findings were analyzed using univariate and multivariate analyses using Chi-square test and binary logistic regression respectively. RESULT: A total of 443 participants (40.9% males, 59.1% females) included 403 physicians (91%), 21 dentists (4.7%), 15 nurses (3.4%) and 4 pharmacists (0.9%). More than half of the participants (59.8%) were aware of the term micro-aggression. The percentage was significantly higher among respondents from the western region of Saudi Arabia than the Gulf/Middle Eastern countries. Approximately 38.1% of the participants experienced microaggression and more than half (55.62%) did not report experiencing microaggression. The most common form of microaggression was passive-aggressive behavior (80.5%) followed by invalidation of an opinion (73.4%). Among those who experienced microaggression, (12.9%) reported anger as the most predominant emotional response. CONCLUSION: Microaggression is a universal phenomenon. Further research is necessary to determine its prevalence in other countries to establish a comprehensive understanding of its cultural context.

Situações difíceis e sentimentos no cuidado paliativo oncológico / Difficult situations and feelings in palliative oncology care / Situaciones difíciles y sentimientos en el cuidado paliativo oncológico

O ato de cuidar cotidianamente de pessoas com dor, falta de ar e em morte iminente pode potencializar situações difíceis para profissionais da área. Contudo, raramente são discutidas nos serviços e no processo de formação profissional. Objetivou-se, então, analisar situações difíceis e sentimentos que emergem do cuidado de saúde. Esta é uma pesquisa de perspectiva fenomenológica e qualitativa, baseada em 30 situações difíceis de profissionais de saúde que atuam exclusivamente no cuidado paliativo oncológico. As entrevistas foram realizadas de agosto de 2019 a fevereiro de 2020. Os resultados mostram que as principais dificuldades foram motivadas pela identificação (quando o profissional vê semelhança com o paciente que cuida), morte ruim (com sofrimento), quando o paciente era jovem, morte de mãe com filho pequeno e quando havia divergência entre o proposto pelo profissional e a recusa do paciente. Percebeu-se relação entre tipos de situações difíceis e categoria profissional. Os profissionais expressaram tanto sentimentos desagradáveis (tristeza, impotência, angústia, medo) quanto agradáveis (compaixão, gratidão). Os resultados mostram que o ocultamento do processo de morrer ao longo do desenvolvimento civilizatório transformou-o em tabu, angustiante inclusive para quem trabalha com cuidados paliativos. Contribuem, também, para mostrar uma importante dimensão subjetiva do cuidado, geralmente negligenciada, que gera sofrimento, mas também ressignificação. Para que alguém cumpra seu propósito, é necessário encontrar sentido no trabalho, possibilitado pela modificação do estado interno do profissional pela experiência, que gera transformação e novo significado e saber a partir da práxis.

The act of caring for people in pain, shortness of breath, and imminent death on a daily basis can intensify difficult situations for health professionals. However, difficult situations are rarely discussed in the services and in the professional training process. This study aimed to analyze difficult situations and feelings that emerge from healthcare. This is a phenomenological and qualitative study based on 30 difficult situations of health professionals who work exclusively in palliative oncological care. The interviews were conducted from August to February 2020. The results show that the main difficulties were motivated by identification (when the professional recognizes similarities in the patient they are caring for), a bad death (with suffering), caring for young patients, the death of a mother with a small child, and when there was a divergence between what the professional proposed and the patient's choice. There was a relationship between types of difficult situations and professional category. The professionals expressed both unpleasant feelings (sadness, impotence, anguish, fear) and pleasant feelings (compassion, gratitude). The results show that the concealment of the dying process throughout the societies' development turned it into a taboo, causing distress even in those who work in palliative care. They also show an important subjective dimension of care, usually neglected, which generates suffering, but also resignification. To properly provide care, health professionals must find meaning in the work, made possible by the modification of the their internal mindset via experience, which generates transformation, new meaning, and knowledge from praxis.

El acto de atender diariamente a personas con dolor, dificultad para respirar y muerte inminente puede potenciar situaciones difíciles para los profesionales del área. Sin embargo, casi nunca se discuten en los servicios y en el proceso de formación profesional. El objetivo fue analizar situaciones difíciles y sentimientos que emergen del cuidado de la salud. Investigación de perspectiva fenomenológica y cualitativa, basada en 30 situaciones difíciles de profesionales de la salud que actúan exclusivamente en el cuidado paliativo oncológico. Las entrevistas se realizaron entre agosto y febrero de 2020. Los resultados enseñan que las principales dificultades se motivaron por la identificación (cuando el profesional ve similitud con el paciente que atiende), mala muerte (con sufrimiento), cuando el paciente era joven, muerte de una madre con hijo pequeño y cuando hubo discrepancia entre lo propuesto por el profesional y el rechazo del paciente. Se observó una relación entre tipos de situaciones difíciles y categoría profesional. Los profesionales expresaron tanto sentimientos desagradables (tristeza, impotencia, angustia, miedo) como agradables (compasión, gratitud). Los resultados indican que ocultar el proceso de morir a lo largo del desarrollo de la civilización lo convirtió en un tabú e, incluso, es angustiante para las personas que trabajan con cuidados paliativos. También contribuye a mostrar una importante dimensión subjetiva del cuidado, generalmente ignorada, que genera sufrimiento, pero también resignificación. Para que cumpla con su propósito es necesario encontrar sentido en el trabajo, posibilitado por la modificación del estado interno del profesional a través de la experiencia, generando transformación y un nuevo significado y conocimiento a partir de la praxis.

O Impacto da Histerectomia e a Participação dos Profissionais de Saúde Durante o Processo Cirúrgico / The Impact of Hysterectomy and the Involvement of Healthcare Professionals During the Surgical Process / El impacto de la histerectomía y la participación de los profesionales de la salud durante el proceso quirúrgico

Objetivo:descrever a o impacto da histerectomia e a participação dos profissionais de saúde durante o processo cirúrgico. O problema de pesquisa parte do seguinte questionamento: que impacto tem a histerectomia na vida da mulher em idade reprodutiva? Que participação tem os profissionais de saúde no processo cirúrgico? Método: Estudo de natureza descritiva com abordagem qualitativa conforme os pressupostos de Minayo (2009) com método de pesquisa exploratória. Resultados:Foram entrevistadas 7 mulheres que foram submetidas a histerectomia, com idade acima de 18 anos, que responderam perguntas referentes ao impacto do diagnóstico, conhecimento sobre a cirugia e experiências sobre o acolhimento dos profissionais da saúde no processo cirúrgico. A entrevista foi realizada em ambiente virtual na plataforma Google Forms. Conclusão: As entrevistadas revelaram sentimentos de angústia e medo ao se depararem com o diagnóstico cirúrgico por ausência de conhecimento inicialmente, evidenciando insatisfação e ausência dos profissionais da saúde quanto à cirurgia. O estudo reforça a importância das equipes multidisciplinares em hospitais e/ou locais de cuidados de saúde, uma vez que o foco principal no trabalho com pessoas acometidas por uma enfermidade não é a doença em si, mas elas mesmas.

Objective: to describe the impact of hysterectomy and the involvement of healthcare professionals during the surgical process. The research problem originates from the following questions: What impact does hysterectomy have on the life of a woman of reproductive age?What role do healthcare professionals play in the surgical process? Method:A descriptive study with a qualitative approach according to Minayo's (2009) assumptions using an exploratory research method. Results:Seven women who underwent hysterectomy, aged over 18 years, were interviewed. They answered questions regarding the impact of the diagnosis, knowledge about the surgery, and experiences of healthcare professionals' support during the surgical process. The interviews were conducted in a virtual environment using the Google Forms platform. Conclusion:The interviewees revealed feelings of anguish and fear when faced with the surgical diagnosis due to initial lack of knowledge, showing dissatisfaction and absence of healthcare professionals regarding the surgery. The study reinforces the importance of multidisciplinary teams in hospitals and/or healthcare facilities, as the main focus in working with people affected by an illness is not the disease itself, but the individuals themselves

Objetivo: describir el impacto de la histerectomía y la participación de los profesionales de la salud durante el proceso quirúrgico. El problema de investigación se basa en la siguiente pregunta: ¿qué impacto tiene la histerectomía en la vida de las mujeres en edadreproductiva? ¿Qué papel juegan los profesionales de la salud en el proceso quirúrgico? Método:Se trata de un estudio descriptivo con enfoque cualitativo según los supuestos de Minayo (2009) con un método de investigación exploratorio. Resultados:Se entrevistó a 7 mujeres mayores de 18 años sometidas a histerectomía, quienes respondieron preguntassobre el impacto del diagnóstico, conocimientos sobre cirugía y experiencias sobre la recepción de profesionales de la salud en el proceso quirúrgico. La entrevista se realizó en un entorno virtual en la plataforma Google Forms. Conclusión:Los entrevistados revelaron sentimientos de angustia y miedo frente al diagnóstico quirúrgico debido a la falta de conocimiento inicial, evidenciando insatisfacción y ausencia de profesionales de la salud con respecto a la cirugía. El estudio refuerza la importancia de los equipos multidisciplinarios en los hospitales y/o en los entornos sanitarios, ya que el foco principal en el trabajo con personas afectadas por una enfermedad no es la enfermedad en sí, sino ellos mismos.

Moral injury in a global health emergency: a validation study of the Italian version of the Moral Injury Events Scale adjusted to the healthcare setting.

Background: When exposed to events that transgress one's moral beliefs, a plethora of negative consequences may follow, which are captured by the concept of moral injury (MI). Despite its relevance to experiences of healthcare workers during a global health emergency, there is lack of validated MI instruments adapted to the healthcare setting.Objective: The present study aims to provide a validation of the Italian version of the Moral Injury Events Scale (MIES) adjusted to the healthcare setting by assessing its factor structure, internal consistency and construct validity.Methods: A sample of 794 healthcare workers (46% nurses, 51% female) engaged in hospital facilities during the COVID-19 pandemic in Italy completed measures of MI, PTSD, anxiety, depression, burnout, meaning in life and positive affect.Results: Using an exploratory structural equation modelling (ESEM) we assessed the scale factor structure for the entire sample and separately for nurse professional and female healthcare worker groups. Findings support a three-factor solution: Factor 1 'perceived transgressions by others'; Factor 2 'perceived transgressions by self'; and Factor 3 'perceived betrayals by others'. Findings also indicate some level of convergence with measures of PTSD, anxiety, depression and burnout.Conclusion: Results suggest that the MIES may be useful in capturing unique experiences of moral injury amongst healthcare workers engaged in a global health emergency. The low range correlations with measures of psychological distress might potentially indicate that MI, which captures cognitive value judgements rather than manifest symptomatology, may uniquely explain a certain amount of variance. Implications for the development of new empirically derived and theoretical guided tools are discussed, highlighting the need for future research to examine the role of individualising and social binding moral principles in gaining a more nuanced understanding of moral injury experiences amongst healthcare professionals across different socio-cultural settings.

The Italian validation of the MIES adapted to the healthcare setting yielded a three-factor structure: (a) 'perceived transgressions by self'; (b) 'perceived transgressions by others'; (c) 'perceived betrayals by others'.Findings suggest that the MIES may be useful in capturing unique experiences of moral injury amongst healthcare workers engaged in a global health emergency.Future research should consider the role of individualising and social binding moral principles in shaping moral injury experiences among healthcare professionals across different socio-cultural settings.

A busca por um fazer costurado de possibilidades e desafios: a atuação do sanitarista na atenção primária à saúde do campo / The search for making a summaryof possibilities and challenges: The performance of the sanitarian in Primary Health carein the field / La búsqueda por un hacer sembrado de posibilidades y desafíos: la actuación del prestador sanitario en la atención primaria de salud en el campo

As práticas de trabalho em saúde têm historicamente passado por transformações principalmente a partir dos processos de formação dos profissionais da saúde. O profissional sanitarista, ou bacharel em saúde coletiva vem somando esforços e ocupando espaços de trabalho multiprofissionais fortalecendo a perspectiva transversal do cuidado em saúde em diversos campos de atuação. Objetivo:Este estudo objetiva relatar a experiência de construção do processo de trabalho de um bacharel em Saúde Coletiva na Atenção Primária à Saúde do Campo em meio a pandemia de Covid-19. Metodologia:O período de abrangência foi de 2020 a 2022, ocorrendo no município de Caruaru, Pernambuco. A atuação do bacharel em Saúde Coletiva se deu na perspectiva do Núcleo de Apoio àsaúde da famíliae atenção básica,atuando junto a duas equipes de saúde da família de territórios rurais. Resultados: O processo de trabalho se desenvolveu em três principais frentes, sendo elas: 1) Atenção à saúde com base territorial; 2) Articulação com redes intra e intersetoriais; 3) Reorganização do trabalho multiprofissional na Atenção Primária à Saúde. Conclusões: Sendo assim, é possível constatar que o processo de trabalho do bacharel em Saúde Coletiva está em constante movimento, delimitando as suas possibilidades de atuação, bem como os seus limites quanto a um fazer ainda desconhecido em realidades como a Atenção Primária. O avanço da discussão ocorre em paralelo a formação e inserção destes profissionais nos mais diversos contextos a exemplo da saúde do campo. Nota-se a necessidade de desenvolver novos estudos e experiências formativas de bacharéise saúde coletiva conectados aos territórios do campo, apostando na capilarização e ampliação da presença deste profissional nas realidades singulares do Sistema Único de Saúde (AU).

Health work practices have historically undergone transformations, mainly from the training processes of health professionals. The sanitary professional, or bachelor in public health, has been joining efforts and occupying multidisciplinary workspaces, strengthening the transversal perspective of health care in different fields. Objective:This study aims to report the experience of building the work process of a Bachelor of Public Health in Primary Health Care in the Countryside in the midst of the Covid-19 pandemic. Methodology: The coverage period was from 2020 to 2022, taking place in the municipality of Caruaru, Pernambuco. The performance of the bachelor in Collective Health took place from the perspective of the Support Center for family health and primary care, working with two family health teams from rural territories. Results:The work process was developed on three main fronts, namely: 1) Health care based on territory; 2) Articulation with intra and intersectoral networks; 3) Reorganization of multidisciplinary work in Primary Health Care.Conclusions:Therefore, it is possible to verify that the work process of the bachelor in Collective Health is in constant movement, delimiting their possibilities of action, as well as their limits regarding an action still unknown in realities such as Primary attention The advancement of the discussion occurs in parallel with the training and insertion of these professionals in the most diverse contexts, such as rural health. There is a need to develop new studies and training experiences for bachelors and collective health connected to rural territories, focusing on the capillarization and expansion of the presence of this professional in the unique realities of the Unified Health System (SUS) (AU).

Las prácticas del trabajo en salud históricamente han sufrido transformaciones, principalmente a partir de los procesos de formación de los profesionales de la salud. El profesional sanitario, o licenciado en salud pública, viene sumando esfuerzos y ocupando espacios de trabajo multidisciplinarios, fortaleciendo la perspectiva transversal del cuidado de la salud en diferentes campos. Objetivo: Este estudio tiene como objetivo relatar la experiencia de construcción del proceso de trabajo de un Licenciado en Salud Pública en la Atención Primaria de Salud en el Campo en medio de la pandemia de la Covid-19. Metodología: El período de cobertura fue de 2020 a 2022, ocurriendo en el municipio de Caruaru, Pernambuco. La actuación de la licenciatura en Salud Colectiva se dio en la perspectiva del Centro de Apoyo a la salud de lafamilia y atención primaria, trabajando con dos equipos de salud de la familia de territorios rurales. Resultados: El proceso de trabajo se desarrolló en tres frentes principales, a saber: 1) Atención de la salud con base en el territorio; 2) Articulación con redes intra e intersectoriales; 3) Reorganización del trabajo multidisciplinario en la Atención Primaria de Salud. Conclusiones: Por tanto, es posible constatar que el proceso de trabajo del licenciado en Salud Colectiva está en constante movimiento, delimitando sus posibilidades de actuación, así como sus límites frente a un actuar aún desconocido en realidades como la Atención primaria. El avance de la discusión ocurre en paralelo con la formación e inserción de estos profesionales en los más diversos contextos, como la salud rural. Existe la necesidad de desarrollar nuevos estudios y experiencias de formación para licenciaturas y salud colectiva vinculadas a los territorios rurales, con foco en la capilarización y ampliación de la presencia de ese profesional en las realidades singulares del Sistema Único de Salud (SUS) (AU).

Online Training for Primary Care Staff: Skills development on the Mental Health Gap Action Programme (mhGAP) Intervention Guide / Entrenamiento en línea para personal de atención primaria: Desarrollo de habilidades sobre la Guía de Intervención para Superar las Brechas en Salud Mental (mhGAP)

Abstract Developing effective learning strategies to strengthen mental health professionals' capacities and deliver evidence-based interventions in their communities is urgent. We developed and evaluated an online training program for the Intervention Guide for Mental, Neurological and Substance Use Disorders in Non-specialized Health Settings. Nine hundred and seventy-five health professionals in Mexico were enrolled in the training program, during the period of social distancing brought about by the COVID-19 pandemic. Participants completed a pre-post online evaluation strategy including Knowledge screening, assessment of Learning Activities, and performance in Programmed-Simulated cases to evaluate knowledge and skills for the assessment, management, and follow-up of Mental, Neurological and Substance Use Disorders. We found that participants improved their knowledge and skills from training on the mhGAP online course. Notably we observed these positive results regardless of sex, profession, institution, or social vulnerability rating of participants, suggesting that this is a relevant training program for primary care staff. These results contribute to the Mental Health Gap Action Programme and advance the use of online teaching and evaluation technologies in this field.

Resumen El desarrollo de estrategias efectivas de aprendizaje para fortalecer las competencias de los profesionales de la salud mental y brindar intervenciones basadas en evidencia en sus comunidades es necesario. El objetivo del presente trabajo fue desarrollar y evaluar un programa de entrenamiento en línea para la Guía de Intervención en Trastornos Mentales, Neurológicos y por Uso de Sustancias en nivel de atención de salud no especializada. Participaron 975 profesionales de la salud mexicanos durante el período de distanciamiento social provocado por la pandemia de COVID-19. Los participantes completaron una evaluación previa y posterior que incluyó un cuestionario de conocimientos, actividades de aprendizaje y la ejecución en casos simulados programados para evaluar el conocimiento y las habilidades para la evaluación, el manejo y el seguimiento de los trastornos mentales, neurológicos y por uso de sustancias. Los resultados indicaron que los participantes mejoraron sus conocimientos y habilidades en función de su participación en el curso en línea, independientemente del sexo, la profesión, la institución o la vulnerabilidad social de los participantes, sugiriendo que se trata de un programa de formación relevante para el personal de atención primaria. Los resultados contribuyen al Programa de Acción para la Brecha de Salud Mental y promueven el uso de tecnologías de evaluación y enseñanza en línea en este campo.

Conocimiento y manejo de cuidados respiratorios especializados en pacientes con enfermedades neuromusculares en unidades de cuidado intensivo: aproximación por encuesta a profesionales de la salud / Knowledge and management in specialized respiratory care of patients with neuromuscular diseases in intensive care units: survey to health professionals

Introducción: En las enfermedades neuromusculares la disminución de la capacidad vital se relaciona con disminución de la capacidad tusígena y luego ventilatoria, la combinación de ambas genera complicaciones graves por falla ventilatoria. En los pacientes que son intubados, limita la extubación, sino se realizan cuidados respiratorios especializados. El conocimiento y aplicación de los profesionales que atienden a estos pacientes en cuidados intensivos resulta esencial. Objetivos: Reportar el conocimiento y aplicación especializada de cuidados respiratorios en enfermedades neuromusculares en las Unidades de Cuidados Intensivos. Materiales y métodos: Estudio cualitativo, descriptivo de corte transversal, no probabilístico, a criterio. La población accesible fueron profesionales de la Salud de las Unidades de Cuidados Intensivos, y el análisis de las respuestas de una encuesta estructurada, enviada a distintos profesionales a nivel mundial. Resultados: Se incluyeron los cuestionarios de 41 profesionales, el 34% de los profesionales reportaron la utilización regular de Asistente Mecánico de la Tos; 22% refirieron la utilización regular de apilamiento de aire; 31% reportaron la utilización regular de Asistencia Ventilatoria No Invasiva, 56.1% de los profesionales afirmaron conocer la diferencia entre Ventilación No Invasiva y Soporte Ventilatorio No Invasivo, 34% de los profesionales refirieron tener formación especializada en el área. Conclusión: Pese a existir una alta proporción de profesionales con conocimiento especializado, un grupo importante no los aplica rutinariamente. La justificación es principalmente por la dificultad de adquisición y financiación de los equipos necesarios.

Introduction: In neuromuscular diseases, the decrease in vital capacity relates to decreased coughing and then ventilatory capacity, the combination of both generating serious complications due to ventilatory failure. In intubated patients, the extubation process is difficult unless specialized respiratory care is provided. The knowledge and treatment application of the professionals who care for these patients in intensive care is of outmost importance. Objectives: Report the knowledge and specialized application of respiratory care in neuromuscular diseases in Intensive Care Units. Materials and methods: Qualitative, descriptive, cross-sectional, non-probabilistic study, at criteria. The accessible population were Health professionals from the Intensive Care Units, and the analysis of the responses of a structured survey, sent to different professionals worldwide. Results: The questionnaires of 41 professionals were included, 34% of the professionals reported the regular use of the Mechanical Cough Assistant; 22% reported the regular use of air stacking; 31% reported the regular use of Non-Invasive Ventilatory Assistance. 56.1% of the professionals stated that they knew the difference between Non-Invasive Ventilation and Non-Invasive Ventilatory Support, 34% of the professionals reported having specialized training in the area. Conclusion: Despite the existence of a high proportion of professionals with specialized knowledge, an important group does not routinely apply them. The justification is mainly due to the difficulty of acquiring and financing the necessary equipment.

Traducción y adaptación transcultural al contexto español del Person-Centred Practice Inventory-Staff (PCPI-S) para profesionales de la salud / Translation and transcultural adaptation of the Person-Centred Practice Inventory Staff (PCPI-S) for health professionals in Spain

Fundamento: El Cuidado Centrado en la Persona (CCP) se haconvertido en un tema central dentro del ámbito sanitario acorde con las políticas de salud nacionales e internacionales. ElPerson Centred Practice Inventory Staff (PCPI-S) es un instrumentobasado en el modelo teórico Person-Centred Practice Frameworkque evalúa la percepción que tienen los profesionales de la salud sobre una práctica centrada en la persona. El objetivo delestudio es obtener la primera versión española del PCPI-S traducido y adaptado a nuestro contexto español.Método: Se llevó a cabo una traducción y adaptación culturaldel instrumento utilizando la guía Translation and Cultural Adaptation of Patient Reported Outcomes Measures – Principles of GoodPractice (PGP) que incluyó una sesión con expertos. También serealizó una validación de contenido de la claridad y relevanciade cada ítem (I-CVI), así como del cuestionario total (S-CVI/Ave).Resultados: No se encontraron dificultades para llegar a unconsenso en los doce ítems que necesitaron ser clarificados. Elíndice de validez de contenido por ítem (I-CVI) obtuvo una puntuación excelente para claridad en 53 ítems, y para relevanciaen 59; el índice de validez de contenido del cuestionario (S-CVI/Ave) mostró resultados excelentes (≥90).Conclusiones: Se ha obtenido la primera versión del PCPI-Sadaptada al español, conceptual y semánticamente equivalenteal cuestionario original. Este instrumento permitirá identificarla percepción que tienen los profesionales de la salud sobre unapráctica centrada en la persona.(AU)

Background: Person-centred practices – following nationaland international developments in health-care policies – havebecome a key approach in healthcare. The Person-CentredPractice Inventory – Staff is an instrument based on the theo -retical framework Person-Centred Practice that focuses onthe staff’s perspective and how they experience person-centred practices. Here, the aim of this study is to obtain the firstSpanish version of the PCPI-S translated and adapted into theSpanish context. Methods: The translation and adaptation of the instrumentfollowed the Translation and Cultural Adaptation of PatientReported Outcomes Measures – Principles of Good Practice,which included a consulting session with experts. Content validation measures on clarity and relevance were assessed forevery item (I-CVI) and the survey as a whole (S-CVI/Ave).Results: No major difficulties were registered to reach an agreement on the 12 items that needed to be clarified. Regarding clarity and relevance. The validity index per item (I-CVI) obtainedexcellent scores for clarity in 53 items and for relevance in 59;the S-CVI/Ave showed excellent results (≥90).Conclusions: This first version of the Person-Centred PracticeInventory – Staff instrument adapted to the Spanish context isconceptually and semantically equivalent to the original one.This valuable tool will be of great help to identify the perceptionof healthcare professionals on person-centred practices.(AU)

Conocimiento y manejo de cuidados respiratorios especializados en pacientes con enfermedades neuromusculares en unidades de cuidado intensivo: aproximación por encuesta a profesionales de la salud

Introducción: En las enfermedades neuromusculares la disminución de la capacidad vital se relaciona con dismunición de la capacidad tusígena y luego ventilatoria, la combinación de ambas genera complicaciones graves por falla ventilatoria. En los pacientes que son intubados, limita la extubación, sino se realizan cuidados respiratorios especializados. El conocimiento y aplicación de los profesionales que atienden a estos pacientes en cuidados intensivos resulta esencial. Objetivos: Reportar el conocimiento y aplicación especializada de cuidados respiratorios en enfermedades neuromusculares en las Unidades de Cuidados Intensivos. Materiales y métodos: Estudio cualitativo, descriptivo de corte transversal, no probabilístico, a criterio. La población accesible fueron profesionales de la Salud de las Unidades de Cuidados Intensivos, y el análisis de las respuestas de una encuesta estructurada, enviada a distintos profesionales a nivel mundial. Resultados: Se incluyeron los cuestionarios de 41 profesionales, el 34% de los profesionales reportaron la utilización regular de Asistente Mecánico de la Tos; 22% refirieron la utilización regular de apilamiento de aire; 31% reportaron la utilización regular de Asistencia Ventilatoria No Invasiva, 56.1% de los profesionales afirmaron conocer la diferencia entre Ventilación No Invasiva y Soporte Ventilatorio No Invasivo, 34% de los profesionales refirieron tener formación especializada en el área. Conclusión: Pese a existir una alta proporción de profesionales con conocimiento especializado, un grupo importante no los aplica rutinariamente. La justificación es principalmente por la dificultad de adquisición y financiación de los equipos necesarios.

Introduction: In neuromuscular diseases, the decrease in vital capacity relates to decreased coughing and then ventilatory capacity, the combination of both generating serious complications due to ventilatory failure. In intubated patients, the extubation process is difficult unless specialized respiratory care is provided. The knowledge and treatment application of the professionals who care for these patients in intensive care is of outmost importance. Objectives: Report the knowledge and specialized application of respiratory care in neuromuscular diseases in Intensive Care Units. Materials and methods: Qualitative, descriptive, cross-sectional, non-probabilistic study, at criteria. The accessible population were Health professionals from the Intensive Care Units, and the analysis of the responses of a structured survey, sent to different professionals worldwide. Results: The questionnaires of 41 professionals were included, 34% of the professionals reported the regular use of the Mechanical Cough Assistant; 22% reported the regular use of air stacking; 31% reported the regular use of Non-Invasive Ventilatory Assistance. 56.1% of the professionals stated that they knew the difference between Non-Invasive Ventilation and Non-Invasive Ventilatory Support, 34% of the professionals reported having specialized training in the area. Conclusion: Despite the existence of a high proportion of professionals with specialized knowledge, an important group does not routinely apply them. The justification is mainly due to the difficulty of acquiring and financing the necessary equipment.

La revisión emocional del encuentro médico-terapéutico en M. Balint, P. Freeling y K. Browne (1957-1967) / The emotional perspective of the encounter between doctor and patient in m. Balint, P. Freeling and K. Browne (1957-1967)

Se analiza la perspectiva emocional de la relación médico-paciente y la confianza propia de esta interrelación, a través de publicaciones y relatos médicos de Michael Balint, Kevin Browne y Paul Freeling, aparecidos en la década de 1960. Balint promovió en la clínica Tavistock (Londres) los llamados ‘Grupos Balint’ en los que participaron Browne y Freeling. Sus publicaciones se enmarcan en la aproximación psicoanalítica y psicosomática, enfoque que actualizó la consideración de la persona como un todo y mostró el significado de las emociones en la enfermedad. Balint, Browne y Freeling destacaron el carácter terapéutico de la relación médico-paciente y subrayaron la subjetividad y la participación tanto del profesional como del paciente, en el encuentro médico-paciente. El movimiento Balint y en ese marco, la obra de Browne y Freeling, se sumó a otras que llevaron a promover la integración de lo psicológico y el entorno social en la definición de la enfermedad y en la práctica de la medicina de ese tiempo. El artículo pone de manifiesto los contrastes entre las propuestas de Michael Balint y las planteadas por la Escuela Psicosomática norteamericana y otros movimientos de origen psicoanalítico, respecto a la psicogenia y a la relación médico-paciente.(AU)

The emotional perspective of the doctor-patient relationship and the trust inherent in this interrelation are analysed through medical narratives published in the 1960s by Michael Balint, Kevin Browne and Paul Freeling. Balint promoted the so-called ‘Balint Groups’ in the Tavistock clinic (London), in which Browne and Freeling participated. Their publications are part of the psychoanalytic and psychosomatic approach, that updated the consideration of the person as a whole and showed the meaning of emotions in illness. Balint, Browne and Freeling highlighted the therapeutic nature of the doctor-patient relationship and underlined the subjectivity and participation of both the professional and the patient in the doctor-patient encounter. The Balint movement and within this framework, the work of Browne and Freeling, joined others that led to promoting the integration of the psychological and the social environment in the definition of the disease and in the practice of medicine at that time. The article also focusses the contrasts between the proposals of Michael Balint and those raised by the American Psychosomatic Society, and other psychoanalytic movements, regarding the doctor-patient relationship.(AU)

La formación específica en sostenibilidad y medio ambiente en el personal sanitario / Specific training on sustainability and environment for healthcare staff

Objetivo: identificar y describir las pautas formativas específicas en sostenibilidad y medioambiente para el personal sanitario.Método: se llevó a cabo una revisión narrativa en 2021, mediante la búsqueda de artículos en las bases de datos contenidas en la herramienta de búsqueda de la Universidad Católica de Murcia (BUSCAM) y documentos en la entidad Ecoembes. Se usaron los términos MeSH: education, environment, climate change, health, sustainability, health professionals.Resultados: se localizaron 707 documentos, de los cuales 15 fueron incluidos en la revisión. Se evidencia la implicación y el impacto en la salud humana del desarrollo sostenible, que ocasiona y constituye la razón por la cual el sector de la salud ha sido incluido en la búsqueda de soluciones al problema. Aunque se están dando pasos importantes, aún no es suficiente para incorporar totalmente la materia de sostenibilidad en las competencias que adquieren los profesionales de la salud. Es esencial tener entornos de aprendizaje adecuados, acompañado de una actitud y comportamiento responsable. Así como, asumir una actitud proactiva hacia la sostenibilidad ambiental en su vida diaria.Conclusiones: las mejoras en esta materia harán líderes a los profesionales de la salud en este campo, para catalizar y apoyar una respuesta sólida de la salud pública al cambio climático, con el fin de garantizar un futuro seguro y sostenible.(AU)

Objectives: to identify and describe the specific training guidelines on sustainability and environment for healthcare staff.Method: a narrative review was conducted in 2021, through a search for articles in the databases included in the search tool from the Universidad Católica de Murcia (BUSCAM) and documents in the ECOEMBES organization. The following MeSH terms in English were used: education, environment, climate change, health, sustainability, health professionals.Results: in total, 707 documents were retrieved, and 15 of these were included in the review. The consequences and impact on human health of sustainable development was evident; this is the cause and reason for including the health sector in the search for solutions to the problem. Even though great steps are being taken, this is still not enough in order to incorporate completely the subject of sustainability into the skills acquired by health professionals. It is essential to have the adequate learning environments, as well as a responsible attitude and behaviour. Likewise, a proactive attitude towards environmental sustainability must be adopted in daily life.Conclusions: improvements in this matter will lead healthcare professionals to become leaders in this area, in order to catalyse and support a solid response by public health to climate change, with the aim to guarantee a safe and sustainable future.(AU)

Construyendo el futuro de la terapia ocupacional en Catalunya: un viaje a través del tiempo / Shaping the future of occupational therapy in Catalonia: a journey through time

El Colegio de Terapeutas Ocupacionales de Catalunya (COTOC) ha celebrado su décimo aniversario destacando la importancia de la Asociación de Profesionales de Terapeutas Ocupacionales de Catalunya (APTOC) en su creación. Aunque existen desafíos para lograr un mayor reconocimiento, presencia e inclusión en el sistema de salud y otros ámbitos públicos, resulta fundamental garantizar la accesibilidad de las personas a los servicios de terapia ocupacional. Se plantean diversas reflexiones para seguir avanzando, tales como el crecimiento del colegio y de profesionales en Catalunya, la participación activa de las terapeutas ocupacionales y el establecimiento de vínculos con otros profesionales y entidades. Además, se resalta el valor de unirse al ecosistema local, nacional e internacional, promoviendo la visibilidad, sensibilización y conocimiento sobre la terapia ocupacional en la sociedad. Para construir el presente, se necesita dedicación, esfuerzo y perseverancia, recordando que cada una de nosotras puede influir y marcar la diferencia. En conclusión, se subraya la importancia de sumar para construir la terapia ocupacional que deseamos y contribuir a un futuro mejor.(AU)

The College of Occupational Therapists of Catalonia (COTOC) celebrated its tenth anniversary, highlighting the importance of the Association of Occupational Therapists Professionals of Catalonia (APTOC) in its creation. Although there are challenges to achieving greater recognition, presence, and inclusion in the healthcare system and other public domains, it is essential to ensure people's accessibility to occupational therapy services. Various reflections are proposed to continue progressing, such as the growth of the college and professionals in Catalonia, the active participation of occupational therapists, and the establishment of partnerships with other professionals and entities. Additionally, we active voice he value of joining the local, national, and international ecosystem, promoting visibility, awareness, and knowledge about occupational therapy in society. Building the present requires dedication, effort, and perseverance, with the reminder that everyone can influence and make a difference. In conclusion, we underscore the importance of coming together to build the desired occupational therapy and contribute to a better future.(AU)

Construint el futur de la teràpia ocupacional a Catalunya: un viatge a través del temps / Shaping the future of occupational therapy in Catalonia: a journey through time

El Col·legi de Terapeutes Ocupacionals de Catalunya (COTOC) ha celebrat el seu desè aniversari destacant la importància de l’Associació de Terapeutes Ocupacionals de Catalunya (APTOC) en la seva creació. Tot i que hi ha desafiaments per aconseguir un major reconeixement, presència i inclusió en el sistema de salut i altres àmbits públics, resulta fonamental garantir l'accessibilitat de les persones als serveis de teràpia ocupacional. Es plantegen diverses reflexions per continuar avançant, com ara el creixement del col·legi i de professionals a Catalunya, la participació activa de les terapeutes ocupacionals i l'establiment de vincles amb altres professionals i entitats. A més, es ressalta en el valor d'unir-se a l'ecosistema local, nacional i internacional, promocionant la visibilitat, sensibilització i coneixement sobre la teràpia ocupacional en la societat. Per construir el present, cal dedicació, esforç i perseverança, recordant que cadascuna de nosaltres pot influir i marcar la diferència. En conclusió, se subratlla la importància de sumar per construir la teràpia ocupacional que desitgem i contribuir a un futur millor.(AU)

The College of Occupational Therapists of Catalonia (COTOC) celebrated its tenth anniversary, highlighting the importance of the Association of Occupational Therapists Professionals of Catalonia (APTOC) in its creation. Although there are challenges to achieving greater recognition, presence, and inclusion in the healthcare system and other public domains, it is essential to ensure people's accessibility to occupational therapy services. Various reflections are proposed to continue progressing, such as the growth of the college and professionals in Catalonia, the active participation of occupational therapists, and the establishment of partnerships with other professionals and entities. Additionally, we active voice he value of joining the local, national, and international ecosystem, promoting visibility, awareness, and knowledge about occupational therapy in society. Building the present requires dedication, effort, and perseverance, with the reminder that everyone can influence and make a difference. In conclusion, we underscore the importance of coming together to build the desired occupational therapy and contribute to a better future.(AU)

EMDR for symptoms of depression, stress and burnout in health care workers exposed to COVID-19 (HARD): A study protocol for a trial within a cohort study.

Background: Stressful events during a pandemic are a major cause of serious health problems, such as burnout, depression and posttraumatic stress disorder (PTSD) among health care workers (HCWs). During three years, HCWs, on the frontline to fight the COVID-19 pandemic, have been at an increased risk of high levels of stress, anxiety, depression, burnout and PTSD. Regarding potential psychological interventions, Eye Movement Desensitization & Reprocessing (EMDR) is a structured, strongly recommended therapy based on its well-known efficacy in reducing PTSD symptoms and anxiety.Objectives: This study, designed as a trial within a cohort (TwiC), aims to 1) estimate the prevalence of depression, burnout and PTSD in a sample of HCWs after experiencing the COVID-19 emergency (cohort part) and 2) assess the efficacy and acceptability of 'EMDR + usual care' for HCWs from the cohort who report significant psychological symptoms (trial part).Methods: The study, designed as a TwiC, consists of a prospective cohort study (n = 3000) with an embedded, pragmatic, randomized open-label superiority trial with two groups (n = 900). Participants included in the trial part are HCWs recruited for the cohort with significant symptoms on at least one psychological dimension (depression, burnout, PTSD) at baseline, 3 months or 6 months, determined by using the Patient Health Questionnaire (PHQ-9), Professional Quality of Life (ProQOL) scale, and PTSD Checklist for the DSM-5 (PCL-5). The intervention consists of 12 separate EMDR sessions with a certified therapist. The control group receives usual care. The trial has three primary outcomes: changes in depression, burnout and PTSD scores from randomization to 6 months. All participants are followed up for 12 months.Conclusions: This study provides empirical evidence about the impact of the COVID-19 pandemic and the mental health burden it places on HCWs and assesses the effectiveness of EMDR as a psychological intervention.Trial registration NCT04570202.

Health care workers are at increased risk of stress, anxiety, depression, burnout and PTSD following the COVID-19 pandemic.In this study, the effectiveness of EMDR in reducing depression, burnout and PTSD in health care workers exposed to COVID-19 is investigated.In this study, an original 'trial within a cohort' (TwiC) design that consists of a cohort study with an embedded pragmatic randomized trial is used.The study is fully web-based, including online screening, consent and assessments.

Reacondicionamiento de la Atención Primaria de Salud para enfrentar la pandemia COVID-19 y percepción de los profesionales sobre las medidas emprendidas en un municipio brasileño / Primary Healthcare reconditioning to face the COVID-19 pandemic, and perception by professionals of the measures implemented in a Brazilian district

Objetivo: describir las condiciones de la Atención Primaria de Salud (APS) con respecto al reacondicionamiento, equipamiento y organización de los servicios para enfrentar la pandemia y medir la percepción de los profesionales sobre las adecuaciones. Método: investigación de métodos mixtos en una ciudad del estado de San Pablo (Brasil). En la etapa cuantitativa se realizó un estudio descriptivo transversal en 222 profesionales de APS, en quienes se aplicó el cuestionario adaptado del Risk assessment and management of exposure of health care workers in the context of COVID-19 de la Organización Mundial de la Salud. Se siguió del abordaje cualitativo, que consistió en observación de campo en cuatro unidades de APS. Resultados: del total, el 86,94% (n= 193) mencionó que las unidades evalúan los signos y síntomas de los usuarios antes de las consultas; el 63,96% (n=142) que había una rutina de limpieza diaria en la sala de espera; el 92,34% (n= 205) que existían métodos para la higiene de manos; el 77,48% (n= 172) que agendaba citas para mantener el distanciamiento físico; el 80,12% (n= 178) no realizó obras de reacondicionamiento y el 45,95% (n=102) proporcionó material educativo al usuario. Conclusiones: en la observación de campo se identificaron algunas evaluaciones de signos y síntomas de los usuarios, no se observaron acciones de limpieza en las unidades, se percibió que no había suficiente alcohol gel en dispensador, no había marcas en el suelo para mantener el distanciamiento, faltaba material educativo y no se verificó que se hubieran realizado obras de reacondicionamiento. En la integración de los datos hubo convergencia en la estructura física y el reacondicionamiento de las unidades.(AU)

Objective: to describe the Primary Care (PC) scenario regarding reconditioning, equipment and organization of services in order to face the pandemic and to measure the perception by professionals regarding these adaptations. Method: a research with mixed method in a city of the San Pablo state (Brazil). In the quantitative stage, a descriptive cross-sectional study was conducted in 222 PC professionals; the adapted Risk assessment and management of exposure of health care workers in the context of COVID-19 questionnaire by the World Health Organization was implemented. This was followed by the qualitative approach, which consisted in field observation in four PC units.Results: out of the total, 86.94% (n= 193) mentioned that there was an assessment of the signs and symptoms of the users before consultation; 63.96% (n=142) stated that a daily cleaning routine was followed in the waiting room; 92.34% (n= 205) claimed that there were methods available for hand hygiene; 77.48% (n= 172) said that appointments were scheduled in order to maintain physical distancing; 80.12% (n= 178) had not conducted any reconditioning work, and 45.95% (n=102) provided educational materials to users. Conclusions: during field observation, some assessments for signs and symptoms in users were detected; no cleaning actions were observed in the units, it was perceived that there was not enough alcohol gel in the dispenser, there were no marks on the floor to keep distancing, there was a lack of educational materials, and it was not verified that any reconditioning work had been conducted. During data integration, there was convergence regarding physical structure and unit reconditioning.(AU)

Atención de los profesionales de la salud a personas trans en América Latina y el Caribe / Health professionals care for trans people in Latin America and the Caribbean

Resumen El presente estudio tuvo por objetivo analizar las características de artículos científicos publicados durante el último quindenio respecto a la atención en salud a personas trans en América Latina y el Caribe. Se desarrolló una revisión sistematizada de artículos publicados en cuatro bases de datos, entre los años 2005 y 2020, en la que se encontraron 20 estudios que fueron objeto de análisis. En su mayoría, estos dan cuenta de las percepciones que tienen las comunidades trans y, en menor frecuencia, las experiencias de los profesionales de la salud sobre la atención en salud. Los resultados permiten identificar barreras que influyen en los procesos de atención y los desafíos para mejorarla. Sobresale la formación deficiente e insuficiente en los profesionales sobre identidades trans y los enfoques diferenciales y afirmativos del género, y la necesidad de fortalecer los abordajes integrales entre las comunidades académicas, de la salud y la generación de políticas públicas transformativas.

Abstract Health care is important for the transitions of people with trans life experiences and to strengthen the processes of health and disease. Health professionals are educating and accompanying agents; however, the literature frequently reports that there are barriers perceived by professionals regarding their competencies to accompany such processes, in addition to others related to social representations regarding trans identities, the limited scientific evidence regarding the processes of gender reaffirmation and representing the communities themselves according to their historical and sociocultural characteristics. The aim of this study was to analyze the characteristics of scientific articles published during 15 years regarding health care for trans persons in Latin America and the Caribbean. A systematized review of articles published in four databases between 2005 and 2020 was carried out. 20 studies were analyzed in the research. Most of them report the perceptions of trans communities and, less frequently, the experiences of health professionals on health care. The results allow the identification of barriers that influence the processes of care and the challenges to improve it. The deficient and insufficient training of professionals on trans identities and differential and affirmative gender approaches stand out, as well as the need to strengthen comprehensive approaches among the academic and health communities and the generation of trans affirmative public policies. On the other hand, the results evidence a construction of science with respect to gender that is cisnormative and invisibilizes gender diversities. In addition, many of the studies establish vertical relationships between participants, including researchers, which generates research dynamics in which trans communities are considered more as informants and less as expert peers, community researchers or participants in a collaborative and co-creative research process. These findings support the need and renew the urgency to generate processes of knowledge construction with and for trans communities that allow nurturing educational, social, public policy and health spaces that represent their needs for gender transitions, in case the person considers so, and that welcome in an integral and humanized way the processes of health and disease. Research on health and health care in trans communities both in Colombia and in the rest of Latin America and the Caribbean does not show the implementation of health policies focused on the community and that respond to their health needs. Health professionals, around the world, should accompany from care actions focused on the processes of self-identification and self-determination of gender. Being recognized and made visible based on gender identities and expressions has a positive impact on the mental health of trans people and their well-being. In professional practice, it is important and essential to overcome the barriers of social inequality, promoting a critical social vision and understanding of the reality of this population. It is necessary to expand research from gender diversities and separate from the LGBTIQ+ umbrella given the complex social, cultural, biological, and psychological diversities faced by each community. As for health professionals, it is necessary to deepen the measurement and understanding of attitudes, knowledge, beliefs, skills and gaps identified by all staff, from doctors and nurses to institution managers. This in order to articulate and triangulate information and develop intervention programs aimed at comprehensive and accessible care, especially for their reports about the little information on sexual and gender diversity received during their professional training process and organizational culture. Finally, each country should develop clinical guidelines based on local, national, and international evidence that responds to the psychological and sociocultural needs and experiences of trans communities that include the process of gender transitions from hormone therapy, affirmative surgeries and other non-binary processes of gender expressions, family, psychosocial support, and community accompaniment.

Estratégias de Coping de profissionais da saúde de Piracicaba durante a COVID-19 / Coping Strategies of health professionals in Piracicaba during COVID-19 / Estrategias de Afrontamiento de los profesionales de la salud de Piracicaba durante el COVID-19

INTRODUÇÃO: Com a pandemia da COVID-19, os profissionais de saúde tiveram que adotar estratégias de enfrentamento (coping) para lidar com o stress acarretado pela pandemia. OBJETIVO: avaliar as estratégias de coping utilizadas pelos profissionais da saúde (médicos, dentistas, enfermeiros, técnicos em enfermagem) das 52 unidades de Saúde da Família do município de Piracicaba no início da pandemia. METODOLOGIA: Este é um estudo observacional de corte transversal de cunho quantitativo, em que foram utilizados 2 questionários autoaplicáveis: 1) sobre os dados sociodemográficos constituído de 8 questões abertas: idade, profissão, tempo no serviço público, escolaridade, grupo de risco, sexo, estado civil e número de filhos e 2) o Inventário de Coping de Folkman e Lázarus (1985) contendo 66 questões representando ações ou pensamentos específicos utilizados em uma situação de estresse. RESULTADOS: Participaram desta pesquisa 198 profissionais da saúde, após assinatura do termo de consentimento livre e esclarecido, em que 90,9% da amostra era do gênero feminino; 26,8% estavam no grupo de risco; 49% possuíam até o segundo grau de escolaridade. A categoria profissional predominante do estudo foi a dos agentes de saúde com 49,2%, seguido dos auxiliares de enfermagem (16%), enfermeiros (14%), médicos (8,3%), dentistas (6,8%), auxiliares de saúde bucal (4,7%) e outro (1%). A estratégia de coping mais utilizada foi a reavaliação positiva (0,749), seguida da resolução de problemas (0,692). Quanto ao grupo de risco, a fuga-esquiva foi a forma de enfrentamento mais utilizada (0,806). DISCUSSÃO: Houve poucos estudos referentes ao estresse em profissionais da saúde da assistência primária até o momento. Este estudo, como outros no contexto da pandemia de 2019, mostrou que a reavaliação positiva, a resolução de problemas e a busca de apoio social foram as estratégias mais utilizadas pelos profissionais da saúde e as mulheres foram as mais afetadas por serem maioria atuantes na área da saúde. CONCLUSÃO: verificou-se que os profissionais da saúde utilizaram principalmente a reavaliação positiva e a resolução de problemas como formas de enfrentamento e que são necessárias medidas que ofereçam melhores condições de trabalho, treinamentos e valorização desses profissionais.

INTRODUCTION: With the COVID-19 pandemic, health professionals had to adopt coping strategies to deal with the stress caused by the pandemic. OBJECTIVE: to evaluate the coping strategies used by health professionals (doctors, dentists, nurses, nursing technicians) from the 52 Family Health units in the city of Piracicaba at the beginning of the pandemic. METHODOLOGY: This is a crosssectional observational study of a quantitative nature, in which 2 self-administered questionnaires were used: 1) on sociodemographic data consisting of 8 open questions: age, profession, time in public service, education, risk group, sex, marital status and number of children and 2) the Coping Inventory by Folkman and Lázarus (1985) containing 66 questions representing specific actions or thoughts used in a stressful situation. RESULTS: 198 health professionals participated in this research, after signing the free and informed consent form, in which 90.9% of the sample was female; 26.8% were in the risk group; 49% had up to the second level of schooling. The predominant professional category in the study was health agents with 49.2%, followed by nursing assistants (16%), nurses (14%), physicians (8.3%), dentists (6.8%), assistants oral health (4.7%) and another (1%). The most used coping strategy was positive reappraisal (0.749), followed by problem solving (0.692). As for the risk group, escape-avoidance was the most used form of coping (0.806). DISCUSSION: There have been few studies regarding stress in primary care health professionals to date. This study, like others in the context of the 2019 pandemic, showed that positive reassessment, problem solving and the search for social support were the strategies most used by health professionals and women were the most affected because they are the majority active in the area of health. CONCLUSION: It was found that health professionals mainly used positive reassessment and problem solving as ways of coping and that measures are needed to offer better working conditions, training and appreciation of these professionals

INTRODUCCIÓN: Con la pandemia de COVID-19, los profesionales de la salud debieron adoptar estrategias de afrontamiento para lidiar con el estrés causado por la pandemia. OBJETIVO: Evaluar las estrategias de enfrentamiento utilizadas por los profesionales de la salud (médicos, odontólogos, enfermeros, técnicos de enfermería) de las 52 unidades de Salud de la Familia del municipio de Piracicaba al inicio de la pandemia. METODOLOGÍA: Se trata de un estudio observacional transversal de carácter cuantitativo, en el que se utilizaron 2 cuestionarios autoadministrados: 1) sobre datos sociodemográficos constituidos por 8 preguntas abiertas: edad, profesión, tiempo en el servicio público, escolaridad, grupo de riesgo, sexo, estado civil y número de hijos y 2) el Inventario de Afrontamiento de Folkman y Lázarus (1985) que contiene 66 preguntas que representan acciones o pensamientos específicos utilizados en una situación estresante. RESULTADOS: 198 profesionales de la salud participaron de esta investigación, previa firma del formulario de consentimiento libre e informado, en el que el 90,9% de la muestra era del sexo femenino; el 26,8% estaban en el grupo de riesgo; el 49% tenía hasta el segundo nivel de escolaridad. La categoría profesional predominante en el estudio fue la de agentes de salud con 49,2%, seguida de auxiliares de enfermería (16%), enfermeros (14%), médicos (8,3%), odontólogos (6,8%), auxiliares de salud bucal (4,7%) y otro (1%). La estrategia de afrontamiento más utilizada fue la reevaluación positiva (0,749), seguida de la resolución de problemas (0,692). En cuanto al grupo de riesgo, el escape-evitación fue la forma de afrontamiento más utilizada (0,806). DISCUSIÓN: Hasta la fecha existen pocos estudios sobre el estrés en profesionales de salud de Atención Primaria. Este estudio, como otros en el contexto de la pandemia de 2019, mostró que la reevaluación positiva, la resolución de problemas y la búsqueda de apoyo social fueron las estrategias más utilizadas por los profesionales de la salud y las mujeres fueron las más afectadas por ser las mayoritarias activas en el área de salud. CONCLUSIÓN: Se constató que los profesionales de la salud utilizan principalmente la reevaluación positiva y la resolución de problemas como formas de enfrentamiento y que se necesitan medidas para ofrecer mejores condiciones de trabajo, capacitación y valorización de estos profesionales.