[COVID-19 pandemic impact on primary care emergency services activity: Comparative study between 2019 and 2020 periods]. / Impacto de la pandemia de la COVID-19 en la actividad de los servicios de urgencias de atención primaria: estudio comparativo entre periodos de 2019 y 2020.

OBJECTIVE: To compare the care provided by primary care emergency services during the COVID19 lockdown (March-June 2020) and the same period in 2019. DESIGN: Retrospective descriptive study. SETTING: Basic Health Area of Granada. POPULATION: 10.790 emergency reports, 3.319 in 2020 and 7.471 in 2019. OUTCOMES: Age, sex, service, shifts, referrals, priority levels, care times, previous processes, and reasons for consultation. T-Student and Chi Square were used for continuous and categorical variables. Effect size (Cohen's d) and OR along with 95% CI were calculated. RESULTS: The patients attended by primary care emergency services decreased in 2020 compared to 2019, but the percentage of Priority V cases (p<0.01), home discharges (p=0.01) and hospital transfers (p<0.01) increased, and referrals to family doctors (p<0.01) decreased. In 2020, the percentage of emergencies at night (p<0.01) and in low-income neighborhoods (p<0.01) increased. Waiting time for classification decreased (p<0.01), but total care time increased in 2020 (p<0.01). The patients seen in 2020 were older (p<.001), and with a greater number of previous processes (p<0.01), highlighting patients with anxiety, depression, or somatization (p<0.01) and diabetes (p=0.041). Consultations related to various symptoms of COVID19, mental health problems and chronic pathologies increased. CONCLUSIONS: Primary care emergency services offer additional advantages in situations such as the COVID19 pandemic, as they allow channeling part of the health demand.

[Quality of life of health personnel during the COVID-19 pandemic: exploratory reviewQualidade de vida do pessoal de saúde durante a pandemia de COVID-19: revisão exploratória]. / Calidad de vida del personal de salud durante la pandemia de COVID-19: revisión exploratoria.

Objective: Describe the quality of life of health personnel, the work environment, and interactions between employees and their work environment during the pandemic. Methods: A scoping review was conducted. The electronic databases PubMed, Cumulative Index of Nursing and Allied Literature Complete, and Google Scholar were used, as well as the repositories of the World Health Organization and the Centers for Disease Control and Prevention. Primary, secondary, and grey literature studies published between December 2019 and March 2021 in Spanish, English, and Portuguese were included. Methodological quality was assessed using the Authority, Accuracy, Coverage, Objectivity, Date and Importance (AACODS) checklist; a tool for the measurement of multiple systematic reviews (AMSTAR); and the Critical Appraisal Checklist for Text and Opinion Papers. A thematic analysis was carried out based on the quality-of-life and well-being model. Results: Of a total of 208 articles, 11 were included. The quality of life of health personnel during the COVID-19 pandemic was affected by the characteristics of health personnel, the work environment, and interactions between employees and their work environment. Problems related to psychosocial and occupational factors were observed. Discussion: The quality of life of health personnel was characterized by stigmatization, stress, anxiety, and fatigue. Organizational management and the implementation of psychological interventions appear to affect interactions between employees and their work environment, and improve their quality of life.

Objetivo: Descrever a qualidade de vida do pessoal de saúde, o ambiente de trabalho e a interação entre o funcionário e o ambiente de trabalho durante a pandemia. Métodos: Foi realizada uma revisão exploratória. Foram utilizadas as bases de dados eletrônicas PubMed, Cumulative Index of Nursing and Allied Literature Complete, Google Scholar e os repositórios da Organização Mundial da Saúde e dos Centros de Controle e Prevenção de Doenças. Foram incluídos estudos primários, secundários e da literatura cinzenta, publicados entre dezembro de 2019 e março de 2021, em espanhol, inglês e português. A qualidade metodológica foi avaliada pelas checklists AACODS (Authority, Accuracy, Coverage, Objectivity, Date, Significance), AMSTAR (A measurement tool to assess systematic reviews) e Critical Appraisal Checklist for Text and Opinion Papers. Foi realizada uma análise temática com base no modelo de qualidade de vida e bem-estar. Resultados: De um total de 208 artigos, 11 foram incluídos. A qualidade de vida do pessoal de saúde durante a pandemia de COVID-19 foi influenciada pelas características do pessoal de saúde, do ambiente de trabalho e da interação entre o funcionário e o ambiente de trabalho. Constataram-se deficiências relacionadas a fatores psicossociais e ocupacionais. Discussão: A qualidade do pessoal de saúde foi caracterizada por estigma, estresse, ansiedade e fadiga. A gestão organizacional e a aplicação de intervenções psicológicas evidenciam um efeito na interação entre o funcionário e o ambiente de trabalho, e influenciam sua qualidade de vida.

[Assessment and follow-up of patients with suspected COVID-19 in the first pandemic wave in an urban area of Andalusia (Spain)]. / Valoración y seguimiento de los pacientes con sospecha de COVID-19 en la primera ola pandémica en una zona urbana de Andalucía.

OBJECTIVE: To know the characteristics of the initial care and telephone follow-up of patients with suspected COVID-19 in the first wave of the pandemic. DESIGN: Observational, retrospective (audit of medical records). LOCATION: Urban Primary Care Center of Andalusia (Spain). PARTICIPANTS: Probable cases of SARS-CoV-2 (from 20/03/15 to 20/06/15). PRINCIPAL MEASUREMENTS: Initial medical assessment (place and modality) and telephone follow-up (number of calls and duration). Sociodemographic variables (including family structure). Clinical course (symptoms, vulnerability, tests, hospital admission and outcome). RESULTS: Three hundred one patients (51.5±17.8 years; 23% vulnerable people; 17% non-nuclear family structure). First assessment in Primary Care by phone (59.8%) and face-to-face (25.2%). At the hospital emergency department (11%), patients were more frequently from non-nuclear families (P<.05 χ2) and more tests were carried out (P<.05 χ2) despite having similar symptoms. Vulnerable elderly patients needed home health care (P<.01 ANOVA). 8.2±4.4 follow-up phone calls were made per patient, for 17.1±10.3 days. It increases after ≥2 face-to-face consultations (OR 4.8), the presence of alarm symptoms (OR 2.3) and age ≥45 years (OR 2.0). Few confirmatory tests were performed (19.3% antigenic, 13% serology). The 15.3% hospital admissions (all assessed previously in Primary Care), with 6.3% severe cases and 2.3% death. CONCLUSION: Population chose to be attended in Primary Care during the pandemic first wave, above all by phone. Telephone follow-up was well accepted and useful to select patients with serious complications. Initial medical assessment in the hospital emergency department was related to a lack of social support but not with greater clinical severity.

Primary health care response in the management of pandemics: Learnings from the COVID-19 pandemic.

Primary care is an essential foundation for the global response to COVID-19 pandemic. It plays a significant role in the health care response: identifying and triaging potential COVID-19 cases, making an early diagnosis, helping vulnerable people cope with their anxiety about the virus, strengthening compliance with prevention and protection measures, and reducing the demand for hospital services. Primary care teams have continued to address citizens' health problems during the pandemic, adapting to strict social control measures imposed by governments such as closing of borders, lockdowns and self-isolation of cases and contacts. We describe the COVID-19 response from primary care in Hong Kong and China, based on their recent pandemic experiences. We also present that of a European country, United Kingdom, less experienced in pandemic management, but with universal and highly developed primary care with great social recognition. Finally, we point out some crucial learning for future pandemic management, highlighting the crucial need to improve the relationship between primary care and public health to improve pandemics response.

COVID-19: implications of SARS-CoV-2 in Colombia.

COVID-19 arrived in Latin America early in March 2020. Currently, strategies are being developed in Colombia focusing on the quarantine and social and economic capital reactivation, whereby the expected results are not being obtained. In this article, we propose to review scientific evidence-based literature where information on the operation and adaptation of health systems, and social, economic and solidarity sectors of Colombia is presented. The purpose is to identify COVID-19 implications in the network that provides health services, quality of life and health-disease prognosis in the country, which is not prepared to face crises of social nature and of health systems, as well as the economic and solidarity impacts that are brought about by pandemics and crude episodes of disease.

COVID-19 llegó a Latinoamérica a principios de marzo de 2020. Actualmente, en Colombia se desarrollan estrategias enfocadas en la cuarentena y la reactivación del capital social y económico, con las cuales no se están obteniendo los resultados esperados. En este artículo se propone revisar literatura basada en evidencia científica en la que se exponga información del funcionamiento y adaptación de los sistemas de salud, sectores sociales, económicos y solidarios de Colombia. El objetivo es identificar las implicaciones de COVID-19 en la red prestadora de servicios de salud, calidad de vida, pronóstico de salud-enfermedad en el país, el cual no está preparado para afrontar crisis de orden social, de sistemas de salud e impactos económicos y solidarios que conllevan las pandemias y episodios graves de enfermedad.

[Quality of life of people with Parkinson's disease during confinement due to the covid-19 pandemic]. / Calidad de vida de las personas con enfermedad de Parkinson durante el confinamiento por la pandemia por covid-19.

INTRODUCTION: The study was aimed to explore the quality of life of people with Parkinson's disease during confinement due to the coronavirus infectious disease 2019 (covid-19) pandemic. MATERIAL AND METHODS: The study was quantitative, descriptive and correlational. The sample was 51 people with Parkinson's disease, from the region of Magallanes and Chilean Antarctica, and whose information was collected from the database of the Rehabilitation Corporation Club de Leones Cruz del Sur, to which they belong. RESULTS: The main results show that 51.6% of people with Parkinson's disease report a «good and very good¼ quality of life and that the main domains of the Parkinson's Disease Questionnaire (PDQ-39) affected are: body discomfort, mobility and emotional well-being. According to the analysis of the qualitative ranges of the PDQ-39, the dimensions that were most compromised during the confinement by the covid-19 pandemic were: communication, stigma and emotional well-being. In addition, women had a poorer quality of life than men. Finally, it was shown that the progression of symptoms affects the quality of life of people with Parkinson's disease. CONCLUSIONS: In conclusion, during the confinement due to the covid-19 pandemic people with Parkinson's disease increased symptoms and presented a lower quality of life, especially women.

Description of a telehealth mental health programme in the framework of the COVID-19 pandemic in Colombia.

BACKGROUND: A telehealth mental health programme was designed at the LivingLab of the Faculty of Medicine of the Universidad de Antioquia [University of Antioquia]. OBJECTIVES: To describe the development and operation of the programme and evaluate the satisfaction of the patients treated during the COVID-19 pandemic in 2020 and 2021. METHODS: Descriptive study that details the development of the programme. Data were extracted from medical records to describe the patients who were treated. A satisfaction scale was applied to a random sample and the data were summarised with descriptive statistics. RESULTS: In March 2020 and August 2021, 10,229 patients were treated, with 20,276 treated by telepsychology and 4,164 by psychiatry, 1,808 by telepsychiatry and 2,356 by tele-expertise, with a total of 6,312 visits. The most frequent diagnoses were depressive (36.8%), anxiety (12.0%), and psychotic (10.7%) disorders. Respondents were satisfied to the point that more than 93% would recommend it to another person. CONCLUSIONS: The LivingLab telehealth mental health programme allowed for the care of patients with mental health problems and disorders in Antioquia during the first two years of the COVID-19 pandemic, and there was a high degree of satisfaction among the beneficiaries. Therefore it could be adopted in mental health care.

Old and new aspects of influenza. / Nuevos y viejos aspectos de la gripe.

Influenza is a classic infectious disease that, through the continuous variation of the viruses that produce it, imposes new challenges that we must solve as quickly as possible. The COVID-19 pandemic has substantially modified the behavior of influenza and other respiratory viruses, and in the coming years we will have to coexist with a new pathogen that will probably interact with existing pathogens in a way that we cannot yet glimpse. However, knowledge prior to the pandemic allows us to focus on the aspects that must be modified to make influenza an acceptable challenge for the future. In this review, emphasis is placed on the most relevant aspects of epidemiology, disease burden, diagnosis, and vaccine prevention, and how scientific and clinical trends in these aspects flow from the previously known to future challenges.

Impact of COVID-19 on a rare disease (uveal melanoma) in a national reference unit of intraocular tumors in Spain.

OBJECTIVE: To analyse the impact of the COVID-19 pandemic on the diagnosis and management of uveal melanoma (a tumour included in the Orphanet catalogue of rare diseases) in a Spanish national reference unit for intraocular tumours during the first year of the pandemic. METHOD: An observational retrospective study of patients with uveal melanoma in the National Reference Unit for Adult Intraocular Tumors of the Hospital Clínico Universitario de Valladolid (Spain) was performed, analysing the pre- and post-COVID-19 periods: from March 15, 2019 to March 15, 2020 and from March 16, 2020 to March 16, 2021. Demographic data, diagnostic delay, tumour size, extraocular extension, treatment and evolution were collected. A multivariable logistic regression model was used to identify factors that were associated with the variable: enucleation. RESULTS: Eighty-two patients with uveal melanoma were included, of which 42 (51.21%) belonged to the pre-COVID-19 period and 40(40.78%) to the post-COVID-19 period. An increase in tumour size at diagnosis and in the number of enucleations was observed during the post-COVID-19 period (p < 0.05). Multivariable logistic regression demonstrated that both medium-large tumour size and patients diagnosed in the post-COVID-19 period were independently related to an increased risk of enucleation (OR 250, 95%CI, 27.69-2256.37; p < 0.01 and OR 10; 95%CI, 1.10-90.25; p = 0.04, respectively). CONCLUSIONS: The increase in tumour size observed in uveal melanomas diagnosed during the first year of the COVID-19 pandemic may have favored the increase in the number of enucleations performed during that period.

[Community participation: COVID-19 learning for new crises. SESPAS Report 2022]. / Participación comunitaria: aprendizajes de la COVID-19 para nuevas crisis. Informe SESPAS 2022.

Community participation has been put as secondary due to the management of the COVID-19 pandemic. This is despite the evidence of its importance in relation to equity and health promotion. Even so, there have been a number of experiences of community participation that can give us clues towards how to confront potential future emergencies focusing on health promotion and social determinants. The main aim of this article is reflecting critically on the role of community participation during the pandemic as well as extracting a number of ideas which could be useful and ensure a better management of a future crisis. They arise from evidence and experiences undertaken in Spain. In order to do so, it is key to build and maintain community networks whilst identifying common goals and the role that different community agents must play, adapting to different contexts and participatory assessments. Community action cannot be improvised: it demands time, resources and specific political willingness to make it sustainable and efficient.

Performance of the case definition of suspected influenza before and during the COVID-19 pandemic.

OBJECTIVE: This study aimed to evaluate the performance, before and during the COVID-19 pandemic, of the case definition of suspected influenza used in community surveillance in Mexico. METHODS: A cross-sectional analysis of a cohort study was performed and cases that met the suspected case criteria (n = 20,511) and that had laboratory-conclusive evidence (quantitative real-time polymerase chain reaction) to confirm or discard influenza virus infection were analysed. RESULTS: A high sensitivity and modest specificity were documented, which later decreased during the COVID-19 outbreak, as well as its diagnostic accuracy. However, no significant differences were observed in the area under the receiver operating characteristics curve among the analysed periods. CONCLUSIONS: The evaluated case definition remains to be a cost-effective alternative for identifying patients who may benefit from influenza-specific antiviral drugs, even during the global COVID-19 outbreak.

State of child and adolescent mental health during the first wave of the COVID-19 pandemic and at the beginning of the 2020-2021 school year.

INTRODUCTION: The aim of this project was to evaluate the psychopathological impact of home confinement and school closing between March and September 2020 on the mental health of Catalonian children. METHODS: PEDSAME study: first cross-sectional section (beginning of the school year) and retrospective data (lockdown), carried out through the network of Primary Care pediatricians in the Catalan population between 5 and 14 years (included) from 09/14/2020 to 10/30/2020 in a random sample. Data were collected with an online survey through the RedCap platform at the beginning of the school year. The main variable was the result of the Strengths and Difficulties Questionnaire answered by parents to assess the risk of psychopathology, in addition to other related variable. RESULTS: The results obtained at the beginning of the school year show that 9.8% of the patients were probable cases of psychopathology. The most affected group were those between 5 and 8 years. The perception of the children's level of concern for their health and that of their family was a risk factor for presenting psychopathology, while the good family environment was a protective factor. Emotional and behavioral symptoms, sleep disorders and problematic use of screens were detected more frequently during confinement than at the beginning of the school year. CONCLUSIONS: Confinement and the absence of schooling for 6 months had a negative impact on the mental health of the child-adolescent population who showed worse indicators than the previous year.

Mental health interventions for college and university students during the COVID-19 pandemic: A critical synthesis of the literature.

BACKGROUND: The aim of the study is to compare the emotional effects of COVID-19 among three different groups, namely: health personnel, medical students, and a sample of the general population. METHODS: 375 participants were recruited for this study, of which 125 were medical students (preclinical studies, 59; clinical studies, 66), 125 were health personnel (COVID-19 frontline personnel, 59; personnel not related with COVID-19, 66), and 125 belonged to the general population. The PHQ-9, GAD-7, and CPDI scales were used to assess the emotional impact. A multinomial logistic regression was performed to measure differences between groups, considering potential confounding factors. RESULTS: Regarding CPDI values, all other groups showed reduced values compared to COVID-19 frontline personnel. However, the general population, preclinical and clinical medical students showed increased PHQ-9 values compared to COVID-19 frontline personnel. Finally, confounding factors, gender and age correlated negatively with higher CPDI and PHQ-9 scores. CONCLUSIONS: Being frontline personnel is associated with increased COVID-19-related stress. Depression is associated, however, with other groups not directly involved with the treatment of COVID-19 patients. Female gender and younger age correlated with COVID-19-related depression and stress.

Emotional Impact on Health Personnel, Medical Students, and General Population Samples During the COVID-19 Pandemic in Lima, Peru.

BACKGROUND: The aim of the study is to compare the emotional effects of COVID-19 among three different groups, namely: health personnel, medical students, and a sample of the general population. METHODS: 375 participants were recruited for this study, of which 125 were medical students (preclinical studies, 59; clinical studies, 66), 125 were health personnel (COVID-19 frontline personnel, 59; personnel not related with COVID-19, 66), and 125 belonged to the general population. The PHQ-9, GAD-7, and CPDI scales were used to assess the emotional impact. A multinomial logistic regression was performed to measure differences between groups, considering potential confounding factors. RESULTS: Regarding CPDI values, all other groups showed reduced values compared to COVID-19 frontline personnel. However, the general population, preclinical and clinical medical students showed increased PHQ-9 values compared to COVID-19 frontline personnel. Finally, confounding factors, gender and age correlated negatively with higher CPDI and PHQ-9 scores. CONCLUSIONS: Being frontline personnel is associated with increased COVID-19-related stress. Depression is associated, however, with other groups not directly involved with the treatment of COVID-19 patients. Female gender and younger age correlated with COVID-19-related depression and stress.

[Comparison of expert recommendations on clinical nutrition for hospitalized patients with COVID-19]. / Comparación de las recomendaciones de expertos sobre nutrición clínica en pacientes hospitalizados con COVID-19.

INTRODUCTION: Introduction: in SARS-CoV-2-infected patients nutritional requirements are increased. These patients present symptoms that make food intake and nutrient absorption difficult, therefore involving nutritional risk. On the other hand, acute respiratory complications require prolonged ICU stays, and this predisposes to increased malnutrition and loss of skeletal muscle mass and function, which can lead to poor quality of life, disability and morbidity long after discharge. For this reason, the world's leading nutrition societies and associations believe that nutritional therapy should be considered a part of the basic treatment of patients with COVID-19. Methods: we have reviewed and compared 9 expert recommendations (ER) published by nutrition societies and associations from China, Spain, Brazil, Europe, Colombia, Australia, America, and the United Kingdom, in relation to critical and non-critical hospitalized patients due to the COVID-19 pandemic. Conclusions: the 9 ERs reviewed agree on the importance of nutritional management in critical and non-critical hospitalized patients with COVID-19, as well as on the early detection of nutritional risk, the intervention, and subsequent follow-up. Even so, each published document has its own particularities and puts a special stress on some specific aspect.

INTRODUCCIÓN: Introducción: la infección por SARS-CoV-2 implica riesgo nutricional debido a la dificultad de cubrir los requerimientos nutricionales aumentados en presencia de una sintomatología que dificulta la ingesta y la absorción de nutrientes. Por otro lado, las complicaciones respiratorias agudas requieren estancias prolongadas en unidades de cuidados intensivos (UCI) y esto predispone a una mayor desnutrición y a pérdida de masa y función del músculo esquelético, que a su vez puede conducir a una mala calidad de vida, discapacidad y morbilidad mucho después del alta. Por este motivo, las principales sociedades y asociaciones de nutrición clínica del mundo consideran que la terapia nutricional debe considerarse parte del tratamiento básico de los pacientes con COVID-19. Métodos: se han revisado y comparado 9 recomendaciones de expertos (RE) publicadas por sociedades y asociaciones de nutrición clínica de China, España, Brasil, Europa, Colombia, Australia, América y Reino Unido, a raíz de la pandemia por COVID-19, en relación a los pacientes hospitalizados críticos y no críticos. Conclusiones: las 9 RE revisadas coinciden en la importancia del tratamiento nutricional en los pacientes hospitalizados críticos y no críticos con COVID-19, así como en la detección precoz del riesgo nutricional, la intervención y el seguimiento. Aun así, cada documento publicado tiene sus propias particularidades e incide especialmente en algún aspecto.

Immune thrombocytopenia secondary to COVID-19: a case report. / Trombocitopenia inmune secundaria a COVID-19: reporte de un caso.

BACKGROUND: The SARS-CoV-2 virus, which emerged in late 2019 in Wuhan province, China, has shown a wide spectrum of manifestations, some of which it shares with some autoimmune disorders. Until now, the association of SARS-CoV-2 with immune thrombocytopenia (ITP) is poorly understood, since the mechanisms that explain the complex relationship between these two prothrombotic states are still unknown. CLINICAL CASE: It is presented the case of a 66-year-old woman, with no chronic disease history, who arrived at the Emergency Department due to respiratory symptoms. It was carried out a polymerase chain reaction with reverse transcriptase, which was positive for SARS-CoV-2. Isolated thrombocytopenia was found in laboratory studies, which was protocolized by ruling out other causes and finally diagnosing ITP secondary to COVID-19. Intravenous steroids treatment was given observing a complete recovery in platelet levels. CONCLUSIONS: Until now, the association of IPT and COVID-19 is unclear and presents challenges in treatment. Steroids continue to be the first choice with the indication to reduce their dose and duration to the minimum necessary. Other second-line treatments present more questions than answers in the context of this pandemic.

INTRODUCCIÓN: el virus del SARS-CoV-2, el cual surgió a finales de 2019 en la provincia de Wuhan, China, ha mostrado un espectro amplio de manifestaciones, algunas de las cuales comparte con algunos trastornos autoinmunes. La asociación del SARS-CoV-2 con la trombocitopenia inmune (TIP) es hasta ahora poco entendida, pues todavía no se conocen los mecanismos que expliquen la compleja relación entre estos dos estados protrombóticos. CASO CLÍNICO: se presenta el caso de una mujer de 66 años, sin antecedentes crónicos, que acudió al Servicio de Urgencias por sintomatología respiratoria. Se realizó prueba de reacción en cadena de la polimerasa con transcriptasa reversa, la cual fue positiva para SARS-CoV-2. En los estudios de laboratorio se encontró trombocitopenia aislada que se protocolizó, por lo que se descartaron otras causas de esta y se diagnosticó TIP secundaria a COVID-19. Se inició tratamiento con esteroides intravenosos y se obtuvo una respuesta completa. CONCLUSIONES: la asociación de TIP y COVID-19 es hasta ahora poco clara y plantea retos en el tratamiento. Los esteroides continúan siendo de primera elección con la indicación de disminuir su dosis y duración a las mínimas necesarias. Otros tratamientos de segunda línea plantean más dudas que respuestas en el contexto de esta pandemia.

Communicating bad news in the context of COVID-19.

Communicating bad news is one of the most frequent activities in hospitals, for which some recommendations have been adapted to the needs within the coronavirus-2 disease (COVID-19) context. This document presents nine steps to deliver bad news (face to face or remotely) adapted to the COVID-19 context from two international protocols (SPIKES and GRIEV_ING). The importance of promoting physical and emotional self-care skills in health personnel is also described, as well as psychological first aid strategies to address the emotional response of the family member who receives the news. Finally, the limitations and advantages of the proposal should be considered.

La comunicación de malas noticias es una de las actividades más frecuentes en los hospitales dentro del contexto de la COVID-19. A pesar de su alta frecuencia, existen pocas recomendaciones adaptadas a las necesidades que el contexto de la COVID-19 demanda. Debido a lo anterior, en el presente escrito se presentan nueve pasos para dar malas noticias (cara a cara o por vía remota) de dos protocolos internacionales (SPIKES y GRIEV_ING) adaptados a las necesidades de transmisión de información de la COVID-19. Se describe también la importancia de promover habilidades de autocuidado físico y emocional en el personal de salud, así como estrategias de primeros auxilios psicológicos para el abordaje de la respuesta emocional del familiar que recibe la noticia. Finalmente, se deben considerar las limitaciones y ventajas de la propuesta.

Miscelânea de sentimentos: reflexões de quem sobreviveu a covid-19 / Mixture of feelings: reflections of those who survived covid-19 / Mezcla de sentimientos: reflejos de quienes sobrevivieron al covid-19

O objetivo deste estudo foi compreender os sentimentos atribuídos à pandemia da COVID-19 por indivíduos que vivenciaram a doença. Trata-se de um estudo qualitativo que utilizou como referencial teórico o Interacionismo Simbólico e metodológico a Teoria Fundamentada nos Dados vertente construtivista, realizado em um município de médio porte situado na região noroeste do Paraná. A coleta de dados ocorreu no período de abril a novembro de 2021, por meio de entrevistas individuais mediadas por tecnologias. Os informantes foram 19 indivíduos hospitalizados pela COVID-19. A análise seguiu a codificação aberta e focalizada proposta pelo método. Os resultados demonstram como houve a ressignificação da pandemia da COVID-19 por indivíduos hospitalizados pela doença, sendo que este momento levou a uma maior valorização da vida e mudanças comportamentais. Conclui-se que os sentimentos revelaram uma nova percepção de vida diante do contexto da pandemia de COVID-19, com alterações de rotinas, sentimentos e readaptações, o que gerou o desenvolvimento de estratégias de enfrentamento.

The objective of this study was to understand the feelings attributed to the COVID-19 pandemic by individuals who experienced the disease. This is a qualitative study that used Symbolic and methodological Interactionism as a theoretical framework, the Data-Based Theory, constructivist aspect, carried out in a medium-sized municipality located in the northwest region of Paraná. Data collection took place from April to November 2021, through individual interviews mediated by technology. The informants were 19 individuals hospitalized by COVID-19. The analysis followed the open and focused coding proposed by the method. The results demonstrate how the COVID-19 pandemic was given new meaning by individuals hospitalized for the disease, and this moment led to a greater appreciation of life and behavioral changes. It is concluded that the feelings revealed a new perception of life, given the context of the COVID-19 pandemic, with changes in routines, feelings and readaptations, which generated the development of coping strategies.

El objetivo de este estudio fue comprender los sentimientos atribuidos a la pandemia de COVID-19 por parte de las personas que vivieron la enfermedad. Se trata de un estudio cualitativo que utilizó como marco teórico el Interaccionismo simbólico y metodológico, la Teoría Basada en Datos, vertiente constructivista, realizado en un municipio de mediano tamaño ubicado en la región noroeste de Paraná. La recolección de datos se realizó de abril a noviembre de 2021, a través de entrevistas individuales mediadas por tecnología. Los informantes fueron 19 personas hospitalizadas por COVID-19. El análisis siguió la codificación abierta y enfocada propuesta por el método. Los resultados demuestran cómo las personas hospitalizadas por la enfermedad dieron un nuevo significado a la pandemia de COVID-19, y este momento condujo a una mayor apreciación de la vida y cambios de comportamiento. Se concluye que los sentimientos revelaron una nueva percepción de la vida, dado el contexto de pandemia COVID-19, con cambios en rutinas, sentimientos y readaptaciones, que generaron el desarrollo de estrategias de afrontamiento.

The response to COVID-19 in Argentina, Brazil, and Mexico: challenges to national coordination of health policies / La respuesta al COVID-19 en Argentina, Brasil y México: los desafíos a la coordinación federativa de las políticas de salud / A resposta à COVID-19 na Argentina, no Brasil e no México: desafios à coordenação federativa das políticas de saúde

Abstract: The article analyzes the fight against COVID-19 in three Latin American countries: Argentina, Brazil, and Mexico. A multiple case study was carried out in a comparative perspective, based on a bibliographic review, documentary analysis, and secondary data, considering characteristics of the countries and the health system, evolution of COVID-19, national governance, containment and mitigation measures, health systems response, constraints, positive aspects and limits of responses. The three countries had distinct health systems but were marked by insufficient funding and inequalities when hit by the pandemic and recorded high-COVID-19 mortality. Structural, institutional, and political factors influenced national responses. In Argentina, national leadership and intergovernmental political agreements favored the initial adoption of centralized control measures, which were not sustained. In Brazil, there were limits in national coordination and leadership related to the President's denialism and federative, political, and expert conflicts, despite a universal health system with intergovernmental commissions and participatory councils, which were little used during the pandemic. In Mexico, structural difficulties were associated with the Federal Government's initial reluctance to adopt restrictive measures, limits on testing, and relative slowness in immunization. In conclusion, facing health emergencies requires strengthening public health systems associated with federative, intersectoral, and civil society coordination mechanisms and effective global solidarity mechanisms.

Resumen: El artículo analiza la lucha contra el COVID-19 en tres federaciones latinoamericanas: Argentina, Brasil y México. Se realizó un estudio de casos múltiple en perspectiva comparada, basado en revisión bibliográfica, análisis documental y de datos secundarios, teniendo en cuenta: las características de los países y del sistema de salud, la evolución del COVID-19, la gobernanza nacional, las medidas de contención y mitigación, la respuesta de los sistemas de salud, los factores condicionantes, los aspectos positivos y los límites de las respuestas. Los tres países tenían sistemas de salud diferentes, pero marcados por financiación insuficiente y desigualdades, cuando afectados por la pandemia, y registraron una alta mortalidad por COVID-19. Las respuestas nacionales se influyeron por factores condicionantes estructurales, institucionales y políticos. En Argentina, el liderazgo nacional y los acuerdos políticos intergubernamentales favorecieron la adopción inicial de medidas de control centralizadas, que no se sustentaron. En Brasil, hubo límites en la coordinación y liderazgo nacional, relacionados con el negacionismo del presidente y los conflictos federativos, políticos y con expertos, a pesar de existir un sistema de salud universal que tiene comisiones intergubernamentales y consejos participativos, poco utilizados en la pandemia. En México, las dificultades estructurales se asociaron con la renuencia inicial del gobierno nacional en adoptar medidas restrictivas, límites en las pruebas y relativa lentitud en la vacunación. Se concluye que para enfrentar emergencias sanitarias hay que fortalecer los sistemas públicos de salud asociados con mecanismos de coordinación federativa, intersectorial y con la sociedad civil, así como mecanismos efectivos de solidaridad global.

Resumo: Este artigo analisa o enfrentamento da COVID-19 em três federações latino-americanas: Argentina, Brasil e México. Realizou-se um estudo de casos múltiplos em perspectiva comparada, baseado em revisão bibliográfica, análise documental e de dados secundários, considerando: características dos países e do sistema de saúde, evolução da COVID-19, governança nacional, medidas de contenção e mitigação, resposta dos sistemas de saúde, condicionantes, aspectos positivos e limites das respostas. Os três países apresentavam sistemas de saúde distintos, porém marcados por financiamento insuficiente e desigualdades quando atingidos pela pandemia, e registraram alta mortalidade por COVID-19. As respostas nacionais foram influenciadas por condicionantes estruturais, institucionais e políticos. Na Argentina, a liderança nacional e acordos políticos intergovernamentais favoreceram a adoção inicial de medidas centralizadas de controle, que não se sustentaram. No Brasil, houve limites na coordenação e liderança nacional, relacionadas ao negacionismo do presidente e a conflitos federativos, políticos e com especialistas, apesar da existência de um sistema de saúde universal que têm comissões intergovernamentais e conselhos participativos, pouco acionados na pandemia. No México, dificuldades estruturais se associaram à relutância inicial do governo nacional em adotar medidas restritivas, limites na testagem e relativa lentidão na vacinação. Conclui-se que o enfrentamento de emergências sanitárias requer o fortalecimento dos sistemas públicos de saúde associados a mecanismos de coordenação federativa, intersetorial e com a sociedade civil, bem como mecanismos efetivos de solidariedade global.

Representação social da Covid-19 para a população de uma cidade de pequeno porte / Social representation of Covid-19 for the population of a small-sized city / Representación social del Covid-19 para la población de un pequeño pueblo

Objetivo: analisar a representação social da Covid-19 para a população geral de uma cidade de pequeno porte do Estado do Rio de Janeiro. Método: estudo qualitativo, apoiado na abordagem estrutural das representações sociais. Participaram 100 usuários de serviços de saúde. Os dados foram coletados por questionário sociodemográfico de evocações livres de palavras e roteiro de entrevista semiestruturada. Os dados foram analisados com o auxílio dos softwares Excel, EVOC 2005 e análise de conteúdo temático-categorial para contextualização das evocações respectivamente. Resultados: os termos do possível núcleo central foram: morte, sofrimento, cuidados, ansiedade-angústia e vacina. Na primeira periferia: medo e prevenção. À segunda periferia: informação-desinformação; desgoverno; ter-fé e proteção. A zona de contrate: doença; isolamento-social; dificuldades; catástrofe-mundial; desemprego e pandemia. Considerações finais: marcaram essa representação os impactos psicossociais negativos resultantes da desestruturação da vida e das mortes ocasionadas pela nova doença, no entanto o grupo aderiu as medidas de cuidados de proteção.

Objective: to analyze the social representation of Covid-19 among the general population of a small-sized city in the State of Rio de Janeiro. Method: Qualitative study, based on the structural approach of social representations. One hundred healthcare service users participated. Data were collected through a sociodemographic questionnaire, free word evocation, and a semi-structured interview guide. The data were analyzed using Excel software, EVOC 2005, and thematic-categorical content analysis for contextualization of the evocations, respectively. Results: the terms of the possible central core were: death, suffering, care, anxiety-distress, and vaccine. In the first periphery: fear and prevention. In the second periphery: information-misinformation; mismanagement; having faith and protection. The contrast zone: disease; social isolation; difficulties; global catastrophe; unemployment; and pandemic. Final considerations: this representation was marked by the negative psychosocial impacts resulting from the disruption of life and the deaths caused by the new disease; however, the group adhered to protective care measures.

Objetivo: analizar la representación social del Covid-19 para la población general de una pequeña ciudad del Estado de Río de Janeiro. Método: estudio cualitativo, basado en el enfoque estructural de las representaciones sociales. Participaron 100 usuarios de servicios de salud. Los datos se recolectaron mediante un cuestionario sociodemográfico con evocación libre de palabras y una guía de entrevista semiestructurada. Los datos fueron analizados utilizando lo software Excel y EVOC 2005 y análisis de contenido temático-categórico para contextualizar las evocaciones respectivamente. Resultados: los términos del posible núcleo central eran: muerte, sufrimiento, cuidados, ansiedad-angustia y vacuna. En la primera periferia: miedo y prevención. En la segunda periferia: información-desinformación; desgobierno; tener fe y protección. La zona de contraste: enfermedad; aislamiento-social; dificultades; catástrofe-mundial; desempleo y pandemia. Consideraciones finales: esta representación se caracterizó por los impactos psicosociales negativos derivados de la desestructuración de la vida y de las muertes causada por la nueva enfermedad, sin embargo, el grupo adhirió a las medidas de protección.