[Application of the cultural competence model in the experience of care in nursing professionals Primary Care]. / La aplicación del modelo de competencia cultural en la experiencia del cuidado en profesionales de Enfermería de Atención Primaria.

OBJECTIVE: To know the experiences and perceptions of nurses in providing care and health promotion, women belonging to groups at risk of social vulnerability, applying the model of cultural competence Purnell. DESIGN: Phenomenological qualitative study. LOCATION: Department of Health Elda. PARTICIPANTS: A total of 22 primary care professional volunteers. METHOD: Semi-structured interviews and focus groups with recording and content analysis, according to the theory model of cultural competence. RESULTS: Socio-cultural factors influence the relationship between professionals and users of the system. The subtle racism and historical prejudices create uncomfortable situations and mistrust. The language barrier makes it difficult not only communication, but also the monitoring and control of the health-disease process. The physical appearance and stereotypes are determining factors for primary care professionals. Although perceived misuse of health services are also talking about changes. The spiritual aspects of religious beliefs alone are taken into account in the case of Muslim women, not being considered as important in the case of Gypsy women and Romanian women. CONCLUSIONS: To provide quality care, consistent and culturally competent, it is necessary to develop training programs for professionals in cultural competence, to know the culture of other, and work without preconceived ideas, and ethnocentric; since the greater the knowledge of the cultural group being served, the better the quality of care provided.

Demographic and social profile of epilepsy in a vulnerable low-income population in Bogotá, Colombia. / Perfil demográfico y social de la epilepsia en una población vulnerable y de bajos recursos económicos en Bogotá, Colombia.

INTRODUCTION: Very few studies describe the demographic and social profile of epilepsy in vulnerable low-income populations. METHODS: Observational, descriptive, cross-sectional study prospectively recording data from all patients diagnosed with epilepsy who attended a specialist neurology consultation between January and March 2014. Data were analysed using descriptive epidemiology tools. RESULTS: A total of 107 patients were evaluated, of whom 24.2% were illiterate and only 10.2% had completed a higher education programme. Most of the patients (86.8%) had a low socioeconomic status; 73.8% were single and 76.7% were unemployed. The main risk factors for epilepsy in this population were recorded as follows: delayed psychomotor development (n=24, 22.4%), head trauma (n=16, 14.9%), and central nervous system infection (n=13, 12.1%). Most patients (70.1%) responded to antiepileptic drugs (controlled cases) and 15.4% (n=15) had drug-resistant epilepsy (refractory cases). CONCLUSION: The demographic and clinical profiles of the patients included in this study resemble those published for high-income populations; differences are mostly limited to aetiological classification and risk factors. The social profile of the patients evaluated in this study shows high rates of unemployment, illiteracy, and single marital status. These findings seem to be more frequent and prevalent in this group than in high income populations.

[RIU project: perceived changes by health agents and professionals after a health intervention in an urban area of socioeconomic disadvantage]. / Projecte RIU: cambios percibidos por agentes de salud y profesionales tras una intervención en salud en un barrio en situación de vulnerabilidad.

OBJECTIVE: To describe how health agents and professionals working in a community project perceive the changes related to the population health status and their use of health-care services after the RIU intervention in an urban area of socioeconomic disadvantage. DESIGN: A qualitative descriptive study based on individual and group interviews and participant observation conducted between October 2008-July 2009. LOCATION: Raval (Algemesí-Valencia) PARTICIPANTS: We selected by purposive sample 7 women health agents, all persons who completed the intervention, and 10 professionals for their involvement in the intervention. METHOD: We conducted a group interview with the women at 6 months and a group and 7 individuals interviews both at 9 months of intervention. We realized a thematic descriptive analysis from health promotion framework. We used participant observation in a meeting with professionals at 9 months and analyzed field notes as: appraisal project, detected changes, challenges and recommendations. RESULTS: Women acquired information about health, contraception, pregnancy and heath services; they noted changes in self-care and social skills and leadership; they internalized the role of health worker disseminating what they learned and showed improvement in self-esteem and social recognition. They caused changes in the people related on health care and access to services. Professionals didn't incorporate at their work the community perspective; they valued positively the project; professionals and women agreed on improving access and use of services and closeness population-professionals. CONCLUSIONS: RIU increases the capabilities of the participants, their social recognition and improves access and use of health services.

[Health-related quality of life in Chileans from vulnerable communes]. / Calidad de vida relacionada con la salud en chilenos de comunas vulnerables.

OBJECTIVE: The COVID-19 pandemic and the resulting social and health crisis impacted the well-being of the population. Health-related quality of life (HRQoL) could be affected, mainly in conditions of social vulnerability. The objective was to analyze the HRQoL and the psychometric properties of the EQ-5D instrument in adult Chilean population from vulnerable communes of the Metropolitan Region. METHOD: Cross-sectional study carried out during quarantine period April to June 2021. Five hundred adults residing in Chilean communes were selected and completed a structured questionnaire by video-call, including the EQ-5D instrument. Descriptive analyzes and confirmatory factor analyzes of the traditional reflective model were performed. RESULTS: The age of the sample was 36.36±12.41 years, the majority reported having a secondary education level and being employed. Regarding the EQ-5D instrument, the most affected dimensions were pain/discomfort and anxiety/depression. The global health status was 73.0±19.71 points. The model showed an adequate fit: χ2=6.992, p=0.221, CFI=0.996, TLI=0.993, RMSEA=0.028 (90% CI: 0.000-0.073) and SRMR=0.067. In addition, the items of the scale were good indicators of the construct of interest. CONCLUSIONS: In a pandemic context, the population was mostly affected by pain/discomfort and anxiety/depression. The EQ-5D instrument is a useful tool to estimate CRSV in the Chilean population in the context of pandemic. In addition, the psychometric evidence supports the dimensionality of the construct and the potential utility of decomposing its analysis.

[Personality traits associated with the substance consumption in young people in a context of vulnerability]. / Rasgos de la personalidad asociados al consumo de sustancias en jóvenes en contexto de vulnerabilidad.

OBJECTIVE: To analyze the patterns of alcohol and cannabis consumption, and their associated factors, in young people aged 16 and 21 in a context of vulnerability. METHOD: Cross-sectional study based on a pre-test questionnaire from an evaluation study, administered to a convenience sample of 365 young people from Social Guarantee Programs (SGP), or who attended activities of community entities from disadvantaged neighborhoods in Barcelona. Dependent variables were experimental, regular, and problematic alcohol and cannabis consumption, while independent variables were impulsivity, sensation seeking, expectations, and beliefs regarding drug use, social skills, and contextual variables. Associations were established using multivariate logistic regression models. RESULTS: The prevalence of intensive alcohol consumption (24.2% for binge drinking and 33.3% for binge drinking) and experimental (51.1%) and problematic cannabis use (12.9%) was higher in SGP students than entity youth. Likewise, they presented higher scores on the impulsivity scales, sensation seeking, expectations and beliefs favorable to alcohol consumption. In general, the prevalence of experimental alcohol consumption was higher in girls than in boys. Regular binge drinking was associated with intense sensations seeking (adjusted odds ratio [aOR]: 1.06; 95% confidence interval [95%CI]: 1.01-1.12), while attending SGP was associated with problematic cannabis use (aOR: 2.73; 95%CI: 1.26-5.89). Positive expectations to alcohol and cannabis use were associated with problematic substance use. CONCLUSION: Individual risk, linked to the higher risk trajectories of SGP students, is associated with a higher problematic consumption of alcohol and cannabis than in young people from community entities exposed to an environmental risk of high frequency of consumption.

[COVID-19 on migrants and ethnic minorities]. / COVID-19 en migrantes y minorías étnicas.

There are still few publications that analyse the effects on migrants or ethnic minorities of COVID-19 or of measures taken to curb this pandemic, although early studies point to a greater impact on black, asian and ethnic minority populations in the UK or on migrants in Mexico. In addition to barriers to access to information and health services, we consider it a priority to focus on their living conditions, particularly those in situations of vulnerability or social exclusion. People who are unemployed or with precarious jobs, without social benefits, in overcrowded conditions, may be more at risk of infection and not receiving adequate treatment. Confinement has predictably more negative impact on migrants in irregular administrative situations, victims of gender-based violence and those unable to comply with physical estrangement measures, such as refugees in camps or migrants under-living and settlements, without adequate hygienic conditions. Recommendations such as suspending deportations, extending or facilitating residence and work permits, closing detention centres for foreign persons, evacuating those in prisons and refugee camps or settlements have been applied unequally in different countries. Only a strong political commitment to global health equity can ensure the health of migrant populations and ethnic minorities, as well as their access to protection measures, information, medical testing and health services.Keywords: Migrants, COVID-19, Minority Groups, Vulnerable Populations, Social Determinants of Health.

[Long-acting reversible contraception methods in women under 26 years of age]. / Métodos anticonceptivos de larga duración en mujeres menores de 26 años.

OBJECTIVES: Long-acting reversible contraception (LARC) methods have proven their high safety and efficacy for pregnancy prevention and they are specially indicated in young and vulnerable population, but their use encounter barriers both between providers and users due to lack of information or to the economic cost. The aim of this study was to assess the use of two LARC methods, intrauterine device (IUD) and implant, in minors under 26 years old after giving an adequate contraceptive advice and subsidizing them in vulnerability situations. To analyze the population that chooses them, the side effects, the reasons for abandoning and the permanence time. MATERIAL AND METHODS: Retrospective descriptive study of IUD and implants inserted to minors under 26 years old from January 2016 to December 2019 at the Municipal Health Center of Usera belonging to Madrid Salud. Data is collected from n=266 women who started using IUD or implant. 87 copper IUD, 37 medicated IUD and 142 implants have been placed. RESULTS: Increased prescription of both methods, with significant implant use in the last year of the study. There has been vulnerability in 91.7% of women. The average age of IUD users is about 21.4 years, almost 2 years older than that of the implant and they have more children. The side effects frequency has been similar with both methods, being abnormal bleeding as the most frequent side effect. 31% of copper IUD, 32% of medicated IUD and 12% of implants have been removed early. The average permanence time was 19.3 months (SD=13.3), 89.1% remained at the end of the first year, 81.2% at two years and 77.4% at three years. CONCLUSIONS: An adequate contraceptive advice and free access are essential keys for increasing the LARC methods use in this particularly vulnerable population. Few and minor side effects and high continuity rate have been found, especially for the implant.

Variabilidad geográfica, inequidades en salud y letalidad por COVID-19 en Bariloche, Río Negro, 2020-2021 / Geographic variability, health inequities and lethality due to COVID-19 in Bariloche, Río Negro, 2020-2021

Resumen Introducción : El objetivo de este estudio fue exami nar cómo la variabilidad geográfica y los determinantes sociales de la salud influyen en la tasa de letalidad por COVID-19 en Bariloche. Métodos : Se utilizó una base de datos del Sistema Nacional de Vigilancia Epidemiológica para analizar los casos positivos de COVID-19 desde enero de 2020 hasta diciembre de 2021. Los datos se geo-codificaron y se incorporaron en un sistema de información geográfica (SIG). Se aplicó un marco de análisis en tres pasos para medir la inequidad en salud, utilizando indicadores socioeconómicos y de acceso a servicios. Se realizó un análisis multivariado para predecir la letalidad. Resultados : Se diagnosticaron un total de 25 020 casos de COVID-19 en Bariloche durante el período de estudio. La letalidad fue del 2.1%. Se observó una variabilidad significativa en indicadores socioeconó micos entre las diferentes delegaciones territoriales de la ciudad. Discusión : Los resultados mostraron inequida des en salud y una asociación entre determinantes sociales y letalidad por COVID-19 en Bariloche. Las personas que vivían en áreas con mayor vulnerabili dad socioeconómica presentaron un mayor riesgo de mortalidad. Estos hallazgos resaltan la importancia de abordar las inequidades en salud en la respuesta a una pandemia.

Abstract Introduction : The objective of this study was to ana lyze the geographic variability and the relationship between social determinants of health and COVID-19 lethality in Bariloche. Methods : A database from the National Epidemiologi cal Surveillance System was used to analyze COVID-19 positive cases from January 2020 to December 2021. The data were geocoded and incorporated into a geo graphic information system (GIS). A three-step analytical framework was applied to measure health inequity, us ing socioeconomic indicators and access to services. A multivariate analysis was conducted to predict fatality. Results : A total of 25 020 COVID-19 cases were diag nosed in Bariloche during the study period. The fatality rate was 2.1%. Significant variability in socioeconomic indicators was observed among different territorial delegations of the city. Discussion : The results showed health inequities and an association between social determinants and COVID-19 lethality in Bariloche. Individuals living in areas with higher socioeconomic vulnerability had a higher risk of mortality. These findings highlight the importance of addressing health inequities in a pan demic response.

Insegurança alimentar e insegurança hídrica domiciliar: um estudo de base populacional em um município da bacia hidrográfica do Rio Amazonas, Brasil / Food insecurity and household water insecurity: a population-based study in a municipality in the Amazon River basin, Brazil / Inseguridad alimentaria e inseguridad hídrica en los hogares: un estudio de base poblacional en un municipio de la cuenca hidrográfica del río Amazonas, Brasil

Resumo: Este estudo analisa a insegurança alimentar e os fatores a ela associados na área urbana de um município na bacia hidrográfica do Rio Amazonas, Amazônia Ocidental. Trata-se de pesquisa transversal, de base populacional, realizada de agosto a novembro de 2021, com 983 domicílios selecionados por amostragem probabilística estratificada. Empregou-se o modelo de regressão logística multinomial, adotando-se os seguintes critérios: valor de p < 20% na análise bivariada e valor de p < 5% para o ajuste multivariado. Os resultados das análises foram descritos como odds ratios (OR) e intervalo de 95% de confiança (IC95%). Foram significantemente associadas à insegurança alimentar leve ou moderada as seguintes variáveis: insegurança hídrica domiciliar, número de moradores ≥ 5 no domicílio, pertencer à classe socioeconômica D ou E, ter pai, mãe ou outro, como chefe da família e ter algum morador beneficiário do Programa Bolsa Família. No modelo de análise para a insegurança alimentar grave constatou-se que viver em insegurança hídrica domiciliar, pertencer à classe socioeconômica D ou E, ter pai, mãe ou outro chefe da família, e tendo este menos que 55 anos, e renda familiar menor que dois salários mínimos aumentaram as chances de insegurança alimentar grave, comparativamente àqueles em segurança alimentar. Em conclusão, verificou-se alta prevalência de insegurança alimentar no Município de Itapiranga, Amazonas, Região Norte do Brasil, associada à situação de vulnerabilidade social e econômica, à falta de serviços públicos e à insegurança hídrica domiciliar.

Abstract: This study analyzed food insecurity and associated factors in the urban area of a municipality in the Amazon River basin, Western Amazon. This is a cross-sectional population-based study conducted from August to November 2021 with 983 households selected by stratified probability sampling. A multinomial logistic regression model was used, adopting the following criteria: p-value < 20% in the bivariate analysis and p-value < 5% for the multivariate adjustment. The results of the analyses were described as odds ratio (OR) and 95% confidence interval (95%CI). The following variables were significantly associated with mild or moderate food insecurity: household water insecurity; number of residents ≥ 5 in the household; belonging to socioeconomic class D or E; having a father, mother or another as the head of the family; and having any resident as a beneficiary of the Brazilian Income Transfer Program. The analysis model for severe food insecurity showed that living with household water insecurity; belonging to socioeconomic class D or E; having a father, mother or another as the head of the family; age of the head of the family < 55 years; and family income lower that two minimum wages increased the chances of severe food insecurity when compared to those with food security. In conclusion, this study found a high prevalence of food insecurity in the Municipality of Itapiranga, State of Amazonas, North Region of Brazil, associated with social and economic vulnerability, lack of public services, and household water insecurity.

Resumen: Este estudio analiza la inseguridad alimentaria y los factores asociados, en el área urbana de un municipio de la cuenca hidrográfica del río Amazonas, Amazonia occidental. Se trata de una encuesta transversal, de base poblacional, realizada en el período de agosto a noviembre del 2021, con 983 hogares seleccionados mediante muestreo probabilístico estratificado. Se utilizó el modelo de regresión logística multinomial, adoptando los siguientes criterios: valor de p < 20% en el análisis bivariado y valor de p < 5% para el ajuste multivariado. Los resultados de los análisis se describieron como odds ratios (OR) e intervalo de 95% de confianza (IC95%). Las siguientes variables se asociaron significativamente con la inseguridad alimentaria leve o moderada: inseguridad hídrica en el hogar, número de residentes ≥ 5 en el hogar, pertenecer a la clase socioeconómica "D" o "E", tener padre, madre u otra persona como cabeza de familia y tener a algún residente como beneficiario del Programa Bolsa Familia. En el modelo de análisis para la inseguridad alimentaria severa se encontró que vivir en hogar con inseguridad hídrica, pertenecer a la clase socioeconómica D o E, tener padre, madre u otra persona como cabeza de familia, edad del jefe de familia < 55 años, y un ingreso familiar más bajo que dos salarios mínimos aumentó las probabilidades de sufrir inseguridad alimentaria grave, en comparación con aquellos en situación de seguridad alimentaria. En conclusión, se constató una alta prevalencia de inseguridad alimentaria en el Municipio de Itapiranga, en el interior del Amazonas, Región Norte de Brasil, asociada a la situación de vulnerabilidad social y económica, a la falta de servicios públicos y a la inseguridad hídrica de los hogares.

Cross-cultural nursing care for immigrant women during pregnancy and childbirth: experiences and vulnerabilities / Cuidado transcultural de enfermería para la mujer inmigrante durante el embarazo y el parto: experiencias y vulnerabilidades / Cuidado transcultural de enfermagem à mulher imigrante na gestação e parto: experiências e vulnerabilidades

ABSTRACT Objective: To understand the experiences and vulnerabilities for cross-cultural nursing care for immigrant women during pregnancy and delivery. Method: Exploratory, qualitative research, in the light of the Theory of Diversity and Universality of Cultural Care, in Foz do Iguaçu, Brazil, through interviews with eight postpartum woman and 18 nurses, between February and September 2022. The interpretation of meanings was adopted for analysis. Results: The categories of analysis emerged: Experiences, vulnerabilities and acculturation of immigrant women during pregnancy and delivery; Cross-cultural care and vulnerabilities experienced by immigrants in Brazilian health services. Vulnerabilities were identified in Cultural and Social Structure Dimensions expressed in access to work, low socioeconomic conditions, lack of family and social support and specific services for this population. The potentialities experienced included good care provided by health services, quality of the multidisciplinary team and appreciation of professional knowledge, however, the understanding of expectations and cultural aspects needs to be deepened. Final considerations: Understand that immigrant women experience situations of vulnerability in pregnancy and childbirth, in the Brazilian context, mainly related to social and programmatic dimensions. However, potentialities were also experienced, evidenced by positive aspects in cross-cultural nursing care in Brazil.

RESUMEN Objetivo: Comprender las experiencias y vulnerabilidades de la atención de enfermería transcultural a mujeres inmigrantes durante el embarazo y parto. Método: Investigación cualitativa, exploratoria, basada en la Teoría de la Diversidad y Universalidad del Cuidado Cultural, realizada en Foz do Iguazú, Brasil, a través de entrevistas con ocho madres y 18 enfermeras, entre febrero/septiembre de 2022. Se adoptó la interpretación de significados para el análisis. Resultados: Emergieron las categorías de análisis: Experiencias, vulnerabilidades y aculturación de mujeres inmigrantes durante el embarazo y parto; Atención transcultural y vulnerabilidades vividas por inmigrantes en los servicios de salud brasileños. Se identificaron vulnerabilidades en las Dimensiones de Estructura Cultural y Social expresadas en acceso al trabajo, bajas condiciones socioeconómicas, falta de apoyo familiar y social y de servicios específicos para esta población. Las potencialidades vividas incluyeron: buena atención en los servicios de salud, calidad del equipo multidisciplinario y valoración del conocimiento profesional, sin embargo, es necesario profundizar la comprensión de las expectativas y los aspectos culturales. Consideraciones finales: Se entendió que las mujeres inmigrantes vivieron situaciones de vulnerabilidad durante el embarazo y el parto, en el contexto brasileño, principalmente relacionadas con dimensiones sociales y programáticas. Sin embargo, también se experimentaron potencialidades, evidenciadas por aspectos positivos en la atención de enfermería transcultural en Brasil.

RESUMO Objetivo: Compreender as experiências e as vulnerabilidades para o cuidado transcultural de enfermagem à mulher imigrante na gestação e parto. Método: Pesquisa exploratória, qualitativa, à luz da Teoria da Diversidade e Universalidade do Cuidado Cultural, realizada em Foz do Iguaçu, Brasil, mediante entrevistas com oito puérperas e 18 enfermeiros,entre fevereiro e setembro de 2022. Adotou-se, para análise, a interpretação de sentidos. Resultados: Emergiram as categorias: Experiências, vulnerabilidades e aculturação da mulher imigrante na gestação e parto; Cuidado transcultural e vulnerabilidades experienciadas pela imigrante em serviços de saúde brasileiros. Vulnerabilidades foram identificadas nas Dimensões Culturais e de Estrutura Social expressas no acesso ao trabalho, baixas condições socioeconômicas, falta de suporte familiar, social e serviços específicos para essa população. As potencialidades experienciadas incluíram: bom atendimento nos serviços de saúde, qualidade da equipe multiprofissional e valorização do saber profissional; entretanto a compreensão das expectativas e dos aspectos culturais precisam ser aprofundados. Considerações finais: Compreendeu-se que as mulheres imigrantes experienciaram situações de vulnerabilidade na gestação e parto, no contexto brasileiro, principalmente relacionadas às dimensões sociais e programáticas. Contudo, potencialidades também foram experienciadas, evidenciadas pelos aspectos positivos no cuidado transcultural de enfermagem no Brasil.

Relação entre apoio social e sono de pessoas idosas cuidadoras em vulnerabilidade social / Relationship between social support and sleep of elderly caregivers in social vulnerability / Relación entre apoyo social y sueño de adultos mayores cuidadores con vulnerabilidad social

Objetivo: analisar a relação entre apoio social e qualidade do sono de pessoas idosas que cuidam de outros idosos em ambiente de vulnerabilidade social. Método: estudo transversal realizado com 65 cuidadores entrevistados por meio de instrumento de caracterização, Índice de Katz, Escala de Lawton e Brody, Índice de Qualidade do Sono de Pittsburgh e Escala de Apoio Social do Medical Outcomes Study, com dados analisados com testes de comparação e de correlação. Resultados: a maioria eram mulheres, cônjuges do idoso cuidado e possuíam sono de má qualidade. Observou-se correlação fraca e inversa entre má qualidade do sono e a dimensão interação social positiva (Rho=-0,27; p=0,028). Identificou-se relação significativa entre: apoio material e disfunção diurna (p=0,034); apoio afetivo e eficiência do sono (p=0,026); interação social positiva e qualidade subjetiva do sono (p=0,001) e disfunção diurna (p=0,008). Conclusão: Quanto maior a interação social positiva, melhor é a qualidade do sono.

Objective: to analyze the relationship between social support and sleep quality of elderly individuals who care for other elderly individuals in a socially vulnerable environment. Method: a cross-sectional study conducted with 65 caregivers interviewed using a characterization instrument, Katz Index, Lawton and Brody Scale, Pittsburgh Sleep Quality Index, and Medical Outcomes Study Social Support Scale, with data analyzed using comparison and correlation tests. Results: the majority were women, spouses of the elderly being cared for, and had poor sleep quality. A weak and inverse correlation was observed between poor sleep quality and the positive social interaction dimension (Rho=-0.27; p=0.028). Significant relationships were identified between: material support and daytime dysfunction (p=0.034); emotional support and sleep efficiency (p=0.026); positive social interaction and subjective sleep quality (p=0.001), as well as daytime dysfunction (p=0.008). Conclusion: The higher the positive social interaction, the better the sleep quality.

Objetivo: analizar la relación entre el apoyo social y la calidad del sueño de personas mayores que cuidan de otras personas mayores en entornos socialmente vulnerables. Método: estudio transversal realizado con 65 cuidadores entrevistados mediante un instrumento de caracterización, Índice de Katz, Escala de Lawton y Brody, Índice de Calidad del Sueño de Pittsburgh y Escala de Apoyo Social del Medical Outcomes Study, los datos fueron analizados mediante pruebas de comparación y correlación. Resultados: la mayoría eran mujeres, cónyuges del adulto mayor que recibe el cuidado y tenían mala calidad del sueño. Se observó una correlación débil e inversa entre la mala calidad del sueño y la dimensión de interacción social positiva (Rho=-0,27; p=0,028). Se identificó que había relación significativa entre: apoyo material y disfunción diurna (p=0,034); apoyo afectivo y eficiencia del sueño (p=0,026); interacción social positiva y calidad subjetiva del sueño (p=0,001) y disfunción diurna (p=0,008). Conclusión: Cuanto mayor sea la interacción social positiva, mejor será la calidad del sueño.

Social protection in areas vulnerable to tuberculosis: a mixed methods study in São Luís, Maranhão / Protección social en zonas vulnerables a la tuberculosis: un estudio mixto en São Luís, Maranhão / Proteção social em áreas vulneráveis à tuberculose: um estudo misto em São Luís, Maranhão

ABSTRACT Objectives: to analyze the risk areas for tuberculosis and the influences of social protection on the development of treatment for the disease in the municipality of São Luís, Maranhão. Methods: this is explanatory sequential mixed method research. In the quantitative phase, the data were obtained from the Notifiable Diseases Information System from 2010 to 2019, with georeferencing being carried out to identify areas vulnerable to tuberculosis. In the qualitative phase, semi-structured interviews were carried out with individuals who received social benefits. Results: 7,381 cases were geocoded, and, from the purely spatial scanning analysis, it was possible to identify 13 spatial clusters of risk. As for the interviews, there was a positive relationship between patient improvement and receiving benefits. Conclusions: geographic space and social determinants are relevant for reorienting monitoring actions for the conditions that generate the health-disease process.

RESUMEN Objetivos: analizar las áreas de riesgo para la tuberculosis y las influencias de la protección social en el desarrollo del tratamiento de la enfermedad en el municipio de São Luís, Maranhão. Métodos: se trata de una investigación explicativa de método mixto secuencial. En la fase cuantitativa, los datos se obtuvieron del Sistema de Información de Enfermedades de Declaración Obligatoria del 2010 al 2019, realizándose georreferenciación para identificar áreas vulnerables a la tuberculosis. En la fase cualitativa se realizaron entrevistas semiestructuradas a personas que recibían beneficios sociales. Resultados: se geocodificaron 7.381 casos y, a partir del análisis de escaneo puramente espacial, fue posible identificar 13 grupos espaciales de riesgo. En cuanto a las entrevistas, hubo una relación positiva entre la mejora del paciente y la recepción de beneficios. Conclusiones: el espacio geográfico y los determinantes sociales son relevantes para reorientar las acciones de seguimiento de las condiciones que generan el proceso salud-enfermedad.

RESUMO Objetivos: analisar as áreas de risco para a tuberculose e as influências da proteção social no desenvolvimento do tratamento para a doença no município de São Luís, Maranhão. Métodos: trata-se de pesquisa de método misto sequencial explanatório. Na fase quantitativa, os dados foram obtidos do Sistema de Informação de Agravos de Notificação de 2010 a 2019, sendo realizado georreferenciamento para identificação das áreas vulneráveis à tuberculose. Na fase qualitativa, realizaram-se entrevistas semiestruturadas com indivíduos que recebiam benefício social. Resultados: foram geocodificados 7.381 casos, e, a partir da análise de varredura puramente espacial, foi possível identificar 13 aglomerados espaciais de risco. Quanto às entrevistas, verificou-se uma relação positiva entre a melhora dos pacientes e o recebimento de benefícios. Conclusões: o espaço geográfico e os determinantes sociais são relevantes para reorientação das ações de monitoramento das condições geradoras do processo saúde-doença.

The context of homeless people who live with ostomies / O contexto de pessoas em situação de rua que vivem com estomias / El contexto de las personas callejeras que viven con estomías

Objetivo: Comprender el contexto vivido por personas sin hogar, con estomías, en un municipio del sur de Brasil. Método: Se realizó un estudio etnográfico cualitativo, cuya muestra estuvo conformada por cuatro personas, la recolección de datos se realizó de mayo a junio de 2022. Se utilizó observación participante, diario de campo, datos de historias clínicas y entrevistas. Resultados: En relación al perfil de los participantes, la mayoría eran adultos jóvenes, hombres y usuarios de drogas. Todos los participantes tenían hijos y recibían asistencia del gobierno. El tiempo promedio de vida con una estomía fue de dos años y el motivo principal fueron las heridas por arma de fuego. Buscamos conocer y comprender las características y condiciones de salud de esas personas, desde el contexto del sistema de salud brasileño y la forma como se organizan los servicios de atención. Conclusión: Se encontró que, además de la vulnerabilidad de estar en la calle, su contexto de vida tiene consecuencias sociales y mentales, siendo notable la invisibilidad de esas personas en la sociedad y en la red de atención de salud. (AU)

Objetivo: Conhecer o contexto vivenciado por pessoas em situação de rua com estomias em um município do Sul do Brasil. Método: Estudo qualitativo etnográfico, cuja amostra foi constituída por quatro pessoas e cuja coleta de dados ocorreu de maio a junho de 2022, por meio de observação participante, diário de campo, dados de prontuários e entrevistas. Resultados: Em relação ao perfil dos participantes, a maioria deles é adultos jovens, do sexo masculino e usuários de drogas. Todos os participantes possuíam filhos e recebiam auxílio do governo. A média de tempo com estomia é de dois anos, e o motivo principal foi ferimento por arma de fogo. Buscou-se conhecer e entender as características e as condições de saúde dessas pessoas, visualizadas a partir do contexto do sistema de saúde brasileiro e na forma como os serviços se organizam para atendimentos. Conclusão: Constatou-se que, além da situação de vulnerabilidade por estarem na rua, o contexto de vida dessas pessoas acarreta consequências sociais e mentais, e é marcante sua invisibilidade na sociedade e na rede de atenção à saúde. (AU)

Objective: To understand the context experienced by homeless people, with ostomies, in a municipality in southern Brazil. Method: A qualitative ethnographic study, whose sample consisted of four individuals. Data collection took place from May to June 2022. Participant observation, field diary, data from medical records, and interviews were used. Results: Regarding the participants' profile, the majority are young adults, male, and drug users. All participants had children and received government assistance. The average duration of living with an ostomy was two years and the primary reason was gunshot wounds. The aim was to understand the characteristics and health conditions of these individuals, viewed within the context of the Brazilian healthcare system and the way services are organized to provide care. Conclusion: It was found that in addition to the vulnerability of being homeless, their life context leads to social and mental consequences, and the invisibility of these individuals within society and the healthcare network is remarkable. (AU)

Acesso e qualidade da alimentação: percepção da população em situação de rua / Acceso y calidad de la alimentación: percepción de personas en situación de calle / Access to food and food quality: perception of the homeless population

Resumo Objetivo Compreender a percepção do acesso e da qualidade da alimentação para a população em situação de rua. Métodos Estudo descritivo qualitativo, realizado em um Centro de Referência da População de Rua na região centro-sul de Belo Horizonte (MG). Utilizou-se roteiro semiestruturado para a realização das entrevistas de 18 participantes. A coleta de dados ocorreu entre dezembro de 2020 e janeiro de 2021. A análise temática do material, proposta por Bardin, possibilitou a elaboração de três categorias empíricas. Resultados O público entrevistado era masculino, com idade média de 43 anos e tempo médio de situação de rua de 44,6 meses. O acesso à alimentação foi proveniente das doações de alimentos, refeições em instituições governamentais e aquisições ao dispor de renda. Foram relatadas dificuldades quanto à quantidade e qualidade dos alimentos, à aquisição das refeições nos fins de semana, aos sentimentos de medo e angústia perante a fome, à falta do alimento e pelo estigma social, agravados pela COVID-19. Conclusão Diante do cenário de iniquidades sociais, o direito ao acesso à alimentação não é garantido, sendo necessária a implementação de políticas públicas de proteção social que garantam os direitos básicos.

Resumen Objetivo Comprender la percepción del acceso y de la calidad de la alimentación según personas en situación de calle. Métodos Estudio descriptivo cualitativo, realizado en un Centro de Referencia de Personas de la Calle en la región centro-sur de Belo Horizonte (Minas Gerais). Se utilizó un guion semiestructurado para realizar entrevistas a 18 participantes. La recopilación de datos se realizó entre diciembre de 2020 y enero de 2021. El análisis temático del material, propuesto por Bardin, permitió la elaboración de tres categorías empíricas. Resultados El público entrevistado era masculino, de 43 años de edad promedio y tiempo promedio de situación de calle de 44,6 meses. El acceso a la alimentación fue proveniente de donaciones de alimentos, comidas en instituciones gubernamentales y adquisiciones al disponer de ingresos. Las personas relataron dificultades con relación a la cantidad y calidad de los alimentos, a la adquisición de comida los fines de semana, a los sentimientos de miedo y angustia ante el hambre, a la falta de alimentos y al estigma social, agravados por el COVID-19. Conclusión Ante el escenario de iniquidades sociales, el derecho al acceso a la alimentación no está garantizado, por lo cual es necesario implementar políticas públicas de protección social que garanticen los derechos básicos.

Abstract Objective To understand the perception of access to food and food quality for the street population. Methods This qualitative descriptive study was performed in a Reference Center for the Homeless Population in the south-central region of Belo Horizonte (MG). A semi-structured script was used to conduct interviews with 18 participants. Data collection occurred between December 2020 and January 2021. The thematic analysis of the material, as proposed by Bardin, made it possible to elaborate three empirical categories. Results The public interviewed was male, with a mean age of 43 years, and a mean time on the streets of 44.6 months. Access to food came from donations, meals at government institutions, and acquisition when income was available. Difficulties were reported regarding the quantity and quality of food, acquisition of meals on weekends, feelings of fear and anguish in the face of hunger, lack of food, and social stigma, which were aggravated by COVID-19. Conclusion As in this scenario of social inequalities the access to food is not guaranteed, implementing public policies of social protection is necessary to guarantee basic rights.

Vulnerabilidad sobrevenida. El impacto social de la Covid-19 / Successful vulnerability. The social impact of Covid-19

Las crisis sanitarias, así como las medidas adoptadas para hacerles frente, pueden aumentar las desigualdades. Este estudio quiere ahondar sobre el impacto social que ha tenido la crisis sanitaria de la COVID-19. Objetivos: 1. Identificar aquellas personas, grupos o familias más vulnerables y aquellas a las que les ha afectado especialmente la crisis del COVID-19; 2. Describir en profundidad la situación que han vivido y cómo la han afrontado; 3. Conocer qué dificultades han encontrado para solicitar las ayudas del Gobierno. Métodos: Estudio cualitativo que forma parte de un estudio más amplio cuantitativo, que combinó una encuesta telefónica con un estudio geográfico. Se entrevistaron 1.321 personas mediante un cuestionario semiestructurado con algunas preguntas abiertas, de las cuales se seleccionaron 243 para su análisis cualitativo. Se realizaron 8 entrevistas en profundidad. Resultados: El impacto de la pandemia se ha reflejado en forma de malestar psicológico. Algunas familias han tenido que cambiar de vivienda, comunidad autónoma e incluso volver a la vivienda de sus padres. Se han observado grandes dificultades para las familias con personas dependientes (mayores, con discapacidad, hijos e hijas); monoparentales; para familias cuyo sustento básico son pensiones no contributivas y para las personas solas. Los Servicios Sociales han sido un gran apoyo, aunque se ha percibido falta de coordinación entre estos y las diferentes instituciones. Conclusiones: Dadas las características de esta pandemia, algunos grupos no vulnerables se han encontrado con dificultades, no han podido hacer frente a la situación, y los que ya eran vulnerables han aumentado su vulnerabilidad. (AU)

Objectives: 1) To rank more vulnerable people, groups, or households in relation to how the COVID-19 crisis has affected them; 2) To describe the circumstances experienced during the COVID-19 crisis, the way to dealt with, and the success in handling them; 3) To identify the difficulties when applying for government aid. Methods: It was a qualitative study that was part of a broader quantitative study, combining a telephone survey with a geographical study. We phone surveyed 1321 persons using a semi-structured questionnaire with some open questions. From them, 243 we selected for qualitative analysis. Afterwards, we conducted eight in-depth interviews. Results: The COVID-19 crisis caused psychological discomfort. The drawback most frequently reported has been the need to move into worse homing conditions, which include moving to other neighbourhoods or regions, or sharing with relatives (typically, moving into parent’s home). The households more frequently reporting difficulties have been those with dependent persons (young children, elderly or disabled people), single-parents households, households receiving basic subsidy only, and singles living alone. In most cases, Social Services have helped to dealt with the effects of COVID -19 crisis. However, coordination between different institutions should be improved. Conclusions: Given the characteristics of this pandemic and the impossibility of anticipating it, people already socially vulnerable have encountered special difficulties in dealing with the COVID-19 crisis, have been unable to cope with them, and have worsened their degree of vulnerability. (AU)

Contexto, ser humano y epigenética / Context, human being and epigenetics

Resumen Los últimos años de investigación científica han visto un crecimiento en los estudios que relacionan situaciones de vulnerabilidad (particularmente, durante la vida temprana) con el desarrollo de psicopatologías. Tales disfuncionalidades en la salud mental y en las emociones entienden una sinergia entre factores contextuales y la biología del organismo. Lo que da en llamarse "puente" entre ambas instancias es estudiado por un área de la investigación científica relativamente nueva: la epigenética. La epigenética fue establecida como un interesante factor que permite relacionar, desde un punto de vista biológico, el contexto en que se desarrollan las personas con sus estados emocionales. Este artículo se propone revisar algunos trabajos e integrarlos dentro de una concepción compleja del ser humano, que lo entiende como un sistema de relaciones entre diversas dimensiones que incluyen las esferas genéticas, epigenéticas, neurológicas, emocionales, interaccionales, cognitivas y socioculturales enmarcadas en un contexto particular.

Abstract The discovery of the whole sequence of the human genome in 2001 promised to be a revolution in terms of dealing with diseases and understanding what makes us a "different" species from other animals. However, the scope of this promising discovery was more limited than expected. The information carried by DNA is complex and, furthermore, it does not explain the vast repertoire of functions and dysfunctions that organisms present. For this reason, it began to be thought that it was necessary to change the focus to understand how individuals are formed and develop, and turn the attention paid to DNA to what surrounds that DNA: the environment of the organism (both internal and external). In this way, the studies began to focus on the influence of the context to which organisms are exposed to understand the characteristics of the body and its actions. In thinking about the concept of the body in development, this renewed focus in the environmental influence allows an understanding of it as a permeable and complex system, where dysregulations (diseases) may also be triggered by exogenous events and not only from the endogenous factors. Therefore, in a recursive way, the influence of the human being on the environment transforms the environment that returns to influence the human being. Here is the history of mankind. There are contexts that offer a healthy framework for the growth of its inhabitants and there are others that make life vulnerable and produce lifetime consequences. However, while some people are and feel vulnerable to contexts of adversity, other people are resilient and manage to positively live and growth despite the difficulties that might appear throughout life. Epigenetics has been proposed as one of the molecular mechanisms that explain how those contexts "get under the skin" and trigger phenotypic characteristics. Although the regulation of gene expression by epigenetic mechanisms occurs naturally and constantly in the developing organism, it can also be influenced by environmental factors, such as age, lifestyle, health conditions or social relationships. Epigenetics is sensitive to environmental changes allowing organisms to adapt their physiology and behavior. Unlike the changes that occur in the DNA sequence, epigenetic processes are reversible. One of the most known examples of epigenetic action in determining phenotypes according to the environment is the stress response through the hypothalamus-pituitary-adrenal (HPA) axis. The functioning of the HPA axis and the response to stress can be related to the concepts of vulnerability and trauma. If an emotionally sensitive event is disturbing, it becomes a stressful situation, with the activation of the HPA axis, flooding the bloodstream with cortisol. This allostatic process is the basis of the mechanism of adaptability of humans to traumatic impacts. But if the situation continues to impact, allostasis is systematized and generates an allostatic circuit that produces a residual charge that ends up creating dysfunction in the organism. In this article the involvement of epigenetics in this regulation is discussed and some seminal studies in rodents and humans are presented. The last few years of scientific research have seen an explosive growth of studies linking situations of vulnerability (particularly, during early life) with the development of psychopathologies. Epigenetics was established as an interesting factor that allows to relate, from a biological point of view, the context in which people develop with their emotional states. This article proposes a review of some of these works in order to integrate them into a complex conception of the human being, which understands it as a system of relationships between various dimensions, including genetics, epigenetics, neurology, emotions, social interactions, cognition, and socio-culture, framed in a particular context.

Análise comparativa de classificações de vulnerabilidade para municípios g100 / Comparative analysis of vulnerability ratings for g100 municipalities / Análisis comparativo de calificaciones de vulnerabilidad de municipios g100

Resumo Em 2009, a Frente Nacional de Prefeitos (FNP) denominou g100 um grupo de municípios caracterizados por possuir mais de 80 mil habitantes, baixos níveis de receita pública per capita e alta vulnerabilidade socioeconômica. Este estudo buscou descrever o g100 a partir da posição comparativa segundo três medidas de vulnerabilidade socioeconômica aplicadas aos municípios com mais de 80 mil habitantes, discutindo a pertinência do uso da proposta da FNP como critério de priorização em políticas sociais. Comparou-se a listagem dos 100 primeiros municípios g100 com aquelas do Índice do Desenvolvimento Humano Municipal (IDHM), Índice de Vulnerabilidade Social (IVS) e Índice Brasileiro de Privação (IBP). Identificou-se que 25 municípios classificados como g100 não estavam entre os 100 primeiros nos demais índices; mas 46 municípios g100 encontravam-se entre os mais vulneráveis nas três medidas. Discute-se a necessidade de amplo debate e consenso sobre as medidas de vulnerabilidade socioeconômica empregadas no planejamento e execução de políticas públicas. Esta reflexão está ancorada na defesa de que as ações e políticas públicas sejam intrinsicamente planejadas para garantia de maior equidade geográfica e alocativa em face da efetividade de resposta às demandas da população.

Abstract In 2009, the Frente Nacional de Prefeitos (FNP) named a group of municipalities with more than 80,000 inhabitants, low levels of public revenue per capita and high socioeconomic vulnerability g100. This study sought to describe the g100 from the comparative position according to three measures of socioeconomic vulnerability applied to municipalities with more than 80,000 inhabitants, and to discuss the pertinence of using the FNP proposal as a suggestion for prioritization in social policies. Comparing the list of the first 100 g100 municipalities with the indices: Municipal Human Development Index (HDIM), Social Vulnerability Index (IVS) and Brazilian Deprivation Index (IBP), we identified 25 municipalities classified as g100 that were not classified among the top 100 in the other indices; but 46 g100 counties were among the most considered in all three measures. The need for broad debate and consensus on measures of socioeconomic vulnerability used in the planning and execution of public policies is discussed. This reflection is based on the belief that public actions and policies are intrinsically implemented to guarantee greater geographic and allocative equity in order to respond to the demands of the population.

Resumen En 2009, el Frente Nacional de Alcaldes (FNP) nombró como g100 a un grupo de municipios caracterizados por tener más de ochenta mil habitantes, bajos niveles de ingreso público per cápita y alta vulnerabilidad socioeconómica. Este estudio buscó describir el g100 a partir de la posición comparativa según tres medidas de vulnerabilidad socioeconómica aplicadas a municipios con más de ochenta mil, y a partir de ahí discutir la pertinencia de utilizar la propuesta del FNP como sugerencia de priorización en las políticas sociales. Para ello se comparó la lista de los primeros cien municipios del g100 con los índices de desarrollo humano municipal (HDIM), de vulnerabilidad social (IVS) y brasileño de privación (IBP). Se identificó que 25 municipios clasificados como g100 no estaban clasificados entre los 100 primeros en los demás índices, aunque 46 estuvieron entre los más considerados en las tres medidas. Se discute la necesidad de un amplio debate y consenso sobre las medidas de vulnerabilidad socioeconómica utilizadas en la planificación y ejecución de políticas públicas. Esta reflexión se ancla en la defensa de que las acciones y políticas públicas se inician intrínsecamente para garantizar una mayor equidad geográfica y distributiva frente a la obediencia para responder a las demandas de la población.

Representaciones sociales del desastre natural para las madres damnificadas de una comunidad urbano-marginal de Lima, Perú / Social Representations of Natural Disasters for Affected Women from an Urban-Marginal Community in Lima, Peru

Introducción: Los desastres naturales generan un impacto negativo en la salud y vida de la población; sin embargo, existen escasos estudios cualitativos que aborden su repercusión en la vida, la salud mental y el imaginario de los afectados. Objetivo: Caracterizar las representaciones sociales del desastre natural que tienen las madres damnificadas del fenómeno del Niño Costero de una comunidad urbano-marginal de Lima, Perú. Métodos: Investigación cualitativa, exploratoria, basada en la metodología de las representaciones sociales. Se realizó en diciembre del 2019, en Lima, Perú. El muestreo fue no probabilístico intencional, debido al acceso al lugar y la disponibilidad hasta llegar al punto de saturación; se entrevistó en profundidad a 11 madres y luego se realizó análisis del discurso. Resultados: Emergieron tres categorías: vivir la vulnerabilidad socioambiental, reconfortarse con un ser divino y enfrentar la crisis ecológica. Conclusiones: Las mujeres damnificadas reconocen la vulnerabilidad socioambiental por su condición socioeconómica precaria y vivir en la ribera del río. Asimismo, no encuentran las estrategias para superar su situación y se refugian en la ayuda y protección de un ser divino; frente al desastre natural tienen conciencia de la crisis ecológica en la que viven y la necesidad de una respuesta integral y colectiva(AU)

Introduction: Natural disasters generate a negative impact on the health and life of the population; however, there are few qualitative studies addressing their impact on the life, mental health and imaginary of those affected. Objective: To characterize the social representations of the natural disaster held by mothers affected by "El Niño Costero" phenomenon in an urban-marginal community of Lima, Peru. Methods: A qualitative and exploratory research, based on the methodology of social representations, was conducted in December 2019, in Lima, Peru. The sampling was intentional nonprobabilistic, due to the access to the place and the availability until reaching the saturation point; in-depth interviews were conducted with 11 mothers and then discourse analysis was performed. Results: Three categories emerged: living the socioenvironmental vulnerability, being comforted by a divine being, and facing the ecological crisis. Conclusions: The affected women recognize their socioenvironmental vulnerability due to their precarious socioeconomic condition and the fact that they live on the riverbank. Likewise, they do not find any strategies for overcoming their situation and take refuge in the help and protection from a divine being instead. In the face of the natural disaster, they are aware of the ecological crisis in which they live and the need for an integral and collective response(AU)

Auxiliar o compartir. Un análisis sobre las prácticas de cuidado de jóvenes padres de un barrio popular platense / Ajude ou compartilhe. Análise das práticas de cuidado de jovens país em um bairro popular de La Plata / Help or share. An analysis on the care practices of young parents in a popular neighborhood of La Plata

Resumen En el marco de una investigación doctoral que abordó las experiencias de paternidades juveniles, el presente artículo analiza las prácticas de cuidado de jóvenes padres de un barrio popular a partir de dos modelos de cuidado construidos (modelo auxiliar y modelo compartido). Las entrevistas fueron realizadas a cuarenta jóvenes varones padres residentes de un barrio popular de La Plata (Buenos Aires, Argentina) durante el período 2013-2015 en base a una muestra intencional seleccionada por bola de nieve, a partir de los criterios de accesibilidad y heterogeneidad. Aunque es posible encontrar mayor involucramiento de los jóvenes en el cuidado, las responsables últimas en ambos modelos de cuidado son las mujeres (especialmente las parejas, pero también suegras, hermanas, vecinas de los jóvenes). Los jóvenes entrevistados cuidan más, pero no logran romper con la división sexual del trabajo clásica y descentrar a las mujeres como cuidadoras principales o expertas.

Resumo No âmbito de uma pesquisa de doutorado que abordou as experiências de paternidade de homens jovens, este artigo analisa as práticas de cuidado de jovens país en um bairro popular a partir de dois modelos de cuidado construídos (modelo auxiliar e modelo compartilhado). As entrevistas foram realizadas com quarenta homens jovens residentes em um bairro popular de La Plata (Buenos Aires, Argentina) durante o período 2013-2015 com base em uma amostra intencional selecionada por bola de neve com base nos critérios de acessibilidade e heterogeneidade. Embora seja possível encontrar um maior envolvimento dos jovens no cuidado, os responsáveis últimos nos dois modelos de cuidado são as mulheres (principalmente casais, mas também sogras, irmãs e vizinhos dos jovens). Os jovens entrevistados são mais cuidadosos, mas não conseguem romper com a clássica divisão sexual do trabalho e descentralizar as mulheres como cuidadoras principais ou especializadas.

Abstract In the framework of a doctoral research that addressed the fatherhood experiences of young men, this article analyzes the care practices of young fathers in a popular neighborhood based on two constructed care models (auxiliary model and shared model). The interviews were conducted with forty young male parents residing in a popular neighborhood of La Plata (Buenos Aires, Argentina) during the period 2013-2015 based on an intentional sample selected by snowball, based on the criteria of accessibility and heterogeneity. Although it is possible to find greater involvement of young men in care, the ultimate responsible in both models of care are women (mainly couples, but also mothers-in-law, sisters and neighbors of young men). The young people interviewed care more, but they are unable to break with the classic sexual division of labor and decentralize women as main or expert caregivers.

COVID-19 Y su relación con factores sociodemográficos en la etapa pre-vacunatoria, provincia de Tucumán, Argentina, 2020-2021 / COVID-19 and its relationship with sociodemographic factors in the pre-vaccination period in Tucumán Province, Argentina, 2020-2021

RESUMEN INTRODUCCIÓN El impacto de COVID-19 en una población puede explicarse a través de los factores sociodemográficos y las respuestas de intervención. El objetivo fue evaluarlo en la provincia de Tucumán en la etapa previa a la vacunación. Se analizó la incidencia, letalidad y mortalidad de COVID-19 a nivel provincial y departamental, y se identificaron los factores sociodemográficos asociados. MÉTODOS Se realizó un estudio observacional de tipo ecológico con fuentes de datos secundarias en Tucumán. El período fue de marzo de 2020 a marzo de 2021. RESULTADOS Se registró una tasa de incidencia de COVID-19 de 4941 por 100 000 habitantes y una tasa de mortalidad de 93,29 por 100 000 habitantes. La incidencia de casos fue similar en varones y mujeres, y el grupo de 30 a 49 años presentó las tasas más altas. La tasa de mortalidad y letalidad en varones fue mayor que en mujeres, y en ambos sexos el grupo de 80 años o más presentó las mayores tasas. A nivel departamental, Capital, Tafí Viejo, Cruz Alta y Yerba Buena tuvieron las tasas de incidencia más altas. Burruyacú, Monteros y Trancas registraron las mayores tasas de mortalidad y letalidad. La incidencia de casos se vio afectada por la densidad poblacional y por el porcentaje de personas en hogares con alguna necesidad básica insatisfecha. DISCUSIÓN Se resalta la importancia de conocer la estructura, funcionalidad e identidad de las ciudades para comprender mejor su capacidad de resiliencia y adaptación frente a eventos como COVID-19.

ABSTRACT INTRODUCTION The population impact of COVID-19 can be explained by socio-demographic factors and the intervention responses. The objective was to evaluate it in the province of Tucumán in the pre-vaccination stage. Incidence, lethality and mortality of COVID-19 at province and department level were analyzed, identifying associated socio-demographic factors. METHODS An observational ecological study was conducted in Tucumán using secondary data sources. The period of study was from March 2020 to March 2021. RESULTS There was an incidence rate of COVID-19 of 4941 per 100000 inhabitants and a mortality rate of 93.29 per 100000 inhabitants. The incidence of cases was similar among males and females, and the age group between 30 and 49 years showed the highest rates. Mortality and lethality were higher in men than in women, and in both sexes the age group of 80 years and over presented the highest rates. At department level, Capital, Tafí Viejo, Cruz Alta and Yerba Buena had the highest incidence rates. Burruyacú, Monteros and Trancas had the highest mortality and lethality rates. The incidence of cases was affected by population density and by the percentage of people living in households with an unsatisfied basic need. DISCUSSION This work highlights the importance of knowing the structure, functionality and identity of cities to better understand their resilience and adaptation capacity in the face of events such as COVID-19.