Acceptance of a third COVID-19 vaccine dose, vaccine interchangeability, and clinical trial enrolment among parents of children 12-17 years in Lima, Perú.

Objectives: To characterize factors associated with parental willingness for their children participation in a COVID-19 vaccine trial, use of different COVID-19 vaccines and acceptance of a third vaccine dose. Methods: Parents of children aged 12-17 years in Lima, Perú were asked to complete an online questionnaire via social networks, from November 9, 2021, to April 23, 2022. We calculated crude and adjusted prevalence ratios with 95% confidence intervals to compare factors with the mentioned outcomes. Results: From 523 parents responding, 374 completed the survey. 90.4% would give their children a third vaccine dose, 36.6% would allow their children participation in a COVID-19 vaccine clinical trial, and 33.2% would accept different vaccine brands between doses. Parental belief that COVID-19 vaccine studies met quality standards was associated with acceptance of a third booster dose (adjusted PR 3.25; 95% CI1.57-6.74; p = 0.002), enrolment in a COVID-19 clinical trial (adjusted PR 4.49; 95% CI1.25-16.06; p = 0.02), and acceptance of different COVID-19 vaccine brands between doses (adjusted PR 10.02; 95% CI1.40-71.95; p = 0.02). Conclusion: Most parents would accept a third vaccine booster dose, approximately a third would participate in COVID-19 vaccine trials. Believing COVID-19 vaccines studies fulfilled quality standards was associated with the study outcomes. It is necessary to inform about the rigorous processes for the development of COVID-19 vaccines to generate confidence in parents to accept these vaccine-related outcomes.

Aspects that facilitate access to care for viral hepatitis: An evaluative research

ABSTRACT BACKGROUND: Viral hepatitis is a major public health concern worldwide. OBJECTIVES: This study aimed to analyze the factors that facilitate access to care for viral hepatitis. DESIGN AND SETTING: Using a sequential mixed method, this evaluation research was conducted in the state of Mato Grosso, Brazil. METHODS: Mapping of references and selection of regions were made based on the quantity and heterogeneity of services. The stakeholders, including the managers of the State Department of Health and professionals from reference services, were identified. Nine semi-structured interviews were conducted using content analysis and discussions guided by the dimensions of the analysis model of universal access to health services. RESULTS: In the political dimension, decentralizing services and adhering to the Intermunicipal Health Consortium are highly encouraged. In the economic-social dimension, a commitment exists to allocate public funds for the expansion of referral services and subsidies to support users in their travel for appointments, medications, and examinations. In the organizational dimension, the availability of inputs for testing, definition of user flow, ease of scheduling appointments, coordination by primary care in testing, collaboration following the guidelines and protocols, and engagement in extramural activities are guaranteed. In the technical dimension, professionals actively commit to the service and offer different opening hours, guarantee the presence of an infectious physician, expand training opportunities, and establish intersectoral partnerships. In the symbolic dimension, professionals actively listen to the experiences of users throughout their care trajectory and demonstrate empathy. CONCLUSIONS: The results are crucial for improving comprehensiveness, but necessitate managerial efforts to enhance regional governance.

Acceptability of teleconsultation in a public service specialized in the prevention and care of HIV infection and other sexually transmitted infections / Aceitabilidade da teleconsulta em um serviço público especializado na prevenção e cuidado da infecção pelo HIV e outras infecções sexualmente transmissíveis

Introduction: Telemedicine was leveraged for its contribution to mitigate the impact of COVID-19 in Brazil and worldwide. Objective: We aim to evaluate the acceptability of incorporating teleconsultation through synchronized videoconference by users and professionals in a service specialized in the prevention and treatment of the human immunodeficiency virus and other sexually transmitted infections, and to identify associated factors. Methods: This is a cross-sectional study with 410 users and 57 professionals who answered a category-standardized questionnaire. Predictors of acceptability were assessed using logistic regression model. Results: A total of 364 (88.8%) users said they would accept the modality. The factors positively associated with the odds of acceptance were the self-assessment of having favorable conditions to participate in a teleconsultation (aOR 54.8; 95%CI 12.4­242.1; p<0.001), the perception of saving money (aOR 5.2; 95%CI 1.9­14.0; p=0.001), and perceived convenience of the modality (aOR 6.7; 95%CI 2.9­15.9; p<0.001). Factors associated with reduced odds of acceptance were the fear of not being evaluated well (aOR 0.2; 95%CI 0.1­0.4; p<0.001), or remaining long without seeing the professional (aOR 0.2; 95%CI 0.1­0.5; p<0.001). The acceptance of the modality among professionals was 75.4% and the perception of its convenience (aOR 16.8; 95%CI 2.6­108.4; p=0.003) and that the institution has appropriated conditions (aOR 7.7; 95%CI 1.5­40.6; p=0.016) were associated with increased odds of accepting its incorporation in their routine. Conclusion: Governance should invest in infrastructure and support, secure protocols, digital literacy, and training of its users and employees for video teleconsultation. (AU)

Introdução: A telemedicina foi alavancada por sua contribuição para mitigar o impacto da COVID-19 no Brasil e no mundo. Objetivo: Pretendemos avaliar a aceitabilidade da incorporação da teleconsulta por videoconferência síncrona por usuários e profissionais de um serviço especializado na prevenção e tratamento da infecção pelo vírus da imunodeficiência humana (HIV) e outras infecções sexualmente transmissíveis, bem como identificar fatores associados. Métodos: Estudo transversal com 410 usuários e 57 profissionais, que responderam a um questionário padronizado por categoria. Os preditores de aceitabilidade foram avaliados utilizando-se um modelo de regressão logística. Resultados: O total de 364 (88,8%) usuários disseram que aceitariam a modalidade. Os fatores positivamente associados à probabilidade de aceitação foram a autoavaliação quanto a ter condições favoráveis para participar de uma teleconsulta (razão de chances ajustada ­ aOR 54,8; intervalo de confiança de 95% ­ IC95% 12,4­242,1; p<0,001), a percepção de poupar dinheiro (aOR 5,2; IC95% 1,9­14,0; p=0,001) e a percepção de conveniência da modalidade (aOR 6,7; IC95% 2,9­15,9; p<0,001). As menores probabilidades de aceitação foram o medo de não ser bem avaliado (aOR 0,2; IC95% 0,1­0,4; p<0,001) e de permanecer muito tempo sem ver o profissional (aOR 0,2; IC95% 0,1­0,5; p<0,001). A aceitação da modalidade pelos profissionais foi de 75,4% e a percepção de sua conveniência (aOR 16,8; IC95% 2,6­108,4; p=0,003) e a de que a instituição possui condições favoráveis (aOR 7,7; IC95% 1,5­40,6; p=0,016) foram associadas com a maior probabilidade de aceitar a incorporação da modalidade em sua rotina. Conclusão: A governança deve investir em infraestrutura e apoio, protocolos seguros, literacia digital e treinamento de seus usuários e funcionários para a videoconsulta. (AU)

Aceitabilidade social de tecnologias da atenção primária à saúde: uma revisão de escopo / Social acceptance of primary health care technologies: a scoping review

Alma-Ata definiu a Atenção Primária à Saúde (APS) como "cuidados essenciais de saúde baseados em métodos e tecnologias práticas, cientificamente bem fundamentadas e socialmente aceitáveis"1, mas parece faltar "aceitabilidade social" paradiversas tecnologias usadas na APS, além de pouca investigação de tal conceito. Esta pesquisa buscou compreendera aceitabilidade social das tecnologias praticadas na APS,no Brasil e no mundo, por meio de uma revisão de escopo, visando mapear conceitos-chave, tipos de evidências e lacunas no campo através de sistemática busca, seleção e síntese do conhecimento existente. Buscaram-se artigos de 1978 a 2019 no Medline -PubMed, BVS/Lilacs, Academic Search Premier, Web of Science, Science Direct, SciELO e CINAHL complete. Pesquisou-se, também, nas referências desses artigos e por meio de busca complementar efetuada no Google e no Google Scholar. Identificados13.874 artigos, foram selecionados 201 para tabulação e análise. Encontrou-se grande variedade de tecnologias usadas na APS em 41 países, que foram organizadas em forma temática. Identificaram-se sete acepções para"aceitabilidade social": percepções sobre uma tecnologia, intenções de aceitar uma tecnologia, aceitar uma tecnologia ou não, confiança, participação, acesso e qualidade do cuidado.

Alma-Ata defined Primary Health Care (PHC) as "essential health care based on practical, scientifically and socially acceptable methods and technology," 1 but it seems that several technologies used in PHC lack social acceptability ­a concept seldom investigated. This research was pursued to acknowledge the social acceptability of PHC technologies, in Brazil and in the world, through a Scoping Review, in order to map concepts, evidence, and gaps in the research field through a systematic search, selection, and synthesis of existing knowledge. The articles, published between the years of 1978 and 2019, were searched in the following databases: Medline-PubMed, BVS/Lilacs, Academic Search Premier, Web of Science, Science Direct, SciELO, and CINAHL Complete. Further references cited in these articles were explored along with complementary searches on Google and Google Scholar. Out of 13,874 articles identified, 201 wereselected for data extraction and analysis. As a result, thematic maps of the large scope of technologies used in PHC were created. Seven different groups were created to assess "social acceptability": perceptions about a specific technology; the intentionto accept it; simply accepting it; trust; participation; access; and quality of care.

Itinerários terapêuticos de pessoas com diabetes mellitus no Brasil: revisão integrativa / Therapeutic itineraries of people with diabetes mellitus in Brazil: an integrative review / Itinerarios terapéuticos de personas con diabetes mellitus en Brasil: revisión integrativa

Objetivo: Analisar a produção científica sobre itinerários terapêuticos de pessoas com diabetes mellitus no Brasil. Métodos: Trata-se de uma revisão integrativa da literatura com publicações recuperadas a partir do acesso a Medical Literature Analysis and Retrievel System Online (MEDLINE), Scientific Electronic Library Online (SciELO), Web of Science, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Base de Dados em Enfermagem (BDENF), incluindo nestes dois últimos casos a literatura cinzenta (dissertações e teses). Os critérios de inclusão deram-se por: artigo de pesquisa de campo, teórico e de revisão; relato de experiência ou trabalho de conclusão de curso que abordasse os itinerários terapêuticos de pacientes com diabetes mellitus no Brasil, no idioma inglês, português ou espanhol, publicado até a data das buscas (março e abril de 2020), sem restrição quanto à data inicial. Resultados: Dez publicações compuseram a amostra final. Os resultados apresentaram-se agrupados em quatro categorias temáticas: a) experiência em relação aos serviços de atenção à saúde; b) recursos de apoio no cuidado à saúde; c) práticas de autocuidado utilizadas; e d) dificuldades para o autocuidado e enfrentamento do diabetes mellitus. Conclusão: A organização e a articulação dos serviços, a atuação das equipes, o apoio familiar ou social, além de aspectos pessoais, socioeconômicos e laborais são fatores que influenciam os itinerários terapêuticos e o enfrentamento do diabetes mellitus.

Objective: To analyze the scientific production on therapeutic itineraries of people with Diabetes Mellitus in Brazil. Methods: This is an integrative literature review of publications retrieved from the Medical Literature Analysis and Retrieval System Online (MEDLINE), Scientific Electronic Library Online (SciELO), Web of Science, Latin American and Caribbean Health Sciences Literature (LILACS) and the Nursing Database (Base de Dados Enfermagem ­ BDENF), including in these last two cases the gray literature (theses and dissertations). Inclusion criteria were: field, theoretical and review research article, experience report or course completion work that addressed the therapeutic itineraries of patients with Diabetes Mellitus in Brazil, in English, Portuguese or Spanish, published until the date of the searches (March and April 2020), without restrictions as to the starting date. Results: Ten publications made up the final sample. The results were grouped into four thematic categories: a) experience in relation to health care services, b) health care support resources, c) self-care practices used and d) difficulties in self-careand coping with Diabetes Mellitus. Conclusion: The organization and articulation of services, the performance of the teams, the family or social support and personal, socioeconomic, and work aspects are factors that influence therapeutic itineraries and coping with Diabetes Mellitus.

Objetivo: Analizar la producción científica sobre los itinerarios terapéuticos de personas con diabetes mellitus en Brasil. Métodos: Se trata de una revisión integrativa de la literatura con publicaciones recuperadas a partir del acceso al Medical Literature Analysis and Retrievel System Online (MEDLINE), Scientific Electronic Library Online (SciELO), Web of Science, Literatura Latino-Americana y del Caribe en Ciencias de la Salud (LILACS) y la Base de Datos en Enfermería (BDENF), incluyendo en los dos últimos casos la literatura gris (trabajos de maestría y tesis). Los criterios de inclusión se dieron por artículo de investigación de campo, teórico y de revisión; relato de experiencia o trabajo de fin de grado que tratara de itinerarios terapéuticos de pacientes con diabetes mellitus en Brasil, en los idiomas inglés, portugués o español, que hubiera sido publicado hasta la fecha de las búsqueda (marzo y abril de 2020), sin restricción de la fecha inicial. Resultados: Diez publicaciones han compuesto la muestra final. Los resultados se presentaron de manera agrupada en cuatro categorías temáticas: a) experiencia con los servicios de atención a la salud; b) recursos de apoyo con el cuidado de salud; c) prácticas de autocuidado utilizadas; y d) dificultades para el autocuidado y el afrontamiento de la diabetes mellitus. Conclusión: La organización y la articulación de los servicios, la actuación de los equipos, el apoyo familiar o social, además de los aspectos personales, socioeconómicos y laborales son factores que influyen en los itinerarios terapéuticos y el afrontamiento de la diabetes mellitus

Percepción y disposición al tacto rectal en la prevención de cáncer de próstata / Perception and disposition to digital rectal examination in the prevention of prostate cancer

RESUMEN Introducción. El cáncer de próstata puede detectarse por el tacto rectal. Objetivo. Explorar la percepción y disposición al tacto rectal. Métodos. Se realizó un estudio cualitativo. La unidad de análisis fue el paciente que viene a consulta externa. Se utilizó entrevista a profundidad. Resultados. La percepción del tacto rectal tuvo como categorías apriorísticas el machismo, la homosexualidad, vergüenza, dolor e impotencia sexual. Se tuvo como categoría emergente la predisposición al tacto rectal del servicio de urología, predisposición por el beneficio de realizar el tacto rectal y predisposición de los pacientes que ya se realizaron el tacto rectal. Conclusiones. La percepción tiene categorías emergentes como son la predisposición al tacto rectal en pacientes del servicio de urología, predisposición de los pacientes que tuvieron una consulta anterior. La disposición al tacto rectal es aceptada por los pacientes ya que es una indicación médica realizada por un profesional capacitado.

ABSTRACT Introduction. Prostate cancer can be detected by digital rectal examination. Objectives. To explore the perception and disposition to digital rectal examination. Methods. A qualitative study was carried out. The unit of analysis was the patient who comes to the service's outpatient consultation. An in-depth interview was used. Results. The perception of digital rectal examination has as a priori categories that are machismo, homosexuality, shame, pain and sexual impotence. The emerging category was predisposition to digital rectal examination in the urology service, predisposition due to the benefit of performing digital rectal examination, and predisposition of patients who had already undergone digital rectal examination. Conclusions. The perception has emerging categories such as the predisposition to digital rectal examination in patients of the urology service, predisposition of patients who had a previous consultation. The willingness to digital rectal examination is accepted by patients as it is a medical indication performed by a trained professional.

Quali-quantitative analysis of adherence and perceived satisfaction of individuals with COPD after high-intensity training on land and in water: additional analysis from a randomized clinical trial / Análise quali-quantitativa da aderência e percepção da satisfação de indivíduos com DPOC após treinamento físico de alta intensidade no solo e na água: análises adicionais de um ensaio clínico randomizado / Análisis cuali-cuantitativo de adherencia y percepción de la satisfacción de individuos con EPOC después de entrenamiento físico de alta intensidad en suelo y en agua: análisis adicionales de un ensayo clínico aleatorizado

ABSTRACT Although patients with chronic obstructive pulmonary disease (COPD) benefit in many ways after participating in pulmonary rehabilitation programs, high dropout rates are still observed among participants. This study aims to analyze the adherence rate and perceived satisfaction in individuals with chronic obstructive pulmonary disease who underwent high-intensity physical training on land (LG) and in water (WG). This study is an additional analysis from a randomized controlled trial. In total, 36 subjects (51%) completed the intervention. All participants underwent six months of high-intensity endurance and strength training. Adherence was assessed by the proportion of patients who completed the training program. Perceived satisfaction was evaluated using a questionnaire composed of structured and semi-structured questions. The interviews were recorded, transcribed, and analyzed according to the criteria of our thematic analysis. The Shapiro-Wilk test was used to assess data normality, and dropout rates were compared using the chi-square test. Statistical significance was set at 5%. Regarding adherence, 59% of WG participants and 44% of LG participants completed the program, with no difference between the groups (p>0.05). Individuals from both groups were equally satisfied after six months of physical training (<90%); the therapist-patient relationship and treatment effectiveness being important factors for this perception. Qualitative analysis also showed that WG participants reported a more prominent improvement in their respiratory symptoms, leisure, sensation of pain, and sleep. In conclusion, patients with COPD were satisfied after six months of high-intensity physical training in water and on land, noting that water exercising promoted additional benefits compared to land exercising. There seems to be no superiority to any of the regimens (water or land) regarding the adherence to the training programs.

RESUMO Embora os pacientes com doença pulmonar obstrutiva crônica (DPOC) se beneficiem de muitas maneiras de programas de reabilitação pulmonar, ainda são observadas altas taxas de desistência entre os participantes. O objetivo deste estudo foi analisar a taxa de adesão e a percepção de satisfação de indivíduos com DPOC que realizaram treinamento físico de alta intensidade em solo (GS) e água (GA). Foram realizadas análises adicionais de um ensaio clínico randomizado. 36 indivíduos (51%) completaram a intervenção. Todos os participantes foram submetidos a seis meses de treinamento de força e resistência de alta intensidade. A adesão foi avaliada pela proporção de pacientes que completaram o programa de treinamento e a satisfação foi avaliada por meio de um questionário composto por questões estruturadas e semiestruturadas. As entrevistas foram gravadas, transcritas e analisadas de acordo com o critério de análise de conteúdo. Foi utilizado o teste de Shapiro-Wilk para avaliar a normalidade dos dados e o teste qui-quadrado para a comparação da taxa de aderência. Foi adotado p<0,05 como significância estatística. Em relação à adesão, 59% dos participantes do GA e 44% do GS completaram o programa, sem diferença entre os grupos (p>0,05). Os indivíduos de ambos os grupos estavam igualmente satisfeitos após seis meses de treinamento físico (<90%), sendo a relação terapeuta-paciente e a eficácia no tratamento fatores importantes para essa percepção. A análise qualitativa também mostrou que os participantes do GA relataram benefícios mais proeminentes em relação aos sintomas respiratórios, ao lazer, a sensação de dor e ao sono. Portanto, os pacientes com DPOC se mostraram satisfeitos após seis meses de treinamento e perceberam que o exercício na água promoveu mais benefícios do que em solo. Em relação à adesão aos programas de treinamento não pareceu haver superioridade de nenhum dos regimes (água ou solo).

RESUMEN Aunque los programas de rehabilitación pulmonar ayudan a los pacientes con enfermedad pulmonar obstructiva crónica (EPOC), todavía se observan altas tasas de abandono de los participantes en estos programas. El objetivo de este estudio fue evaluar la tasa de adherencia y la percepción de satisfacción de las personas con EPOC que realizaron entrenamiento físico de alta intensidad en suelo (GS) y en agua (GA). Se realizaron análisis adicionales de un ensayo clínico aleatorizado. 36 participantes (51%) completaron la intervención. Todos se sometieron a seis meses de entrenamiento de fuerza y resistencia de alta intensidad. La adherencia se evaluó por la proporción de pacientes que completaron el programa de entrenamiento, y la satisfacción se evaluó mediante un cuestionario con preguntas estructuradas y semiestructuradas. Las entrevistas fueron grabadas, después transcritas y analizadas según el criterio de análisis de contenido. Para evaluar la normalidad de los datos, se utilizó el test de Shapiro-Wilk, y para comparar la tasa de adherencia se aplicó la prueba de chi-cuadrado. El nivel de significación estadística fue de p<0,05. En cuanto a la adherencia, el 59% de los participantes del GA y el 44% del GS completaron el programa, sin diferencia entre grupos (p>0,05). Ambos grupos estaban igualmente satisfechos después de seis meses de entrenamiento físico (<90%), por lo que la relación terapeuta-paciente y la eficacia del tratamiento fueron los factores importantes de esta percepción. El análisis cualitativo también apuntó que los participantes de GA informaron más beneficios con respecto a los síntomas respiratorios, el ocio, la sensación de dolor y el sueño. Por lo tanto, los pacientes con EPOC estaban satisfechos después de seis meses de entrenamiento y se dieron cuenta de que el ejercicio en el agua les brindaba más beneficios que el ejercicio en el suelo. En cuanto a la adherencia al carácter de los programas de entrenamiento (si agua o suelo), no pareció haber superioridad en ninguno de ellos.

Acceptability and adoption of clinical practice guidelines and treatment protocols on preeclampsia/eclampsia in the Dominican Republic.

OBJECTIVE: Estimate the acceptability and adoption by health care workers of clinical practice guidelines and treatment protocols for women with preeclampsia/eclampsia and identify the facilitating factors and barriers to their implementation. METHODS: A qualitative study was conducted, using semi-structured interviews and focus groups in five maternity hospitals. Interviews were compiled for analysis, and barriers and facilitators were characterized. RESULTS: Seventy health professionals (52 female and 18 male) participated, representing different levels of the health system. The majority of workers and managers were aware of the existence and content of clinical practice guidelines (CPGs) for preeclampsia/eclampsia, especially the participants with more time in the health service. With respect to facilitating factors, both medical and nursing staff were positive about continued development and implementation of high-quality CPGs. There was consensus that limitations exist, especially with respect to a lack of the necessary medicines, supplies, and equipment to meet and implement the established recommendations. DISCUSSION: The results of the study show the need to strengthen strategies that help close the gap between research and public policy. Studies suggest that research should focus on users, policymakers, and decisionmakers in the health system. The actors in the Dominican health system recognize the GRADE methodology as an appropriate instrument for the development and implementation of CPGs. Implementation barriers require systemic and comprehensive approaches.

Acceptability of dual HIV/syphilis rapid test in community- and home-based testing strategy among transgender women in Buenos Aires, Argentina.

BACKGROUND: Little is known of acceptability and feasibility of dual HIV and syphilis rapid tests in community- and home-based provider-initiated strategies among transgender women (TGW), in Latin America. Objectives were (1) to assess the acceptability of this strategy and, (2) to determine the percentage of positive results of HIV and syphilis, analyze the correlates of HIV or syphilis positive results, and measure the rates of effective referral and treatment completion among TGW. METHODS: A multidisciplinary team tested 89 TGW in Buenos Aires. An acceptability survey was administered after the HIV/syphilis Duo test was used. All confirmed cases were referred for treatment initiation. RESULTS: We found high levels of acceptability (98.8%) of this strategy among TGW. However, only 60.7% preferred simultaneous HIV and syphilis diagnosis test. Moreover, we found 9% of positive results of HIV, 51.7% of syphilis, and 3.4% of positive results for both infections. Only not being tested before was associated with an HIV positive result, and only low level of education was associated with a positive syphilis result. Among 8 TGW who tested positive for HIV, 37.5% (n = 3) started antiretroviral therapy. Of 46 who tested positive for syphilis, only 73.9% (n = 34) were effectively referred and from 23 who started treatment, only 39.1% completed it. CONCLUSIONS: Community- and home-based dual HIV and syphilis rapid test is a feasible and highly acceptable approach for this hard-to-reach population. Implementing similar strategies could improve screening uptake and accessibility. However, these results highlight the need to improve strategies for treatment uptake, in order to reduce morbidity and risk of onward transmission.

Effect of necessity-concern framework and polypharmacy on treatment adherence in psychiatric patients. Comparing an Argentinian with a Spanish sample.

OBJECTIVE: We aimed to replicate a prior Spanish study of medication adherence where logistic regression models provided highly significant odds ratios (ORs) for three continuous scores: necessity, concern and the necessity-concern differential, and a dichotomous variable: skeptical attitude. Adherence ORs in the necessity-concern framework were very strong in patients taking five or six medications. METHODS: The sample comprised consecutive adult psychiatric outpatients in Mendoza, Argentina. The necessity-concerns framework was assessed using a subscale of the Beliefs about Medicines Questionnaire. Adherence (yes/no) to prescribed psychiatric medications was assessed by the Sidorkiewicz adherence tool. RESULTS: When compared with the Spanish sample, the Argentinian group (508 patients with 875 medications) was characterized by: (1) significantly stronger adherence ORs with the necessity-concern framework, (2) significantly lower number of medications per patient and percentage of patients with marked psychiatric polypharmacy (≥4 medications), (3) though a higher number of medications still was significantly associated with poor adherence. CONCLUSIONS: The Argentinian sample replicated the previous finding that patient beliefs regarding necessity and concern were associated with poor adherence to prescribed medications. Polypharmacy had an additive role decreasing adherence in both samples. In both samples, when prescribed ≥4 psychiatric medications, patients reported adherence to only two-third of the medications.

Acceptability and adoption of clinical practice guidelines and treatment protocols on preeclampsia/eclampsia in the Dominican Republic / Aceptabilidad y adopción de guías de práctica clínica y protocolos de atención sobre preeclampsia-eclampsia en la República Dominicana / Aceitabilidade e adoção de diretrizes de prática clínica e protocolos de atenção para pré-eclâmpsia e eclâmpsia na República Dominicana

ABSTRACT Objective. Estimate the acceptability and adoption by health care workers of clinical practice guidelines and treatment protocols for women with preeclampsia/eclampsia and identify the facilitating factors and barriers to their implementation. Methods. A qualitative study was conducted, using semi-structured interviews and focus groups in five maternity hospitals. Interviews were compiled for analysis, and barriers and facilitators were characterized. Results. Seventy health professionals (52 female and 18 male) participated, representing different levels of the health system. The majority of workers and managers were aware of the existence and content of clinical practice guidelines (CPGs) for preeclampsia/eclampsia, especially the participants with more time in the health service. With respect to facilitating factors, both medical and nursing staff were positive about continued development and implementation of high-quality CPGs. There was consensus that limitations exist, especially with respect to a lack of the necessary medicines, supplies, and equipment to meet and implement the established recommendations. Discussion. The results of the study show the need to strengthen strategies that help close the gap between research and public policy. Studies suggest that research should focus on users, policymakers, and decisionmakers in the health system. The actors in the Dominican health system recognize the GRADE methodology as an appropriate instrument for the development and implementation of CPGs. Implementation barriers require systemic and comprehensive approaches.

RESUMEN Objetivo. Estimar la aceptabilidad y adopción de las guías de prática clínica (GPC) y protocolos de atención a la mujer con preeclampsia-eclampsia por parte del personal prestador de los servicios de salud, e identificar los factores facilitadores y las barreras para su implementación. Métodos. Se desarrolló un estudio cualitativo por medio de entrevistas semiestructuradas y grupos focales en cinco maternidades. Se recopilaron las entrevistas para su análisis y se caracterizaron las barreras y facilitadores. Resultados. Participaron 70 profesionales de la salud (52 de sexo femenino y 18 de sexo masculino) que se desempeñan en distintos niveles del sistema de salud, participaron. La mayoría de los prestadores y gerentes conocen la existencia de las GPC de eclampsia-preeclampsia y su contenido, sobre todo los participantes con más tiempo en el servicio. Para los facilitadores, se estableció una valoración positiva entre el personal médico y de enfermería ante el proceso de continuar con la elaboración e implementación de GPC de alta calidad. Hubo consenso en cuanto a la existencia de limitaciones, sobre todo, por la falta de medicamentos, insumos y equipos requeridos, para cumplir y aplicar las recomendaciones formuladas. Discusión. Los resultados del estudio exponen la necesidad de fortalecer estrategias que ayuden a cerrar la brecha entre la investigación y la política pública. Estudios fundamentan la investigación en priorizar la atención a los usuarios, y los encargados de formular políticas y los tomadores de decisiones en el sistema de salud. Los actores del sistema de salud dominicano reconocen la metodología GRADE como un instrumento apropiado para la formulación e implementación de GPC. Las barreras de implementación requieren de abordajes sistémicos e integrales.

RESUMO Objetivo. Estimar a aceitabilidade e a adoção de diretrizes de prática clínica (DPCs) e protocolos de atenção para mulheres com pré-eclâmpsia e eclâmpsia por profissionais da saúde e identificar os fatores facilitadores e barreiras à sua implementação. Métodos. Desenvolvemos um estudo qualitativo baseado em entrevistas semiestruturadas e grupos focais em cinco maternidades. As entrevistas foram coletadas para análise, sendo caracterizadas as barreiras e fatores facilitadores. Resultados. O estudo contou com a participação de 70 profissionais da saúde (52 mulheres e 18 homens) que trabalham em diferentes níveis do sistema de saúde. Em sua maioria, os profissionais e administradores estão cientes da existência de DPCs para pré-eclâmpsia e eclâmpsia e conhecem seu conteúdo, especialmente os que têm mais tempo de experiência. Em relação aos fatores facilitadores, os profissionais médicos e de enfermagem consideraram positivo o processo de elaboração e implementação de DPCs de alta qualidade. Houve consenso sobre a existência de limitações, especialmente no que diz respeito à falta de medicamentos, insumos e equipamentos necessários para cumprir e implementar as recomendações. Discussão. Os resultados do estudo deixam clara a necessidade de reforçar as estratégias que ajudam a estabelecer vínculos entre a pesquisa e as políticas públicas. A pesquisa futura deve priorizar a atenção aos usuários e o apoio aos decisores e responsáveis pela elaboração de políticas no sistema de saúde. Os atores do sistema de saúde dominicano reconhecem a metodologia GRADE como um instrumento apropriado para a formulação e implementação de DPCs. As barreiras à implementação exigem abordagens sistêmicas e abrangentes.

Risk Stratification and Factors Associated with Abandonment of Tuberculosis Treatment in a Secondary Referral Unit.

PURPOSE: To study the factors associated with the risk of discontinuing active tuberculosis treatment among patients in an outpatient referral unit and to analyze the association between patients' abandonment risk score and their odds of discontinuing the treatment. PATIENTS AND METHODS: In this cohort study, tuberculosis patients were prospectively followed up from June 2012 through July 2019 at a secondary tuberculosis referral unit in Mato Grosso do Sul, Brazil. At initial consultation, patients were interviewed using a standardized questionnaire and were assigned a score for the risk of treatment abandonment by the nurse. Univariate and multivariate analyses were performed using logistic regression. RESULTS: One hundred and forty-eight patients were included in the study, of which 65.0% (96/148) were male. Their mean age was 43.3 ± 14.8 years (range: 18-89 years). Smoking, drug use, repeated admissions, and a high abandonment risk score were the variables associated with the highest risk of discontinuing the treatment. The rate of tuberculosis and human immunodeficiency virus coinfection was 37.2%. The overall rate of global treatment abandonment was 10.8% (95% confidence interval [CI]: 6.1-16.2). Upon stratification of patients that abandoned by the risk score, 22.9% (8/35) of the ones that abandoned had a high risk, 10.9% (6/55) had an intermediate risk, and 3.5% (2/58) had a low risk of treatment abandonment. In multivariate analysis, the factors associated with abandoning the treatment were smoking [adjusted odds ratio (aOR) = 4.91 (95% CI: 1.08, 22.32)] and undergoing retreatment (aOR) = 3.66 (95% CI: 1.04, 12 88). CONCLUSION: Smoking and undergoing retreatment were independent risk factors for tuberculosis treatment abandonment in this center. Risk stratification can help prioritize the strengthening of treatment adherence among patients at higher risk of abandoning treatment in referral units.

[Acceptability and adoption of clinical practice guidelines and treatment protocols on preeclampsia/eclampsia in the Dominican RepublicAceitabilidade e adoção de diretrizes de prática clínica e protocolos de atenção para pré-eclâmpsia e eclâmpsia na República Dominicana]. / Aceptabilidad y adopción de guías de práctica clínica y protocolos de atención sobre preeclampsia-eclampsia en la República Dominicana.

OBJECTIVE: Estimate the acceptability and adoption by health care workers of clinical practice guidelines and treatment protocols for women with preeclampsia/eclampsia and identify the facilitating factors and barriers to their implementation. METHODS: A qualitative study was conducted, using semi-structured interviews and focus groups in five maternity hospitals. Interviews were compiled for analysis, and barriers and facilitators were characterized. RESULTS: Seventy health professionals (52 female and 18 male) participated, representing different levels of the health system. The majority of workers and managers were aware of the existence and content of clinical practice guidelines (CPGs) for eclampsia/preeclampsia, especially the participants with more time in the health service. With respect to facilitating factors, both medical and nursing staff were positive about continued development and implementation of high-quality CPGs. There was consensus that limitations exist, especially with respect to a lack of the necessary medicines, supplies, and equipment to meet and implement the established recommendations. DISCUSSION: The results of the study show the need to strengthen strategies that help close the gap between research and public policy. Studies suggest that research should focus on users, policy-makers, and decision-makers in the health system. The actors in the Dominican health system recognize the GRADE methodology as an appropriate instrument for the development and implementation of CPGs. Implementation barriers require systemic and comprehensive approaches.

OBJETIVO: Estimar a aceitabilidade e a adoção de diretrizes de prática clínica (DPCs) e protocolos de atenção para mulheres com pré-eclâmpsia e eclâmpsia por profissionais da saúde e identificar os fatores facilitadores e barreiras à sua implementação. MÉTODOS: Desenvolvemos um estudo qualitativo baseado em entrevistas semiestruturadas e grupos focais em cinco maternidades. As entrevistas foram coletadas para análise, sendo caracterizadas as barreiras e fatores facilitadores. RESULTADOS: O estudo contou com a participação de 70 profissionais da saúde (52 mulheres e 18 homens) que trabalham em diferentes níveis do sistema de saúde. Em sua maioria, os profissionais e administradores estão cientes da existência de DPCs para pré-eclâmpsia e eclâmpsia e conhecem seu conteúdo, especialmente os que têm mais tempo de experiência. Em relação aos fatores facilitadores, os profissionais médicos e de enfermagem consideraram positivo o processo de elaboração e implementação de DPCs de alta qualidade. Houve consenso sobre a existência de limitações, especialmente no que diz respeito à falta de medicamentos, insumos e equipamentos necessários para cumprir e implementar as recomendações. DISCUSSÃO: Os resultados do estudo deixam clara a necessidade de reforçar as estratégias que ajudam a estabelecer vínculos entre a pesquisa e as políticas públicas. A pesquisa futura deve priorizar a atenção aos usuários e o apoio aos decisores e responsáveis pela elaboração de políticas no sistema de saúde. Os atores do sistema de saúde dominicano reconhecem a metodologia GRADE como um instrumento apropriado para a formulação e implementação de DPCs. As barreiras à implementação exigem abordagens sistêmicas e abrangentes.

Trajetórias assistenciais de idosos em uma região de saúde do Distrito Federal, Brasil / Healthcare pathways of the elderly in one health region in the Federal District, Brazil

RESUMO O objetivo foi identificar as trajetórias assistenciais de idosos em uma região de saúde do Distrito Federal e suas percepções acerca desses percursos. Pesquisa qualitativa que analisou, com base na metodologia de caso traçador, 14 percursos assistenciais de idosos. Foram realizadas entrevistas com idosos e cuidadores, processadas por análise de conteúdo; e consulta a prontuários. Mapas das trajetórias descritas foram elaborados por geoprocessamento. Identificou-se que o percurso real feito pelos idosos difere do previsto na legislação, e que as fragilidades apontadas estiveram relacionadas à difícil acessibilidade, ao deficit de profissionais, à falta de medicamentos e ao tempo de espera para atendimento na atenção especializada. As potencialidades relatadas pelos idosos envolveram humanização no atendimento, tais como o bom acolhimento por parte da equipe, a construção de vínculos e escuta qualificada, e sensação de bem-estar após as consultas. Apesar de o modelo de atenção ainda ser fragmentado e estar distante da situação ideal, os usuários se sentem satisfeitos com os cuidados recebidos, evidenciando aspectos positivos no processo do cuidar em saúde. Entretanto, a organização de processos de trabalho e a articulação entre os níveis de atenção à saúde precisam ser revistas e adequadas às especificidades desse ciclo de vida.

ABSTRACT The aim was to identify the healthcare pathways of the elderly in one health region in the Federal District and their perceptions about these pathways. A qualitative study analyzed 14 healthcare pathways of elderly people, using tracer methodology. Interviews were conducted with the elderly and caregivers, processed by content analysis; and medical records were reviewed. Maps of the paths described were prepared by geoprocessing. It was found that the actual healthcare pathways taken by the elderly differ from what law would predict, and that the weaknesses detected were related to poor accessibility conditions, lack of professionals, lack of medicines, and the long waiting time for specialized health care. The expectations reported by the elderly involved humanization of care, emerging elements such as being well received by the personnel, the building of bonds, qualified listening, and a feeling of well-being after the medical consultation. Although the care model is still fragmented and far from ideal, users feel satisfied with the care provision and identify positive aspects in the health care process. However, the organization of work processes and the articulation between levels of health care need to be reviewed and adapted to the specificities of this life phase.

Aceitabilidade da quimioprofilaxia em área endêmica para a hanseníase: projeto PEP-Hans Brasil / Acceptability of chemoprophylaxis in an endemic area for leprosy: the PEP-Hans Brazil Project / Aceptabilidad de la quimioprofilaxis en un área endémica de hanseniasis: Proyecto PEP-Hans Brasil

Resumo: O objetivo deste artigo foi analisar a aceitabilidade da quimioprofilaxia com rifampicina em dose única (PEP) entre os contatos, casos índices de hanseníase e profissionais da saúde e fatores relacionados que possam influenciar na adesão. Realizou-se um estudo qualitativo de análise de conteúdo após aplicação de entrevistas semiestruturadas segundo protocolo proposto no programa LPEP (2016), realizado em Alta Floresta, Mato Grosso, Brasil, em julho de 2016. Participaram do estudo indivíduos notificados com hanseníase, contatos e profissionais da saúde. Utilizou-se o software QRS NVivo versão 10. Foram contatados 80 indivíduos, sendo 54 (67%) contatos, 11 (14%) casos índices e 15 (19%) profissionais de saúde. Dentre os contatos, 94% (51/54) tomaram PEP. Foram identificadas 3 categorias quanto à PEP: compreensão, aceitação e expectativa da intervenção. A compreensão se mostrou relacionada ao cuidado da equipe de saúde. Aceitar ou não a medicação revelou-se relacionada ao medo, confiança e proteção, operacionalidade da estratégia, autoestima e insegurança quanto à intervenção. A expectativa da intervenção relacionou-se ao bem-estar, prevenção da doença e de sequelas, diminuição de gastos públicos e ampliação do acesso. Houve reconhecimento da relevância da estratégia PEP pela possibilidade de interrupção da cadeia de transmissão, diminuição de casos novos e melhora na qualidade de vida. A insegurança em tomar a medicação e de a doença se manifestar influenciaram negativamente à aceitação da PEP; por outro lado, as informações prévias sobre a estratégia PEP contribuíram para o fortalecimento da confiança nos profissionais de saúde e para a aceitabilidade da medicação(AU).

Abstract: The aim was to analyze the acceptability of chemoprophylaxis with single-dose rifampicin (PEP) in contacts, index leprosy cases, and health professionals and related factors that can influence adherence. A qualitative content analysis study was performed after application of semi-structured interviews according to the protocol proposed in the LPEP program (2016) drafted at Alta Floresta, Mato Grosso State, Brazil, in July 2016. Study participants included individuals with leprosy, contacts, and health professionals. The QRS NVivo software version 10 was used. A total of 80 individuals were contacted, including 54 (67%) contacts, 11 (14%) index cases, and 15 (19%) health professionals. 94% of the contacts (51/54) took PEP. Three PEP categories were identified: understanding, acceptance, and expectation towards the intervention. Understanding proved to be related to care by the health team. Acceptance (or lack thereof) of the medication was related to fear, trust, and protection, the strategy's operability, self-esteem, and insecurity regarding the intervention. Expectation towards the intervention was related to wellbeing, prevention of the disease, sequelae, decrease in public expenditures, and expanded access. Participants acknowledged the relevance of the PEP strategy based on the possibility of interrupting the transmission chain, reduction in new cases, and improved quality of life. Insecurity in taking the medication and the possibility of the disease manifesting itself had a negative influence on acceptance of PEP, while prior information on the PEP strategy helped strengthen trust in the health professionals and the medication's acceptance(AU).

Resumen: El objetivo fue analizar la aceptabilidad de la quimioprofilaxis con rifampicina en dosis única (PEP) entre los contactos, casos índices de hanseniasis y profesionales de salud, así como los factores relacionados que puedan influenciar en la adhesión al tratamiento. Se realizó un estudio cualitativo de análisis de contenido, tras la realización de entrevistas semiestructuradas, según el protocolo propuesto en el programa LPEP (2016), realizado en Alta Floresta, Mato Grosso, Brasil, en julio de 2016. Participaron en el estudio individuos diagnosticados con hanseniasis, contactos y profesionales de la salud. Se utilizó el software QRS NVivo versión 10. Se contactó con 80 individuos, siendo 54 (67%) contactos, 11 (14%) casos índices y 15 (19%) profesionales de salud. Entre los contactos 94% (51/54) tomaron PEP. Se identificaron 3 categorías respecto a la PEP: comprensión, aceptación y expectativa de intervención. La comprensión estuvo relacionada con el cuidado del equipo de salud. El aceptar o no la medicación estuvo relacionado con el miedo, confianza y protección, operatividad de la estrategia, autoestima e inseguridad de la intervención. La expectativa de la intervención estuvo relacionada con el bienestar, prevención de la enfermedad, así como secuelas, disminución de gasto público y ampliación del acceso. Existió un reconocimiento de la relevancia de la estrategia PEP por la posibilidad de interrupción de la cadena de transmisión, disminución de casos nuevos y mejora en la calidad de vida. La inseguridad en tomar la medicación y de que la enfermedad se manifestara influenciaron negativamente en la aceptación de la PEP, por otro lado, la información previa sobre la estrategia PEP contribuyó al fortalecimiento de la confianza en los profesionales de salud y a la aceptabilidad de la medicación(AU).

Preditores de aceitação da vacina contra influenza: tradução para o português e validação de um questionário / Predictores de la aceptación de la vacuna contra la gripe: traducción para el portugués y validación de un cuestionario / Predictors of influenza vaccine uptake: translation into Portuguese and validation of a questionnaire

Resumo: A dificuldade de alcançar coberturas ideais para a vacina contra influenza no Brasil e a crescente onda do movimento antivacina no mundo apontam a necessidade de aprofundar a compreensão dos determinantes individuais de adesão a essa vacina. O Modelo de Crenças em Saúde, um modelo teórico que objetiva explicar e predizer o comportamento em relação à saúde, sugere que crenças individuais influenciam a adoção de comportamentos relacionados a essa área. Este trabalho teve como objetivo a adaptação transcultural de um instrumento para avaliar os preditores de aceitação da vacina da influenza em adultos no Brasil. Realizaram-se a tradução, a retrotradução, a validade de face e um inquérito para validade de construto. Também foram analisados os fatores associados à adesão à vacina da influenza em 2017. Um instrumento, originalmente com sete domínios, foi identificado e selecionado. Na análise fatorial, quatro dos sete construtos do modelo teórico foram validados: Suscetibilidade, Barreiras, Estímulos para a ação e Motivação para a saúde. No inquérito das 396 pessoas, 59,3% relataram vacinação contra influenza na última campanha de 2017. Sexo feminino, idade > 50 anos, gestante, vacina na rede privada, vacinação contra a hepatite B e influenza antes de 2017 mostraram-se como fatores associados à vacinação em 2017. No modelo logístico final, a percepção de Barreiras apresentou-se como um forte Estímulo para não vacinação, ao passo que Estímulos para a ação atuou aumentando a chance de vacinação.

Resumen: La dificultad de alcanzar coberturas ideales para la vacuna contra la gripe en Brasil y la creciente ola del movimiento antivacunas en el mundo apunta la necesidad de profundizar la comprensión de los determinantes individuales de adhesión a esa vacuna. El Modelo de Creencias en Salud, un modelo teórico que tiene como objetivo explicar y predecir el comportamiento en relación con la salud, sugiere que las creencias individuales influencian la adopción de comportamientos relacionados con esa área. El objetivo de este trabajo es la adaptación transcultural de un instrumento para evaluar los predictores de aceptación de la vacuna de la gripe en adultos en Brasil. Se realizó la traducción, retrotraducción, validez de la presentación, así como una encuesta para la validez del constructo. También se analizaron los factores asociados con la adhesión a la vacuna de la gripe en 2017. Un instrumento, originalmente con siete dominios, fue identificado y seleccionado. En el análisis factorial, cuatro de los siete constructos del modelo teórico fueron evaluados: Susceptibilidad, Barreras, Estímulos para la acción y Motivación para la salud. En el cuestionario a las 396 personas, 59,3% informaron haber sido vacunadas contra la gripe en la última campaña de 2017. Sexo femenino, edad > 50 años, embarazada, vacunada en la red privada, vacunación contra la hepatitis B y gripe antes de 2017 se mostraron como factores asociados a la vacunación en 2017. En el modelo logístico final, la percepción de Barreras se presentó como un fuerte Estímulo para la no vacunación, al paso que Estímulos para la acción actuó aumentando la oportunidad de vacunación.

Abstract: The difficulty in achieving ideal coverage rates with the influenza vaccine in Brazil and the growing wave of antivaccine movements in the world point to the need for a more in-depth understanding of the individual determinants of to this vaccine uptake. The Health Belief Model, a theoretical model that aims to explain and predict health-related behaviors, suggests that individual beliefs influence the adoption of health-related behaviors. The objective of this study was a cross-cultural adaptation of an instrument to assess predictors of influenza vaccine uptake in Brazilian adults. The authors conducted translation, back-translation, face validity, and a survey for construct validity. They also analyzed the factors associated with influenza vaccine uptake in 2017. An instrument originally with seven domains was identified and selected. In the factor analysis, four of the model's seven constructs were validated: Susceptibility, Barriers, Cues to action, and Self-efficacy. In the survey with 396 persons, 59.3% reported having received the influenza vaccine in the last campaign in 2017. Female sex, age > 50 years, pregnancy, vaccination in private healthcare services, hepatitis B vaccination, and influenza vaccination prior to 2017 were associated with vaccination in 2017. In the final logistic regression model, perceived Barriers appeared as a strong factor for non-vaccination, while Cues to action increased the odds of vaccination.

Itinerários terapêuticos de mulheres com câncer de colo de útero na Bahia, Brasil / Therapeutic itineraries of women with cervical neoplasms in Bahia, Brazil

Resumo Objetivo: analisar os itinerários terapêuticos de mulheres com câncer de colo de útero (CCU) a partir do tratamento, na região Sudoeste da Bahia, Brasil. Materiais e métodos: estudo qualitativo descritivo e exploratório realizado em uma unidade de alta complexidade em oncologia que é referência para a região sudoeste da Bahia. Cinco mulheres em tratamento para o CCU foram entrevistadas, sendo a coleta de dados realizada a partir de entrevistas semiestruturadas e registros em diário de campo, no período de julho a agosto de 2017. Adotou-se a análise categorial temática. Resultados: emergiram duas categorias empíricas: Aspectos simbólicos e experiências de mulheres em tratamento para o CCU e a busca por tratamentos para o CCU. As racionalidades e práticas acionadas no curso dos itinerários revelaram a externalização de signos e significados da doença a partir de elementos biomédicos e sobrenaturais, experiências de adoecimento caracterizadas por sentimentos de dor e sofrimento, superação e enfrentamento como também o acionamento de estratégias terapêuticas de caráter empírico, popular e biomédico. Conclusão: os itinerários tecidos a partir de conexões com familiares, profissionais de saúde, membros da comunidade e com a religiosidade, denotam que não existem padrões únicos e definidos nas trajetórias em busca de cuidado e que os mesmos podem permitir uma maior aproximação dos sentidos, modos de lidar com a doença e estratégias terapêuticas valorizadas e acionadas por estas mulheres.

Resumen Objetivo: analizar los itinerarios terapéuticos de las mujeres con neoplasias del cuello uterino (NCU) desde el tratamiento, en la región suroeste de Bahía, Brasil. Materiales y métodos: estudio cualitativo descriptivo y exploratorio realizado en una unidad de alta complejidad en oncología, que es referencia para la región suroeste de Bahía. Se entrevistó a cinco mujeres sometidas a tratamiento para NCU y se recopilaron datos de entrevistas semiestructuradas y registros de diario de campo de julio a agosto de 2017. Se adoptó un análisis categórico temático. Resultados: surgieron dos categorías empíricas: Aspectos simbólicos y experiencias de mujeres sometidas a tratamiento para NCU y Búsqueda de tratamientos para NCU. Las racionalidades y prácticas accionadas en el curso de los itinerarios revelaron la externalización de signos y significados de la enfermedad a partir de elementos biomédicos y sobrenaturales, experiencias de enfermedad caracterizadas por sentimientos de dolor y sufrimiento, superación y afrontamiento, como también la activación de estrategias terapéuticas de carácter empírico, popular y biomédico. Conclusión: los itinerarios basados en conexiones con familiares, profesionales de la salud, miembros de la comunidad y con la religiosidad, denotan que no existen patrones únicos y definidos en las trayectorias de búsqueda de atención, y que pueden permitir una mayor aproximación de los sentidos, formas de tratar la enfermedad y estrategias terapéuticas valoradas y desencadenadas por estas mujeres.

Abstract Objective: to analyze the therapeutic itineraries of women with cervical neoplasms (NCU) from treatment, in the southwest region of Bahia, Brazil. Materials and methods: qualitative descriptive and exploratory study carried out in a unit of high complexity in oncology, which is a reference for the southwest region of Bahia. Five women undergoing treatment for NCU were interviewed and data from semi-structured interviews and field diary records were collected from July to August 2017. A categorical thematic analysis was adopted. Results: two empirical categories emerged: Symbolic aspects and experiences of women undergoing NCU treatment and Search for NCU treatments. Outsourcing of signs and meanings of the disease from biomedical and supernatural elements, experiences of illness characterized by feelings of pain and suffering, overcoming and coping, and activation of therapeutic strategies of empirical, popular and biomedical character, were results of the study. Conclusion: itineraries based on connections with family members, health professionals, community members, and religiosity, denote that there are no unique and defined patterns in the paths of care search, and that they can allow a nearest sense, ways to treat the disease and therapeutic strategies valued and triggered by these women.

Perception about barriers and facilitators of the school-based HPV vaccine program of Manizales, Colombia: A qualitative study in school-enrolled girls and their parents.

In 2012, Colombia implemented a school-based HPV vaccination program of a 3-dose series for nine year old girls. Following a mass psychogenic response after vaccination in a Colombian town, vaccination rates dropped from 80% in 2012-2013 to 5% in 2016. The study aimed to identify barriers and facilitators of HPV vaccine uptake among girls eligible for vaccination in the initial years of vaccine implementation from 2012 to 2014, and their parents. We conducted 19 individual qualitative interviews and 18 focus groups with an average of 5 girls, in Manizales, Colombia between 2016 and 2017. In total, 49 girls from six schools and 58 of their parents participated in the study. Participants had some degree of awareness about cervical cancer, especially among those of middle and upper socioeconomic level. However, the vaccine was known as a prevention measure only after pap-smears and condoms. The main facilitator for vaccine uptake for parents was the desire to prevent diseases in general and for girls, it was facilitated by receiving positive information about the vaccine. The main barriers for vaccine uptake or for three doses completion were the event in Carmen de Bolivar, fear of adverse effects and fear of needles. Girls and parents stated that they received little or no information from schools or health care services about the HPV vaccine prior to vaccination. Our results suggest that improving HPV vaccination rates in Colombia will require a comprehensive education program including mass media information about HPV vaccine.

[Human papillomavirus vaccine receptivity: a systematic reviewReceptividad con respecto a la vacuna contra el virus del papiloma humano: revisión sistemática]. / Receptividade à vacina contra o papilomavírus humano: uma revisão sistemática.

OBJECTIVE: To characterize the receptivity to human papillomavirus (HPV) vaccine and to describe factors that hinder or facilitate receptivity. METHOD: A systematic review was performed based on the 2015 PRISMA protocol. MEDLINE and Web of Science were searched using combinations of the terms papillomavirus, vaccine, adherence, and acceptance to identify articles published from 2006 to 2017. Original articles published in any language were included, and duplicate articles were excluded. Information was collected regarding article identification, methodological design, sample characteristics, and description of contents. Receptivity was characterized in terms of acceptance and adherence. RESULTS: Of 212 articles identified, 10 were selected for analysis. Most showed favorable, but heterogeneous, receptivity, with more acceptance than adherence, especially on the part of female adolescents. The analysis identified 11 facilitators and nine barriers to receptivity, especially knowledge of the theme and individual pattern of behavior regarding the problem. The analysis also detected the absence of a standardized method to evaluate receptivity and the imprecision of the concepts associated with acceptance and adherence. Therefore, a definition was proposed for acceptance (voluntary intention of receiving the vaccine or agreement that the vaccine is a good prevention strategy) and adherence (initiation and completion of the vaccination scheme). CONCLUSIONS: Additional studies are required to further investigate predictors of receptivity. For that, the development of an instrument based on the perceptions of target publics and employing precise concepts of acceptance and adherence is recommended, so as to allow a better understanding of the phenomenon and stimulate adherence and the achievement of adequate vaccine coverage.

OBJETIVO: Caracterizar la receptividad con respecto a la vacuna contra el virus del papiloma humano (VPH) y describir los factores inhibidores o facilitadores correspondientes. MÉTODOS: Se trata de una revisión sistemática según el protocolo PRISMA 2015. Se consultaron las bases de datos MEDLINE y Web of Science, utilizando combinaciones de los términos "papilomavirus", "vaccine" [vacuna], "adherence" [adhesión] y "acceptance" [aceptación] para encontrar artículos publicados desde el 2006 hasta el 2017. Se incluyeron artículos originales en cualquier idioma y se excluyeron los artículos duplicados. Se analizaron la identificación del artículo, la tipificación metodológica y las características de la muestra. La receptividad se caracterizó en términos de aceptación y adhesión. RESULTADOS: Se encontraron 212 artículos de los cuales se seleccionaron 10 para el análisis. En la mayoría de los estudios se demostró una receptividad favorable, pero heterogénea, con mayor aceptación que adhesión, principalmente por parte de adolescentes del sexo femenino. Se identificaron once factores facilitadores y nueve inhibidores de la receptividad, entre los cuales se destacan el conocimiento del tema y el patrón de comportamiento individual frente al problema. Se observó que faltaba un método normalizado que permitiera evaluar la receptividad y la imprecisión de los conceptos relacionados con la aceptación y la adhesión. Por lo tanto, se propuso una definición de aceptación (intención voluntaria de recibir una vacuna o expresión de acuerdo de que la vacuna representa una buena estrategia preventiva) y adhesión (acto de iniciar y finalizar el esquema de vacunación). CONCLUSIONES: Se necesitan nuevos estudios para profundizar el análisis de los factores de predicción de la receptividad. Para ello, se sugiere la creación de un instrumento basado en la percepción del público destinatario y el empleo de conceptos precisos de aceptación y adhesión, con el fin poder comprender mejor el fenómeno y fomentar la adhesión y el logro de tasas adecuadas de cobertura con la vacuna.

Calidad percibida en el servicio del sistema público de salud de Bogotá / Perceived service quality in the Bogotá public health system

RESUMEN Objetivo Conocer el nivel de satisfacción de los usuarios en relación con los servicios prestados por las entidades del sector público de salud de Bogotá Método Estudio descriptivo de corte trasversal, en el cual se indagó a 12 573 usuarios y pacientes de 196 puntos de atención de las subredes de servicios de salud, la entidad administradora de planes de beneficios (Capital Salud EPS) y la entidad rectora del sistema de salud en Bogotá, acerca de aspectos relacionados con la calidad y satisfacción percibidas. Se diseñaron tres instrumentos con calificación entre 1 y 5, en los que puntajes de 4 y 5 representaron satisfacción. Resultados Se presentan en cinco categorías: 1. El resultado global de desempeño del sistema, entendido como la confianza que genera y el posicionamiento del mismo; 2. Si hay mejoras en la gestión en relación con el año anterior; 3. El nivel de adherencia a los tratamientos; 4. La intención de colaborar con el sistema, y; 5. La experiencia vivencial integral, como la suma de las interacciones durante el proceso de atención. Aunque se encuentran niveles de satisfacción aceptables, se identifican diversas oportunidades de mejoramiento. Discusión Se analiza la importancia y validez del estudio, se postulan algunas acciones de mejora y se recomienda la implementación sistemática de este tipo de estudios.(AU)

ABSTRACT Objective To know the user satisfaction level in relation to the services provided by the Bogotá Health Department and its affiliated institutions. Materials and Methods A descriptive, cross-sectional study was performed, in which 12 573 users and patients at 196 care points of the health services sub-networks, the benefits plan administration entity (Capital Salud EPS) and the governing entity of the Bogotá Health System were asked about aspects related to perceived quality and satisfaction. Results Five categories are presented: 1. overall performance result, understood as the confidence generated; 2. management improvements compared to the previous year; 3. level of adherence to treatments; 4. intention to cooperate with the system; and 5. comprehensive experience as the sum of the interactions during the care process. Although acceptable levels of satisfaction were found, improvement opportunities were also identified. Discussion The importance and validity of the study was analyzed. Some improvement actions are proposed, and the systematic implementation of this type of studies is recommended.(AU)