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BACKGROUND: Previous research has highlighted inequalities in access to Swedish youth clinics (YCs). These inequalities exist not only between non-migrant and young migrant populations but also within various migrant groups. OBJECTIVES: To assess awareness and utilization of Swedish YCs among migrants enrolled in Swedish language programmes and explore associated factors. METHODS: This cross-sectional study involved 1,112 migrants aged 15-65. The analytical sample included 642 (57%) participants who answered the main outcome question about awareness of YCs. Descriptive statistics, bivariate, and multivariate log-binomial regression analyses using a Bayesian approach were applied to summarize the data and identify factors associated with awareness and utilization of YCs among migrants. RESULTS: The results revealed that 30% of all participants and 40% of the participants aged 15-25 years had heard of YCs. Additionally, 23% of the target group (15-25 years) had ever visited one. During descriptive and bivariate analyses, socio-demographic variations were evident in YCs' awareness and utilization. However, in multivariate analyses, only the associations between awareness and year of arrival, and YCs' utilization and year of arrival and type of residence permit, remained statistically significant. CONCLUSION: This study highlights the level of awareness of YCs among migrants attending Swedish language programmes and their utilization by those aged 15-25 years, potentially impacting their access to crucial services and resources. Targeted interventions and sustainable strategies beyond one-time interventions are essential to address the specific needs of different socio-demographic groups and ensure equitable access to YCs' information and services.

Main findings: This study highlights the level of awareness and utilization of youth clinics among migrants attending Swedish language programmes, revealing socio-demographic disparities across different groups.Added knowledge: Migrant men and unaccompanied minors are more likely to be aware of and use youth clinics than migrant women and those with legal guardians, while recent migrants and those with temporary residence permits are at an increased risk of being unaware of or not utilizing these services.Global health impact for policy and action: Targeted interventions and sustainable strategies, beyond one-time efforts, are essential to address the specific needs of different migrant subgroups and ensure equitable and universal access to crucial information and services related to sexual and reproductive health and rights.

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OBJECTIVE: To analyze the degree, evolution and causes of socioeconomic inequality in perceived access to health services among the older adults in China. METHODS: The data used in this study were drawn from the 4 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2008, 2011, 2014, 2018. Erreygers index (EI) was used to measure socioeconomic inequality in perceived access to health services in each survey wave. A panel logit regression model was used to examine the impact of socioeconomic status on perceived access to health services. The recentered influence function (RIF) regression decomposition method was used to explore the causes of socioeconomic inequality in perceived access to health services. Inverse probability weighting (IPW) was employed to adjust estimates for missing responses and loss to follow-up. RESULTS: "Pro-rich" socioeconomic inequality in perceived access to health services in China was found with inequality falling through time. The older adults with higher incomes, who had adequate financial support, and those who were wealthier compared with other residents reported lower socioeconomic inequality in perceived access to health services. Having basic health insurance and access to care resources when ill can help alleviate such inequalities. CONCLUSIONS: Socioeconomic inequality in perceived access to health services was shown to be responsive to policies that enhance health insurance coverage and support the provision of (paid and unpaid) caregiving for the older adults.

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The evaluation of living kidney donor candidates is a complex and lengthy process. Donor candidates face geographic and socioeconomic barriers to completing donor evaluation. Inequities in access to living donations persist. With a growing demand for kidney transplants and a shortage of living donors, transplant centers are more permissive of accepting less-than-ideal donor candidates. Donors have an increased lifetime risk of kidney failure, but the absolute risk increase is small. Efforts are needed to support donor candidates to complete donor nephrectomy safely and efficiently and receive optimal follow-up care to prevent risk factors for kidney disease and detect complications early. In this article, the authors address key elements of donor kidney evaluation, including current living donation policy requirements and transplant center practices. The authors present a simplified comprehensive practical approach to help guide providers in completing donor evaluation and follow-up care with best outcomes possible.

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Background: During the COVID-19 pandemic, there was an increase in the number of unhoused individuals in Asheville, North Carolina resulting in more tent encampments.Understanding the physical, mental, and socially determined health characteristics associated with being unhoused can help guide stakeholders with policy development, healthcare program planning, and funding decisions to support unhoused individuals. Methods: In this study, we used an observational cross-section methodology. Using a convenience sample approach, we interviewed 101 participants who were receiving services from 2 emergency hotel shelters, a day center, and a resource center. Data were analyzed using descriptive statistics, and open-ended responses were collected and grouped to provide context. Results: Most participants were White (71%) and identified as male (76%). Over 60% reported having a high school education or advanced degree. Of the participants, 76% reported being unhoused for more than 6 months, and their last permanent housing was in Western North Carolina. Dental disease, chronic pain, and hypertension were common physical conditions. PTSD, depression, and anxiety were common mental health conditions. A lack of transportation was the most noted socially determined challenge. Marijuana, methamphetamine, and alcohol were the most often used substances, where methamphetamine was noted to be particularly problematic for the participants. Conclusion: Understanding the physical, mental, and social issues of the complex unhoused population can assist policymakers, healthcare providers, and other stakeholders in addressing challenges and testing improvement strategies.

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Introdução: Entre os desafios para se alcançar o cuidado integral está o acesso às unidades básicas, que não ocorre com tanta facilidade como deveria, caracterizando-se como uma grande dificuldade para os gestores municipais. O Programa de Melhoria ao Acesso e Qualidade de Atenção Básica, teve como objetivo incentivar a ampliação do acesso e melhorar a qualidade da atenção básica, garantindo um padrão de qualidade comparável nacionalmente, regionalmente e localmente de maneira a permitir maior transparência e efetividade das ações governamentais relacionadas a atenção básica. Objetivo: Avaliar a qualidade da atenção básica dos municípios da 6ª região de saúde, na perspectiva do acesso aos serviços de saúde. Metodologia: Trata-se de uma pesquisa avaliativa, com abordagem quantitativa. Foram utilizados dados secundários extraídos dos relatórios analíticos disponibilizados publicamente. A coleta dos dados ocorreu no período de março a maio de 2020. As informações foram organizadas a partir da elaboração de um protocolo de pesquisa contendo a dimensão: acesso. Resultados: Em relação ao acolhimento à demanda espontânea, 34 equipes não realizavam classificação de risco e 44 não realizavam acolhimento durante todo o funcionamento. Na análise dos indicadores de consulta médicas, identificou-se que 18 equipes não apresentaram resultados para os cálculos e não realizavam consultas médicas essenciais. Os dados evidenciaram que 40 equipes não agendavam consultas durante todo o horário e nana organização da agenda, apenas 9 equipes atenderam aos critérios descritos nas dimensões analisadas. Conclusões: Foi possível identificar que existem muitas barreiras organizacionais em relação ao acesso, principalmente quanto a marcação de consultas e ao acolhimento à demanda espontânea (AU).

Introduction: Among the challenges in achieving comprehensive care is access to basic units, which does not occur as easily as it should, representing a major difficulty for municipal managers. The Program for Improving Access and Quality of Primary Care aimed to encourage the expansion of access and improve the quality of primary care, ensuring a comparable quality standard nationally, regionally, and locally to allow greater transparency and effectiveness of government actions related to primary care.Objective:Evaluate the quality of primary care in the municipalities of the 6th health region, from the perspective of access to health services.Methodology: This is an evaluative research, with a quantitative approach. Secondary data extracted from publicly available analytical reports were used. Data collection took place from March to May 2020. The information was organized based on the development of a research protocol containing the dimension: access. Results: About welcoming spontaneous demand, 34 teams did not carry out risk classification and 44 did not provide support throughout the operation. In the analysis of medical consultation indicators, it was identified that 18 teams did not present results for the calculations and did not carry out essential medical consultations. The data showed that 40 teams did not schedule appointments during all hours and when organizing the agenda, only 9 teams met the criteria described in the dimensions analyzed. Conclusions:It was possible to identify that there are many organizational barriers to access, mainly regarding scheduling appointments and accepting spontaneous demand (AU).

Introducción: Entre los desafíos para alcanzar el cuidado integral está el acceso a las unidades básicas, que no ocurre con tanta facilidad como debería, caracterizándose como una grandificultad para los gestores municipales. El Programa de Mejora al Acceso y Calidad de Atención Básica, tuvo como objetivo incentivar la ampliación del acceso y mejorar la calidad de la atención básica, garantizando un estándar de calidad comparable nacionalmente, regionalmente y local de manera a permitir mayor transparencia y efectividad de las acciones gubernamentales relacionadas con la atención básica.Objetivo: Evaluar la calidad de la atención primaria en los municipios de la 6ª región sanitaria desde la perspectiva del acceso a los servicios sanitarios.Metodología: Se trata de una investigación evaluativa, con enfoque cuantitativo. Se utilizaron datos secundarios extraídos de informes analíticos disponibles públicamente. La recolección de datos se realizó de marzo a mayo de 2020. La información se organizó a partir del desarrollo de un protocolo de investigación que contiene la dimensión: acceso.Resultados: En relación al acogimiento a la demanda espontánea, 34 equipos no realizaban clasificación de riesgo y 44 no realizaban acogida durante todo el funcionamiento. En el análisis de los indicadores de consulta médicas, se identificó que 18 equipos no presentaron resultados para los cálculos y no realizaban consultas médicas esenciales. Los datos evidenciaron que 40 equipos no programaban consultas durante todo el horario y en la organización de la agenda, solo 9 equipos atendieron a los criterios descritos en las dimensiones analizadas. Conclusiones: Fue posible identificar que existen muchas barrerasorganizacionales en relación al acceso, principalmente en cuanto a la marcación de consultas y a la acogida a la demanda espontánea (AU).

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INTRODUCTION: Suicide is a complex, global public health problem. The Colombian clinical practice guideline provides relevant input for its prevention, diagnosis and treatment. The objective was to evaluate the methodological quality, credibility and applicability of the Colombian clinical practice guideline for suicidal behaviour. METHODS: An academic group of 12 evaluators was established to assess the guide and its recommendations in a standardised way, using the AGREE-II and AGREE-REX instruments. The evaluations were given in the range of 0.0-1.0 with 0.7 as a cut-off point for appropriate quality. RESULTS: The global assessment of the AGREE-II was greater than 0.7 in the dimensions: "scope and objective" (0.86), "clarity of presentation" (0.89), "applicability" (0.73) and "editorial independence" (0.89). The lowest scores were for "participation of those involved" (0.67) and "rigour in preparation" (0.69). With the AGREE-REX, the results in all dimensions were below 0.70, which indicates lower quality and suitability for use. CONCLUSIONS: The adoption process of the Colombian guideline for suicidal behaviour was a rigorous methodological process, while the practice recommendations were valued as of low applicability due to low support in local evidence. It is necessary to strengthen the generation and synthesis of evidence at the national level to give greater support and applicability to the practice recommendations.

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OBJECTIVE: The aim of this study was to measure the knowledge about breast cancer and to identify the barriers in screening among Saudi women in the Al-Baha region. To achieve this, a cross-sectional study was conducted, involving 468 women, to assess their understanding of breast cancer and to explore the obstacles they face in accessing breast cancer screening services. METHODS: The cross-sectional study included 468 women from Al Baha, Saudi Arabia, starting from May 17, 2022, to May 17, 2023. Participants were interviewed by well-trained team members of the research, and their responses were subsequently entered into a Google Form. This process aimed to evaluate their awareness, knowledge, and barriers to breast cancer screening. RESULTS: The majority of participants (48.9%) were in the 18-28 age group. The findings reveal a high level of awareness (96.4%) among participants regarding the significance of early breast cancer detection. For the effectiveness of breast cancer treatment, 59% believed there is an effective treatment, while 32.9% were uncertain or did not know. Knowledge about various risk factors for breast cancer varied. Smoking (73.5%), genetic factors (65.6%), and a family history of breast cancer (70.7%) were well-recognized as risk factors. Education and occupation significantly influenced knowledge about breast cancer (p-value of 0.000, and 0.035 respectively). CONCLUSION: this research highlights strong awareness of breast cancer's importance but gaps in knowledge regarding lesser-known factors. Education is crucial, requiring tailored campaigns and healthcare professional engagement.

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Purpose: Stroke is the second leading cause of global adult mortality and the primary cause of disability. A rapid assessment by a neurologist for general and reperfusion treatments in ischemic strokes is linked to decreased mortality and disability. Telestroke assessment is a strategy that allows for neurological consultations with experienced professionals, even in remote emergency contexts. No randomized studies have compared face-to-face neurological care outcomes with telestroke care. Whether neurologists in an institution achieve better results remotely than in person is also unknown. This study aimed to compare mortality and other outcomes commonly measured in stroke protocols for stroke patients assessed by a neurologist via face-to-face evaluations and telestroke assessment. Methods: Observational single-center retrospective study from August/2009 to February/2022, enrolling 2,689 patients with ischemic stroke, subarachnoid hemorrhage, and intracerebral hemorrhage. Group 1 (G1) comprised 2,437 patients with in-person neurological assessments, and Telemedicine Group 2 (G2) included 252 patients. Results: The in-person group had higher admission NIHSS scores (G1, 3 (0; 36) vs. G2, 2 (0; 26), p < 0.001). The door-to-groin puncture time was lower in the in-person group than in the telestroke group (G1, 103 (42; 310) vs. G2, 151 (109; 340), p < 0.001). The telestroke group showed superior metrics for door-to-imaging time, symptomatic hemorrhagic transformation rate in ischemic stroke patients treated with intravenous thrombolysis, hospital stay duration, higher rates of intravenous thrombolysis and mechanical thrombectomy, and lower mortality. Symptomatic hemorrhagic transformation rate was smaller in the group evaluated via telestroke (G1, 5.1% vs. G2, 1.1%, p = 0.016). Intravenous thrombolysis and mechanical thrombectomy rates were significantly higher in telestroke group: (G1, 8.6% vs. G2, 18.2%, p < 0.001 and G1, 5.1% vs. G2, 10.4%, p = 0.002, respectively). Mortality was lower in the telestroke group than in the in-person group (G1, 11.1% vs. G2, 6.7%, p = 0.001). The percentage of patients with an mRS score of 0-2 at discharge was similar in both groups when adjusting for NIHSS score and age. Conclusion: The same neurological emergency team may assess stroke patients in-person or by telemedicine, with excellent outcome metrics. This study reaffirms telestroke as a safe tool in acute stroke care.

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BACKGROUND: Neuromuscular diseases are inherited and the prevalance of neuromuscular disease is estimated to be around 1:2000. METHODS: This cross-sectional research was conducted with a qualitative research model. Data were collected from patients with an online survey using the snowball sampling method. The study was conducted in accordance with the STROBE checklist methodology. Frequencies and percentages were used to analyse demographic data, and content analysis was used for qualitative opinions. RESULTS: Most of the participants were men and their education levels were low. Participants reported experiencing physical and socio-economic barriers to accessing healthcare. Participants also stated that these barriers have worsened since COVID-19. CONCLUSIONS: Patients with hereditary myopathy are stigmatised by society and face different problems depending on the type of disease and level of function. It is recommended that decision-makers enable patients with hereditary myopathy in exceptional situations to access healthcare services and take steps to resolve their problems.

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BACKGROUND: In the face of drought and food insecurity emergency, evidence on access to health and nutrition services is important. Karamoja is one of the regions that have experienced extreme drought and food insecurity emergency in Uganda. As a part of the drought and food insecurity emergency response, World Health Organization (WHO) with Ministry of Health (MoH) has designed and implemented a qualitative study in 15 districts that have experienced drought and food insecurity emergency in north-east Uganda. Thus, we aimed to explore the barriers of access to health and nutrition services in drought and food insecurity emergency affected districts in north-east Uganda. METHODS: We employed a descriptive qualitative study design. We interviewed 30 patients and 20 Village Health Teams (VHT) from 15 districts. We employed an in-depth interview with semi-structured questions to collect data until information saturation reached. We used thematic data analysis approach by ATLAS.ti version 7.5.1.8 software. RESULTS: Of the 30 interviewed subjects, 15 were female, and the median age of the subjects was 29 years with interquartile range (IQR) of 23 to 37 years. Majority (68.8%) of subjects reported that access to health and nutrition services was harder to them. Four themes: sociocultural and economic; environmental; health system, and individual related factors were identified as the barriers of access to health and nutrition services. CONCLUSION: The present study identified several modifiable barriers that hinder access to health and nutrition services in drought and food insecurity affected districts. Comprehensive interventions aimed at addressing sociocultural, economic, environmental, health system and subject related challenges are required to improve access to health and nutrition services in drought and food insecurity affected setups.

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INTRODUCTION: The perceived mental health of individuals in Canada who faced health care barriers during the COVID-19 pandemic is underexplored. METHODS: We analyzed data collected March to June 2021 from adults who reported needing health care services within the past 12 months in the Survey on Access to Health Care and Pharmaceuticals during the Pandemic. Unadjusted and adjusted logistic regression analyses examined the associations between health care barriers (appointment scheduling problems, delaying contacting health care) and high self-rated mental health and perceived worsening mental health compared to before the pandemic, overall and stratified by gender, age group, number of chronic health conditions and household income tertile. RESULTS: Individuals who experienced pandemic-related appointment changes or had appointments not yet scheduled were less likely to have high self-rated mental health (aOR = 0.81 and 0.64, respectively) and more likely to have perceived worsening mental health (aOR = 1.50 and 1.94, respectively) than those with no scheduling problems. Adults who delayed contacting health care for pandemic-related reasons (e.g. fear of infection) or other reasons were less likely to have high self-rated mental health (aOR = 0.52 and 0.45, respectively) and more likely to have perceived worsening mental health (aOR = 2.31 and 2.43, respectively) than those who did not delay. Delaying contacting health care for pandemic-related reasons was associated with less favourable perceived mental health in all subgroups, while the association between perceived mental health and pandemic-related appointment changes was significant in some groups. CONCLUSION: Health care barriers during the pandemic were associated with less favourable perceived mental health. These findings could inform health care resource allocation and public health messaging.

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OBJECTIVES: To explore the perceptions that Colombians have about voluntary private health insurance plans (VPHI) in the health system to identify the tensions that exist between the public and private systems. METHODS: A qualitative case study approach with 46 semi structured interviews of patients, healthcare workers, healthcare administrators, decision-makers, and citizens. Interviews were recorded, transcribed, anonymized, digitally stored, and analyzed following grounded theory guidelines. RESULTS: We developed a paradigmatic matrix that explores how, in a context mediated by both the commodification of health and social stratification, perceptions about the failures in the public health system related to lack of timely care, extensive administrative procedures, and the search for privileged care led to positioning VPHI as a solution to these failures. The interviewees identified three consequences of using VPHI: first, the worsening of problems of timely access to care in the public system; second, higher costs for citizens translated into double payment for technologies and services to which they are entitled; third, the widening of inequity gaps in access to health services between people with similar needs but different payment capacities. CONCLUSIONS: These findings can help decision makers to understand citizens´ perceptions about the implications that VPHI may have in worsening equity gaps in the Colombian health system. It also shows, how VPHI is perceived as a double payment for services covered within social security plans and suggests that the perceived lack of timely access to care in the public systems and the fear that citizens have for themselves or their family members when using suboptimal healthcare are important drivers to purchase these private insurances.

RESUMEN: OBJETIVOS: Explorar las percepciones que tienen los colombianos sobre los planes de seguro de salud privados voluntarios (VPHI) en el sistema de salud para identificar las tensiones que existen entre los sistemas público y privado. MéTODOS: Un estudio cualitativo de caso con 46 entrevistas semiestructuradas a pacientes, trabajadores de la salud, administradores de salud, tomadores de decisiones y ciudadanos. Las entrevistas se grabaron, transcribieron y almacenaron de manera anónima. El análisis se hizo siguiendo conceptos de la teoría fundamentada. RESULTADOS: Desarrollamos una matriz paradigmática que explora cómo, en un contexto mediado tanto por la mercantilización de la salud como por la estratificación social, las percepciones sobre las fallas en el sistema de salud público relacionadas con la falta de atención oportuna, procedimientos administrativos extensos y la búsqueda de atención privilegiada llevaron a posicionar los VPHI como una solución a estas fallas. Los entrevistados identificaron tres consecuencias del uso de los VPHI: primero, el empeoramiento de los problemas de acceso oportuno a la atención en el sistema público; segundo, mayores costos para los ciudadanos, traducidos en un pago doble por tecnologías y servicios a los que tienen derecho; tercero, el aumento de las brechas de equidad en el acceso a los servicios de salud entre personas con necesidades similares pero diferentes capacidades de pago. CONCLUSIONES: Estos hallazgos pueden ayudar a los tomadores de decisiones a comprender las percepciones de los ciudadanos sobre las implicaciones que el VPHI puede tener en el empeoramiento de las brechas de equidad en el sistema de salud colombiano. También muestra cómo el VPHI se percibe como un pago doble por servicios cubiertos dentro de los planes de seguridad social y sugiere que la falta percibida de acceso oportuno a la atención en los sistemas públicos y el miedo que los ciudadanos tienen por sí mismos o por sus familiares cuando utilizan una atención sanitaria subóptima son factores importantes para adquirir estos seguros privados.

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Objetivo principal: Comprender el significado que los pacientes que consultan al servicio de urgencias le dan al proceso de triage. Metodología: Estudio cualitativo con enfoque etnográfico, la información se recolectó por medio de 14 entrevistas semiestructuradas y se llevó diario de campo, para el análisis se sacaron unidades de significado que se agruparon en categorías. Resultados principales: Los participantes acuden al servicio de urgencias después de intentar manejar sus situaciones por medio de recursos que tienen en su entorno, al no encontrar soluciones se desplazan al servicio de urgencias, donde quieren ser atendidos inmediatamente, sin embargo, encuentran barreras que los presiona a usar estrategias para lograr la solución de sus necesidades en la atención de urgencias, en todo este proceso los pacientes esperan ser “primero yo” en la atención. Conclusión principal: el significado que los pacientes le dan al triage es que ellos sean el eje de la atención y por lo tanto tienen la expectativa que sea sin demora, sin complicaciones y que sea humanizado.(AU)

Objective: To understand the meaning that patients who consult the emergency department give to the triage process. Methods: qualitative study with an ethnographic approach, the information was collected through semi-structured interviews and a field diary was kept. Results: the participants go to the emergency department after trying to manage their situations through the resources that they have in their environment, not finding solutions, they go to the emergency department, where they want to be attended immediately, however, they find barriers that pressure them to Using strategies to achieve the solution of their needs in emergency care, throughout this process patients expect to be "first me" in care. Conclusions: the meaning that the patients give to triage is that they are the axis of care and therefore, they expect it to be without delay, without complications and that it be humanized.(AU)

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Abstract Quilombola communities are present in many Brazilian states living in precarious health conditions. This is due to geographic isolation, limitations to the access of the area in which they live in, and the lack of quality in the service when it is needed to be provided. Therefore, the aim of this study was to analyze the quality of life of women from a quilombola community in northeastern Brazil. It is an observational, cross-sectional and descriptive study. 160 adult women were first interviewed through a form to collect a profile and then it was applied the WHOQOL Quality of Life questionnaire bref. It was observed that the women were on average 40.7 years old (±17.25), married, self-declared black, who did not finish elementary school, housewife, had no income, with their own masonry house, with up to 6 rooms, supplied by a box of community treated water. Quality of Life had median scores in the domains: physical (3.18), psychological (3.4), social relationships (3.45) and environment (2.59). With this research, it was possible to characterize the quilombola community of Santa Luzia do Norte-AL regarding the difficulties of access to health and income generation, issues that affect their health condition. The problems described in this study can contribute to health actions being planned and carried out in order to improve socioeconomic and health conditions in this community, considering the social, political and environmental context, valuing their traditional knowledge and practices.

Resumo As comunidades quilombolas, estão presentes em diversos estados brasileiros, vivendo em condições de saúde mais precárias. Isto ocorre por conta do isolamento geográfico, das limitações de acesso e da falta de qualidade no serviço quando este é prestado. Nesse sentido, o objetivo do estudo foi analisar a qualidade de vida de mulheres de uma comunidade quilombola do nordeste brasileiro. Estudo observacional, transversal e descritivo. Foram entrevistadas 160 mulheres adultas, através de um formulário para a coleta de perfil e do questionário de Qualidade de Vida WHOQOL bref. Foi observado que as mulheres tinham em média 40,7 anos (±17,25), casadas, autodeclaradas negras, com fundamental incompleto, do lar, sem renda, com moradia de alvenaria, própria, com até 6 cômodos, abastecidas por caixa de água comunitária, tratada. A Qualidade de Vida, apresentou escores medianos nos domínios: físico (3,18), psicológico (3,4), relações sociais (3,45) e meio ambiente (2,59). Com a realização desta pesquisa foi possível caracterizar a comunidade quilombola de Santa Luzia do Norte-AL quanto as dificuldades de acesso a saúde e geração de renda, fatos que repercutem na sua condição de saúde. Os problemas descritos neste estudo podem contribuir para que ações de saúde sejam planejadas e efetivadas com o intuito de melhorar as condições socioeconômicas e de saúde nessa comunidade, considerando-se o contexto social, político e ambiental, valorizando seus saberes e práticas tradicionais.

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Resumo O objetivo deste artigo é identificar a satisfação dos usuários em relação às cadeiras de rodas e à prestação de serviços públicos e privados de saúde da Região Metropolitana da Baixada Santista. Estudo transversal com abordagem quantitativa. Os participantes responderam a um questionário sociodemográfico e à versão brasileira do Quebec Assistive Technology User Satisfaction Assessment. Os dados foram analisados utilizando a estatística descritiva e comparativa por meio do teste t de Student. Os tamanhos de efeito d de Cohen foram calculados. Os participantes (n = 42) estavam "mais ou menos satisfeitos" com as cadeiras de rodas e "pouco satisfeitos" com a prestação de serviços. Os usuários de cadeiras de rodas monobloco apresentaram satisfação significativamente maior com suas cadeiras em comparação com usuários de cadeiras de rodas acima de 90kg (p = 0,010, d = 1,04). Os usuários de serviços privados apresentaram satisfação significativamente maior com a prestação de serviço em comparação aos usuários de serviços públicos (p = 0,021, d = 0,75). Os usuários de cadeiras de rodas da Região Metropolitana da Baixada Santista estão mais satisfeitos com as cadeiras de rodas monobloco e menos satisfeitos com os serviços públicos.

Abstract This article seeks to identify user satisfaction in relation to wheelchairs and the provision of public and private health services in the Baixada Santista Metropolitan Region. It involved a cross-sectional study with a quantitative approach. Participants answered a sociodemographic questionnaire and the Brazilian version of the Quebec Assistive Technology User Satisfaction Assessment. Data were analyzed using descriptive and comparative statistics by means of Student's t test. Cohen's d effect sizes were also calculated. Participants (n = 42) were "more or less satisfied" with the wheelchairs and "quite satisfied" with the services provided. Rigid frame wheelchair users were significantly more satisfied with their wheelchairs compared to users of wheelchairs weighing over 198 lbs. (p = 0.010, d = 1.04). Users of private services showed significantly greater satisfaction with the provision of the service compared to public services users (p = 0.021, d = 0.75). Wheelchair users in the Baixada Santista Metropolitan Region are more satisfied with the rigid frame wheelchair and less satisfied with public services.

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ABSTRACT Objective: To verify the association between social determinants of health and access to health services for COVID-19 patients. Method: Analytical, cross-sectional study, carried out in three states in the Northeast of Brazil (Ceará, Maranhão and Pernambuco), with 968 patients, using questionnaires with sociodemographic data, determinants and the Primary Care Assessment Tool, adapted to the reality of COVID-19, with 58 items, classified as high (score ≥ 6.6) and low (score < 6.6), whose high value reveals better standards of access to health services. The Chi-square test was used for comparative analysis. Results: There was a significant difference (p < 0.05) between the domains of the instrument and the following determinants: age, skin color, body mass index, origin, schooling, employment, services close to home, first service, income and means of transport. Conclusion: Access to health services for people with COVID-19 was associated with various determinants, including individual, behavioural and social ones, correlated with the structural and organizational aspects of the health services offered by the three states of Northeastern Brazil.

RESUMEN Objetivo: Verificar la asociación de los determinantes sociales de la salud con el acceso de los pacientes con COVID-19 a los servicios de salud. Método: Estudio analítico, transversal, realizado en tres estados del Nordeste de Brasil (Ceará, Maranhão y Pernambuco), con 968 pacientes, utilizando cuestionarios con datos sociodemográficos, determinantes y la Herramienta de Evaluación de la Atención Primaria (PCATool), adaptada a la realidad de la COVID-19, con 58 ítems, clasificados en alto (puntuación ≥ 6,6) y bajo (puntuación < 6,6), cuyo valor alto revela mejores estándares de acceso a los servicios de salud. Se utilizó la prueba de chi-cuadrado para analizar las comparaciones. Resultados: Hubo diferencia significativa (p < 0,05) entre los dominios del instrumento y los siguientes determinantes: edad, color de piel, índice de masa corporal, origen, escolaridad, empleo, servicios cercanos al domicilio, primer servicio, ingreso y medio de transporte. Conclusión: El acceso a los servicios de salud de las personas con COVID-19 se asoció a diversos determinantes, entre ellos individuales, comportamentales y sociales, correlacionados con los aspectos estructurales y organizativos de los servicios de salud ofrecidos por los tres estados del nordeste de Brasil.

RESUMO Objetivo: Verificar a associação dos determinantes sociais da saúde com o acesso de pacientes com COVID-19 aos serviços de saúde. Método: Estudo analítico, transversal, desenvolvido em três estados do Nordeste brasileiro (Ceará, Maranhão e Pernambuco), com 968 pacientes, utilizando-se de questionários de dados sociodemográficos, determinantes e do Primary Care Assessment Tool, adaptado para realidade da COVID-19, com 58 itens, classificado em alto (escore ≥ 6,6) e baixo (escore < 6,6), cujo valor alto revela melhores padrões de acesso aos serviços de saúde. Para análise comparativa, empregou-se o teste do Qui-quadrado. Resultados: Verificou-se diferença significativa (p < 0,05) entre os domínios do instrumento e os seguintes determinantes: idade, cor da pele, índice de massa corporal, procedência, escolaridade, vínculo empregatício, serviços próximos à residência, primeiro serviço de atendimento, renda e meios de transporte. Conclusão: O acesso aos serviços de saúde de pessoas com COVID-19 esteve associado aos diversos determinantes, sendo estes individuais, comportamentais, sociais, correlacionados aos aspectos estruturais e organizacionais dos serviços de saúde ofertados pelos três estados do Nordeste brasileiro.

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Tendo em vista o papel importante que os enfermeiros desempenham no processo de vacinação, o objetivo do presente estudo foi examinar a perspectiva desses profissionais em duas Unidades Básicas de Saúde (UBSs), que utilizam diferentes modelos de agendamento (Carve-Out e Acesso Avançado), com relação a como aproveitar as oportunidades de discutir a imunização durante o atendimento aos usuários que procuram ajuda sem agendamento prévio. Para realizar a comparação entre as unidades, foram utilizados dados secundários dos relatórios do Sistema de Informação do Programa Nacional de Imunizações e do e-SUS AB, no período de janeiro a dezembro de 2019. Foram realizadas entrevistas semiestruturadas com os enfermeiros dessas unidades sendo utilizada a Matriz SWOT para análise do ambiente interno. Com relação à escuta inicial, pode-se observar uma superioridade da UBS que segue o modelo de Acesso Avançado, porém não houve diferenças significativas quanto ao quantitativo de imunizações. A estratégia para diminuir as Oportunidades Perdidas de Vacinação (OPVs) mais citada, foi a abordagem do usuário no momento da procura na "demanda espontânea". No entanto, foi evidenciada como barreira a falta da caderneta de vacinação, já que o usuário não estaria na unidade para essa demanda e o pouco tempo disponível. Não houve diferenças significativas entre a percepção dos enfermeiros atuantes nos diferentes modelos de agendamento, Carve-Out e Acesso Avançado, no que se refere a oportunizar abordagens sobre imunização durante o atendimento à demanda espontânea.

Considering the important role that nurses play in the vaccination process, the objective of the present study was to examine the perspective of these professionals in two Basic Health Units (UBSs), which use different scheduling models (Carve-Out and Advanced Access), regarding how to take advantage of opportunities to discuss immunization during care for users who seek help without prior scheduling. To carry out the comparison between the units, secondary data from reports from the Information System of the National Immunization Program and e-SUS AB were used, from January to December 2019. Semi-structured interviews were carried out with nurses from these units. The SWOT Matrix for analyzing the internal environment. Regarding initial listening, we can observe the superiority of the UBS that follows the Advanced Access model, but there were no significant differences in terms of the number of immunizations. The most cited strategy to reduce Missed Vaccination Opportunities (OPVs) was the user approach when searching for "spontaneous demand". However, the lack of a vaccination booklet was highlighted as a barrier, as the user would not be at the unit for this demand and there was little time available. There were no significant differences between the perception of nurses working in the different scheduling models, Carve-Out and Advanced Access, with regard to providing opportunities for approaches to immunization when meeting spontaneous demand.

Considerando el importante papel que desempeña el enfermero en el proceso de vacunación, el objetivo del presente estudio fue examinar la perspectiva de estos profesionales en dos Unidades Básicas de Salud (UBS), que utilizan diferentes modelos de programación (Carve-Out y Acceso Avanzado), respecto a cómo aprovechar oportunidades para discutir sobre inmunización durante la atención a usuarios que buscan ayuda sin programación previa. Para realizar la comparación entre las unidades, se utilizaron datos secundarios de los informes del Sistema de Información del Programa Nacional de Inmunizaciones y del e-SUS AB, de enero a diciembre de 2019. Se realizaron entrevistas semiestructuradas a enfermeros de estas unidades. Matriz FODA para el análisis del entorno interno. En cuanto a la escucha inicial, se observa la superioridad de la UBS que sigue el modelo de Acceso Avanzado, pero no hubo diferencias significativas en cuanto al número de inmunizaciones. La estrategia más citada para reducir las Oportunidades de Vacunación Perdidas (OPV) fue el enfoque del usuario al buscar "demanda espontánea". Sin embargo, se destacó como una barrera la falta de cartilla de vacunación, ya que el usuario no estaría en la unidad para esta demanda y había poco tiempo disponible. No hubo diferencias significativas entre la percepción de las enfermeras que trabajan en los diferentes modelos de programación, Carve-Out y Advanced Access, con respecto a brindar oportunidades de enfoques de inmunización cuando se satisface la demanda espontánea.

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Resumo: Na pandemia de COVID-19, as populações que vivem mais afastadas dos centros urbanos enfrentaram imensas dificuldades no acesso aos serviços de saúde. O objetivo deste estudo é analisar como os municípios rurais remotos brasileiros enfrentaram a pandemia de COVID-19, tendo como base sua resposta política, estrutural e organizativa ao acesso à saúde. Trata-se de estudo qualitativo de casos múltiplos com a análise de conteúdo temática e dedutiva de 51 entrevistas conduzidas com gestores e profissionais de saúde em 16 municípios rurais remotos dos estados de Rondônia, Mato Grosso, Tocantins, Piauí, Minas Gerais e Amazonas. Com dinâmicas socioespaciais próprias, grandes distâncias até os centros de referência, os municípios rurais remotos responderam às demandas da pandemia, mas não tiveram suas necessidades atendidas oportunamente. Preservaram a comunicação com a população, reorganizaram o sistema local centrado na atenção primária à saúde (APS), alteraram o funcionamento das unidades de saúde, ultrapassando os limites de suas atribuições para prestar o cuidado necessário e aguardar o encaminhamento aos demais níveis de complexidade. Enfrentaram a escassez de serviços, as lacunas assistenciais da rede regional e o transporte sanitário inadequado. A pandemia reiterou as dificuldades da APS em coordenar o cuidado e expôs os vazios assistenciais nas regiões de referência. A provisão equitativa e resolutiva do sistema local de saúde nos municípios rurais remotos implica na articulação interfederativa à formulação e implementação de políticas públicas de modo a assegurar o direito à saúde.

Abstract: During the COVID-19 pandemic, populations living further away from urban centers faced immense difficulties accessing health services. This study aims to analyze how Brazilian remote rural municipalities faced the COVID-19 pandemic based on their political, structural, and organizational response to access to healthcare. A qualitative study of multiple cases was conducted with thematic and deductive content analysis of 51 interviews conducted with managers and healthcare professionals in 16 remote rural municipalities in the states of Rondônia, Mato Grosso, Tocantins, Piauí, Minas Gerais, and Amazonas. With their socio-spatial dynamics and long distances to reference centers, the remote rural municipalities responded to the demands of the pandemic but did not have their needs met promptly. They preserved communication with the population, reorganized the local system centered on primary health care (PHC), and changed the functioning of healthcare units, exceeding the limits of their responsibilities to provide the necessary care and awaiting referral to other levels of complexity. They faced a shortage of services, gaps in assistance in the regional network, and inadequate healthcare transport. The pandemic reiterated PHC's difficulties in coordinating care, exposing care gaps in reference regions. The equitable and resolute provision of the local health system in the remote rural municipalities implies inter-federative articulation in formulating and implementing public policies to ensure the right to health.

Resumen: En la pandemia de COVID-19, las poblaciones que viven más alejadas de los centros urbanos enfrentaron inmensas dificultades para acceder a los servicios de salud. El objetivo de este estudio es analizar cómo los municipios rurales remotos de Brasil enfrentaron la pandemia de COVID-19, a partir de su respuesta política, estructural y organizativa al acceso a la salud. Se realizó el estudio cualitativo de casos múltiple con el análisis de contenido temático y deductivo de 51 entrevistas realizadas con gestores y profesionales de la salud en 16 municipios rurales remotos de los estados de Rondônia, Mato Grosso, Tocantins, Piauí, Minas Gerais y Amazonas. Con dinámicas socioespaciales propias y alejados de los centros de referencia, los municipios rurales remotos respondieron a las demandas de la pandemia, pero no se atendieron sus necesidades de manera oportuna. Preservaron la comunicación con la población, reorganizaron el sistema local centrado en la atención primaria de salud (APS), modificaron el funcionamiento de las unidades de salud, superando los límites de sus atribuciones para proporcionar la atención necesaria, y esperar la derivación a los demás niveles de complejidad. Enfrentaron la falta de servicios, las lagunas asistenciales de la red regional y el transporte sanitario inadecuado. La pandemia reafirmó las dificultades de la APS para coordinar la atención y expuso las lagunas asistenciales en las regiones de referencia. La provisión equitativa y resolutiva del sistema de salud local en los municipios rurales remotos implica en la articulación interfederativa para elaborar e implementar políticas públicas para asegurar el derecho a la salud.

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Resumo A América Latina é uma das regiões mais desiguais do mundo. Desigualdades estruturais, fruto dos processos de colonização e ocupação do território, marcam as condições de vida e saúde das pessoas. Na saúde, é possível observar como diferentes dimensões das desigualdades condicionam o acesso e a experiência do usuário no serviço. Objetivou-se mapear e analisar as expressões das desigualdades no acesso aos serviços de saúde nos países da América Latina a partir da produção científica dos últimos dez anos. O desenho de estudo foi a revisão de escopo, por meio da qual foram selecionados 272 artigos. A análise categorial permitiu a classificação dos artigos em cinco dimensões, que caracterizam as expressões das desigualdades no acesso aos serviços de saúde: socioeconômica, geoespacial, étnica/racial, gênero e de pessoas com deficiência. As barreiras de acesso mais frequentes foram: socioeconômica ou capacidade de pagamento; geográfica ou dificuldade de transporte; disponibilidade de serviços; cultural/étnica; comunicação; e arquitetônica. Os principais fatores condicionantes das desigualdades em saúde foram renda, escolaridade, transporte e condições de moradia. O enfrentamento das desigualdades em saúde requer a proposição de políticas estruturantes e setoriais.

Abstract Latin America is one of the most unequal regions in the world. Due to colonization and occupation of the territory, structural inequalities mark people's living and health conditions. In health, we can observe how different dimensions of inequalities condition access and user experience in the service. This scoping review aimed to map and analyze the expressions of inequalities in access to health services in Latin American countries from the scientific production of the last ten years, from which 272 articles were selected. The categorical analysis classified articles into five dimensions, which characterize the expressions of inequalities in access to health services: socioeconomic, geospatial, ethnic/racial, gender, and people with disabilities. The most frequent access barriers were socioeconomic or ability to pay, geographic or transportation difficulty, availability of services, cultural/ethnic, communication, and architecture. The main conditioning factors of health inequalities were income, schooling, transportation, and living conditions. Combating health inequalities requires proposing structuring and sectorial policies.