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Rev Bras Enferm ; 74Suppl 1(Suppl 1): e20200571, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33533804


OBJECTIVE: to report the experience of a health team in restructuring service at a mastology outpatient clinic. METHODS: an experience report in a public university service mastology outpatient in Ceará between March and April 2020. Service in this outpatient clinic is exclusively for women and who have breast changes for surgical treatments ranging from nodulectomies to mastectomies with oncoplastic. RESULTS: increased COVID-19 cases brought the need to restructure healthcare services. The following steps were followed: identification of scheduled patients, reading of clinical developments in electronic medical records, individual assessment to define whether or not appointment would remain, telephone contact to inform about unscheduling. Among the 555 consultations scheduled for March and April 2020, 316 (56.9%) were maintained. FINAL CONSIDERATIONS: restructuring consultations at a mastology outpatient clinic optimized the waiting time for consultations and avoided crowds at service, providing patient safety.

Instituições de Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/organização & administração , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , /terapia , Reestruturação Hospitalar/organização & administração , Serviços de Saúde da Mulher/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias
Am Fam Physician ; 103(4): 209-217, 2021 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-33587575


Health maintenance for women of reproductive age includes counseling and screening tests that have been demonstrated to prevent disease and improve health. This article focuses mainly on conditions that are more common in women or have a unique impact on female patients. Family physicians should be familiar with evidence-based recommendations for contraception and preconception care and should consider screening patients for pregnancy intention. The American Academy of Family Physicians recommends against screening pelvic examinations in asymptomatic women; the U.S. Preventive Services Task Force (USPSTF) found insufficient evidence to make a recommendation for or against screening pelvic examinations. The USPSTF recommendations for women in this age group include screening for obesity and other cardiovascular risk factors, depression, intimate partner violence, cervical cancer, HIV, hepatitis C virus, tobacco use, and unhealthy alcohol and drug use as part of routine primary care. Breast cancer screening with mammography is recommended for women 50 years and older and should be individualized for women 40 to 49 years of age, although other organizations recommend earlier screening. Screening for sexually transmitted infections is based on age and risk factors; women younger than 25 years who are sexually active should be screened routinely for gonorrhea and chlamydia, whereas screening for syphilis and hepatitis B virus should be individualized. Immunizations should be recommended according to guidelines from the Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practices; immunizations against influenza; tetanus; measles, mumps, and rubella; varicella; meningococcus; and human papillomavirus are of particular importance in women of reproductive age. To have the greatest impact on health, physicians should focus on USPSTF grade A and B recommendations with patients.

Detecção Precoce de Câncer/normas , Prática Clínica Baseada em Evidências/normas , Guias de Prática Clínica como Assunto , Serviços Preventivos de Saúde/normas , Reprodução , Serviços de Saúde da Mulher/normas , Saúde da Mulher , Adulto , Currículo , Educação Médica Continuada , Feminino , Humanos , Gravidez , Fatores de Risco , Estados Unidos
J Nurs Adm ; 51(2): 67-73, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33449595


This article describes one heath system's creation of a new women's health hospital using an innovative model integrating patient care delivery, Lean building design, and Lean integrated project methodology. The article describes a 5-year journey detailing the innovative process that guided the planning and implementation of the new care delivery model, as well as employee and leader roles, employee behavior and engagement, and key insights and lessons learned that will benefit nurse leaders.

Centros Comunitários de Saúde/organização & administração , Eficiência Organizacional , Assistência Centrada no Paciente/organização & administração , Melhoria de Qualidade/organização & administração , Criança , Feminino , Humanos , Estudos de Casos Organizacionais , Equipe de Assistência ao Paciente/organização & administração , Serviços de Saúde da Mulher/organização & administração
JAMA Netw Open ; 3(12): e2030214, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33337495


Importance: Sexual and reproductive health services are a primary reason for care seeking by female young adults, but the association of the 2010 Patient Protection and Affordable Care Act Dependent Coverage Expansion (ACA-DCE) with insurance use for these services has not been studied to our knowledge. Insurer billing practices may compromise dependent confidentiality, potentially discouraging dependents from using insurance or obtaining care. Objective: To evaluate the association between implementation of ACA-DCE and insurance use for confidential sexual and reproductive health services by female young adults newly eligible for parental coverage. Design, Setting, and Participants: For this cross-sectional study, a difference-in-differences analysis of a US national sample of commercial claims from January 1, 2007, to December 31, 2009, and January 1, 2011, to December 31, 2016, captured insurance use before and after policy implementation among female young adults aged 23 to 25 years (treatment group) who were eligible for dependent coverage compared with those aged 27 to 29 years (comparison group) who were ineligible for dependent coverage. Data were analyzed from January 2019 to February 2020. Exposures: Eligibility for parental coverage under the ACA-DCE as of 2010. Main Outcomes and Measures: Probability of insurance use for contraception and Papanicolaou testing. Emergency department and well visits were included as control outcomes not sensitive to confidentiality concerns. Linear probability models adjusted for age, plan type, annual deductible, comorbidities, and state and year fixed effects, with SEs clustered at the state level. Results: The study sample included 4 690 699 individuals (7 268 372 person-years), with 2 898 275 in the treatment group (mean [SD] age, 23.7 [0.8] years) and 1 792 424 in the comparison group (mean [SD] age; 27.9 [0.8] years). Enrollees in the treatment group were less likely to have a comorbidity (77.3% vs 72.9%) and more likely to have a high deductible plan (14.6% vs 10.1%) than enrollees in the comparison group. Implementation of the ACA-DCE was associated with a -2.9 (95% CI, -3.4 to -2.4) percentage point relative reduction in insurance use for contraception and a -3.4 (95% CI, -3.9 to -3.0) percentage point relative reduction in Papanicolaou testing in the treatment vs comparison groups. Emergency department and well visits increased 0.4 (95% CI, 0.2-0.7) and 1.7 (95% CI, 1.3-2.1) percentage points, respectively. Conclusions and Relevance: The findings suggest that implementation of the ACA-DCE was associated with a reduction in insurance use for sexual and reproductive health services and an increase in emergency department and well health visits by female young adults newly eligible for parental coverage. Some young people who gained coverage under the expansion may not be using essential, confidential services.

Cobertura do Seguro/tendências , Seguro Saúde , Serviços de Saúde Reprodutiva , Saúde Sexual , Serviços de Saúde da Mulher , Anticoncepção/estatística & dados numéricos , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Revisão da Utilização de Seguros , Seguro Saúde/organização & administração , Seguro Saúde/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Teste de Papanicolaou/estatística & dados numéricos , Patient Protection and Affordable Care Act , Serviços de Saúde Reprodutiva/economia , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Saúde Sexual/economia , Saúde Sexual/estatística & dados numéricos , Estados Unidos , Serviços de Saúde da Mulher/economia , Serviços de Saúde da Mulher/estatística & dados numéricos , Adulto Jovem
Nursing (Säo Paulo) ; 23(269): 4703-4706, out.2020.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1145384


Objetivo: Identificar os principais traumas em mulheres vítimas de violência física atendidas em um hospital público da cidade do Recife/PE. Métodos: Pesquisa descritiva, quantitativa e retrospectiva, desenvolvida em um hospital de Recife/PE no setor de Serviço de Arquivo Médico e Estatístico. Foram analisados dados de 152 prontuários quanto à pessoa, tipo de violência e trauma sofrido. Foi elaborado um questionário, e os dados foram analisados no Statistical Package for the Social Sciences versão 23.0. Resultados: Verificou-se que a idade média das mulheres era de 31,82 anos, 52,6% sofreram violência física/espancamento; 45,4% sofreram traumatismo cranioencefálico enquanto 23,7% tiveram politraumas. O traumatismo cranioencefálico foi o trauma mais frequente entre os casos de violência física/espancamento (58,8%) (p-valor: 0,001). Conclusão: À luz dos resultados foi constatado que a principal lesão traumática decorrente da violência foi o traumatismo cranioencefálico seguida por politraumas, acometendo mulheres jovens ­ 16 a 29 anos, principalmente vítimas de violência física/espancamento.(AU)

Objective: To identify the main traumas in women victims of physical violence treated at a public hospital in the city of Recife/PE. Methods: Descriptive, quantitative and retrospective research, developed in a hospital in Recife / PE in the Medical and Statistical Archive Service sector. Data from 152 medical records were analyzed regarding the person, type of violence and trauma suffered. A questionnaire was prepared, and the data were analyzed in the Statistical Package for the Social Sciences version 23.0. Results: It was found that the average age of women was 31.82 years, 52.6% suffered physical violence / beatings; 45.4% suffered traumatic brain injury while 23.7% had polytrauma. Head trauma was the most frequent trauma among cases of physical violence / beatings (58.8%) (p-value: 0.001). Conclusion: In light of the results, it was found that the main traumatic injury resulting from violence was traumatic brain injury followed by polytrauma, affecting young women - 16 to 29 years old, mainly victims of physical violence / beatings.(AU)

Objetivo: Identificar los principales traumas en mujeres víctimas de violencia física atendidas en un hospital público de la ciudad de Recife/PE. Métodos: Investigación descriptiva, cuantitativa y retrospectiva, desarrollada en un hospital en Recife/PE en el sector del Servicio de Archivo Médico y Estadístico. Se analizaron datos de 152 registros médicos con respecto a la persona, tipo de violencia y trauma sufrido. Se preparó un cuestionario y los datos se analizaron en el Statistical Package for the Social Sciences versión 23.0. Resultados: Se encontró que la edad promedio de las mujeres era de 31.82 años, el 52.6% sufría violencia física / palizas; El 45,4% sufrió una lesión cerebral traumática, mientras que el 23,7% tenía politraumatismos. El traumatismo craneoencefálico fue el traumatismo más frecuente entre los casos de violencia física / palizas (58.8%) (valor p: 0.001). Conclusión: À la luz de los resultados, se descubrió que la principal lesión traumática resultante de la violencia fue la lesión cerebral traumática seguida de politraumatismo, que afecta a mujeres jóvenes de 16 a 29 años, principalmente víctimas de violencia física / palizas.(AU)

Humanos , Feminino , Ferimentos e Lesões , Inquéritos e Questionários , Violência contra a Mulher , Violência de Gênero , Serviços de Saúde da Mulher , Assistência Ambulatorial
BMC Public Health ; 20(1): 1467, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993596


BACKGROUND: Breast cancer is one of the leading public health problem globally, especially in low-resource countries (LRCs). Breast cancer screening (BCS) services are an effective strategy for early determining of breast cancer. Hence, it is imperative to understand the utilisation of BCS services and their correlated predictors in LRCs. This study aims to determine the distribution of predictors that significantly influence the utilisation of BCS services among women in LRCs. METHODS: The present study used data on 140,974 women aged 40 years or over from 14 LRCs. The data came from country Demographic and Health Surveys (DHS) between 2008 and 2016. Multivariate logistic regression analysis was employed to investigate the significant predictors that influence the use of BCS services. RESULTS: The utilisation of BCS services was 15.41%, varying from 81.10% (95% CI: 76.85-84.73%) in one European country, to 18.61% (95% CI: 18.16 to 19.06%) in Asian countries, 14.30% (95% CI: 13.67-14.96%) in American countries, and 14.29% (95% CI: 13.87-14.74%). Factors that were significantly associated to increase the use of BCS services include a higher level of education (OR = 2.48), advanced age at first birth (> 25 years) (OR = 1.65), female-headed households (OR = 1.65), access to mass media communication (OR = 1.84), health insurance coverage (OR = 1.09), urban residence (OR = 1.20) and highest socio-economic status (OR = 2.01). However, obese women shown a significantly 11% (OR = 0.89) lower use of BSC services compared to health weight women. CONCLUSION: The utilisation of BCS services is low in many LRCs. The findings of this study will assist policymakers in identifying the factors that influence the use of BCS services. To increase the national BCS rate, more attention should be essential to under-represented clusters; in particular women who have a poor socioeconomic clusters, live in a rural community, have limited access to mass media communication, and are have a low level educational background. These factors highlight the necessity for a new country-specific emphasis of promotional campaigns, health education, and policy targeting these underrepresented groups in LRCs.

Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde da Mulher/estatística & dados numéricos , Saúde da Mulher/estatística & dados numéricos , Adulto , Idoso , Ásia , Neoplasias da Mama/epidemiologia , Europa (Continente) , Feminino , Educação em Saúde/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Estados Unidos
Obstet Gynecol ; 136(4): 739-744, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925622


Since 1970, the American College of Obstetricians and Gynecologists' Committee on American Indian and Alaska Native Women's Health has partnered with the Indian Health Service and health care facilities serving Native American women to improve quality of care in both rural and urban settings. Needs assessments have included formal surveys, expert panels, consensus conferences, and onsite program reviews. Improved care has been achieved through continuing professional education, recruitment of volunteer obstetrician-gynecologists, advocacy, and close collaboration at the local and national levels. The inclusive and multifaceted approach of this program should provide an effective model for collaborations between specialty societies and health care professionals providing primary care services that can reduce health disparities in underserved populations.

Ginecologia , Acesso aos Serviços de Saúde , Obstetrícia , Melhoria de Qualidade/organização & administração , Serviços de Saúde da Mulher , Feminino , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/tendências , Disparidades em Assistência à Saúde/etnologia , Humanos , Índios Norte-Americanos , Colaboração Intersetorial , Avaliação de Programas e Projetos de Saúde , Serviços de Saúde Rural/normas , Inquéritos e Questionários , Estados Unidos/epidemiologia , Serviços Urbanos de Saúde/normas , Populações Vulneráveis/etnologia , Serviços de Saúde da Mulher/organização & administração , Serviços de Saúde da Mulher/normas , Serviços de Saúde da Mulher/tendências
BMC Public Health ; 20(1): 1013, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590963


BACKGROUND: Migrants experience disparities in healthcare quality, in particular women migrants. Despite international calls to improve healthcare quality for migrants, little research has addressed this problem. Patient-centred care (PCC) is a proven approach for improving patient experiences and outcomes. This study reviewed published research on PCC for migrants. METHODS: We conducted a scoping review by searching MEDLINE, CINAHL, SCOPUS, EMBASE and the Cochrane Library for English-language qualitative or quantitative studies published from 2010 to June 2019 for studies that assessed PCC for adult immigrants or refugees. We tabulated study characteristics and findings, and mapped findings to a 6-domain PCC framework. RESULTS: We identified 581 unique studies, excluded 538 titles/abstracts, and included 16 of 43 full-text articles reviewed. Most (87.5%) studies were qualitative involving a median of 22 participants (range 10-60). Eight (50.0%) studies involved clinicians only, 6 (37.5%) patients only, and 2 (12.5%) both patients and clinicians. Studies pertained to migrants from 19 countries of origin. No studies evaluated strategies or interventions aimed at either migrants or clinicians to improve PCC. Eleven (68.8%) studies reported barriers of PCC at the patient (i.e. language), clinician (i.e. lack of training) and organization/system level (i.e. lack of interpreters). Ten (62.5%) studies reported facilitators, largely at the clinician level (i.e. establish rapport, take extra time to communicate). Five (31.3%) studies focused on women, thus we identified few barriers (i.e. clinicians dismissed their concerns) and facilitators (i.e. women clinicians) specific to PCC for migrant women. Mapping of facilitators to the PCC framework revealed that most pertained to 2 domains: fostering a healing relationship and exchanging information. Few facilitators mapped to the remaining 4 domains: address emotions/concerns, manage uncertainty, make decisions, and enable self-management. CONCLUSIONS: While few studies were included, they revealed numerous barriers of PCC at the patient, clinician and organization/system level for immigrants and refugees from a wide range of countries of origin. The few facilitators identified pertained largely to 2 PCC domains, thereby identifying gaps in knowledge of how to achieve PCC in 4 domains, and an overall paucity of knowledge on how to achieve PCC for migrant women.

Emigrantes e Imigrantes/estatística & dados numéricos , Assistência Centrada no Paciente/organização & administração , Refugiados/estatística & dados numéricos , Saúde da Mulher/estatística & dados numéricos , Adulto , Feminino , Humanos , Qualidade da Assistência à Saúde , Isolamento Social/psicologia , Apoio Social , Serviços de Saúde da Mulher/organização & administração
BMC Public Health ; 20(1): 921, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32532227


BACKGROUND: Screening programmes for cervical cancer, breast cancer and colorectal cancer have been implemented in many Western countries to reduce cancer incidence and mortality. Ethnic minority women are less likely to participate in cancer screening than the majority population. In worst case this can result in higher incidence rates, later diagnosis and treatment and ultimately inferior survival. In this paper we explored the perceptions about cancer and perceived barriers towards cancer screening participation among ethnic minority women in a deprived area in Denmark. METHODS: Interview study with ethnic minority women in a deprived area in Denmark. The interviews were transcribed verbatim followed by an inductive content analysis. RESULTS: Cancer was perceived as a deadly disease that could not be treated. Cancer screening was perceived as only relevant if the women had symptoms. Knowledge about cancer screening was fragmented, often due to inadequate Danish language skills and there was a general mistrust in the Danish healthcare system due to perceived low medical competences in Danish doctors. There was, however, a very positive and curious attitude regarding information about the Danish cancer screening programmes and a want for more information. CONCLUSION: Ethnic minority women did not have sufficient knowledge about cancer and the purpose of cancer screening. Perceptions about cancer screening were characterised by openness and the study showed positive and curious attitudes towards screening participation. The findings emphasise the importance of culturally adapted interventions for ethnic minority women in attempts to reduce inequality in screening participation.

Neoplasias da Mama/prevenção & controle , Detecção Precoce de Câncer/psicologia , Emigrantes e Imigrantes , Neoplasias dos Genitais Femininos/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Adulto , Neoplasias da Mama/etnologia , Dinamarca/epidemiologia , Grupos Étnicos , Feminino , Neoplasias dos Genitais Femininos/etnologia , Acesso aos Serviços de Saúde , Humanos , Entrevistas como Assunto , Fatores Socioeconômicos , Serviços de Saúde da Mulher
Can J Nurs Res ; 52(3): 194-198, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32517489


Midwives are being called to serve a growing population of vulnerable women, those with substance use disorders (SUDs). Increasing numbers of women across the lifespan are being diagnosed with SUDs. In addition, women with SUDs are experiencing very unique and distinct differences in stigma related to their substance use. This stigma is coming from varied sources and through many different forms including mislabeling, misinformation, the media, and a devalued maternal/child relationship. Mothers frequently experience different types of adverse health encounters during the perinatal and postpartum period that also contribute to stigma. Midwives are positioned to provide woman-centered care in a variety of practice settings as integral members of interprofessional teams. Midwives can decrease the stigma women with SUDs are experiencing while improving the health of women, mothers, and families worldwide.

Tocologia , Estigma Social , Transtornos Relacionados ao Uso de Substâncias/enfermagem , Transtornos Relacionados ao Uso de Substâncias/psicologia , Serviços de Saúde da Mulher/organização & administração , Adolescente , Adulto , Feminino , Humanos , Gravidez , Adulto Jovem
Sex Reprod Healthc ; 25: 100538, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32534228


Because of the COVID-19 Pandemic many problems have emerged in the organization of the National Health Systems. In Italy, a very serious problem is emerging which needs a rapid solution. Italian women are finding increasingly difficult to access abortion. These difficulties are related to the organizational changes that have occurred in many hospitals due to the emergency COVID-19. A possible solution would be to resort to the procedure of pharmacological abortion which, however, in Italy, is characterized by many limitations imposed by law. To protect the right to health of all women will need a reorganization of abortion procedures in Italy with implementation of telehealth services.

Aborto Legal , Infecções por Coronavirus , Acesso aos Serviços de Saúde , Pandemias , Pneumonia Viral , Serviços de Saúde da Mulher , Aborto Legal/legislação & jurisprudência , Aborto Legal/métodos , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Feminino , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/normas , Necessidades e Demandas de Serviços de Saúde , Humanos , Itália/epidemiologia , Inovação Organizacional , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Gravidez , Telemedicina , Serviços de Saúde da Mulher/organização & administração , Serviços de Saúde da Mulher/normas , Direitos da Mulher
Rev. esp. quimioter ; 33(3): 187-192, jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-197876


OBJETIVOS: La candidiasis vulvovaginal es una infección oportunista provocada por levaduras del género Candida. Los principales factores predisponentes son la gestación, los tratamientos con antibióticos y la diabetes mellitus. Candida albicans es la especie más frecuente, pero en países de África y Asia la frecuencia de Candida no C. albicans es más elevada. Hemos estudiado la distribución de las diferentes especies de Candida en mujeres españolas e inmigrantes. MATERIAL Y MÉTODOS: Estudio retrospectivo de los exudados vaginales recibidos en nuestro laboratorio durante los años 2015 a 2018. RESULTADOS: Se recibieron 2.283 estudios. Se detectó Candida spp. en el 25,7% en españolas y el 28,5% en extranjeras (la diferencia no es significativa). La tasa en inmigrantes es mayor que otras descritas en España. El 82,4% de los aislamientos correspondió a C. albicans. CONCLUSIONES: No hay diferencias significativas entre las tasas de los aislamientos de españolas versus extranjeras. Se observa una demanda proporcionalmente mayor de estudios en las mujeres inmigrantes

OBJECTIVES: Vulvovaginal candidiasis (VVC) is a common vaginal infection. Risk factors include diabetes, antibiotic use and pregnancy. Candida albicans is the most common species identified but non-C. albicans species appear to be more commonly associated with VVC in some Asian and African countries. We had studied the distribution of Candida species in Spanish and immigrants' women residents in Spain. MATERIAL AND METHODS: Retrospective study of vaginal yeast cultures between 2015 and 2018. RESULTS: A total of 2,283 vaginal yeast cultures were collected. Candida spp. was detected in 25.7% from Spanish women and in 28.5% from immigrants (no significant differences). Immigrants have higher rates of vaginal candidiasis compared other studies in Spain. C. albicans was the most common species isolated (82.4%). CONCLUSIONS: There were no differences in vaginal candidiasis rate between Spanish and immigrants' women. Immigrants consulted proportionally more compared with the Spanish women

Humanos , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Candida albicans/isolamento & purificação , Candidíase Vulvovaginal/epidemiologia , Vaginite/microbiologia , Candida/patogenicidade , Emigrantes e Imigrantes/estatística & dados numéricos , Serviços de Saúde da Mulher/estatística & dados numéricos , Estudos Retrospectivos