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Resumo Objetivo Descrever o processo de construção e avaliação de um protótipo de aplicativo de telefonia móvel que promova acessibilidade em chamada de socorro pré-hospitalar por pessoas com necessidades comunicativas especiais. Métodos Estudo metodológico, realizado em três etapas: definição de requisitos funcionais da população alvo; construção e disponibilização do protótipo de aplicativo para celulares touchscreen para solicitação de atendimento pré-hospitalar; avaliação das heurísticas de usabilidade por peritos, por meio de checklist, e pela população-alvo, pessoas com necessidades comunicativas especiais, utilizando a System Usability Scale. Foi realizada análise estatística descritiva e calculadas as pontuações e escores de avaliação do aplicativo. Resultados O aplicativo apresentou alta usabilidade (média de 58,75 pontos) e 21 sujeitos da população-alvo indicaram um excelente índice de satisfação do usuário (média de 89,5 pontos), oportunizando o registro e patente do protótipo. Conclusão O protótipo construído, demonstrou capacidade para promover acessibilidade comunicativa de convocação de socorro pré-hospitalar para pessoas com necessidades comunicativas especiais.

Resumen Objetivo Describir el proceso de elaboración y evaluación de un modelo de aplicación de telefonía móvil que promueva la accesibilidad en llamadas de asistencia prehospitalaria para personas con necesidades comunicativas especiales. Métodos Estudio metodológico realizado en tres etapas: definir los requisitos funcionales del público destinatario; elaborar y poner a disposición el modelo de la aplicación para celulares touchscreen para la solicitación de asistencia prehospitalaria, y evaluar las heurísticas de usabilidad por peritos, mediante checklist, y por el público destinatario, personas con necesidades comunicativas especiales, utilizando la System Usability Scale. Se realizó el análisis estadístico descriptivo y se calcularon los puntajes de evaluación de la aplicación. Resultados La aplicación presentó una alta usabilidad (promedio de 58,75 puntos) y 21 personas del público destinatario indicaron un excelente índice de satisfacción del usuario (promedio de 89,5 puntos), lo que permite el registro y patente del modelo. Conclusión El modelo elaborado demostró tener capacidad para promover la accesibilidad comunicativa de pedido de asistencia prehospitalaria para personas con necesidades comunicativas especiales.

Abstract Objective To describe the process of developing and evaluating a mobile application prototype to enable people with complex communication needs to call pre-hospital emergency services. Methods This methodological study was conducted in three stages: determining the target population's functional requirements; developing and making available a prototype application for touchscreen mobile phones to request pre-hospital services; experts assessed the usability heuristics using a checklist, while the target population (people with complex communication needs) used the System Usability Scale. Descriptive statistics were performed, and the scores assigned to the application were analyzed. Results The application obtained high usability scores (mean=58.75) and 21 individuals from the target population reported an excellent user satisfaction index (mean=89.5), which allowed registering and applying for the prototype's patent. Conclusion The prototype showed the ability to enable individuals with complex communication needs to access and request pre-hospital emergency services.

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RESUMO Este estudo tem como objetivo descrever a percepção dos pais acerca da trajetória do paciente cirúrgico pediátrico, desde o diagnóstico, indicação de cirurgia até sua realização, reconhecendo fatores que levaram ao atraso no atendimento. Trata-se de estudo qualitativo, descritivo, que inicialmente identificou, nos prontuários, as crianças encaminhadas em atraso para a idade para avaliação com o cirurgião. Identificaram-se 77/289 (26,6%) pacientes encaminhados em atraso. Após sorteio realizaram-se entrevistas, por telefone, com sete pais. Utilizou-se da análise de conteúdo na modalidade temática com a emergência de três categorias: dificuldades encontradas; atendimento na atenção primária; e da descoberta do problema à realização da cirurgia. Em referência à espera para atendimento pelos especialistas, observa-se excesso de demanda ante a menor oferta de consultas. A qualidade do atendimento recebido na atenção primária foi bem avaliada e a empatia das equipes foi elogiada. Os familiares reconheceram que a espera pelo atendimento era considerada normal e esteve dentro do esperado, e que, mesmo sendo longa, quando não se tratava de emergência, era considerada aceitável. Conclui-se que o atendimento recebido foi considerado como de qualidade. Em relação ao tempo de espera pela avaliação e cirurgia, a escassez de profissionais da especialidade e a falta de coordenação na rede de atenção primária podem ser considerados como pontos de dificuldade no itinerário percorrido.

ABSTRACT This study aims to describe parents' perception of pediatric surgical patient's trajectory, from diagnosis and indication for surgery to its completion, and to recognize factors that led to delays in care. This is a qualitative, descriptive study, which first identified in medical records children who were late referred for evaluation by the surgeon, and those responsible were randomly selected to be interviewed via telephone call. Content data analysis was carried out, thematic modality. Furthermore, 77/289 (26.6%)patients referred late were identified. Three thematic categories were listed: difficulties encountered; care in primary care; and from discovering the problem to performing surgery. Regarding the wait for the expert assessment, there is an excess of demand against a lower availability of appointments. A positive aspect was the quality of care received in primary care; the empathy of the teams was praised. Regarding the perception of time, family members considered the wait for care as normal and within expectations. Even when long, if it was not an emergency, it was considered acceptable. In conclusion, regarding the waiting time for evaluation and surgery, the lack of specialists and coordination of primary care may be pointed as difficulties during the course of care.

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Objetivo: Analizar las percepciones del personal de salud sobre los efectos de la pandemia por COVID-19 en la organización de un servicio de salud mental y adicciones. Materiales y métodos: Estudio descriptivo, transversal, cuantitativo. Se aplicó una encuesta diseñada por el Observatorio Argentino de Drogas de la SEDRONAR (Secretaría de Políticas sobre Drogas de la Nación Argentina) al personal de salud del Centro Asistencial Córdoba durante el mes de noviembre 2020. Resultados: Según las percepciones del personal de salud, la institución sostuvo la admisión y la suspensión fue solamente sobre las prestaciones de terapia grupal durante la primera etapa, que se revirtió desarrollando grupos terapéuticos mediante videollamadas. En relación con la variación de la demanda de atención, el 68,9% mencionó estar totalmente en desacuerdo con la afirmación de que la misma disminuyó. El personal de salud observó una variabilidad en los motivos de consulta y un aumento en la demanda de atención, con un crecimiento de las consultas por violencia autoinfligida y por consumos problemáticos de sustancias. Conclusión: Las medidas de aislamiento implicaron una reorganización de los servicios y sus modalidades de atención. Se torna importante preparar a los servicios de salud mental y adicciones para brindar las prestaciones necesarias y dar respuesta a las demandas de atención durante este tipo de contingencias.

Objetive: To analyze the perceptions of health personnel about the effects of the COVID-19 pandemic on the organization of a mental health and drug abuse service. Materials and Methods: A descriptive, cross-sectional and quantitative. A survey designed by the Argentine Drugs Observatory of SEDRONAR (Secretaría de Políticas sobre Drogas de la Nación Argentina) was applied to all the health professionals at Centro Asistencial Córdoba during November 2020. Results: According to the perceptions of health personnel, the organization kept admissions open for new treatments and the suspension was only about group therapy benefits during the first moment of lockdown measures, which was reversed by developing therapeutic groups through video calls. Regarding the change in demand for attention, 68, 9% mentioned being totally at odds with the claim that it diminished. Health personnel perceived a variability in the reasons for consultation and an increase in the demand for attention with a growth in consultations due to self-inflicted violence and substance-related disorders. Conclusion: It is possible to conclude that lockdown measures involved a reorganization of services and their modalities of attention. Therefore, it becomes important to prepare mental health services and substance-related disorders to provide the necessary benefits and respond to the demands for attention during this type of critical incidents.

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PURPOSE: Towards informing health research policy and planning, this article evaluates the relationship of the research publications in cardiac rehabilitation (CR) and pulmonary rehabilitation (PR) with the rehabilitation needs arising from cardiovascular diseases (except stroke) and chronic respiratory diseases, over time (1990-2017). METHODS: Ecological study using a secondary analysis and linear regressions of public domain data to associate two datasets of population-level data: (1) research publications for CR and PR (data from the PubMed database); and (2) global need for CR and PR (data from the Global Burden of Disease study). RESULTS: The percentage of both CR and PR publications (among total rehabilitation research) significantly decreased from 1990 to 2017 (both: p < 0.01). PR needs and research publications were aligned: around 5% of total rehabilitation needs and rehabilitation research. For CR needs (around 2%, but significantly increasing since 1990), we found a greater portion of CR research publications (6.5% or over). Finally, we found an inverse association among the percentage of CR research publications and CR needs (b = -6.08; r2  = 0.37, p = 0.001). CONCLUSION: The portion of CR and PR research (among total rehabilitation research) is declining over time. Yearly percentage of CR publications were greater than those of PR but for lower level of rehabilitation need, but the disparate trend was significantly decreasing over time. Population rehabilitation needs and their alignment with research volume must be one factor in the design of population-centred, equitable health research priorities.

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Introdução: As famílias de crianças com Síndrome Congênita do Zika (SCZ) convivem com dificuldades para suprir suas necessidades de saúde, portanto acionam o poder judiciário para gozar do seu direito à saúde. Objetivo: Apreender as principais motivações das impetrações judiciais requeridas por mães de crianças com SCZ e seus desfechos. Metodologia: Estudo exploratório documental com abordagem qualitativa, realizado no sítio eletrônico JusBrasil e coleta procedida em março de 2020. Foram incluídas 15 impetrações judiciais publicadas entre janeiro de 2016 e junho de 2019. A análise lexical através do software IRaMuTeQ e a análise de conteúdo temática foram realizadas. Resultados: O acesso às tecnologias assistivas é a principal motivação para impetrações judiciais, com vistas a assegurar melhora no desenvolvimento da criança e consequente independência da criança. As decisões judiciais beneficiaram as crianças com SCZ, fundamentadas no direito à saúde, direito à vida e proteção, e o direito de ir e vir. Conclusão: Para mitigar os impactos da judicialização da saúde as autoridades sanitárias e judiciárias podem investir em melhor vigilância e monitoramento dos fatores de risco e morbidades; rigor nos protocolos sanitários que envolvem migração de pessoas em zonas fronteiriças; ofertas de condições ambientais e de moradia dignas; realização de cuidados preventivos com destaque para a eficiência da imunização; além da organização e funcionamento de uma rede de atenção à saúde eficaz com abordagem interdisciplinar.

Introducción: Las familias de personas menores con síndrome de zika congénito (SZC) viven con dificultades para satisfacer sus necesidades de salud, por lo que hacen un llamado al Poder Judicial para gozar de este derecho. Objetivo: Conocer las principales motivaciones de las demandas presentadas por madres de niños y niñas con SZC y sus desenlaces. Metodología: Estudio documental exploratorio con enfoque cualitativo, realizado en el sitio web de JusBrasil y recogido en marzo de 2020. Se incluyeron 15 juicios publicados entre enero de 2016 y junio de 2019 en JusBrasil. Se realizó el análisis léxico a través del software IRaMuTeQ y el análisis de contenido temático. Resultados: El acceso a las tecnologías asistenciales es la principal motivación de las demandas, con el fin de asegurar la mejora en el desarrollo de la persona menor y su consecuente independencia. Las decisiones judiciales beneficiaron a niñas y niños con SZC, basadas en los derechos a la salud, a la vida y protección y a ir y venir. Conclusiones: Para mitigar los impactos de la judicialización en salud, las autoridades sanitarias y judiciales pueden invertir en una mejor vigilancia y seguimiento de los factores de riesgo y morbilidades, rigor en los protocolos sanitarios que implican la migración de personas en zonas fronterizas, ofrecer condiciones ambientales y habitacionales dignas, realizar cuidados preventivos, con énfasis en la eficiencia de la inmunización, además de la organización y operación de una red de atención de salud efectiva con enfoque interdisciplinario.

Introduction: Families of children with Congenital Zika Syndrome (CSZ) live with difficulties to meet their health needs; therefore, they resort to the law system in order claim their right to health. Objective: To apprehend the main motivations and outcomes of the lawsuits filed by mothers of children with CSZ. Methodology: Exploratory documentary study with a qualitative approach carried out on the JusBrasil website and collected in March 2020. The study included 15 lawsuits published between January 2016 and June 2019 in JusBrasil. A lexical analysis through the IRaMuTeQ software and a thematic content analysis were performed. Results: The access to assistive technologies is the main motivation for the lawsuits; these are issued with the objective to ensure improvement in the child's development and further independence of the child. Court decisions benefited children with CSZ based on the right to health, the right to life and protection, and the right to come and go. Conclusion: To mitigate the impacts of health judicialization, health and judicial authorities can invest in better surveillance and monitoring of the risk factors and morbidities, strictness in the health protocols that involve migration of people in border areas, offering of decent environmental and housing conditions, execution of preventive care with emphasis on the efficiency of immunization, as well as the organization and execution of an effective health care network with an interdisciplinary approach.

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BACKGROUND: Access to palliative care is an emerging global public health challenge. In Chile, a palliative care law was recently enacted to extend palliative care coverage to the non-oncologic population. Thus, a reliable and legitimate estimate of the demand for palliative care is needed for proper health policy planning. OBJECTIVE: To estimate the demand for Palliative Care in Chile. METHODOLOGY: Diseases likely to require palliative care were identified according to literature and expert judgement. Annual deaths of diseases identified were estimated for the periods 2018-2020. Demand estimation corresponds to the identification of the proportion of deceased patients requiring palliative care based on the burden of severe health-related suffering. Finally, patient-years were estimated based on the expected survival adjustment. RESULTS: The estimated demand for palliative care varies between 25,650 and 21,679 patients depending on the approximation used. In terms of annual demand, this varies between 1,442 and 10,964 patient-years. The estimated need has a minor variation between 2018 and 2019 of 0.85% on average, while 2020 shows a slightly higher decrease (7.26%). CONCLUSION: This is a replicable method for estimating the demand of palliative care in other jurisdictions. Future studies could approach the demand based on the decedent population and living one for a more precise estimation and better-informed health planning. It is hoped that our methodological approach will serve as an input for implementing the palliative care law in Chile, and as an example of estimating the demand for palliative care in other jurisdictions.

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OBJECTIVE: Mental illness is noted for being in one of the first places in global burden of disease in terms of years lived with disability (YLDs). Notably, absences due to mental health problems greatly affect the world of work, and mental illness is one of the most economically important diseases. However, there is a high rate of those not seeking care in mental health, both in the general population but also in workers in private and public sectors with significant economic impacts. The aim of our study was to identify factors associated with low access to specialized psychiatric care among French Public Sector employees referred to a psychiatric expertise upon request from the Departmental Medical Board of Martinique (Comité médical départemental [CMD] de Martinique), between 2000 and 2013. METHODS: We carried out an observational and transversal study, analyzing sociodemographic and clinical data from psychiatric assessments done to help the CMD give notification on the medico-administrative situation of Public Sector employees, a large majority of whom had been on sick leave due to mental health for at least 6 months. The variable of interest - low access to psychiatric care - was defined as the absence of consultation at the time of the assessment provided by a psychiatrist since at least 12 months. Descriptive analyses were performed first, then univariate analysis using a non-adjusted binary logistic regression model, to identify factors associated with low access to psychiatric care. Finally, multivariate analyses using a binary logistic regression model were performed after excluding non-relevant factors (with significance level above 5%) during the univariate analysis. A significance threshold of 0.05 was adopted for all of the statistical analyses. RESULTS: We retrospectively analysed the records of 516 Public Sector employees. Two hundred and ninety-three subjects (57% of the population) had a low access to psychiatric care as part of their regular clinical follow-up, even the 81% who were identified has having had psychiatric antecedents (55% with 'mood disorders', and 17% with 'neurotic, stress-related and somatoform disorders'). Moreover, psychiatric expertise found a psychiatric diagnostic in 96 % of cases, mostly 'mood disorders', 'neurotic, stress-related and somatoform disorders' and 'personality disorders'. For mood disorders, clinical characteristics of episodes were defined as 'severe' or 'with psychotic symptoms' in many cases. Suicidal thoughts were found in 96 subjects (18%) during the expertise. Fewer than half of the subjects (43%) had a specialized psychiatric care (mostly subjects with 'mood disorders' and 'psychotic disorders') and 41% only had care by a general practitioner (mostly subjects with 'neurotic, stress-related and somatoform disorders'). In most of the cases, psychotropic drugs were insufficiently and inadequately prescribed. Using multivariate analysis, we found a significant association between low access to psychiatric care and: being masculine, having had more than two children, having had personal life events (in particular chronic somatic diseases), and having had no history of mental illness or of psychiatric hospitalization. It appears that chronic somatic diseases are frequently associated with psychiatric diseases, and the association worsens the prognosis of the two disorders. However, even if employees with mental disorders associated with chronic somatic diseases are unfit for work, many of them do not have access to mental health care and only have care by a general practitioner. CONCLUSION: More than half of French Public Sector employees referred to the Departmental Medical Board of Martinique for a medico-administrative decision relevant to sick leave due to mental diseases, had low access to specialized psychiatric care. By identifying barriers to care and reasons for not seeking specialized mental health care, we would be able to prevent disability claims and days off work (predicting malaise in the workplace and health-related limitations). Our results demonstrate the need to strengthen existing partnerships, and thus enhancing cooperation between public psychiatric sectors and primary healthcare players, facilitating access to mental healthcare and decreasing the stigma about mental disorders.

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ABSTRACT Introduction: The interest in spinal endoscopy is rising, particularly among younger spine surgeons. Formalized postgraduate training programs for endoscopic spinal surgery techniques are lacking behind. Methods: The authors performed a retrospective survey study amongst participants of the 2022 AMCICO endoscopic surgery symposium. Descriptive and correlative statistics were done on the surgeon's responses recorded in multiple-choice questions. In addition, surgeons were asked about their clinical experience and preferences with spinal endoscopy, training background, the types of lumbar endoscopic decompression they perform by approach, and future training requirements. SPSS (version 27) statistical software package was used for data analysis. Descriptive statistic measures were used to count responses and calculate the mean, range, standard deviation, and percentages. In addition, chi-square statistics were used to determine the strength of the association between factors. Results: The online survey was accessed by 321 surgeons, of which 92 completed it (53.4%). Demographic data showed the majority of responding surgeons being orthopedic surgeons (73.6%) and under the age of 50 (69.2%), with over half (51.1%) having less than three months of formalized training in endoscopic spinal surgery techniques. Most surgeons practiced uni-portal (58.9%) versus bi-portal (3.4%) spinal endoscopy. The transforaminal approach (65.5%) was preferred over the interlaminar method (34.4%). The bi-portal technique was indicated almost exclusively for the lumbar spine (94.8%). For endoscopically assisted spinal fusions, a uni-portal approach was preferred by 72% of surgeons over a bi-portal procedure (24.5%). 84.1% of respondents were interested in navigation, of which 30.7% preferred optical over electromagnetic technology (18.2%). Robotics was of interest to 51.1% of survey participants. Respondents' bias was estimated with course attendance assessments, with 37% of surgeons having attended all three days, 27.2% two days, and 16.3% one day. One-fifth of responding spine surgeons did not participate in any curriculum activities but completed the survey. The academic impact of the AMCICO endoscopy symposium was high, with 68.1% of respondents indicating interest in continued training and 61.1% of trainees ready to apply their newly acquired knowledge base to clinical practice. Conclusion: The interest in spinal endoscopy surgery techniques and protocols is high among AMCICO members. Many surgeons are interested in learning advanced endoscopic surgical techniques to integrate the technology into their surgical procedure portfolio to address common painful conditions of the degenerative spine beyond herniated discs and foraminal stenosis. The authors concluded that its academic impact was high based on the responses given by the participating surgeons. Level of evidence III; Retrospective study.

Resumo: Introdução: O interesse em cirurgia endoscópica da coluna tem aumentado especialmente entre os jovens cirurgiões, contudo, são poucos os centros que atualmente oferecem programas de treinamento nesta disciplina. Métodos: Foi realizada uma pesquisa retrospectiva entre os participantes do simpósio de "Cirurgia Minimamente Invasiva e Endoscópica da Coluna Vertebral" realizado durante o Congresso AMCICO 2022. Estatísticas descritivas e testes de correlação foram aplicados às respostas das perguntas de múltipla escolha. Os cirurgiões foram questionados sobre experiência clínica e preferências pela endoscopia espinhal, histórico de treinamento, tipos de descompressão lombar endoscópica que realizaram e requisitos futuros para um treinamento adicional. O software estatístico SPSS (versão 27) foi utilizado para a análise de dados. As medidas estatísticas descritivas foram utilizadas para quantificar as respostas e calcular a mediana, a média, o desvio padrão e as porcentagens. O qui-quadrado foi empregado para determinar a associação entre os fatores estudados. Resultados: A pesquisa on-line foi visualizada por 321 cirurgiões, dos quais 92 a completaram (53,4%). As informações demográficas mostraram que a maioria dos participantes são cirurgiões ortopédicos (73,6%) e menores de 50 anos (69,2%), com mais da metade deles (51,1%) possuindo menos de 3 meses de treinamento formal em técnicas endoscópicas. A maioria dos cirurgiões pratica abordagens uniportais (58,9%, contra 3,4% bi-portais). A abordagem transforaminal (65,5%) foi preferida em relação à abordagem interlaminar (34,4%). A abordagem biportal foi selecionada como a abordagem indicada para a região lombar (94,8%). Para a fusão endoscopia-assistida, a abordagem unilateral foi preferida por 72% dos participantes contra a abordagem biportal (24,5%). Os sistemas de navegação foram de interesse para 84,1% dos participantes, dos quais 30,7% responderam que preferiam a óptica em vez da eletromagnética (18,2%). O uso da robótica foi de interesse para 51,1% dos participantes. O viés dos participantes foi calculado com base no percentual de participação, onde 37% participaram de todos os 3 dias de conferências, 27,2% participaram de 2 dias e 16,3% participaram de apenas um dia. Um quinto dos cirurgiões não participaram das atividades do simpósio e ainda assim responderam à pesquisa. O impacto acadêmico do simpósio de "Cirurgia Minimamente Invasiva e Endoscópica da Coluna Vertebral" foi alto, com 68,1% dos participantes respondendo que têm interesse em treinamento adicional nestas técnicas e 61,1% respondendo que estão prontos para aplicar novos conhecimentos em sua prática médica. Conclusão: O interesse em técnicas cirúrgicas endoscópicas da coluna vertebral é alto entre os membros da AMCICO. Um grande número de cirurgiões está interessado em aprender técnicas cirúrgicas endoscópicas avançadas da coluna vertebral e integrar esta tecnologia como parte de suas ferramentas cirúrgicas para resolver problemas comuns que afetam a coluna com doença degenerativa, além de hérnias de disco e estenoses foraminais. Baseados nas respostas fornecidas pelos cirurgiões participantes, os autores concluem que o impacto acadêmico foi elevado. Nível de evidência III; Estudo retrospectivo.

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Objetivo: Verificar la relación entre el factor tiempo dispensado en la prestación de cuidados y las principales necesidades de la persona cuidadora familiar de población adulta mayor hospitalaria y en cuidados paliativos. Método: Estudio descriptivo transversal con abordaje cuantitativo, realizado con 205 cuidadores familiares de personas adultas mayores sometidas a cuidados paliativos en un gran hospital de una capital del Noreste de Brasil. La recolección de datos se llevó a cabo entre agosto y octubre de 2019, mediante un cuestionario validado que incluía datos sociodemográficos, el tiempo de cuidado y 21 preguntas relacionadas con las necesidades humanas básicas. Se utilizó la prueba de chi-cuadrado para verificar la asociación entre los aspectos de cada dimensión (físico, emocional, social y espiritual) y la duración del cuidado, considerando un valor de p ≤ 0.05 como estadísticamente significativo. Resultados: Las personas cuidadoras familiares presentaron altos porcentajes de necesidades, relacionadas con el control emocional, la resolución de conflictos consigo mismas, salir de casa, hacer planes y poder llevarlos a cabo y suprimir sus demandas económicas y financieras asociadas al mayor tiempo dedicado al seguimiento de su familiar. Conclusiones: Los resultados de este estudio aportan un perfil de las principales necesidades de la persona cuidadora familiar, evidenciando que esta persona necesita apoyo del equipo de salud, con el fin de desarrollar estrategias para su control emocional, minimizar conflictos consigo misma, revisar sus demandas personales y mantener la rutina de actividades de ocio, además de sentirse bien para realizar planes futuros.

Objetivo: verificar a relação entre o fator tempo dispensado na prestação dos cuidados e as principais necessidades do familiar cuidador de pessoas idosas hospitalizadas e em cuidados paliativos. Método: estudo descritivo de corte transversal e abordagem quantitativa, realizado com 205 familiares cuidadores de pessoas idosas em cuidados paliativos num hospital de grande porte de uma capital do Nordeste brasileiro. A coleta de dados ocorreu entre os meses de agosto e outubro de 2019 utilizando-se de um questionário validado que contemplou dados sociodemográficos, o tempo de cuidados e 21 perguntas relacionadas as necessidades humanas básicas. Foi usado o teste qui quadrado para verificar a relação entre os aspectos de cada uma das dimensões (física, emocional, social e espiritual) e o tempo de cuidado considerando-se como estatisticamente significante um p-valor ≤ 0,05. Resultados: Os cuidadores familiares apresentaram elevados percentuais de necessidades relacionadas ao controle emocional, resolução de conflitos consigo mesmo, dificuldade em sair de casa, fazer planos e poder realizá-los e suprimir suas demandas econômico-financeiras associadas ao maior tempo gasto no acompanhamento do ente querido. Conclusões: os resultados deste estudo fornecem um perfil das principais necessidades do familiar cuidador, ficando evidente que esse cuidador necessita de suporte, por parte da equipe de saúde, no sentido de desenvolver estratégias para seu controle emocional, minimizar os conflitos consigo próprio, rever suas demandas pessoais e manter a rotina de atividades de lazer, além de sentir-se bem para realizar planos futuros.

Objective: to verify the relationship between the time spent in providing care and the main needs of the family caregiver of hospitalized elderly people in palliative care. Method: this was a descriptive, cross-sectional study with a quantitative approach. It was carried out with 205 family caregivers of elderly people undergoing palliative care in a large hospital in a Northeast of Brazil capital. The data collection took place between August and October 2019 using a validated questionnaire that included sociodemographic data, care time, and 21 questions related to basic human needs. A chi-square test was used to verify the relationship between the aspects of each dimension (physical, emotional, social and spiritual) and the length of care; a p-value of ≤ 0.05 was considered to be statistically significant. Results: family caregivers had high percentages of needs related to emotional control, conflict resolution with themselves, difficulty leaving home, making plans and being able to carry them out, and suppressing their economic and financial demands related with the longer time spent in monitoring their beloved one. Conclusion: the results of this study provide a profile of the main needs for family caregiver. This makes evident that caregivers need support from the health team in order to develop strategies for their emotional control, minimize their conflicts with themselves, review their personal demands, and maintain a routine of leisure activities while also feeling good to perform future plans.

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Aim: We analyze the impact of the COVID-19 pandemic on oncology service demand in a middle-income country with universal health coverage. Methods: We collected data from January 1st-2017 to December 31th-2021 at a reference center in Bogotá-Colombia regarding first-time consultations of cross-cutting services (clinical oncology, hematology, palliative care, radiation oncology); specialized multidisciplinary units (breast, prostate, lung, stomach); inpatient and outpatient systemic therapy; radiotherapy; oncology surgery; and bone marrow transplant. A descriptive time series analysis was performed, estimating monthly percent change and endemic channels. Results: Starting the confinement (April 2020), a general decrease in service demand was observed (R: -14.9% to -90.0%), with an additional but lower decrease in August 2020 coinciding with the first pandemic wave (R: -11.3% to -70.0%). Follow-up visits and ambulatory treatment showed no consistent reductions. New patients' consultations for cross-cutting services had a speedy recovery (1 month), but clinical oncology, specialized units, and in-hospital treatment resumed more slowly. Only breast and stomach cancer showed a sustained reduction in early-stage disease. Women and older patients had a more significant reductionin service demand. Conclusion: Despite no changes in service supply, the confinement induced a significant reduction in service demand. Variations by cancer type, service type, and population demographics deserve careful consideration for a suitable response to the emergency. The speedy recovery and the absence of a significant decrease during subsequent waves of the pandemic suggest patient resiliency and a lower impact than expected in middle-income settings in the presence of universal health insurance.

Objetivo: Analizar el impacto de la pandemia de COVID-19 sobre la demanda de servicios oncológicos. Metodos: Se recolectaron datos de enero 1/2017 hasta diciembre 31/2021 de consulta de primera vez en servicios transversales (oncología clinica, hematología, cuidados paliativos, oncología radioterápica) y servicios especializados multidisciplinarios (mama, próstata, pulmón, estómago), así como de suministro de tratamiento (terapia sistémica ambulatoria y hospitalaria, radioterapia, cirugía oncológica, trasplante de médula ósea), en un centro de referencia en Bogotá-Colombia. Se realizó un análisis descriptivo de series de tiempo estimando el cambio porcentual mensual y los canales endémicos. Resultados: Al inicio del confinamiento obligatorio (abril/2020) hubo una disminución general en la demanda de servicios transversales (R: -14.9% a -90.0%), con nuevo descenso de menor grado en agosto/2020 durante la primera ola de infecciones (R: -11.3% a -70.0%). Las consultas de seguimiento y tratamientos ambulatorios no mostraron reducciones consistentes. Exceptuando oncología clínica, las consultas de primera vez para servicios transversales tuvieron rápida recuperación hasta cifras basales (1 mes), pero las unidades especializadas y los tratamientos intrahospitalarios tuvieron recuperación mas lenta. Únicamente los cánceres de mama y estómago mostraron una reduccion sostenida de estadios tempranos de la enfermedad. La reducción de la demanda fue mas marcada en mujeres y adultos mayores. Conclusión: A pesar de no tener cambios en la oferta, el confinamiento indujo una reducción significativa en la demanda de servicios oncológicos con variación diferencial por tipo de cáncer, servicio y características demográficas de la población. Esto merece consideración especial para generar respuestas adecuadas a las emergencias sanitarias. La rápida recuperación de la demanda y la ausencia de caídas en olas de infección subsiguientes sugieren resiliencia de los pacientes e impacto menor del esperado en países con cobertura de salud universal.

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RESUMO O objetivo do estudo foi analisar o perfil e as principais demandas apresentadas por jovens de 15 a 29 anos à Ouvidoria-Geral do Sistema Único de Saúde (SUS) do Ministério da Saúde. Foram extraídas as bases de dados 'manifestações' e 'perfil cidadão' do Sistema Informatizado OuvidorSUS, de 2014 a 2018. Os dados foram analisados segundo os canais de atendimento, classificação e tipificação. O perfil foi desagregado em idade, raça/cor, sexo, orientação sexual, escolaridade, ocupação e faixa de renda. Foram registradas 114.618 manifestações com perfil do cidadão, sendo que 15,17% possuíam entre 15 e 29 anos. Prevaleceram negros (pretos e pardos), mulheres, heterossexuais, com nível superior concluído ou em curso, renda de até 2 salários mínimos e empregados no setor privado. A maior parte das manifestações foram solicitações, seguidas de reclamações e denúncias. As solicitações majoritariamente eram de consultas e cirurgias, nas áreas de ginecologia e obstetrícia e ortopedia e traumatologia. As reclamações e denúncias referiam-se, em grande parte, à gestão, sobretudo a profissionais e estabelecimentos de saúde. As sugestões foram as menos frequentes. As demandas refletem, em geral, os serviços utilizados pelos jovens e devem ser consideradas pela gestão para o direcionamento de políticas de saúde adequadas a essa população.

ABSTRACT This study aimed to analyze the profile and the main demands presented by young people (15 to 29 years old) to the Unified Health System (SUS) General Ombudsman of the Ministry of Health of Brazil. The databases 'manifestations' and 'citizen profile' of the System were extracted from the OuvidorSUS computerized system, referring to the years 2014 to 2018. The data were analyzed according to the service channels, classification, and typification. The profile was disaggregated by age, race/color, gender, sexual orientation, education, occupation, and income. 114,618 manifestations were registered with the citizen's profile, with 15.17% being by people from 15 to 29 years old. Blacks (including pardos), women, heterosexuals, with completed or ongoing higher education, income of up to 2 minimum wages, and employed in the private sector prevailed. Most of the manifestations were 'requests', followed by 'complaints' and 'denunciations'. Most requests were for consultations and surgeries, in the areas of gynecology and obstetrics, and orthopedics and traumatology. Complaints and denunciations were largely related to management, especially to health professionals and establishments. The suggestions were the least frequent. The demands largely reflect the services used by young people and should be considered by managers to guide health policies appropriate to this population.

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ABSTRACT Introduction: Since the coronavirus disease 2019 (COVID-19) pandemic, cardiac surgeries in patients with previous infection by COVID-19 were suspended or postponed, which led to surgeries performed in patients with an advanced stage of their disease and an increase in the waiting list. There is a heterogeneous attitude in Latin America on the optimal timing to cardiac surgery in patients with previous COVID-19 infection due to scarce data on its outcome. Two Latin American associations joined to establish common suggestions on the optimal timing of surgery in patients with previous COVID-19 infection. Methods: Data collection was performed using a pre-established form, which included year of publication, objective, type of study (prospective/retrospective, descriptive/analytical), number of patients, year of study, waiting time between infection and surgery, type of surgery, morbidity, mortality, and conclusions regarding the association between mortality and morbidity. Final recommendations were approved by the board of directors of Latin American Association of Cardiac and Endovascular Surgery (LACES) and Latin American Confederation of Anesthesia Societies (CLASA). Results: Of the initial 1,016 articles, 11 comprised the final selection. Only six of them included patients who underwent cardiac surgery. According to the analyzed literature, optimal timing for cardiac surgery needs to consider the following aspects: deferable surgery, symptomatic COVID-19 infection, completeness of COVID-19 vaccination. Conclusion: These recommendations derive from the analysis of the scarce literature published at present on outcomes after cardiac surgery in patients with previous COVID-19 infection. These are to be taken as a dynamic recommendation in which Latin American reality was taken into consideration.

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INTRODUCTION: Since the coronavirus disease 2019 (COVID-19) pandemic, cardiac surgeries in patients with previous infection by COVID-19 were suspended or postponed, which led to surgeries performed in patients with an advanced stage of their disease and an increase in the waiting list. There is a heterogeneous attitude in Latin America on the optimal timing to cardiac surgery in patients with previous COVID-19 infection due to scarce data on its outcome. Two Latin American associations joined to establish common suggestions on the optimal timing of surgery in patients with previous COVID-19 infection. METHODS: Data collection was performed using a pre-established form, which included year of publication, objective, type of study (prospective/retrospective, descriptive/analytical), number of patients, year of study, waiting time between infection and surgery, type of surgery, morbidity, mortality, and conclusions regarding the association between mortality and morbidity. Final recommendations were approved by the board of directors of Latin American Association of Cardiac and Endovascular Surgery (LACES) and Latin American Confederation of Anesthesia Societies (CLASA). RESULTS: Of the initial 1,016 articles, 11 comprised the final selection. Only six of them included patients who underwent cardiac surgery. According to the analyzed literature, optimal timing for cardiac surgery needs to consider the following aspects: deferable surgery, symptomatic COVID-19 infection, completeness of COVID-19 vaccination. CONCLUSION: These recommendations derive from the analysis of the scarce literature published at present on outcomes after cardiac surgery in patients with previous COVID-19 infection. These are to be taken as a dynamic recommendation in which Latin American reality was taken into consideration.

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ABSTRACT Migraine is a prevalent disorder and a cause of high disability, influenced by modifiable and non-modifiable risk factors. Comorbid and psychiatric illnesses are prevalent in migraine patients and should be considered when choosing preventive drugs. There have been unforeseen problems with the use of preventive treatment of migraine with oral drugs, mainly due to side-effects that cannot be tolerated and lack of efficacy, leading to high discontinuation rates. Anti-CGRP monoclonal antibodies (mAbs) have shown better tolerance profiles, based on the low dropout rates in clinical trials due to adverse events. First-line therapy is a term most expressed in some medical specialties that adopt standardized protocol treatments and may not be suitable for treating migraine. Regarding efficacy, mAbs don't seem to perform much better than the current prophylactic oral drugs in reduction of monthly migraine days compared to placebo. Monoclonal antibodies against CGRP pathway have been prescribed recently, which raises some concern about their safety in the long term. Only side effects observation will confirm whether CGRP blockade causes susceptibility to severe side-effects, at least to specific subpopulations. CGRP may play a role in regulating uteroplacental blood flow and myometrial and uterine relaxation, as well as blood pressure control, raising the suspicion that its blockade could cause complications during pregnancy. Recent guidelines retain the recommendation of starting preventive treatment of migraine with oral drugs. Both the fact that it is new and costs are the reason why guidelines recommend the prescription of mAbs only after failure of at least two oral drugs.

RESUMO A migrânea é uma condição prevalente e motivo de grande incapacidade, influenciada por fatores de risco modificáveis e não-modificáveis. Comorbidades e doenças psiquiátricas são prevalentes em doentes com migrânea e devem ser levadas em consideração na escolha do tratamento profilático com medicações orais. Os anticorpos monoclonais anti-CGRP possuem melhor perfil de tolerabilidade, baseando-se nos baixos indicadores de desistência devido a efeitos colaterais em ensaios clínicos. O termo "tratamento de primeira linha" é muito utilizado em algumas especialidades médicas que adotam protocolos de tratamento padronizados e pode não ser adequado à migrânea. Quanto à eficácia, os anticorpos monoclonais não possuem desempenho muito superior que os medicamentos profiláticos orais atuais no tocante à redução de dias de migrânea por mês, quando comparados ao placebo. Os anticorpos monoclonais anti-CGRP são recentes no mercado, o que leva a suspeitas quanto à sua segurança a longo prazo. Apenas a vigilância de efeitos adversos confirmará se o bloqueio da via do CGRP não leva à suscetibilidade de efeitos colaterais graves, ao menos em subpopulações específicas. O CGRP pode ter um papel na regulação do fluxo sanguíneo uteroplacentário, bem como no relaxamento do miométrio e do útero e controle da pressão arterial, levando à possibilidade de que o seu bloqueio poderia causar complicações durante a gestação. Guidelines recentes recomendam o início do tratamento preventivo da migrânea com drogas orais. Tanto a precocidade quanto os elevados custos são a razão porque os guidelines orientam a prescrição de anticorpos monoclonais após falha a pelo menos duas medicações orais.

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Abstract Aim: We analyze the impact of the COVID-19 pandemic on oncology service demand in a middle-income country with universal health coverage. Methods: We collected data from January 1st-2017 to December 31th-2021 at a reference center in Bogotá-Colombia regarding first-time consultations of cross-cutting services (clinical oncology, hematology, palliative care, radiation oncology); specialized multidisciplinary units (breast, prostate, lung, stomach); inpatient and outpatient systemic therapy; radiotherapy; oncology surgery; and bone marrow transplant. A descriptive time series analysis was performed, estimating monthly percent change and endemic channels. Results: Starting the confinement (April 2020), a general decrease in service demand was observed (R: -14.9% to -90.0%), with an additional but lower decrease in August 2020 coinciding with the first pandemic wave (R: -11.3% to -70.0%). Follow-up visits and ambulatory treatment showed no consistent reductions. New patients' consultations for cross-cutting services had a speedy recovery (1 month), but clinical oncology, specialized units, and in-hospital treatment resumed more slowly. Only breast and stomach cancer showed a sustained reduction in early-stage disease. Women and older patients had a more significant reductionin service demand. Conclusion: Despite no changes in service supply, the confinement induced a significant reduction in service demand. Variations by cancer type, service type, and population demographics deserve careful consideration for a suitable response to the emergency. The speedy recovery and the absence of a significant decrease during subsequent waves of the pandemic suggest patient resiliency and a lower impact than expected in middle-income settings in the presence of universal health insurance.

Resumen Objetivo: Analizar el impacto de la pandemia de COVID-19 sobre la demanda de servicios oncológicos. Metodos: Se recolectaron datos de enero 1/2017 hasta diciembre 31/2021 de consulta de primera vez en servicios transversales (oncología clinica, hematología, cuidados paliativos, oncología radioterápica) y servicios especializados multidisciplinarios (mama, próstata, pulmón, estómago), así como de suministro de tratamiento (terapia sistémica ambulatoria y hospitalaria, radioterapia, cirugía oncológica, trasplante de médula ósea), en un centro de referencia en Bogotá-Colombia. Se realizó un análisis descriptivo de series de tiempo estimando el cambio porcentual mensual y los canales endémicos. Resultados: Al inicio del confinamiento obligatorio (abril/2020) hubo una disminución general en la demanda de servicios transversales (R: -14.9% a -90.0%), con nuevo descenso de menor grado en agosto/2020 durante la primera ola de infecciones (R: -11.3% a -70.0%). Las consultas de seguimiento y tratamientos ambulatorios no mostraron reducciones consistentes. Exceptuando oncología clínica, las consultas de primera vez para servicios transversales tuvieron rápida recuperación hasta cifras basales (1 mes), pero las unidades especializadas y los tratamientos intrahospitalarios tuvieron recuperación mas lenta. Únicamente los cánceres de mama y estómago mostraron una reduccion sostenida de estadios tempranos de la enfermedad. La reducción de la demanda fue mas marcada en mujeres y adultos mayores. Conclusión: A pesar de no tener cambios en la oferta, el confinamiento indujo una reducción significativa en la demanda de servicios oncológicos con variación diferencial por tipo de cáncer, servicio y características demográficas de la población. Esto merece consideración especial para generar respuestas adecuadas a las emergencias sanitarias. La rápida recuperación de la demanda y la ausencia de caídas en olas de infección subsiguientes sugieren resiliencia de los pacientes e impacto menor del esperado en países con cobertura de salud universal.

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A pesquisa tem por objetivo analisar as dimensões do cuidado e as necessidades em saúde relatadas por usuários da Rede de Atenção às Urgências e Emergências (RUE) em uma Região de Saúde. O estudo tem caráter qualitativo e foi realizado por meio da coleta de narrativas de usuários de serviços sobre suas experiências com o processo de adoecimento e a utilização da RUE. A análise considerou os referenciais da Taxonomia das Necessidades em Saúde e das Múltiplas Dimensões da Gestão do Cuidado. Observou-se nos relatos especial ênfase à busca dos usuários por autonomia e a ação do cuidado familiar. A compreensão das necessidades em saúde dos usuários e das diferentes dimensões da gestão do cuidado em ação devem ser consideradas para formulação de políticas de saúde e para a organização de redes rumo à integralidade.(AU)

El objetivo de la investigación fue analizar las dimensiones del cuidado y las necesidades de salud relatadas por usuarios de la Red de Atención a Urgencias y Emergencias (RUE) en una región de salud. El estudio tiene carácter cualitativo y se realizó por medio de la colecta de narrativas de usuarios de servicios sobre sus experiencias con el proceso de enfermarse y de la utilización de la RUE. El análisis considera los factores referenciales de la "Taxonomía de las Necesidades de Salud" y de las "Múltiples Dimensiones de la Gestión del Cuidado". Se observó en los relatos un énfasis especial a la búsqueda de los usuarios por autonomía y la acción del cuidado familiar. La comprensión de las necesidades de salud de los usuarios y de las diferentes dimensiones de la gestión del cuidado en acción deben considerarse para la formulación de políticas de salud y para la organización de redes hacia la integralidad.(AU)

This research aims to analyze the dimensions of care and health needs reported by users of the Urgent and Emergency Care Network (RUE) in a health region. The qualitative study was conducted by collecting statements from health service users about their experiences with the illness process and the use of RUE. The analysis considered the references of the "Taxonomy of Health Needs" and the "Multiple Dimensions of Care Management". The statements emphasized the users search for autonomy and the action of family care. Understanding the health needs of users and the different dimensions of care management is essential to formulate health policies and organize networks towards comprehensiveness.(AU)

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Este artigo visa analisar aspectos no cuidado aos "hiperutilizadores" na Atenção Básica por meio da percepção dos profissionais e dos usuários. Foi realizada uma pesquisa qualitativa de caráter exploratório, do tipo estudo de caso, em que "hiperutilizadores" e profissionais foram entrevistados. A maneira como os profissionais definem quem é um usuário "hiperutilizador" é mais complexa do que o número total de consultas realizadas, passando pela identificação das necessidades em saúde que motivam a busca por cuidados. Os usuários com necessidades que extrapolam o alcance do modelo biomédico muitas vezes não têm as suas necessidades corretamente identificadas ou consideradas legítimas, e são considerados "hiperutilizadores" independentemente do número de consultas. O estudo serviu como um analisador da Atenção Básica à Saúde (ABS). Mantém-se um modelo ainda centrado na racionalidade biomédica, com pouca abertura para a "vida como ela é" e para o conhecimento e o "agir-leigo". (AU)

El objetivo de este artículo es analizar aspectos en el cuidado a los "hiperutilizadores" en la atención básica, a partir de la percepción de los profesionales y de los usuarios. Se realizó una investigación cualitativa, de carácter exploratorio, del tipo estudio de caso, en la que fueron entrevistados "hiperutilizadores" y profesionales. La manera en que los profesionales definen quién es un usuario "hiperutilizador" es más compleja que el número total de consultas realizadas y pasa por la identificación de las necesidades de salud que motivan la búsqueda de cuidados. Los usuarios con necesidades que extrapolan el alcance del modelo biomédico, muchas veces no tienen sus necesidades correctamente identificadas o consideradas legítimas y son considerados "hiperutilizadores", independientemente del número de consultas. El estudio sirvió como un analizador de la ABS. Se mantiene un modelo que todavía está centrado en la racionalidad biomédica, con poca apertura para la "vida tal como es" y para el conocimiento y el "actuar-lego". (AU)

This article aims to analyze aspects involved in the health assistance provided for "high users" in primary care, based on the perception of professionals and users. A qualitative and exploratory case study was carried out in which "high users" and professionals were interviewed. The way in which primary care professionals define who is a "high user" is more complex than the total number of medical consultations and involves identifying the health needs that motivate users to seek assistance. Users whose needs are beyond the scope of the biomedical model often do not have their needs correctly identified or considered legitimate and are viewed as "high users" regardless of the number of appointments. The study served as an analyzer of primary care. A model still centered on the biomedical rationality is maintained, with little opening to "life as it is" and to "lay-action" and knowledge. (AU)

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Resumo Objetivo: compreender as necessidades em saúde que emergem durante a rota percorrida por mulheres que sofreram violência sexual para realização do aborto legal. Método: estudo exploratório, descritivo, qualitativo, cujo referencial teórico foi o campo conceitual da Saúde Coletiva, tendo como base a concepção marxiana de necessidades. Participaram do estudo dez mulheres que solicitaram aborto legal em um serviço de referência localizado em São Paulo. Para coleta de dados utilizou-se roteiro de entrevista semiestruturado. Os dados foram submetidos à análise de conteúdo com apoio do software WebQDA. As categorias analíticas utilizadas foram necessidades em saúde e gênero. Resultados: apesar de a efetivação do aborto ter sido apontada como necessidade primaz, os dados revelaram outras necessidades sentidas pelas mulheres, relacionadas ao processo saúde-doença com ênfase na saúde mental, ao trabalho, à situação financeira, ao exercício da maternidade, ao acesso à informação, à autonomia, à sororidade e ao acolhimento nos serviços de saúde. Conclusão: as necessidades propriamente humanas estiveram em maior evidência no estudo, superando necessidades meramente biológicas. Os resultados apontam para a importância de corresponsabilização dos serviços de saúde junto às mulheres, visando minimizar vulnerabilidades e efetivação de direitos reprodutivos.

Abstract Objective: to understand the health needs that emerge on the path followed toward legal abortion by women who have suffered sexual violence. Method: an exploratory, descriptive and qualitative study, whose theoretical framework was the conceptual field of Collective Health, based on the Marxian conception of needs. The study participants were ten women who requested legal abortion at a reference service located in São Paulo. A semi-structured interview script was used for data collection. The data were submitted to content analysis with the support of the WebQDA software. The analytical categories used were health needs and gender. Results: despite the fact that abortion was identified as a primary need, the data revealed other needs felt by women, related to the health-disease process and with an emphasis on mental health, work, financial situation, the exercise of motherhood, access to information, autonomy, sisterhood and welcoming in the health services. Conclusion: the properly human needs were in greater evidence in the study, surpassing merely biological needs. The results point to the importance of co-responsibility of the health services with women, aiming to minimize vulnerabilities and to effectively implement reproductive rights.

Resumen Objetivo: comprender las necesidades de salud que surgen en el camino que recorren las mujeres que han sufrido violencia sexual para realizarse un aborto legal. Método: estudio exploratorio, descriptivo, cualitativo, cuyo marco teórico fue el campo conceptual de la Salud Colectiva, basado en la concepción marxista de las necesidades. Participaron del estudio diez mujeres que solicitaron el aborto legal en un servicio de referencia ubicado en San Pablo. Para la recolección de datos se utilizó una guía para la entrevista semiestructurada. Los datos fueron sometidos a análisis de contenido con la ayuda del software WebQDA. Las categorías analíticas utilizadas fueron necesidades de salud y género. Resultados: a pesar de que el aborto fue identificado como la principal necesidad, los datos revelaron que las mujeres tienen otras necesidades que se relacionan con el proceso salud-enfermedad principalmente la salud mental, el trabajo, la situación económica, el ejercicio de la maternidad, el acceso a la información, la autonomía, la sororidad y la acogida en los servicios de salud. Conclusión: las necesidades humanas son las que más se destacaron en el estudio, superando a las necesidades meramente biológicas. Los resultados señalan que es importante que exista corresponsabilidad entre los servicios de salud y las mujeres, para reducir la vulnerabilidad y lograr la efectivización de los derechos reproductivos.

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Objetivo: descrever o perfil epidemiológico da clientela que busca atendimento em Práticas Integrativas e Complementares. Método: pesquisa descritiva, tipo corte transversal e abordagem quantitativa, realizado com 104 indivíduos que buscaram atendimento em Práticas Integrativas e Complementares na Universidade Federal Fluminense. Resultados: houve predomínio de jovens de 19 a 30 anos com alta escolaridade. Apesar de 57 (76%) ingerem regularmente a água e 14 (79%) praticam atividade física três ou mais vezes/semana, 14 (18,9%) eram etilistas, sete (9,3%) tabagistas, três (4,2%) consumiam drogas ilícitas e 27 (39,6%) dedicavam-se "nada" ou "muito pouco" ao lazer. Apenas 29 (37,1%) possuíam boa disposição geral, nove (11,8%) bom humor e 10 (9,3%) sentiam-se tranquilos a maior parte do tempo. Apetite e sede normal foram relatados em 43 (56,5%) e 38 (49,3%) respectivamente e 59 (90,7%) exibiram problemas com o sono. Conclusão: o atendimento tem sido buscado pela população que manifesta certo grau de sofrimento mental

Objective: describe the epidemiological profile of the clientele that seeks assistance in Integrative and Complementary Practices. Method: descriptive, cross-sectional research and quantitative approach, conducted with 104 individuals who sought assistance in Integrative and Complementary Practices at Universidade Federal Fluminense. Results: there was a predominance of young people from 19 to 30 years old with high schooling. Although 57 (76%) regularly drink water and 14 (79%) practice physical activity three or more times/week, 14 (18,9%) were alcoholics, seven (9,3%) smokers, three (4,2%) used illicit drugs and 27 (39,6%) devoted "nothing" or "very little" to leisure. Only 29 (37,1%) had good general disposition, nine (11,8%) good mood and 10 (9,3%) felt calm most of the time. Normal appetite and thirst were reported in 43 (56,5%) and 38 (49,3%) respectively and 59 (90,7%) exhibited problems with sleep. Conclusion: care has been sought by the population that manifests a certain degree of mental suffering

Objetivo: describir el perfil epidemiológico de la clientela que busca asistencia en Prácticas Integrativas y Complementarias. Método: enfoque descriptivo, transversal y cuantitativo, realizado con 104 personas que buscaron asistencia en Prácticas Integrativas y Complementarias en la Universidad Federal Fluminense. Resultados: predominó la juventud de 19 a 30 años con estudios secundarios. Aunque 57 (76%) beben regularmente agua y 14 (79%) practican actividad física tres o más veces/semana, 14 (18,9%) eran alcohólicos, siete (9,3%) fumadores, tres (4,2%) usaron drogas ilícitas y 27 (39,6%) dedicaron "nada" o "muy poco" al ocio. Solo 29 (37,1%) tenían buen humor general, nueve (11,8%) estaban de buen humor y 10 (9,3%) se sentían tranquilos la mayor parte del tiempo. Se informaron apetito y sed normales en 43 (56,5%) y 38 (49,3%) respectivamente y 59 (90,7%) exhibieron problemas con el sueño. Conclusión: la población ha buscado atención que manifieste cierto grado de sufrimiento mental

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ABSTRACT OBJECTIVE To map and analyze the vulnerabilities of Arab refugees in the context of primary health care. METHOD Scoping review in which studies published in English, Spanish and Portuguese languages from 2011 onwards were reviewed. The following databases were surveyed: Cochrane, Scopus, Health System Evidence, MedLine-PubMed, CINAHL, Embase, Lilacs, Web of Science, SciELO, NYAM Grey Literature, BVS, Capes Thesis and Dissertation Database, Refworld and Journal of Refugee Studies. Data were analyzed in light of the concept of vulnerability. RESULTS Of the 854 studies identified, 40 articles were held for analysis and extraction of vulnerability indicators in the individual, social and programmatic dimensions. Regarding the individual dimension, the main indicators identified were unemployment, unstable and overcrowded housing, lack of sanitation and access to water, mental disorders, communicable and chronic noncommunicable diseases, etc. In the programmatic dimension, were identified, mainly, health teams with work overload, lack of preparation to deal with cultural and linguistic barriers, and delays in providing care. In relation to the social dimension, lack of access to schools, to information about health programs in the host countries, and to rights, among others, were found. CONCLUSION Vulnerabilities found highlight the disadvantage of refugees regarding health programs, services and system in host countries, in addition to highlighting the deep inequalities that affect this group. It is pointed out the need for programs and policies that promote actions, within the scope of primary health care, which recognize and respond to the health needs of refugees.

RESUMO OBJETIVO Mapear e analisar as vulnerabilidades de refugiados árabes no contexto da atenção primária à saúde. MÉTODO Revisão de escopo em que foram analisados estudos publicados nos idiomas inglês, espanhol e português, a partir de 2011. As bases foram Cochrane, Scopus, Health System Evidence , MedLine-PubMed, CINAHL, Embase, Lilacs, Web of Science , SciELO, NYAM Grey Literature , BVS, Banco de teses e dissertações Capes, Refworld e Journal of Refugee Studies. A análise dos dados foi realizada à luz do conceito de vulnerabilidade. RESULTADOS Dos 854 estudos identificados, restaram 40 artigos para análise e extração dos indicadores de vulnerabilidade nas dimensões individual, social e programática. Em relação à dimensão individual, os principais indicadores identificados foram desemprego, moradias instáveis e superlotadas, falta de saneamento e de acesso à água, agravos mentais, doenças transmissíveis e crônicas não transmissíveis etc. Na dimensão programática foram identificadas, principalmente, equipes de saúde com sobrecarga de trabalho, falta de preparo para lidar com as barreiras culturais e linguísticas, demora para o atendimento. Em relação à dimensão social, constatou-se falta de acesso às escolas, à informação sobre os programas de saúde dos países de acolhida, aos direitos, entre outros. CONCLUSÃO As vulnerabilidades constatadas evidenciam desvantagem dos refugiados perante os programas, serviços e sistema de saúde nos países de acolhida, além de colocar em evidência as profundas desigualdades que incidem nesse grupo. Aponta-se a necessidade de programas e políticas que promovam ações, no âmbito da atenção primária à saúde, que reconheçam e respondam às necessidades de saúde de refugiados.

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