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PURPOSE: The objective of this qualitative study is to explore experiences and challenges of university students living with invisible disabilities. METHODS: Nine videotaped medical consultations with students, conducted at the health centre of a higher education institution in northern Chile, were analysed, drawing on the thematic analysis to organize the most salient themes. RESULTS: Three major themes were identified in the analysis, along with their subthemes: (1) experiencing overpowering symptoms, including variable, multiple, and severe symptoms; (2) facing medical, social, and academic barriers; (3) engaging in self-management behaviours, such as self-medication, self-treatment, changing therapies, and non-compliance. CONCLUSION: As the healthcare system is mostly ineffective in diagnosing students with invisible disabilities as well as providing them with long-lasting help, the students often have to manage their conditions by themselves, without much success. It seems essential to promote the development of stronger links between health providers and universities to allow for early disability detection and awareness-raising programs within educational institutions. Further research should focus on strategies promoting effective support mechanisms to decrease barriers and increase the inclusion of these individuals.

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Due to the Coronavirus-19 (COVID-19) pandemic, most resources of the public health system were allocated to the increasing demand from respiratory patients. From this, it is expected that specialty consultations would decrease drastically. Access to dermatology care in the Chilean public health has been historically limited. To evaluate the impact of the pandemic on dermatology care, the total number of dermatological consultations (DCs) to the Chilean public sector in 2020 is analyzed according to sex and age range and compared with the available databases from 2017 to 2019. From this, 120,095 DCs were performed during 2020, with an incidence of 6.3 consultations per 1000 inhabitants. When compared to 2019 (n = 250,649), there was a 52.1% decrease. The regions most affected were located in the central part of Chile, which correlates with the regions most affected by the pandemic. Age and sex distributions remained similar to previous years but lower in amplitude. The month with the lowest number of consultations was April, with a gradual increase observed thereafter until December 2020. Although DCs decreased drastically in the Chilean public sector during 2020, sex and age range proportions were conserved, thus affecting all groups in a similar manner.

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INTRODUCTION: The demand for specialty care is rising worldwide. In the state of Rio Grande do Sul, Brazil, more than 150,000 people were waiting for specialist consultations in 2013. A telemedicine programme (RegulaSUS) developed referral protocols, audited waitlisted cases, authorised/prioritised referrals by risk and discuss deferred cases primary-care physician. This study assesses the effectiveness of RegulaSUS. METHODS: A retrospective cohort analysis with contemporaneous controls was performed from June 2014 to June 2016. Six medical specialties included in RegulaSUS (50,185 patients) were compared to 50,124 control patients waitlisted according to the usual routine (scheduled for specialty consultation at the next available date). The groups were matched (1:1) by semester and year of waitlisting and by the specialty demand-to-supply ratio. Primary outcomes were referral-to-consultation time and number of waitlisted patients. RESULTS: The mean referral-to-consultation time was 584.8 days in the intervention group and 607.0 days in controls (p<0.001). For specialties regulated by RegulaSUS, the mean referral-to-consultation time was 237.6 days for higher-risk patients. At the end of the observation, 26,708 control patients had been unlisted compared to 31,050 patients in the intervention group (reduction of 53.5% vs. 61.9%, respectively; p<0.001). The number of cancelled referrals was lower in the control group (n=14,403; 28.7%) than in the intervention group (n=16,387; 32.7%; p<0.001). DISCUSSION: Telemedicine support for primary care effectively decreased the time to specialty consultation, reduced the number of waitlisted patients and allowed sicker patients to reach a specialist faster.

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Background: This will be a before-and-after study nested within a randomized clinical trial. Its objective will be to analyze the effectiveness of a teleconsultation and validate a questionnaire for performing teletriage in dental urgency/emergency situations in children aged 3 to 13, whose parents will have signed a free and informed consent form, and who have had full access to the internet. Methods: The Questionnaire for Teletriage of Emergencies and Urgencies in Pediatric Dentistry (QuesT-Odontoped)-will be validated by applying it to 140 randomized child parents/guardians. After validation, another 260 children seeking emergency dental care in the municipality of Carangola, Minas Gerais, Brazil, will receive a remote consultation, be randomized, and then allocated into two groups: G1, teleconsultation, and G2, teleconsultation and face-to-face consultation (immediately after the former) with a blinded evaluator, involving anamnesis and conventional clinical examination. The G2 sample will be used in the before-after study. Both groups will be followed-up for 7 and 14 days using pain and quality-of-life scales, applied at baseline and after each follow-up period. Clinical follow-up will be carried out after 12 and 24 months to assess the outcome of the tooth that had been indicated for treatment in the teletriage. The Mann-Whitney test will be used to assess pain; Student's t test or the Mann-Whitney test will be used to assess quality of life and the number of missing teeth after 24 months; and Poisson's regression analysis will be used to assess the influence of other variables. The significance level will be set at 5%. Conclusions: In conclusion, this study expects to confirm the hypothesis that remote urgency consultation (teletriage), through a validated questionnaire, will be able to define the planning of the clinical situation, reducing the chance of displacements and progression of infection, helping to eliminate patient pain and discomfort.

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Introducción: la pandemia de COVID-19 tuvo un gran impacto en la sociedad en general. El aislamiento impuesto modificó las relaciones interpersonales, incluyendo las consultas médicas. Objetivos: describir las consultas reumatológicas en el Servicio de Reumatología del Instituto de Rehabilitación Psicofísica (IREP) durante la pandemia por COVID-19, y compararlas con las recibidas durante 2019. Materiales y métodos: estudio observacional. Se registraron las consultas recibidas durante marzo-septiembre de 2020. Se recolectaron datos sociodemográficos, número y motivo de las consultas realizadas por paciente. Se llevó a cabo un análisis de regresión logística múltiple para estimar las variables asociadas a la consulta presencial. Resultados: se registraron 1.703 consultas; 798 pacientes consultaron al menos una vez, la mediana de consulta por paciente fue de 3 (RIC 1-12). La principal vía de consulta fue por correo electrónico (57%), solo el 13% fue de forma presencial. El principal motivo fue la solicitud de recetas (60%) seguido por consultas por la enfermedad (23%). Se observó una reducción del total de las consultas con respecto al año previo del 57% (3.961) y una reducción mayor del 94% en el número de consultas presenciales (224). La consulta médica presencial durante la pandemia se asoció independientemente con el sexo masculino (OR: 2.4 IC 95% 1,6-3,6), la consulta por enfermedad de base (OR: 5.8 IC 95% 4,1-8,3) y la ausencia de cobertura social (OR: 2.3 IC 95% 1,6-3,3). Conclusiones: las consultas reumatológicas, especialmente las presenciales, disminuyeron sustancialmente durante la pandemia.

Introduction: COVID-19 pandemic had a great impact on society in general. The imposed isolation modified interpersonal relationships, including medical consultations. Objectives: describe the rheumatologic consultations in the Rheumatology Service from Instituto de Rehabilitación Psicofísica (IREP) during the COVID-19 pandemic and compare them with those received the previous year. Materials and methods: observational study. Consultations during March-September 2020 were recorded. Sociodemographics, numbers, and reasons for consultations made per patient were collected. A multiple logistic regression analysis was performed to estimate variables associated with the in-person consultation. Results: 1,703 consultations were registered. 798 patients consulted at least 1 time, and the median number of consultations per patient was 3 (IQR 1-12). The main method of consultation was by email (57%); only 13% were in person. The main reason was requesting prescriptions (60%) followed by consultations for the disease (23%). We observed a reduction in the total number of consultations compared to the same period in 2019 of 57% (3,961 consultations) and an even greater reduction of 94% in the number of in-person consultations (224 consultations). In-person medical consultation during the pandemic was independently associated with male sex (OR: 2,4, 95%CI 1,6-3,6), consultation due to illness (OR: 5,8, 95%CI 4,1-8,3) and lack of social coverage (OR: 2,3. 95%CI 1,6-3,3). Conclusions: rheumatologic consultations, especially in-person, were substantially reduced during the pandemic.

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Resumo Sob a ótica do absenteísmo, este artigo descreve e analisa o processo de agendamento e atendimento de consultas médicas para o município de Ribeirão Preto, SP, Brasil. A partir dos mapas dos processos de agendamento e atendimento na Atenção Primária à Saúde (APS), foram realizadas entrevistas com coordenações da Secretaria Municipal de Saúde e gerentes de Unidades Básicas de Saúde (UBS) e Unidades de Saúde da Família (USF). Em uma abordagem qualitativa, foram identificadas as características, peculiaridades e possibilidades de estruturação no agendamento e atendimento à população. Os resultados são apresentados de modo analítico nos seguintes tópicos temáticos: gestão da agenda, acolhimento, tecnologias de informação e comunicação, modelo de unidade, pronto atendimento, infraestrutura e recursos humanos. Os resultados deste trabalho poderão auxiliar gestores municipais em processos de avaliação e melhoria contínua na rede de APS. (AU)

Abstract Through the lens of absenteeism, this article describes and analyzes the consultation scheduling and appointment process in Ribeirão Preto, São Paulo, Brazil. Based on primary health care scheduling and appointment process maps, we conducted interviews with coordinators of the Municipal Health Department and managers of primary care clinics and family health clinics. Adopting a qualitative approach, we identified the characteristics, peculiarities, and possibilities related to the organization of scheduling and appointments. The results are presented under the following thematic categories: schedule management, welcoming, information and communication technologies, unit model, urgent care, and infrastructure and human resources. The results of this work can help local health managers in implementing evaluation processes and the continuous improvement in primary care services.(AU)

Resumen Bajo la óptica del ausentismo, este artículo describe y analiza el proceso de solicitud y realización de consultas médicas para el municipio de Ribeirão Preto Estado de São Paulo Brasil. A partir de los mapas de los procesos de solicitud y realización de consultas en la Atención Primaria de la Salud (APS), se realizaron entrevistas con coordinaciones de la Secretaría Municipal de Salud y gerentes de unidades básicas de salud (UBS) y unidades de salud de la familia (USF). En un abordaje cualitativo, se identificaron las características, peculiaridades y posibilidades de estructuración en la solicitud de consultas y atención a la población. Los resultados se presentan de modo analítico en los tópicos temáticos siguientes: gestión de la agenda, acogida, tecnologías de información y comunicación, modelo de unidad, urgencias, infraestructura y recursos humanos. Los resultados de ese trabajo podrán ayudar a gestores municipales en procesos de evaluación y mejora continua en la red de APS.(AU)

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Objetivo: mapear o conhecimento produzido sobre a consulta de enfermagem de primeira vez em ambulatório de aplicação de quimioterapia antineoplásica. Método: revisão de escopo de 12 artigos, selecionados nas bases de dados BVS, CINAHL/EBSCO, EMBASE, MEDLINE/PubMed, Scopus e Web os Science. Resultados: os conhecimentos identificados na literatura foram classificados em aspectos a serem avaliados na consulta de enfermagem para uma efetiva gestão do cuidado e propostas de intervenção, entre as quais a avaliação psicológica apresentou grande notoriedade, condutas a serem tomadas por enfermeiros para a promoção da gestão do cuidado efetiva, dentre as quais as a oferta de orientações e informações se destacou, e a comunicação enquanto elemento chave da gestão do cuidado. Conclusão: a consulta de enfermagem de primeira vez tem a possibilidade de organizar os cuidados de enfermagem, e deve ser estruturada para atender à tal.

Objectives: to map the knowledge produced about the first-time nursing consultation in an antineoplastic chemotherapy outpatient clinic. Method: scoping review of 12 articles, selected from the databases BVS, CINAHL/EBSCO, EMBASE, MEDLINE/PubMed, Scopus and Web os Science. Results: the knowledge identified in the literature was classified into aspects to be assessed in the nursing consultation for effective care management and intervention proposals, among which psychological assessment was prominent, procedures to be adopted by nurses to promote effective care management, among which the offer of guidance and information stood out, and communication as a key element of care management. Conclusion: the first-time nursing consultation has the possibility of organizing nursing care, and should be structured to meet this.

Objetivos:mapear el conocimiento producido sobre la primera consulta de enfermería en la aplicación ambulatoria de quimioterapia antineoplásica. Método: revisión de 12 artículos, seleccionados de las bases de datos BVS, CINAHL/EBSCO, EMBASE, MEDLINE/PubMed, Scopus y Web os Science. Resultados:los conocimientos identificados en la literatura se clasificaron en aspectos a valorar en la consulta de enfermería para una gestión eficaz de los cuidados y propuestas de intervención, entre los que destacó la valoración psicológica, conductas a adoptar por las enfermeras para la promoción de una gestión eficaz de los cuidados, entre las que destacó la oferta de orientación e información, y la comunicación como elemento clave de la gestión de los cuidados. Conclusión: la consulta de enfermería de primera vez tiene la posibilidad de organizar los cuidados de enfermería, y debe ser estructurada para atenderlos.

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Introducción: La discapacidad se considera un problema de salud a nivel mundial. Las personas con discapacidad física son susceptibles de padecer distintos problemas de salud. A pesar de ser un grupo priorizado, el acceso a los servicios de salud es menor que el de la población en general, debido a barreras de distintos tipos. Objetivo: Describir las barreras y facilitadores de acceso a la atención primaria de salud en personas con discapacidad física. Métodos: Se realizó una revisión bibliográfica cuya metodología estuvo basada en la búsqueda, selección, revisión, interpretación y síntesis de la evidencia científica relacionada con el problema de investigación. Se utilizó como fuente de literatura científica primaria la publicada en las bases de datos Scielo, Redalyc, Latindex y PudMed en los últimos 5 años, con los términos de búsqueda MeSH en idoma español, inglés y portugués. Desarrollo: Se identificó un total de 67 documentos de los cuales se empleó 46 en la investigación realizada. Los restantes 21 manuscritos fueron excluidos por presentar deficiencias metodológicas que limitaban su utilización. Las principales barreras son las condiciones físicas de las unidades de salud; el funcionamiento del Sistema de Salud; el acceso de las personas con discapacidad a la atención primaria de salud; y las características del paciente y su entorno familiar. El principal facilitador es el relacionado con el Sistema de Salud. Conclusiones: El acceso de las personas con discapacidad física a los servicios de salud está condicionado por situaciones que se interpretan como barreras o facilitadores. En este sentido los factores relacionados con el sistema de salud nacional y con las características y el entorno de la persona con discapacidad pueden comportarse como barrera o como facilitador, en dependencia de su expresión(AU)

Introduction: Disability is considered a health problem worldwide. People with physical disabilities are susceptible to different health problems. Despite being a prioritized group, access to health services is lower than that of the general population, conditioned by the presence of different types of barriers. Objective: To describe the barriers and facilitators of access to primary health care in people with physical disabilities. Methods: A bibliographic review was carried out whose methodology was based on the search, selection, review, interpretation and synthesis of the scientific evidence related to the research problem. It was used as a source of primary scientific literature published in the databases Scielo, Redalyc, Latindex and PudMed in the last 5 years, with the MeSH search terms in Spanish, English and Portuguese. Results: A total of 67 documents were identified, of which 46 were used in the research carried out. The remaining 21 manuscripts were excluded due to methodological deficiencies that limited their use. Conclusions: The access of people with physical disabilities to health services is conditioned by situations that are interpreted as barriers or facilitators. In this sense, the factors related to the national health system and the characteristics and environment of the person with a disability can act as a barrier or as a facilitator, depending on their expression(AU)

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Background: Inpatient consultations are a fundamental component of practice in tertiary care centers. However, such consultations demand resources, generating a significant workload. Objectives: To investigate the profile of inpatient consultations requested by other specialties and provided by the Vascular and Endovascular Surgery team at an academic tertiary hospital. Methods: Prospective observational study. Results: From May 2017 to May 2018, 223 consultations were provided, representing 2.2% of the workload. Most consultations were requested by Oncology (16.6%), Hematology (9.9%), Nephrology (9.0%), and Cardiology (6.3%). The leading reasons for inpatient consultation were: need for vascular access (51.1%) and requests to evaluate a vascular disease (48.9%). Acute venous diseases accounted for 19.3% of consultations, chronic arterial diseases for 14.8%, acute arterial diseases for 7.2%, diabetic feet for 5.4%, and chronic venous diseases accounted for 2.2%. Surgical treatment was performed in 57.0%, either conventional (43.9%) or endovascular (13.0%). Almost all (98.2%) patients' issues were resolved. Conclusions: Inpatient consultations with the Vascular and Endovascular Surgery team in a tertiary academic hospital accounted for 2.2% of the team's entire workload. Most patients were elective and underwent low-complexity elective surgical procedures. There may be an opportunity to improve healthcare, redirecting these patients to the outpatient flow.

Introdução: Interconsultas são um componente fundamental da prática clínica em centros de atendimento terciários. No entanto, esse tipo de consulta requer recursos, resultando em uma alta carga de trabalho. Objetivo: Investigar o perfil das interconsultas solicitadas por outros departamentos e realizadas pela equipe de Cirurgia Vascular e Endovascular em um hospital universitário terciário. Métodos: Estudo observacional prospectivo. Resultados: De maio de 2017 a maio de 2018, foram realizadas 223 consultas, correspondendo a 2,2% da carga de trabalho. A maioria das consultas foram solicitadas pelos departamentos de Oncologia (16,6%), Hematologia (9,9%), Nefrologia (9,0%) e Cardiologia (6,3%). As principais razões das interconsultas foram a necessidade de acesso vascular (51,1%) e de avaliação de doenças vasculares (48,9%). As doenças venosas agudas corresponderam a 19,3% das avaliações; as doenças arteriais crônicas, a 14,8%; as doenças arteriais agudas, a 7,2%; o pé diabético, a 5,4%; e as doenças venosas crônicas corresponderam a 2,2%. Foi realizado tratamento cirúrgico em 57,0% dos casos, tanto convencional (43,9%) quanto endovascular (13,0%). Foram resolvidos os problemas de quase todos os pacientes (98,2%). Conclusão: As interconsultas realizadas pela equipe de Cirurgia Vascular e Endovascular em um hospital universitário terciário corresponderam a 2,2% da carga de trabalho total. A maioria dos pacientes eram eletivos e foram submetidos a procedimentos cirúrgicos eletivos de baixa complexidade. O redirecionamento desses pacientes para o atendimento ambulatorial poderia auxiliar na melhoria dos serviços de saúde.

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Background:The coronavirus disease 2019 (COVID-19) pandemic has disrupted the health care system in various ways, one of which is the implementation of telemedicine as a part of the daily clinical practice for many physicians. Sofía is a Mexican health care and technology startup that implemented an app-based telemedicine program during this pandemic in Mexico.Materials and Methods:The telemedicine program included on-demand video consultations with internal medicine specialists from March to September 2020. In the following study, we present a descriptive analysis of all the patients in the telemedicine program, called Coronaid. Results:2,585 video consultations were conducted for a total of 1,545 patients and 44.4% of these were associated with respiratory symptoms. Of all patients, 46% were female and the mean age was 34 years, 52.2% were overweight or obese, and 25% presented at least one comorbid condition. Aside from respiratory complaints, the most common chief complaints were associated with gastrointestinal, psychiatric, and genitourinary symptoms. Patient satisfaction after video consultation services was >80%.Discussion:During the COVID-19 pandemic, an application-based telemedicine program had a high patient satisfaction rate in a significant sample of young patients, which can be attributed to the accessibility of the medical services and widespread use of smartphones in this patient demographic.Conclusion:Telemedicine has proven to be a useful, safe, and effective tool to improve patients' health, which has been boosted by the COVID-19 pandemic. The use of mobile applications and video consultation services can encourage patients to improve their health and prevent complications in the short and long terms.

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ABSTRACT Background Inpatient consultations are a fundamental component of practice in tertiary care centers. However, such consultations demand resources, generating a significant workload. Objectives To investigate the profile of inpatient consultations requested by other specialties and provided by the Vascular and Endovascular Surgery team at an academic tertiary hospital. Methods Prospective observational study. Results From May 2017 to May 2018, 223 consultations were provided, representing 2.2% of the workload. Most consultations were requested by Oncology (16.6%), Hematology (9.9%), Nephrology (9.0%), and Cardiology (6.3%). The leading reasons for inpatient consultation were: need for vascular access (51.1%) and requests to evaluate a vascular disease (48.9%). Acute venous diseases accounted for 19.3% of consultations, chronic arterial diseases for 14.8%, acute arterial diseases for 7.2%, diabetic feet for 5.4%, and chronic venous diseases accounted for 2.2%. Surgical treatment was performed in 57.0%, either conventional (43.9%) or endovascular (13.0%). Almost all (98.2%) patients' issues were resolved. Conclusions Inpatient consultations with the Vascular and Endovascular Surgery team in a tertiary academic hospital accounted for 2.2% of the team's entire workload. Most patients were elective and underwent low-complexity elective surgical procedures. There may be an opportunity to improve healthcare, redirecting these patients to the outpatient flow.

RESUMO Introdução Interconsultas são um componente fundamental da prática clínica em centros de atendimento terciários. No entanto, esse tipo de consulta requer recursos, resultando em uma alta carga de trabalho. Objetivo Investigar o perfil das interconsultas solicitadas por outros departamentos e realizadas pela equipe de Cirurgia Vascular e Endovascular em um hospital universitário terciário. Métodos Estudo observacional prospectivo. Resultados De maio de 2017 a maio de 2018, foram realizadas 223 consultas, correspondendo a 2,2% da carga de trabalho. A maioria das consultas foram solicitadas pelos departamentos de Oncologia (16,6%), Hematologia (9,9%), Nefrologia (9,0%) e Cardiologia (6,3%). As principais razões das interconsultas foram a necessidade de acesso vascular (51,1%) e de avaliação de doenças vasculares (48,9%). As doenças venosas agudas corresponderam a 19,3% das avaliações; as doenças arteriais crônicas, a 14,8%; as doenças arteriais agudas, a 7,2%; o pé diabético, a 5,4%; e as doenças venosas crônicas corresponderam a 2,2%. Foi realizado tratamento cirúrgico em 57,0% dos casos, tanto convencional (43,9%) quanto endovascular (13,0%). Foram resolvidos os problemas de quase todos os pacientes (98,2%). Conclusão As interconsultas realizadas pela equipe de Cirurgia Vascular e Endovascular em um hospital universitário terciário corresponderam a 2,2% da carga de trabalho total. A maioria dos pacientes eram eletivos e foram submetidos a procedimentos cirúrgicos eletivos de baixa complexidade. O redirecionamento desses pacientes para o atendimento ambulatorial poderia auxiliar na melhoria dos serviços de saúde.

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RESUMO Objetivo identificar a frequência de queixas de deglutição e alimentação em pacientes oncológicos em cuidados paliativos e associá-las com os dados clínicos e funcionais. Métodos estudo transversal e descritivo, realizado com pacientes oncológicos atendidos durante consulta compartilhada em ambulatório de cuidados paliativos, por meio de triagem fonoaudiológica, protocolos e escalas, com análise estatística dos dados obtidos. Resultados amostra constituída de 52 indivíduos, atendidos durante 8 meses, com média de idade de 66,7 anos, Palliative Performance Scale (PPS) média de 57,5. A topografia da neoplasia mais frequente foi trato gastrointestinal e o tratamento foi cirurgia, quimioterapia e radioterapia associadas. As queixas da triagem foram categorizadas em deglutição e alimentação. Dessa forma, as de deglutição foram as mais frequentes e grande parte da amostra necessitou de avaliação funcional da deglutição. Apenas a associação entre queixas de deglutição e a topografia de trato gastrointestinal apresentou relação estatisticamente significativa. As queixas de deglutição foram mais frequentes nos pacientes submetidos à radioterapia e com menores porcentagens na escala PPS. Conclusão as queixas de deglutição foram as mais frequentes e as associações permitiram relacioná-las à localização do tumor e identificar sua frequência, conforme o tratamento oncológico e declínio funcional da terminalidade.

ABSTRACT Purpose to identify the frequency of swallowing and feeding complaints in cancer patients in palliative care, and to associate them with clinical and functional data. Methods cross-sectional and descriptive study, carried out with cancer patients treated during shared consultation in a palliative care outpatient clinic, through speech-language pathology screening, protocols and scales, with statistical analysis of the obtained data. Results Sample consisted of 52 subjects, seen during 8 months, with a mean age of 66.7 years, PSS (Palliative Performance Scale) a mean of 57.5. The topography of the most frequent neoplasm was the gastrointestinal tract and the treatment was surgery and associated chemotherapy and radiotherapy . Complaints identified at screening were categorized into swallowing and feeding. Thus, swallowing was the most frequent and a large part of the sample required a functional assessment of swallowing. Only the association between swallowing complaints and the topography of the gastrointestinal tract showed a significant statistical relationship. Swallowing complaints were more frequent in those undergoing radiotherapy and with lower percentages on the PPS scale. Conclusion swallowing complaints were the most frequent and the associations made it possible to relate them to the location of the tumor, and to identify their frequency according to cancer treatment and terminal functional decline.

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O pedido dos pais por atendimento psicológico do filho tem sido estudado por diversos autores da psicanálise. A ênfase do presente artigo é na teoria do relacionamento paterno-infantil, conforme construída por Winnicott. Segundo o autor, condições favoráveis apresentadas pelo ambiente serão facilitadoras para que a criança possa se desenvolver de acordo com o seu potencial na direção do seu amadurecimento emocional, desde que haja uma sustentação favorável dos pais. O estudo teve objetivo principal verificar se as Consultas Terapêuticas com pais e filhos, desenvolvidas em um Serviço Escola, são um método eficaz para investigar e compreender os mecanismos psíquicos envolvidos na interrupção do percurso de amadurecimento da criança. Nos dois casos analisados, foi possível ter essa compreensão. O método empregado nas intervenções promoveu o resgate da comunicação entre os pais e as crianças, a partir da reinclusão dos pais no papel de sustentação do processo de amadurecimento da criança, cumprindo o complemento da nossa proposta.

La solicitud de los padres de atención psicológica para sus hijos ha sido estudiada por varios autores de psicoanálisis. El énfasis de este artículo está en la teoría de la relación paterno-infantil, construida por Winnicott (1979). Según este autor, las condiciones favorables que presenta el entorno facilitarán que el niño se desarrolle de acuerdo con su potencial hacia su madurez emocional, siempre que haya un apoyo favorable de los padres. Este artículo tiene como objetivo presentar consultas terapéuticas con padres e hijos, realizadas en un Servicio de la Escuela de Psicología, como un método eficaz para investigar y comprender los bloqueos que determinaron la suspensión del camino de maduración del niño y la promoción del rescate de la comunicación entre los padres y los hijos. En los dos casos analizados fue posible tener este entendimiento. El método utilizado en las intervenciones promovió el rescate de la comunicación entre padres e hijos, a partir de la reincorporación de los padres en el rol de apoyo al proceso de maduración del niño, cumpliendo el complemento de nuestra propuesta.

The parents' request for psychological care of the child has been studied by several authors of psychoanalysis. The emphasis of this article is on the paternal-child relationship theory, as constructed by Winnicott (1979). According to this author, favorable conditions presented by the environment will be facilitating so that the child can develop according to his potential in the direction of his emotional maturation provided for a favorable support from the parents. This article aims to present therapeutic consultations with parents and children performed on a Serviço Escola of Psychology as an effective method to investigate and understand the blockages that have determined the suspension of the maturation path of the child and the promotion of the rescue of the communication between the parents and the children. In the two cases analyzed, it was possible to have this understanding. The method used in the interventions promoted the rescue of communication between parents and children, starting from the re-inclusion of parents in the role of supporting the child's maturation process, fulfilling the complement of our proposal.

La demande des parents pour une prise en charge psychologique de leur enfant a été étudiée par plusieurs auteurs de psychanalyse. Le présent article met l'accent sur la théorie de la relation paternelle-enfant, telle que construite par Winnicott. Selon l'auteur, les conditions favorables présentées par l'environnement permettront à l'enfant de se développer plus facilement en fonction de son potentiel vers sa maturité affective, à condition qu'il y ait un soutien favorable des parents. L'objectif principal de l'étude était de vérifier si les consultations thérapeutiques avec les parents et les enfants, développées dans un service scolaire, sont une méthode efficace pour enquêter et comprendre les mécanismes psychiques impliqués dans l'interruption du cours de maturation de l'enfant. Dans les deux cas analysés, il a été possible d'avoir cette compréhension. La méthode utilisée dans les interventions a favorisé le sauvetage de la communication entre parents et enfants, à partir de la réintégration des parents dans le rôle de soutien au processus de maturation de l'enfant, en remplissant le complément de notre proposition.

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Objetivo: Conocer la percepción de los odontólogos clínicos peruanos sobre el uso de la teleodontología para la atención odontológica durante la pandemia de COVID- 19. Métodos: Estudio cualitativo en el que se utilizó el método fenomenográfico y se realizaron entrevistas a dentistas clínicos en el contexto de la cuarentena por la pandemia de la COVID-19 en Lima, Perú. Las entrevistas se efectuaron a través de la plataforma Zoom, y la guía de preguntas claves incluyó: conocimiento previo sobre teleodontología, medios de comunicación utilizados con los pacientes, experiencia en la atención virtual de los pacientes desde el inicio de la cuarentena, calidad del diagnóstico y tratamiento a través de la teleodontología, remuneración de las teleconsultas, beneficios y limitaciones de la teleodontología. Resultados: Once de los 14 odontólogos consideró que es complicado mantener una comunicación a distancia, sobre todo en los casos que requieren control de tratamientos ya realizados. Los odontólogos entrevistados opinan que gran parte de los pacientes se sienten tranquilos al mantener relación con su odontólogo, aun cuando es a distancia, y manifiestan que la teleodontología crea lazos de confianza con los pacientes por el trato constante. Consideran que el contacto por redes sociales puede ser un medio para que aumente la fluidez en la comunicación, lo que ayudaría en los casos de pacientes no muy extrovertidos, al trato persona-persona. Conclusiones: Para los odontólogos entrevistados, la utilización de redes sociales y videollamadas es fundamental, porque permiten mantener el contacto con sus pacientes, consideran que por medio de consejos y recomendaciones a distancia se pueden aliviar molestias y tranquilizar a los pacientes(AU)

Objective: Become acquainted with the perception of Peruvian clinical dentists about the use of teledentistry for dental care during the COVID-19 pandemic. Methods: A qualitative study was conducted based on the phenomenographic method, and interviews were carried out with clinical dentists in the context of the quarantine due to the COVID-19 pandemic in Lima, Peru. The interviews were held on the Zoom platform, and the guide of key questions included the following items: previous knowledge about teledentistry, means of communication used with patients, experience in the virtual care of patients since the start of the quarantine, quality of diagnosis and treatment through teledentistry, teleconsultation fees, and benefits and limitations of teledentistry. Results: Eleven of the 14 dentists considered that it is complicated to maintain distance communication, mainly in cases requiring the control of treatments already performed. The dentists interviewed think that a large number of the patients feel reassured when they maintain contact with their dentist, even if from a distance, reporting that teledentistry creates confidence in patients due to the frequent contact. They think that contact on the social networks may facilitate communication, which would be helpful in the case of introverted patients. Conclusions: The dentists interviewed consider that the use of social networks and video calls is fundamental, for it makes it possible to maintain contact with their patients(AU)

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Resumen La pandemia por COVID-19 y el aislamiento social preventivo y obligatorio (ASPO) han generado cambios en la organización y utilización del sistema de salud en todo el mundo. Analizamos el impacto de la situación sanitaria en el número de consultas ambulatorias, internaciones y acceso a terapias de revascularización por enfermedad cerebrovascular. Se analizó el período desde el 1 marzo al 31 de julio de 2020. Se comparó con el mismo período de 2019. Se evaluaron total de consultas ambulatorias e internaciones, escala NIHSS (National Institute of Health Stroke Scale) al ingreso, tipo de enfermedad cerebrovascular y uso de terapias de revascularización. Ingresaron 197 pacientes con eventos cerebrovasculares agudos en 2019 y 150 pacientes en 2020. Hubo un descenso significativo en el número de internaciones por eventos isquémicos totales y accidentes isquémico transitorios en el comparativo de los 5 meses. Se vio además un aumento en trombosis venosas cerebrales y hemorragias cerebrales. El acceso a fibrinolisis intravenosa y trombectomía mecánica se mantuvo estable, pero con prolongación del tiempo puerta-aguja. Las consultas ambulatorias descendieron 67%, siendo mayor el descenso en abril y más marcado en consultas de seguimiento. El número de internaciones y de consultas ambulatorias durante el ASPO descendió sustancialmente. Esto pareciera obedecer al cumplimiento estricto de la cuarentena y no a mecanismos fisiopatológicos relacionados con el COVID-19. Debe educarse a la población sobre la necesidad del control de enfermedades crónicas y de eventos agudos y se deben garantizar medidas de seguridad en los centros de salud.

Abstract The COVID-19 pandemic and preventive and compulsory social isolation (PCSI) have generated changes in the organization and use of the health system around the world. We analyze the impact of the health situation on the number of outpatient visits, hospitalizations and access to revascularization therapy for cerebrovascular disease. The period from March 1 to July 31, 2020 was analyzed. It was compared with the same period in 2019. Total outpatient and hospital visits were evaluated, NIHSS scale (National Institute of Health Stroke Scale) upon admission, type of cerebrovascular disease and use of revascularization therapies; 197 patients with acute cerebrovascular events were admitted in 2019 and 150 patients in 2020. There was a significant decrease in the number of hospitalizations for total ischemic events and transient ischemic attacks in the comparison of 5 months. An increase in cerebral venous thrombosis and cerebral hemorrhages was also seen. Access to intravenous fibrinolysis and mechanical thrombectomy remained stable, but with prolonged door-to-needle time. Outpatient visits fell 67%, the decrease being greater in April and more marked in follow-up visits. The number of hospitalizations and outpatient visits during the PCSI dropped substantially. This seems to be due to strict compliance with quarantine and not to pathophysiological mechanisms related to COVID-19. The population should be educated about the need to control chronic diseases and acute events and safety measures should be guaranteed in health centers.

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In various responses to the COVID-19 pandemic, we can observe insufficient sensitivity towards the needs and circumstances of poorer citizens. Particularly in a context of high inequality, policy makers need to engage with the wider public in debates and consultations to gain better insights in the realities of the worst-off within their jurisdiction. When consultations involve members of traditionally underrepresented groups, these are not only more inclusive, which is in itself an ethical aim, but pool ideas and observations from a much more diverse array of inhabitants. Inclusivity increases the odds to identify a larger range of weak spots for health security and to design health interventions that are less burdensome on those worst-off.

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BACKGROUND: Pharmaceutical care (PC) through the Dader method (DMet) vs. the usual care process (UCP) significantly reduced psychiatric hospitalizations and emergency service consultations during one year of follow-up of outpatients with bipolar I disorder (BD-I). To date, the effect of long-term PC on the use of health services by BD-I patients once pharmacist intervention has ended is unknown. OBJECTIVE: To determine whether the effect of PC measured by the decrease in psychiatric hospitalizations and emergency service consultations is maintained one year after pharmacist intervention ceases. METHODS: This was a retrospective analysis of patients who had previously participated in a randomized, controlled, prospective, single-center clinical trial to compare PC (intervention group) vs. UCP (control group) in BD-I patients. Data were collected from November 2012 to March 2014. The primary outcome was the use of health services measured by the number of psychiatric hospitalizations and emergency service consultations. Descriptive statistics, Student's t-test, Kaplan-Meier function, and Log-Rank test were used. RESULTS: The study included 92 patients: 43 in the intervention group and 49 in the control group. Eleven psychiatric hospitalizations occurred for the intervention group and 19 for the control group. One year after pharmacist intervention ceased, there were no significant differences between the groups in psychiatric hospitalizations (p = 0.261). There were 14 emergency service consultations for the intervention group, and 24 for the control group without significant differences (p = 0.212). CONCLUSIONS: PC through the DMet has no long-term effects on psychiatric hospitalizations and emergency department consultations in patients with BD-I following discontinuation of pharmacist intervention; the effect dissipates when the intervention ceases. Future studies should focus efforts on identifying factors associated with PC that explain why the outcomes derived from this intervention are not maintained in the long term.

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Recently, social media use has skyrocketed, especially with millennials. The use of filtered images and photo editing has led to a new trend of social media-induced dissatisfaction with appearance, termed "snapchat dysmorphia" and "selfie dysmorphia". It is important for practitioners to recognize and understand this trend in addition to knowing how to manage these patients. As clinicians, we have bioethical and professional obligations to educate ourselves on new and relevant trends, ensure adequate patient safety, and advocate for continued consumer education.

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The COVID-19 pandemic and preventive and compulsory social isolation (PCSI) have generated changes in the organization and use of the health system around the world. We analyze the impact of the health situation on the number of outpatient visits, hospitalizations and access to revascularization therapy for cerebrovascular disease. The period from March 1 to July 31, 2020 was analyzed. It was compared with the same period in 2019. Total outpatient and hospital visits were evaluated, NIHSS scale (National Institute of Health Stroke Scale) upon admission, type of cerebrovascular disease and use of revascularization therapies; 197 patients with acute cerebrovascular events were admitted in 2019 and 150 patients in 2020. There was a significant decrease in the number of hospitalizations for total ischemic events and transient ischemic attacks in the comparison of 5 months. An increase in cerebral venous thrombosis and cerebral hemorrhages was also seen. Access to intravenous fibrinolysis and mechanical thrombectomy remained stable, but with prolonged door-to-needle time. Outpatient visits fell 67%, the decrease being greater in April and more marked in follow-up visits. The number of hospitalizations and outpatient visits during the PCSI dropped substantially. This seems to be due to strict compliance with quarantine and not to pathophysiological mechanisms related to COVID-19. The population should be educated about the need to control chronic diseases and acute events and safety measures should be guaranteed in health centers.

La pandemia por COVID-19 y el aislamiento social preventivo y obligatorio (ASPO) han generado cambios en la organización y utilización del sistema de salud en todo el mundo. Analizamos el impacto de la situación sanitaria en el número de consultas ambulatorias, internaciones y acceso a terapias de revascularización por enfermedad cerebrovascular. Se analizó el período desde el 1 marzo al 31 de julio de 2020. Se comparó con el mismo período de 2019. Se evaluaron total de consultas ambulatorias e internaciones, escala NIHSS (National Institute of Health Stroke Scale) al ingreso, tipo de enfermedad cerebrovascular y uso de terapias de revascularización. Ingresaron 197 pacientes con eventos cerebrovasculares agudos en 2019 y 150 pacientes en 2020. Hubo un descenso significativo en el número de internaciones por eventos isquémicos totales y accidentes isquémico transitorios en el comparativo de los 5 meses. Se vio además un aumento en trombosis venosas cerebrales y hemorragias cerebrales. El acceso a fibrinolisis intravenosa y trombectomía mecánica se mantuvo estable, pero con prolongación del tiempo puerta-aguja. Las consultas ambulatorias descendieron 67%, siendo mayor el descenso en abril y más marcado en consultas de seguimiento. El número de internaciones y de consultas ambulatorias durante el ASPO descendió sustancialmente. Esto pareciera obedecer al cumplimiento estricto de la cuarentena y no a mecanismos fisiopatológicos rel acionados con el COVID-19. Debe educarse a la población sobre la necesidad del control de enfermedades crónicas y de eventos agudos y se deben garantizar medidas de seguridad en los centros de salud.

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Introducción: Existe una amplia heterogeneidad en la distribución de médicos y especialistas en las distintas regiones de Chile. Dermatología no está exenta de esta realidad. Conocer la población consultante resulta clave para complementar la situación sanitaria que la distribución de médicos y diferencias en el acceso, reflejan a nivel nacional. Objetivo: Analizar descriptivamente las consultas a Dermatología durante el 2019 en el Sector Público de salud en Chile; según región, rango etario y consultas en operativos. Materiales y Métodos: 250.649 consultas realizadas a Dermatología reportadas por el DEIS durante el 2019. Resultados: Del total de las consultas a cualquier especialidad en el sector público de salud, las consultas a Dermatología suponen un 2.7%. De estas, la Región Metropolitana concentra el 45.2% mientras que la Región de Aysén es la que más consulta en función de su población. Se establece un promedio nacional de 14.1 consultas por cada 1000 habitantes. Las Zonas Norte y Centro consultan bajo este promedio, mientras que la Zona Sur consulta por sobre este. En cuanto al rango etario, se establecen peaks de consultas entre los 0-4 años, 15-19 y finalmente 75-79. Discusión: Dermatología presenta un porcentaje no despreciable del total de consultas a especialidad. Destaca la baja consulta en la Zona Norte, dado el antecedente de mayor prevalencia de cáncer de piel no melanoma respecto a la media nacional. Asimismo, la mayor consulta en Aysén se condice con una mayor densidad de médicos en la región, respecto a otras regiones.

Introduction: There is wide heterogeneity in the distribution of physicians in the different regions of Chile. Dermatology is no different from this reality. Studying the consulting population is key to complement the health situation that the distribution of physicians and differences in healthcare access reflect at the national level. Objective: To perform a descriptive analysis of the consultations made to Dermatology during 2019 in the Chilean Public Health Sector; according to region, age-range, and consultations in Health operatives. Materials and Methods: 250,649 consultations to Dermatology reported by the DEIS during 2019. Reslts: Of the total number of consultations to any specialty on the public sector, Dermatology accounts for 2.7%. Of these, the Metropolitan Region concentrates 45.2% of the consultations. Aysén is the region with the most consultations according to its population. There is a national average of 14.1 consultations per 1000 inhabitants. The Northern and Central regions consult below this average, while the Southern regions consult above it. Regarding age range, peaks of consultations are established between 0-4 years, 15-19 and finally 75-79. Discussion: Dermatology accounts for a non-negligible percentage of the total number of consultations to specialty. The low number of consultations in the Northern Zone is remarkable, given the history of high UV radiation in the area. Likewise, the greater number of consultations in Aysén is consistent with a greater density of physicians in the region when compared to other regions.

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