How to find undetected cases of dementia in care homes: A new approach to dementia diagnosis using a diagnostic tool with five criteria to check and specialist nurses going into care homes and assessing residents could improve detection rates

The pandemic took its toll on memory clinics with many forced to close or scale back their services. This led to lengthening waits for dementia assessment and left many without a diagnosis.

New care settings and innovation will usher diagnostic testing into the future

The article focuses on the future of diagnostic testing in healthcare, highlighting the importance of testing in tracking and treating diseases like COVID-19. It discusses the advancements in diagnostic technology, including combination tests for multiple respiratory diseases and the rise of at-home testing, which will increase access to testing and empower patients to manage their health.

The right to healthcare during the covid-19 pandemic under the European Convention on human rights

The article presents the challenges exposed by the COVID-19 pandemic from a European perspective, especially its consequences in light of the European Convention on Human Rights' (ECHR) guarantees of the right to health. It is the first attempt to comprehensively examine these challenges for the State Parties of the ECHR. The right to health has traditionally been included in the second generation of human rights;therefore, presumably, it does not in itself give rise to any specific rights for an individual. However, the European Court on Human Rights (ECtHR) has recently been linking the right to health with specific provisions of the European Convention on Human Rights, in particular with Articles 2, 3, and 8. We analyse the Court's relevant rulings and their possible consequences for the assessment of the actions taken by the States Parties in order to fight COVID-19, with special emphasis on possible State responsibility for violating the Convention. This can happen when the State's actions result in different levels of health care access available to different groups of patients (patients with COVID-19 and patients with other conditions). The analysis reveals the weakness of the approach taken by ECtHR in the face of the COVID-19 pandemic. Summary: 1. Introduction;2. Health care and the fight against covid-19 in light of the ECHR;2.1. Article 2 of the ECHR;2.2. Article 3 of the ECHR;2.3. Article 8 of the ECHR 3. The convention and the 'herd immunity' strategy;4. The fight against covid-19;dancing on a minefield;5. Concluding remarks [ FROM AUTHOR] Copyright of International Journal of Human Rights is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Providing Virtual Support to Children With Mild Developmental Delays in Response to the Pandemic

The COVID-19 pandemic has had massive impacts across the globe. Children with developmental delays are an increasingly vulnerable population, highlighting the importance of ensuring they have access to high-quality virtual services during this time. The Early Discovery program currently provides therapeutic interventions for children with mild developmental delays. We sought to compare the outcomes of 2 cohorts within the Early Discovery program using different delivery approaches (n = 238 families): children who received services in person before the pandemic (n = 126) and children who received services via telehealth in the acute phase of the pandemic (n = 112). Both groups of children showed significant improvements in language skills posttreatment, and, with regard to auditory comprehension, both groups showed similar rates of improvement. However, children receiving in-person services before the pandemic showed greater improvements in expressive communication skills than children receiving telehealth services during the pandemic. Results indicate that the Early Discovery program was able to make adjustments during the pandemic that assisted families in maintaining progress in improving their child's language skills.

Agency of English-Speaking Migrant Women during the Pandemic in Israel

This study is embedded within a distinct pro-migration incentivized 'Law of Return' migration policy in Israel, as it considers the impact of the COVID-19 pandemic on migrant women, their agency, and proculturation. It features stories of migrant women during the COVID-19 pandemic, exploring their agency within the Individual-Socio-Ecological frame of reference of I-positions in the dialogical self theory. This qualitative study on English-speaking women in Israel (N = 39) is empirically grounded in lived experiences of meaning making, mothering, family dynamics, work, and access to healthcare under conditions of lockdown. The analysis of participants' stories resulted in identifying six overarching themes relevant to migrant women: familial roles, mental labor, voicing resistance, mindfulness, intergenerational solidarity, and transnationalism. This study provides a construct clarification of agency, introducing three levels of agency: inward, social, and societal. In particular older migrant women may appeared to be losing agency during the COVID-19 pandemic in Israel, if the focus was solely on decision making and taking action. However, this study suggests that inward I-positions, in particular as related to mental labor, seemed to flourish during the COVID-19 pandemic, when many participants could engage in a more limited way on social and societal levels. [ FROM AUTHOR] Copyright of Journal of Constructivist Psychology is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Changes in private health service utilisation and access to the Italian National Health Service between 2006 and 2019: a cross-sectional comparative study.

OBJECTIVES: Previous research highlighted that in the early 2000s a significant share of the Italian population used and paid out of pocket for private healthcare services even when they could potentially have received the same treatments from the National Health Service (NHS). The decrease in public investments in healthcare and the increase in health needs due to the population ageing may have modified the use of private health services and equity of access to the Italian NHS. This study aims to investigate the change in the prevalence of individuals who have fully paid out of pocket for accessing healthcare services in Italy between 2006 and 2019 and the main reasons behind this choice. DESIGN: Cross-sectional comparative study. PARTICIPANTS AND COMPARISON: Two representative samples of the Italian population were collected in 2006 and 2019. OUTCOME MEASURES: Prevalence of access to fully paid out-of-pocket private health services; type of service of the last fully paid out-of-pocket access; main reasons for the last fully paid out-of-pocket access. RESULTS: We found an increase in the prevalence of people who declared having fully paid out of pocket at least one access to health services during their lifetime from 79.0% in 2006 to 91.9% in 2019 (adjusted OR 2.66; 95% CI 1.98 to 3.58). 'To avoid waiting times' was the main reason and it was significantly more frequent in 2019 compared with 2006 (adjusted OR 1.75; 95% CI 1.45 to 2.11). CONCLUSIONS: This comparative study, conducted the year before the outbreak of the COVID-19 pandemic, highlighted an increase in the prevalence of Italian residents who have fully paid out of pocket for access to health services to overcome long waiting times. Our findings may indicate a reduced access and possible worsening of the equity of access to the public and universalistic Italian NHS between 2006 and 2019.

Community Pharmacist Provision of Non-Dispensing Services in Health Professional Shortage Areas.

Individuals living in primary care health professional shortage areas (HPSAs) experience health inequities. Community pharmacists are healthcare professionals with an opportunity to provide care to underserved populations. The objective of this study was to compare non-dispensing services provided by Ohio community pharmacists in HPSAs and non-HPSAs. METHODS: An electronic, IRB-approved 19-item survey was sent to all Ohio community pharmacists practicing in full-county HPSAs and a random sample practicing in other counties (n=324). Questions assessed current provision of non-dispensing services as well as interest and barriers regarding such services. RESULTS: Seventy-four usable responses were received (23% response rate). Respondents in non-HPSAs were more likely to recognize their county's HPSA status than those in an HPSA (p=0.008). Pharmacies in non-HPSAs were significantly more likely to offer 11 or more non-dispensing services than those in HPSAs (p=0.002). Nearly 60% of respondents in non-HPSAs reported starting a new non-dispensing service during the COVID-19 pandemic compared to 27% of respondents in full HPSA counties (p=0.009). Most commonly reported barriers to providing non-dispensing services in both county types included lack of reimbursement (83%), workflow (82%), and space (70%). Respondents expressed interest in learning more information about public health and collaborative practice agreements. CONCLUSION: While the need for non-dispensing services is great in HPSAs, community pharmacies in full-county HPSAs in Ohio were less likely to provide these services or begin novel services. Barriers must be addressed so that community pharmacists can provide more non-dispensing services in HPSAs to increase access to care and promote health equity.

Facilitators of and Barriers to Accessing Hospital Medical Specialty Telemedicine Consultations During the COVID-19 Pandemic: Systematic Review.

BACKGROUND: The COVID-19 pandemic accelerated the digital transition in health care, which required a rapid adaptation for stakeholders. Telemedicine has emerged as an ideal tool to ensure continuity of care by allowing remote access to specialized medical services. However, its rapid implementation has exacerbated disparities in health care access, especially for the most susceptible populations. OBJECTIVE: We aimed to characterize the determinant factors (facilitators and barriers) of access to hospital medical specialty telemedicine consultations during the COVID-19 pandemic and to identify the main opportunities and challenges (technological, ethical, legal, and social) generated by the use of telemedicine in the context of the COVID-19 pandemic. METHODS: We conducted a systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 4 databases (Scopus, Web of Science, PubMed, and Cochrane COVID-19 Study Register) were searched for empirical studies published between January 3, 2020, and December 31, 2021, using established criteria. The protocol of this review was registered and published in PROSPERO (CRD42022302825). A methodological quality assessment was performed, and the results were integrated into a thematic synthesis. The identification of the main opportunities and challenges was done by interpreting and aggregating the thematic synthesis results. RESULTS: Of the 106 studies identified, 9 met the inclusion criteria and the intended quality characteristics. All studies were originally from the United States. The following facilitating factors of telemedicine use were identified: health insurance coverage; prevention of SARS-CoV-2 infection; access to internet services; access to technological devices; better management of work-life balance; and savings in travel costs. We identified the following barriers to telemedicine use: lack of access to internet services; lack of access to technological devices; racial and ethnic disparities; low digital literacy; low income; age; language barriers; health insurance coverage; concerns about data privacy and confidentiality; geographic disparities; and the need for complementary diagnostic tests or the delivery of test results. CONCLUSIONS: The facilitating factors and barriers identified in this systematic review present different opportunities and challenges, including those of a technological nature (access to technological devices and internet services and level of digital literacy), a sociocultural and demographic nature (ethnic and racial disparities, geographic disparities, language barriers, and age), a socioeconomic nature (income level and health insurance coverage), and an ethical and legal nature (data privacy and confidentiality). To expand telemedicine access to hospital-based specialty medical consultations and provide high-quality care to all, including the most susceptible communities, the challenges identified must be thoroughly researched and addressed with informed and dedicated responses.

Patient Characteristics Associated with Telehealth Scheduling and Completion in Primary Care at a Large, Urban Public Healthcare System.

Understanding patient characteristics associated with scheduling and completing telehealth visits can identify potential biases or latent preferences related to telehealth usage. We describe patient characteristics associated with being scheduled for and completing audio and video visits. We used data from patients at 17 adult primary care departments in a large, urban public healthcare system from August 1, 2020 to July 31, 2021. We used hierarchical multivariable logistic regression to generate adjusted odds ratios (aOR) for patient characteristics associated with having been scheduled for and completed telehealth (vs in-person) visits and for video (vs audio) scheduling and completion during two time periods: a telehealth transition period (N = 190,949) and a telehealth elective period (N = 181,808). Patient characteristics were significantly associated with scheduling and completion of telehealth visits. Many associations were similar across time periods, but others changed over time. Patients who were older (≥ 65 years old vs 18-44 years old: aOR for scheduling 0.53/completion 0.48), Black (0.86/0.71), Hispanic (0.76/0.62), or had Medicaid (0.93/0.84) were among those less likely to be scheduled for or complete video (vs audio) visits. Patients with activated patient portals (1.97/3.34) or more visits (≥ 3 scheduled visits vs 1 visit: 2.40/1.52) were more likely to be scheduled for or complete video visits. Variation in scheduling/completion explained by patient characteristics was 7.2%/7.5%, clustering by provider 37.2%/34.9%, and clustering by facility 43.1%/37.4%. Stable and dynamic associations suggest persistent gaps in access and evolving preferences/biases. Variation explained by patient characteristics was relatively low compared with that explained by provider and facility clustering.

Tele-Urology During COVID-19: Rapid Implementation of Remote Video Visits.

INTRODUCTION: COVID-19 has brought unprecedented challenges to the delivery of urological care. Following rapid implementation of remote video visits at our tertiary academic medical center serving a large rural population we describe and assess our experience with planned video visits and ongoing scheduling efforts. METHODS: Patients scheduled for video visits between April 14 and April 27, 2020 were included. Prospective and retrospective data were collected on patient and clinical characteristics as well as telemedicine outcomes. Multivariable logistic regression was performed to evaluate factors influencing video visit success. Concurrently scheduling data were collected from a separate cohort regarding patient access to technology and willingness to participate in video visits. RESULTS: A total of 209 patients were included with an overall video visit success rate of 67%. Of video visits that failed (69) reasons included no-show (35%), inability to connect to the telemedicine platform (23%) and lack of Internet access (10%). Nearly half of failed video visits (46.4%) were completed as phone visits. After adjustment for patient demographics commercial insurance was significantly associated with video visit success. In assessment of scheduling outcomes 179 patients were contacted to offer video visits. Of these patients 6.7% reported not having Internet access. Of those with Internet access 87% agreed to proceed with a video visit in lieu of visiting in person. CONCLUSIONS: Our experience indicates that rapid implementation of video telemedicine is feasible and highly accepted by patients. Efforts focused on standardized pre-visit patient education may further optimize successful telemedicine visits.

The impact of rural status on pediatric chronic kidney disease.

Children and adolescents in rural areas with chronic kidney disease (CKD) face unique challenges related to accessing pediatric nephrology care. Challenges to obtaining care begin with living increased distances from pediatric health care centers. Recent trends of increasing centralization of pediatric care mean fewer locations have pediatric nephrology, inpatient, and intensive care services. In addition, access to care for rural populations expands beyond distance and encompasses domains of approachability, acceptability, availability and accommodation, affordability, and appropriateness. Furthermore, the current literature identifies additional barriers to care for rural patients that include limited resources, including finances, education, and community/neighborhood social resources. Rural pediatric kidney failure patients have barriers to kidney replacement therapy options that may be even more limited for rural pediatric kidney failure patients when compared to rural adults with kidney failure. This educational review identifies possible strategies to improve health systems for rural CKD patients and their families: (1) increasing rural patient and hospital/clinic representation and focus in research, (2) understanding and mediating gaps in the geographic distribution of the pediatric nephrology workforce, (3) introducing regionalization models for delivering pediatric nephrology care to geographic areas, and (4) employing telehealth to expand the geographic reach of services and reduce family time and travel burden.

Inclusive Community Aquatics Programming for Children with Developmental Challenges: A Community Participatory Action Research

Background: Children who are neurodiverse have traditionally been segregated from their peers in community-based programs, despite evidence of health benefits of inclusive education. Objectives: This community-initiated project aims to explore barriers and facilitators to inclusive aquatics programming for children with developmental and/or mental health challenges. Methods: Using a participatory-action research methodology, semi-structured interviews and focus groups were conducted with 14 participants from various stakeholder groups, including parents of children who are neurodiverse, helping professionals, and community programmers. Results: Participants described unique definitions of inclusion, from integration with neurotypical peers, to individualized goal-setting and achievement. Major facilitators include adequate resources, flexibility around accommodations, and motivated staff. Major barriers include social stigma, financial limitations, and lack of communication between caregivers and service providers. Conclusions: Participants felt strongly about the need to improve inclusion practices within aquatics—and other community-based—programs. Increased collaboration between families, community programmers, and helping professionals can foster better inclusion and outcomes for children who are neurodiverse. By incorporating various perspectives into the design of future programs, program administrators can ensure more equitable access such that all children are able to participate.

Patients' satisfaction with teleconsultations during the COVID-19 pandemic in the Kingdom of Bahrain

Background: The SARS-CoV-2 pandemic led to the restructuring of traditional clinical activity;hence, globally, 58% of countries implemented the use of telemedicine to meet their healthcare needs. Background: To examine patients' satisfaction with telemedicine medical service and experience at the level of primary care in the Kingdom of Bahrain. Methods: A retrospective cross-sectional study was conducted on 335 patients who used teleconsultations in January 2022 in primary care. A validated questionnaire was modified to assess patients' satisfaction with teleconsultation medical services and experience during the COVID-19 pandemic. Results: A total of 315 responses were included in the final analysis (response rate 94%). Almost all expressed extreme satisfaction with the medical service as they were able to easily explain their medical problem over the phone and fully understood their illness after the consultation. They were also satisfied with the ability of the doctor to understand their problem, explain their treatment, and provide appropriate management over the phone. Over 90% were satisfied with the consultation time that it does not require transportation and would like to use it in the future. Sharing private or personal information over the phone received the lowest satisfaction rate (77.5%). Conclusion: The overall satisfaction expressed by respondents of this survey with the teleconsultation medical service and experience is very high. Such a result confirms that patients have a positive attitude towards telemedicine services in primary care and are willing to use it again and, therefore, must be adopted as a proactive strategy to ensure long-term sustainability.

The coronavirus conundrum - Covid-19 during the Bicentennial of the Independence of Peru - The postcovid syndrome The vaccines - The pregnant woman / El enigma del coronavirus - Covid-19 durante el Bicentenario de la Independencia del Perú - El síndrome poscovid - Las vacunas - La gestante

RESUMEN Han trascurrido dieciocho meses desde que se declaró como pandemia la infección COVID-19 ocasionada por el SARS-CoV-2. No existe aún tratamiento contra el virus, salvo el sintomático y recuperativo. El rápido reconocimiento del nuevo coronavirus permitió la elaboración de vacunas que están siendo usadas de emergencia y han permitido disminuir los casos graves, hospitalizaciones, uso de unidades de cuidados intensivos, ventilación mecánica y muertes. Pero aún quedan incógnitas sobre las modificaciones genéticas y variantes que el virus utiliza para una mejor invasión y adaptación a las defensas del ser humano, así como sobre sus consecuencias inmediatas y a largo plazo en el hombre, la mujer y su niño. Parece distante alcanzar la inmunización de rebaño, porque desconocemos la inmunidad proporcionada por la infección y por las vacunas, así como su duración, y por la importante parte de la población que no desea vacunarse. Además, existe insuficiente capacidad de oferta de vacunas, accesibilidad limitada a los servicios de salud, situación económica desfavorable, incremento de la pobreza y sus consecuencias, disminución temporal de la expectativa de vida y otras complicaciones secundarias a la infección por el virus. La presente revisión es un recuento breve de lo avanzado recientemente en el conocimiento y manejo del COVID-19, en momentos en que el Perú celebra el Bicentenario de la Independencia del país del dominio español, un 28 de julio de 1821, y que encuentra a los peruanos en medio de una pandemia agresiva, elusiva y mortal, y con aspectos humanos, poblacionales, económicos y políticos a resolver.

ABSTRACT Eighteen months have passed since the COVID-19 infection caused by SARS-CoV-2 was declared a pandemic. There is still no treatment for the virus other than symptomatic and recuperative. The rapid recognition of the novel coronavirus allowed the development of vaccines that are being used on an emergency basis and have led to a decrease in severe cases, hospitalizations, use of intensive care units, mechanical ventilation and deaths. But there are still unknowns about the genetic modifications and variants that the virus uses for better invasion and adaptation to human defenses, as well as about its immediate and long-term consequences in men, women and their children. Herd immunization seems distant to achieve, because we do not know the immunity provided by the infection and vaccines, as well as its duration, and because a large part of the population that does not want to be vaccinated. In addition, there is insufficient vaccine supply capacity, limited accessibility to health services, unfavorable economic situation, increased poverty and its consequences, temporary decrease in life expectancy and other complications secondary to infection by the virus. The present review is a brief account of recent advances in the knowledge and management of COVID-19, at a time when Peru is celebrating the Bicentennial of the country's Independence from Spanish rule, on July 28, 1821, and when Peruvians find themselves in the midst of an aggressive, elusive and deadly pandemic, with human, population, economic and political issues to be resolved.

Impact of healthcare strain on access to mechanical ventilation and mortality of hospitalized COVID-19 patients: a retrospective cohort study.

OBJECTIVE: Healthcare saturation has been a prominent worry during the COVID-19 pandemic. Increase of hospital beds with mechanical ventilators has been central in Mexico's approach, but it is not known whether this actually improves access to care and the resulting quality of it. This study aimed to determine the impact of healthcare strain and other pre-specified variables on dying from coronavirus disease 2019 (COVID-19) without receiving invasive mechanical ventilation (IMV). METHODS: A retrospective cohort study was conducted using open data from Mexico City between 8 May 2020 and 5 January 2021. We performed Cox proportional hazards models to identify the strength of the association between proposed variables and the outcomes. RESULTS: Of 33 797 hospitalized patients with suspected or confirmed COVID-19, 19 820 (58.6%) did not require IMV and survived, 5414 (16.1%) required IMV and were intubated and 8563 (25.3%) required IMV but died without receiving it. A greater occupation of IMV-capable beds increased the hazard of death without receiving IMV (hazard ratio [HR] 1.56, comparing 90% with 50% occupation). Private healthcare was the most protective factor for death without IMV (HR 0.14). CONCLUSIONS: Higher hospital bed saturation increased the hazard of dying without being intubated and worsened the outcomes among mechanically ventilated patients. Older age also increased the hazard of the outcomes, while private healthcare dramatically decreased them.

The impact of the COVID-19 pandemic on the provision of HIV/AIDS-related services in Iran: a qualitative study.

BACKGROUND: Providing services to people living with HIV (PLWH) faced many challenges during the COVID-19 pandemic. This study aimed to examine the impact of the COVID-19 pandemic on providing HIV/AIDS-related services in Iran. METHODS: In this qualitative study, the participants were included by purposive sampling between November 2021 and February 2022. Virtually focused group discussion (FGD) meetings were conducted with the first group including policymakers, service providers, and researchers (n = 17), and the interviews were conducted telephonic and face-to-face using a semi-structured guide with the second group including people who received services (n = 38). Data were analyzed by content analysis using the inductive method in MAXQDA 10 software. RESULTS: Six categories were obtained, including mostly affected services, ways of the effect of COVID-19, healthcare systems reaction, effects on social inequality, opportunities created by the pandemic, and suggestions for the future. In addition, people who received services believed the COVID-19 pandemic has affected their life in several ways, including getting COVID-19, mental and emotional problems during the pandemic, financial problems, changes in the care plan, and changes in high-risk behaviors. CONCLUSION: Considering the level of community involvement with the issue of COVID-19 and the shock caused by the pandemic, as mentioned by the world health organization, it is necessary to improve health systems' resilience for better preparedness for similar conditions.

[Health equity and vulnerability in the access to COVID-19 vaccinesEquidad y vulnerabilidad en la salud respecto del acceso a las vacunas contra la COVID-19]. / Equidade e vulnerabilidade em saúde no acesso às vacinas contra a COVID-19.

The present article discusses the importance of equity in health care access with a focus on the acquisition and distribution of vaccines - strategic and essential inputs in the context of COVID-19. It also addresses aspects that increase the risk of transmission, reinfection, and emergence of new variants, such as fake news, pandemic denial, and the anti-vax movement, which perpetuate the epidemic cycle. The importance of planning and designing whole-of-society health policies to manage the pandemic, within a national and global context of joint control is underscored, considering the need to ensure universal and timely access to vaccines and inputs and to the logistics necessary for vaccination. Equity is examined as the global guiding principle in reducing COVID-19 vaccination vulnerability, with an emphasis on the Brazilian setting, where, despite a strong vaccination expertise, a scenario of decreasing investment in science and technology, precarious logistical infrastructure, and corruption endangers access to vaccines. Finally, possible paths that can be explored and transformed into initiatives to be performed by various sectors in society are presented - for example, the prioritization of regions or vulnerable social groups for vaccine distribution - to ensure that equity in health care access in terms of COVID-19 vaccine coverage is achieved.

En el presente artículo se aborda la importancia de la equidad en el acceso a los servicios de salud, reflexionando sobre la compra y la distribución de vacunas, que son insumos estratégicos y fundamentales en el contexto de la COVID-19. Se analizan también los aspectos que aumentan los riesgos de transmisión, reinfección y surgimiento de nuevas variantes, como son las noticias falsas, el negacionismo y el movimiento antivacunas, que perpetúan el ciclo epidémico. Se resalta la importancia de que todos los sectores de la sociedad elaboren planes y políticas de salud para el control de la pandemia en un contexto nacional y mundial de afrontamiento conjunto, considerando la necesidad de garantizar un acceso universal y oportuno a las vacunas y los insumos, así como los aspectos logísticos necesarios para su aplicación. Se examina la equidad como principio rector global para reducir la vulnerabilidad en el acceso a la vacunas contra la COVID-19, y se pone de relieve la situación de Brasil, donde, a pesar del amplio conocimiento experto sobre la vacunación, una situación en la que se observa un descenso de las inversiones en ciencia y tecnología, una logística precaria y la corrupción pone en riesgo el acceso a las vacunas. Por último, se presentan las vías que pueden explorarse y transformarse en acciones a emprender por parte de diversos sectores de la sociedad (por ejemplo, la priorización de regiones y grupos sociales vulnerables en la distribución de las vacunas) y que permitan alcanzar la equidad en el acceso a los servicios de salud en relación con la cobertura de la vacunación contra la COVID-19.

[Cancer care access in Chile's vulnerable populations during the COVID-19 pandemicAcesso a tratamento de câncer em populações vulneráveis no Chile durante a pandemia de COVID-19]. / Acceso a la atención del cáncer en los grupos vulnerables de Chile durante la pandemia de COVID-19.

Objectives: To examine the COVID-19 pandemic's impact on cancer care access in Chile, analyzing differential effects by insurance type, gender, and age. Methods: We conducted a quasi-experimental study using interrupted time series analysis. We used multiple data sources for a broad evaluation of cancer-related health care utilization from January 2017 to December 2020. We fit negative binomial models by population groups for a range of services and diagnoses. Results: A sharp drop in oncology health care utilization in March was followed by a slow, incomplete recovery over 2020. Cumulative cancer-related services, diagnostic confirmations, and sick leaves were reduced by one third in 2020; the decrease was more pronounced among women and the publicly insured. Early diagnosis was missed in 5132 persons with 4 common cancers. Conclusions: The pandemic stressed the Chilean health system, decreasing access to essential services, with a profound impact on cancer care. Oncology service reductions preceded large-scale lockdowns and supply-side disruptions. Importantly, not all population groups were equally affected, with patterns suggesting that gender and socioeconomic inequalities were exacerbated.

Objetivos: Examinar o impacto da pandemia de COVID-19 no acesso a tratamento de câncer no Chile, analisando efeitos diferenciais por tipo de cobertura de assistência à saúde, gênero e idade. Métodos: Realizamos um estudo quase-experimental utilizando análise de séries temporais interrompidas. A partir de várias fontes de dados, efetuamos uma avaliação abrangente da utilização de atenção à saúde relacionada ao câncer, de janeiro de 2017 a dezembro de 2020. Ajustamos modelos binomiais negativos por grupos populacionais a vários tipos de serviços e diagnósticos. Resultados: Uma queda acentuada no uso da assistência médica oncológica em março foi seguida por uma recuperação lenta e incompleta ao longo de 2020. Cumulativamente, a utilização de serviços oncológicos, as confirmações de diagnóstico e os afastamentos do trabalho por doença foram reduzidos em um terço em 2020. Essa redução foi mais pronunciada em mulheres e usuários do sistema público de saúde. No total, 5132 pessoas com 4 cânceres comuns não foram diagnosticadas precocemente. Conclusões: A pandemia impôs pressão sobre o sistema de saúde chileno, reduzindo o acesso a serviços essenciais e causando um profundo impacto no tratamento do câncer. As reduções na prestação de serviços de oncologia precederam os lockdowns em larga escala e as interrupções na oferta de suprimentos. É importante ressaltar que nem todos os grupos populacionais foram igualmente afetados e os padrões observados sugerem que as desigualdades de gênero e socioeconômicas foram exacerbadas.

Coverage of cervical cancer screening in Uruguay, 2018 / Cobertura de tamizaje de cáncer de cuello de útero en Uruguay, 2018 / Cobertura do rastreamento do câncer do colo do útero no Uruguai, 2018

Introducción: el cáncer de cuello uterino (CCU) causa una significativa pérdida de años por discapacidad y muerte prematura en el mundo. Se relaciona fuertemente, por su etiología, a las inequidades socioeconómicas. Alcanzar una cobertura del 80% del tamizaje poblacional a través de la colpocitología oncológica constituye una de las principales estrategias para disminuir la morbimortalidad por este cáncer. Objetivos: describir la cobertura de tamizaje en CCU de las mujeres de 21 a 64 años, usuarias del Sistema Nacional Integrado de Salud (SNIS) de Uruguay en el año 2018 y explorar su comportamiento según edad, lugar de residencia, características socioeconómicas y culturales del territorio. Métodos: estudio descriptivo, en base a fuentes de datos secundarios, con una muestra que alcanzó el 95% del universo. La técnica de tamizaje considerada fue la colpocitología oncológica de (PAP) con vigencia de hasta 3 años al 30/9/2018. Resultados: la cobertura de tamizaje en CCU en 2018 fue del 57%, siendo menor en las primeras y últimas edades consideradas, variando por zona geográfica, encontrándose menor porcentaje de PAP vigente en las mujeres residentes en departamentos con menores índices de desarrollo humano y con mayor porcentaje de hogares por debajo de la línea de pobreza. Conclusiones: la cobertura de tamizaje en CCU en Uruguay debe aumentar para disminuir la morbimortalidad por este cáncer. Se requiere implementar acciones para reducir la heterogeneidad entre edades y departamentos de residencia. Esta estimación constituye una línea de base que permite comparar la situación país pospandemia COVID-19 replicando la misma metodología.

Summary: Introduction: cervical cancer causes a significant loss of years due to disabilities and early deaths around the world. Due to its etiology, it is closely linked to socio- economic inequalities. Cervical cancer screening coverage of 80 % of the population through and pap smear constitutes one of the main strategies to reduce morbimortality of this kind of cancer. Objectives: to describe cervical cancer screening coverage in women between 21 and 64 years old, users of the National Integrated Health System (SNIS) in Uruguay in 2018 and explore their behavior according to age, place of residence, socio-economic and territorial cultural characteristics. Method: descriptive study, based on secondary data sources of a sample representing 95% of the universe. The screening technique considered in the study was a pap smear, valid for up to three years on September 30, 2019. Results: cervical cancer screening coverage in 2018 was 57%, lower in the first and last ages considered and it varied depending on the geographical area. A lower percentage of valid smear tests was found in women who were residents of provinces with lower human development index and a higher percentage of homes below the poverty line. Conclusions: cervical cancer screening coverage in Uruugay needs to increase in order to reduce morbimortality. The implementation of actions aimed at reducing differences between ages and places of residence is required. This estimation may be taken as a baseline that allows for a comparison with the post-COVID 19 pandemic situation, by replicating the same method.

Introdução: o câncer do colo do útero (CCU), causa uma perda significativa de anos por incapacidade e morte prematura no mundo estando fortemente relacionada, por sua etiologia, às iniquidades socioeconômicas. Uma das principais estratégias para reduzir a morbimortalidade por esse câncer é alcançar 80% de cobertura de rastreamento populacional por meio da colpocitologia oncológica. Objetivos: descrever a cobertura do rastreamento do CCU em mulheres de 21 a 64 anos, usuárias do Sistema Nacional Integrado de Saúde (SNIS) do Uruguai em 2018 e analisar seu comportamento de acordo com idade, local de residência, características socioeconômicas e culturais do território. Métodos: estudo descritivo, baseado em fontes de dados secundárias de uma amostra que atingiu 95% do universo. A técnica de rastreamento considerada foi a colpocitologia oncológica (PAP) válida por até 3 anos a partir de 30/09/2018. Resultados: a cobertura de rastreamento no CCU em 2018 foi de 57%, sendo menor nas primeiras e últimas idades consideradas, variando por área geográfica, encontrando menor percentual de PAP atual em mulheres residentes em departamentos com menores índices de desenvolvimento humano e com maior percentual de famílias abaixo da linha de pobreza. Conclusões: deve-se aumentar a cobertura de rastreamento no CCU no Uruguai para reduzir a morbimortalidade por esse câncer. É necessário implementar ações para reduzir a heterogeneidade entre idades e departamentos de residência. Essa estimativa constitui uma linha de base que permite comparar a situação do país pós-pandemia por COVID-19, replicando a mesma metodologia.