RESUMO Objetivo: Avaliar a sazonalidade da bronquiolite aguda no Brasil durante a temporada 2020–2022 e compará-la com a das temporadas anteriores. Métodos: Os dados de incidência de internações por bronquiolite aguda em lactentes <1 ano de idade foram obtidos do Departamento de Informática da base de dados da Saúde Pública Brasileira para o período entre 2016 e 2022. Esses dados também foram analisados por macrorregiões do Brasil (Norte, Nordeste, Sudeste, Sul e Centro-Oeste). Para descrever características sazonais e de tendência ao longo do tempo, utilizamos o Modelo de Médias Móveis Integradas Autorregressivas Sazonais. Resultados: Em comparação com o período pré-COVID-19, a incidência de hospitalizações relacionadas com bronquiolite aguda diminuiu 97% durante as intervenções não farmacológicas (março de 2020 – agosto de 2021), mas aumentou 95% após a flexibilização das intervenções não farmacológicas (setembro de 2021 – dezembro de 2022), resultando no aumento geral de 16%. Durante o período pré-COVID-19, as hospitalizações por bronquiolite aguda seguiram um padrão sazonal, que foi interrompido em 2020–2021, mas recuperaram-se em 2022, com um pico ocorrido em maio, aproximadamente 4% superior ao pico pré-COVID-19. Conclusões: Este estudo ressalta a influência significativa das intervenções contra a COVID-19 nas hospitalizações por bronquiolite aguda no Brasil. A restauração de um padrão sazonal em 2022 sublinha a interação entre as medidas de saúde pública e a dinâmica das doenças respiratórias em crianças pequenas. Objetivo 20202022 2020–202 comparála compará la anteriores Métodos 1 < 201 Norte, Norte (Norte Nordeste Sudeste CentroOeste. CentroOeste Centro Oeste . Centro-Oeste) tempo Sazonais Resultados préCOVID19, préCOVID19 préCOVID pré COVID 19, 19 pré-COVID-19 97 março 202 2021, , 2021) 95 setembro 2022) 16 16% 20202021 2020–2021 recuperaramse recuperaram se maio 4 préCOVID19. 19. Conclusões COVID19 COVID-1 pequenas 2020202 2020–20 20 Centro-Oeste préCOVID1 pré-COVID-1 9 COVID1 COVID- 202020 2020–2 2 pré-COVID- 20202 2020– pré-COVID

ABSTRACT Objective: To evaluate the seasonality of acute bronchiolitis in Brazil during the 2020–2022 season and compare it with the previous seasons. Methods: Data from the incidence of hospitalizations due to acute bronchiolitis in infants <1 year of age were obtained from the Department of Informatics of the Brazilian Public Health database for the period between 2016 and 2022. These data were also analyzed by macro-regions of Brazil (North, Northeast, Southeast, South, and Midwest). To describe seasonal and trend characteristics over time, we used the Seasonal Autoregressive Integrated Moving Averages Model. Results: Compared to the pre-COVID-19 period, the incidence of hospitalizations related to acute bronchiolitis decreased by 97% during non-pharmacological interventions (March 2020 – August 2021) but increased by 95% after non-pharmacological interventions relaxation (September 2021 – December 2022), resulting in a 16% overall increase. During the pre-COVID-19 period, hospitalizations for acute bronchiolitis followed a seasonal pattern, which was disrupted in 2020–2021 but recovered in 2022, with a peak occurring in May, approximately 4% higher than the pre-COVID-19 peak. Conclusions: This study underscores the significant influence of COVID-19 interventions on acute bronchiolitis hospitalizations in Brazil. The restoration of a seasonal pattern in 2022 highlights the interplay between public health measures and respiratory illness dynamics in young children. Objective 20202022 2020–202 seasons Methods 1 < 201 macroregions macro regions North, North (North Northeast Southeast South Midwest. Midwest . Midwest) time Model Results preCOVID19 preCOVID pre COVID 19 pre-COVID-1 97 nonpharmacological non pharmacological March 202 95 September , 2022) 16 increase 20202021 May 4 Conclusions COVID19 COVID-1 children 2020202 2020–20 20 preCOVID1 pre-COVID- 9 COVID1 COVID- 202020 2020–2 2 pre-COVID 20202 2020–

Abstract Introduction: Positive mental health involves a mix of personal and psychosocial resources, as well as attitudes, affections, and positive behaviors that allow the person to face the challenges that arise in life, at a personal, family, social, and school level. Objective: Determine the association between personal factors and positive mental health in high school students during COVID-19. Methodology: Descriptive correlational study. Intentional non-probabilistic sampling. The sample consisted of 210 students of both sexes, ages 15 to 19, enrolled in cycle 2022-1 of the morning shift. Adolescents with visual conditions were excluded. A personal factors study and Positive Mental Health Scale were applied, with prior assent and informed consent. The statistical analysis was descriptive and inferential Results: The students were 64.8% female, 76.1% were under 17 years of age, 53.3% were in the sixth semester, 42% presented COVID-19 and 45% reported losses due to COVID-19. Global positive mental health was low in 50.5% of students. There was a significant positive statistical association in overall positive mental health with sex p=0.01, and a negative one with suffering from a mental illness p=0.01 and having family members who suffered from a mental illness p=0.05. Conclusion: Mental health of young people was not very positive. It needs to be studied to generate nursing interventions for promotion and prevention of school health to result in effective stress management of young people who are in high school when considering the family, society, and the educational field.

Abstrato Introdução: A saúde mental positiva envolve um conjunto de recursos pessoais e psicossociais, atitudes, afetos e comportamentos positivos que permitem à pessoa enfrentar os desafios que surgem na vida, a nível pessoal, familiar, social e escolar. Objetivo: Determinar a associação entre fatores pessoais e saúde mental positiva em estudantes do ensino médio em tempos de COVID-19. Metodologia: Estudo descritivo, preditivo e correlacional. Amostragem não probabilística intencional, amostra 210 estudantes de ambos os sexos, com idades entre 15 e 19 anos, matriculados no ciclo 2022-1 do turno da manhã. Foram excluídos os adolescentes com problemas visuais. Foram aplicados inquérito de fatores pessoais e Escala de Saúde Mental Positiva, com prévio assentimento e consentimento informado. A análise estatística foi descritiva e inferencial. Resultados: Os alunos eram 64,8% do sexo feminino, 76,1% tinham menos de 17 anos, 53,3% estavam no sexto semestre, 42% apresentaram COVID-19 e 45% relataram perdas por COVID-19. A saúde mental positiva global foi baixa em 50,5% dos estudantes. Houve associação estatística positiva significativa na saúde mental geral positiva com sexo p=0,01, e negativa com sofrer de doença mental p=0,01 e ter familiares que sofriam de doença mental p=0,05. Conclusão: A saúde mental positiva dos jovens foi baixa, necessita ser estudada para gerar intervenções de enfermagem na promoção e prevenção da saúde escolar para promover o enfrentamento eficaz do manejo do estresse dos jovens que estão no ensino médio quando se considera a família, a sociedade e o campo educacional.

Resumen Introducción: La salud mental positiva involucra una mezcla de recursos personales y psicosociales, actitudes, afectos y comportamientos positivos que permiten a la persona enfrentar los retos que se le presentan en la vida, a nivel personal, familiar, social y escolar. Objetivo: Determinar la asociación entre factores personales y la salud mental positiva en estudiantes de bachillerato en tiempos de COVID-19. Metodología: Estudio descriptivo correlacional. Muestreo intencional no probabilístico, en una muestra de 210 estudiantes de ambos sexos, edades de 15 a 19 años, inscritos en ciclo 2022-1 del turno matutino. Se excluyeron adolescentes con afecciones visuales. Se aplicó encuesta de factores personales y Escala de Salud Mental Positiva, previo asentimiento y consentimiento informado. El análisis estadístico fue descriptivo e inferencial. Resultados: Los estudiantes fueron 64.8 % del sexo femenino, 76.1 % eran menores de 17 años, 53.3 % cursaban sexto semestre, 42 % presentó COVID-19 y 45 % manifestó pérdidas por Covid-19. La salud mental positiva global fue baja en 50.5 % de los estudiantes. Hubo asociación estadística significativa positiva en salud mental positiva global con sexo p=0.01, y negativa con padecer alguna enfermedad mental p=0.01 y contar con familiares que padecían alguna enfermedad mental p=0.05. Conclusión: La salud mental positiva de los jóvenes fue baja, se requiere ser estudiada para generar intervenciones de enfermería en promoción y prevención de la salud escolar para favorecer un afrontamiento efectivo del manejo el estrés de los jóvenes que cursan bachillerato al considerar a la familia, la sociedad y al ámbito educativo.

Abstract Introduction: Almost 800 female deaths occur daily due to preventable causes associated with complications during or after pregnancy or childbirth, equivalent to two maternal deaths per minute. Objective: To develop a nursing care process for a pregnant woman who suffered from hyperthyroidism using diagnostic taxonomies, results and nursing interventions with a focus on Orem's theory. Methodology: Case study of a pregnant woman treated in a second level care hospital, the Orem assessment guide was used, developing the stages: assessment, diagnosis, planning, execution and evaluation, individualized care plans were designed and executed. Privacy was protected by omitting identity, respecting the rights and well-being of the participant. Results: The risk conditioning factor that compromised the health of the mother-child binomial gave way to care planning aimed at the process of ineffective motherhood and ineffective self-management of health, establishing interventions such as high-risk pregnancy care and teaching the process of illness and prescribed medications, an improvement was obtained in the patient's health status, which allowed her discharge and adequate management of the high-risk pregnancy. Conclusion: The nursing care process exposed the context in which the pregnant woman with known uncontrolled pathology is admitted, which compromised maternal-fetal well-being. Nursing education is required to promote preconception maternal health for future pregnancies.

Abstrato Introdução: Quase 800 mortes femininas ocorrem diariamente por causas evitáveis associadas a complicações durante ou após a gravidez ou o parto, o equivalente a duas mortes maternas por minuto. Objetivo: Desenvolver um processo de cuidado de enfermagem a uma gestante portadora de hipertireoidismo utilizando taxonomias diagnósticas, resultados e intervenções de enfermagem com enfoque na teoria de Orem. Metodologia: Estudo de caso de uma gestante atendida em um hospital de atenção secundária, utilizou-se o guia de avaliação de Orem, desenvolvendo as etapas: avaliação, diagnóstico, planejamento, execução e avaliação, foram desenhados e executados planos de cuidados individualizados. A privacidade foi protegida pela omissão da identidade, respeitando os direitos e o bem-estar do participante. Resultados: O fator condicionante de risco que comprometia a saúde do binômio mãe-filho deu lugar ao planejamento do cuidado voltado ao processo de maternidade ineficaz e à autogestão ineficaz da saúde, estabelecendo intervenções como o cuidado à gravidez de alto risco e ensinando o processo e medicamentos prescritos, houve uma melhora no estado de saúde da paciente, o que permitiu sua alta e o gerenciamento adequado da gravidez de alto risco. Conclusão: O processo de cuidado de enfermagem expôs o contexto em que a gestante com patologia conhecida não controlada é internada, o que compromete o bem-estar materno-fetal. A educação em enfermagem é necessária para promover a saúde materna pré-concepcional em futuras gestações.

Resumen Introducción: Casi 800 muertes de mujeres en forma diaria ocurren por causas prevenibles asociadas a complicaciones durante o después del embarazo o el parto, equivaliendo dos muertes maternas por minuto. Objetivo: Desarrollar un proceso de atención de enfermería a gestante que cursó con hipertiroidismo empleando las taxonomías diagnósticas, resultados e intervenciones de enfermería con enfoque de la teoría de Orem. Metodología: Estudio de caso a mujer gestante atendida en hospital de segundo nivel de atención, se empleó la guía de valoración de Orem desarrollando las etapas: valoración, diagnóstico, planeación, ejecución y evaluación, se diseñaron y ejecutaron planes de cuidados individualizados. Se protegió la privacidad omitiendo identidad, respetando los derechos y bienestar de la participante. Resultados: El factor condicionante de riesgo que comprometía la salud del binomio madre-hijo, dio paso a la planificación del cuidado encaminado al proceso de maternidad ineficaz y autogestión ineficaz de la salud, estableciendo intervenciones como cuidados del embarazo de alto riesgo y enseñanza del proceso de enfermedad y medicamentos prescritos, se obtuvo mejora en el estado de salud de la paciente, lo que permitió su alta y un adecuado manejo del embarazo de alto riesgo. Conclusión: El proceso de atención de enfermería expuso el contexto en el que ingresa la mujer gestante con patología conocida no controlada, lo que comprometía el bienestar materno-fetal. Se requiere educación por parte de enfermería para fomentar la salud materna preconcepcional para futuros embarazos.

Abstract Introduction Unplanned hospital returns are frequent and may be preventable. Objective To comprehend the reasons for unplanned hospital readmission and return to the Outpatient Department (OPD) and Emergency Department (ED) within 60 days after discharge following head and neck surgery (HNS) at a tertiary care center in Saudi Arabia. Methods In the present retrospective study, the medical records of all patients who underwent HNS for benign and malignant conditions between January 2015 and June 2022 were reviewed in terms of demographic data, comorbidities, and reasons for hospital return. Results Out of 1,030 cases, 119 (11.55%) returned to the hospital within 60 days after discharge, 19 of which (1.84%) were readmitted. In total, 90 (8.74%) patients returned to the OPD, and 29 (2.82%), to the ED. The common reasons for readmission included infections (26.32%) and neurological symptoms (21.05%). For OPD visits, the common causes were hematoma (20%) and neurological symptoms (14.44%). For ED returns, the frequent causes were neurological symptoms (20.69%) and equipment issues (17.24%). Compared with nonreadmitted patients, readmitted patients had a higher preoperative baseline health burden when examined using the American Society of Anesthesiologists (ASA) score (p = 0.004) and the Cumulative Illness Rating Scale (CIRS; p = 0.002). Conclusion The 60-day rates of unplanned hospital return to the OPD and ED were of 8.74% and 2.82% respectively, and 1.84% of the patients were readmitted. Hematoma, infections, and neurological symptoms were common causes. Addressing the common reasons may be beneficial to decrease postoperative hospital visits. preventable (OPD (ED 6 (HNS Arabia study 201 202 data comorbidities 1030 1 030 1,03 cases 11 11.55% 1155 55 (11.55% 184 84 (1.84% total 9 874 8 74 (8.74% 2 2.82%, 282 , 82 (2.82%) 26.32% 2632 26 32 (26.32% 21.05%. 2105 21.05% . 21 05 (21.05%) visits 20% 20 (20% 14.44%. 1444 14.44% 14 44 (14.44%) 20.69% 2069 69 (20.69% 17.24%. 1724 17.24% 17 24 (17.24%) ASA (ASA 0.004 0004 0 004 CIRS (CIRS 0.002. 0002 0.002 002 0.002) 60day day 8.74 2.82 respectively 1.84 Hematoma 103 03 1,0 11.55 115 5 (11.55 18 (1.84 87 7 (8.74 28 (2.82% 26.32 263 3 (26.32 210 21.05 (21.05% (20 144 14.44 4 (14.44% 20.69 206 (20.69 172 17.24 (17.24% 0.00 000 00 8.7 2.8 1.8 10 1, 11.5 (11.5 (1.8 (8.7 (2.82 26.3 (26.3 21.0 (21.05 (2 14.4 (14.44 20.6 (20.6 17.2 (17.24 0.0 8. 2. 1. 11. (11. (1. (8. (2.8 26. (26. 21. (21.0 ( 14. (14.4 20. (20. 17. (17.2 0. (11 (1 (8 (2. (26 (21. (14. (17. (21 (14 (17

ABSTRACT Introduction: Chronic kidney disease is a global health problem. Its most serious manifestation, chronic kidney failure, affects the Cuban context and determines the growth of patients on hemodialysis. The objective of the text is to evaluate the main results of the diagnosis and characterization of the problematic situation in a psychosocial study with patients with Chronic Renal Failure in the Hemodialysis room of the Florida municipality, of the county of Camagüey. Method: It is an experimental participatory action research, which takes place between January 2023 and December 2024, which constitutes the output of the research project System of psychosocial actions for the improvement of comprehensive care for patients with non-communicable diseases. The universe is made up of 56 patients and the sample is made up of 22, who receive purifying and conservative treatment, 22 family members and 12 service professionals. The research instrument par excellence was the participant survey. Results: The age of the patients is not definitive of an age group; men predominate; A high percentage of patients are found to have low tolerance for adherence to treatment and insufficient development of psychosocial skills and declare the need to possess knowledge to achieve health states that lead to survival. Discussion: There is no coincidence with what was found in the determination of the prevalence age groups for the disease, but specialists insist that the disease is not exclusive to a specific period of life; recognize the importance of the patient's knowledge of risk factors for prevention, promotion and health education and highlight the need for communication and empathy between health personnel and the patient, to achieve favorable results and emotional states in the face of the disease and treatment.

RESUMEN Introducción: La enfermedad renal crónica es un problema de salud a nivel mundial, su manifestación más grave, la insuficiencia renal crónica, incide en el contexto cubano y determina el crecimiento de pacientes en hemodiálisis. El objetivo del texto es valorar los principales resultados del diagnóstico y caracterización de la situación problémica en un estudio de carácter psicosocial con pacientes con Insuficiencia Renal Crónica en la sala de Hemodiálisis del municipio Florida, de la provincia de Camagüey. Método: Es una investigación-acción participativa de corte experimental, que se desarrolla entre enero 2023 y diciembre del 2024 la cual constituye salida del proyecto de investigación Sistema de acciones psicosociales para el perfeccionamiento de la atención integral a los pacientes con enfermedades no transmisibles. El universo está constituido por 56 pacientes y la muestra por 22, que reciben tratamiento depurador y conservador, 22 familiares y 12 profesionales del servicio. El instrumento de investigación por excelencia fue la encuesta a participantes. Resultados: La edad de los pacientes no es definitiva de un grupo etario; predominan los hombres; se constata un elevado por ciento de pacientes con poca tolerancia a la adherencia al tratamiento e insuficiente desarrollo de las habilidades psicosociales y declaran la necesidad de poseer conocimientos para lograr estados de salud que conlleven a la sobrevida. Discusión: No existe coincidencia con lo constatado en la determinación de los grupos etarios de prevalencia para la enfermedad, pero los especialistas insisten en que la enfermedad no es privativa de un período de vida específico; reconocen la importancia del conocimiento de los factores de riesgo por el paciente para la prevención, promoción y educación en salud y resaltan la necesidad de la comunicación y la empatía entre el personal de salud y el paciente, para lograr resultados y estados emocionales favorables ante la enfermedad y el tratamiento.

Abstract Objective: Suicide attempt (SA) is the strongest predictive variable for completed suicide. The Department of Cauca in Colombia has an SA rate higher than the national average, but the factors are unknown. The objective was to identify the profiles of SA in children and adolescents of Cauca. Methods: Cross-sectional study, which included all SA (Event-356) records from the SIVIGILA platform in children under 18 years of age between 2016 and 2019. The authors described the variables and multiple correspondence analysis (MCA) with the Burt method, according to the completeness of the data to establish the possible SA profiles using STATA 15.1, and R. The Ethics Committee at Universidad del Cauca approved it. Results: The study found 977 SA during this period, 72.4% female, 97.1% adolescent, 74.4% mestizo, 19.3% indigenous, 45.3% resided in municipalities exposed to the armed conflict, 32.3% expressed ideation and previous attempts, and 15.5% prior attempts. The MCA included 810 SA and identified three profiles: “Classic”, which had mestizo adolescents with a history of prior SA, mental illness, or psychoactive substance use problems; “Related to the armed conflict”, which included female adolescents with a first SA and residents in municipalities exposed to the armed conflict; “Ethnic” represented by male indigenous, with housing in a rural area. Conclusion: The SA profiles found in Cauca were “Classic”, “Related to the armed conflict”, and “Ethnic”; these can be considered to implement prevention strategies from a cross-cultural, mental health, and gender perspective, with the presence of the state in the territories. Objective (SA suicide average unknown Methods Crosssectional Cross sectional Event356 Event 356 (Event-356 1 201 2019 (MCA method 151 15 15.1 R it Results 97 period 724 72 4 72.4 971 97.1 adolescent 744 74 74.4 193 19 3 19.3 indigenous 453 45 45.3 conflict 323 32 32.3 attempts 155 5 15.5 81 Classic, Classic , “Classic” illness problems Related conflict” Ethnic “Ethnic area Conclusion crosscultural, crosscultural cross cultural, cultural cross-cultural health perspective territories Event35 35 (Event-35 20 15. 9 7 72. 97. 74. 19. 45. 32. 8 “Classic Event3 (Event-3 2 (Event- (Event

Resumen. En este artículo interpreto las cuatro primeras secciones de Humano, demasiado humano I para argumentar que la filosofía de Nietzsche tiene pretensiones diagnósticas y terapéuticas. En el primer apartado, se muestra que dicha filosofía es psicológica. En el segundo apartado se ilustra la psicología descriptiva de la filosofía de Nietzsche, la cual señala que las doctrinas metafísicas descansan sobre malentendidos psicológicos y que los sentimientos y representaciones considerados “superiores” se basan en motivos egoístas y errores de la razón. En el tercer apartado se defiende que la filosofía de Nietzsche también es médica e intelectualista: su indagación sobre la psicología humana le permite, primero, diagnosticar dos tipos de enfermedad, una causada por el conocimiento científico (la enfermedad existencial) y otra causada por las doctrinas metafísicas (la enfermedad nerviosa), y segundo, curar ambos tipos de enfermedades al eliminar, con el mismo conocimiento científico, sus causas.

Abstract. In this paper, I interpret the first four sections of Human, All Too Human I to argue that Nietzsche’s philosophy has diagnostic and therapeutic ambitions. In the first section, I show that his philosophy is psychological. In the second section, I illustrate the descriptive psychology of Nietzsche’s philosophy, for which metaphysical doctrines rest on psychological misunderstandings and highly valued sensations and conceptions are based on selfish motives and mistakes of reason. In the third section, I argue that Nietzsche’s philosophy is also medical and intellectualist: his inquiry into human psychology allows him, first, to diagnose two types of illnesses, one caused by scientific knowledge (existential illness) and the other caused by metaphysical doctrines (nervous illness), and second, to cure both types of diseases by eliminating their causes with this same scientific knowledge.

BACKGROUND: Maintaining or promoting employment in the presence of disability or reducing the impact of disability on employability should be the adopted focus to decrease the negative impact that disability has on the economy and just as important on the livelihood and well-being of exposed insured individuals. Group risk disability insurance protects an employee's income when illness or injury result in work disability. To achieve this, factors that promote the success of rehabilitation and support for return-to-work of employees following illness and injury need to be understood from an insurance perspective. OBJECTIVES: To explore principles of disability claims management during the rehabilitation and work reintegration stage using a multi-stakeholder approach for the purpose of successful return to work. METHODS: An exploratory qualitative design was used to collect data via semi-structured interviews with 26 purposively selected participants. Interviews were audio-recorded, data were transcribed and analysed thematically. Qualitative research was used to understand the necessary role players in the work reintegration process, factors that hinder and promote work reintegration and best practice principles for Disability Claims Management (DCM). RESULTS: Three themes emerged from the study; (i) role players and their functions with collaboration is integral to disability claims management, (ii) various factors promote and restrict return-to-work planning, and (iii) best practice principles in the DCM pathway that promote return-to-work. These principles include behavioural economics as the central principle, with resource identification and competency, governance, role engagement and education and awareness as supporting principles. CONCLUSION: Collaborative and integrated approaches by role players within a workers' family unit, health system, employer structure and insurance compensation are required for positive return-to-work outcomes. The various role players are responsible for creating policies, structures, intervention strategies, and environments that foster return-to-work. IMPLICATIONS FOR PRACTICE • An integrated approach is required for optimal RTW outcomes as employers' policies restrict work integration. • A collaborative approach by all role players involved in DCM, focusing on positive RTW outcomes is required in the RTW process • Occupational therapists can influence employer incapacity and disability policies in order to keep people employed and productive in the presence of medical conditions with the application of reasonable accommodations where necessary. • Occupational therapists are suitably positioned to outline workplace environment and other supports required to guide and support employees through rehabilitation and RTW and in ensuring that employees who can remain at work while on a partial or fully insured benefit, can engage optimally in aspects of work function.

Cognitive behavioural therapy (CBT) is a well-researched and evidence-based psychotherapy that is underutilised in Africa. CBT presents opportunities for occupational therapists to expand their practice, for example by promoting engagement in meaningful and purposeful activity (behavioural activation), engaging with a mental health care user's thoughts during and after participation in activity (cognitive restructuring), and grading exposure to traumatic activities (exposure therapy). However, it is also critical that occupational therapists using CBT techniques culturally adapt these for their practice context and engage in professional development activities to develop their competencies as CBT practitioners. This commentary highlights recent advances in CBT practice and calls for CBT and associated techniques to be made more accessible to mental health care users in Africa. IMPLICATIONS FOR PRACTICE • The relationship between participation and mental health is gaining prominence within the field of CBT. Occupational therapists should position themselves as experts in the therapeutic use of activity. • Occupational therapists using CBT techniques should culturally adapt their practice to meet the mental health needs of people living in Africa. • Occupational therapists using CBT techniques should follow internationally recognised pathways to CBT professional development, and register as Affiliated Members of the Cognitive Behavioural Therapy Association of South Africa

ABSTRACT Anxiety refers to a disproportionate fear or worry about the stimulus that generates it. It is a condition that affects people's quality of life and is highly prevalent in the population. This research focused on determining the frequency of anxiety in a sample of the adult population in Paraguay, in the year 2023. The study design was quantitative, descriptive, cross-sectional, applied to 225 people, between the months of March to June 2023, through non-probabilistic convenience sampling, where a digital questionnaire with sociodemographic variables and the GAD-7 anxiety instrument was used. The main results were: average age of the participants 24 years ± 9; 55.1% come from Asunción, 32.9% Central and 12% from the interior of the country; 52.4% were women. 25.8% suffer from chronic diseases and 17.8% from mental illness. Regarding general levels, 76% scored in some form of anxiety and 40% in suspected General Anxiety Disorder. A significant association was found between having children, having a job and income and suspicion of general anxiety disorder. It is concluded that anxiety is highly present in the investigated population, and is related to sociodemographic factors.

RESUMEN La ansiedad hace referencia a un temor o preocupación desproporcionados ante el estímulo que lo genera, es una condición que afecta la calidad de vida de las personas y es altamente prevalente en la población. Esta investigación se centró en determinar la frecuencia de la ansiedad en una muestra de la población adulta en Paraguay, en el año 2023. El diseño del estudio fue cuantitativo, descriptivo, de corte transversal, aplicado a 225 personas, entre los meses de marzo a junio del año 2023, mediante un muestreo no probabilístico por conveniencia, donde se utilizó un cuestionario digital con variables sociodemográficas y el instrumento GAD-7 de ansiedad. Los resultados principales fueron: edad promedio de los participantes 24 años ± 9; el 55.1% provienen de Asunción, 32.9% Central y 12% para el interior del país; 52.4% fueron mujeres. 25.8% padece enfermedades crónicas y 17.8% refirió padecer enfermedad mental. En cuanto a los niveles generales, el 76% puntuó en alguna forma de ansiedad y 40% en sospecha de trastorno de Ansiedad General. Se encontró asociación significativa entre tener hijos, contar con trabajo, los ingresos económicos y la sospecha de trastorno de ansiedad general. Se concluye que la ansiedad se encuentra altamente presente en la población investigada, y se relaciona con factores sociodemográficos.

Resumo Política do orgulho gay na Argentina surgiu nas décadas de 1960 e 1970 no contexto das tensões entre os discursos médico e criminológico sobre a homossexualidade, que propunham, respectivamente, que a homossexualidade era uma imoralidade que deveria ser punida criminalmente ou uma doença que poderia ser tratada. Conclui-se que diante do aumento da violência policial, as bichas, homossexuais e transexuais se apropriam taticamente do discurso médico, identificando-se como doentes e aliando-se aos médicos em suas tentativas de descriminalizar a inversão sexual. Depois, no contexto do clima de modernização cultural, eles usarão as pretensões de objetividade científica da medicina para exigir a despatologização da homossexualidade, abandonando o discurso da vitimização, narrando suas experiências como alegres e questionando suas bases a partir da categoria do orgulho. Se baseia na análise historiográfica de um extenso corpus de imprensa de massa, material político-organizacional, tratados médicos e documentos em primeira pessoa.

Resumen Los orígenes de la política del orgullo gay en Argentina pueden rastrearse en las décadas de 1960 y 1970. En este periodo, mientras la criminología sostenía que la homosexualidad era un delito que debía ser castigado penalmente, la medicina afirmaba que era una enfermedad a tratar. Frente al aumento de la violencia policial, “maricas”, homosexuales y transexuales se apropiaron tácticamente del discurso médico y se identificaron como enfermos/as en sus intentos por descriminalizar la inversión sexual. Luego, en el marco del clima de modernización cultural, usaron las pretensiones de objetividad científica de la medicina para exigir la despatologización. En ese momento, abandonaron el discurso de la victimización, comenzaron a narrar sus experiencias como gozosas y a interpelar a sus bases desde la categoría del “orgullo”. La investigación se basó en el análisis historiográfico de un extenso corpus de prensa, material político-organizacional, tratados médicos y penitenciarios y documentos en primera persona.

Abstract The emergence of gay pride politics in Argentina takes places in the 1960s and 1970s in the context of the tensions between medical and criminological discourses on homosexuality, which respectively proposed that homosexuality was an immorality that should be criminally punished or an illness that could be treated. The conclusion is that, faced with an increase in police violence, maricas, gay men and transgender people tactically appropriated medical discourses, identifying themselves as sick and allying with medical doctors in their attempts to decriminalize sexual inversion. Then, in the context of the climate of cultural modernization, they would use the pretensions of scientific objectivity of medicine to demand the de-pathologization of homosexuality, abandoning the discourse of victimization, narrating their experiences as joyful, and mobilizing their base through the category of pride. The paper is based on the historiographic analysis of an extensive corpus of mass-circulation press, political organizations' material, medical treatises and first-person documents.

Resumo O corpus é composto por uma compilação de histórias sobre a experiência de ser homossexual e conviver com o vírus da imunodeficiência humana (HIV), composta por uma série de entrevistas em profundidade, registros etnográficos situados e conversas informais realizadas durante o ano de 2022 com um homem homossexual que vive com HIV em Puebla, México —e que se chama Patricio—. São analisadas algumas das intersecções semiótico-materiais através das quais se configuram as suas experiências e são destacadas certas figuras imaginárias, os afetos em que se enquadram os seus modos de interação, alguns percursos do seu quotidiano e as suas possibilidades de contenção face às práticas discriminatórias. e cenários estigmatizantes. Em três momentos, são expostas algumas das formas como, entre as formas de corporificação de uma doença e as formas de corporificação da homossexualidade, essas dimensões parecem ser sustentadas pela marca cultural –sempre histórica, sempre política– da vergonha e orgulho.

Resumen El corpus se constituye con un compilado de relatos sobre la experiencia de ser homosexual y vivir con el virus de inmunodeficiencia humana (VIH) conformado a partir de una serie de entrevistas a profundidad, registros etnográficos situados y conversaciones informales realizadas en el transcurso del año de 2022 a un hombre homosexual que vive con VIH en Puebla, México —y a quien se nombra Patricio—. Se analizan algunos de los cruces semiótico-materiales mediante los cuales se configuran sus vivencias y se destacan ciertas figuras imaginarias, los afectos en que se enmarcan sus modos de interacción, algunas travesías de su vida cotidiana y sus posibilidades de contención frente a prácticas discriminatorias y escenarios estigmatizantes. En tres momentos, se exponen algunos de los modos en que, entre las formas de encarnar una enfermedad y los modos en que se corporeiza la homosexualidad, estas dimensiones parecen sostenerse en la marca cultural —siempre histórica, siempre política— de la vergüenza y el orgullo.

Abstract The corpus is made up of a compilation of stories about the experience of being homosexual and living with the human immunodeficiency virus (HIV) made up of a series of in-depth interviews, situated ethnographic records and informal conversations carried out during the year 2022 with a man homosexual who lives with HIV in Puebla, Mexico — and who is named Patricio—. Some of the semiotic-material intersections through which his experiences are configured are analyzed. In addition, certain imaginary figures are highlighted, the affects in which his modes of interaction are framed, some journeys of his daily life and his possibilities of containment in the face of discriminatory practices and stigmatizing scenarios. In three moments, some of the ways in which, between the ways of embodying an illness and the ways in which homosexuality is embodied, are exposed, these dimensions seem to be sustained by the cultural mark —always historical, always political— of shame and pride.

ABSTRACT Introduction: The specialty of Occupational Medicine studies the impact of work conditions on employees' health, promoting health and ensuring safety and health protection in the workplace. Conditional fitness reports are crucial for assessing healthcare professionals' ability to perform their work activities under specific conditions. This study aims to characterize employees with conditional fitness results in a population of hospital workers. Methods: This retrospective descriptive observational study considers conditional fitness reports issued from January 2022 to October 2023. The analysis includes the type of exams, average age of professionals, professional category, length of service, analysis by type of service, and analysis by disease groups. Results and Discussion: During the mentioned time frame, a total of 2172 Occupational Medicine health exams were conducted, with a total of 354 fitness records issued with Conditioned Fitness results, representing 15% of the health exams conducted. Among these, 50% of professionals with disabilities are above the median age of 50 years. The most representative type of exam was the one requested for return to work after illness or temporary incapacity for work exceeding 30 days. The group with the highest representation was operational assistants. The major disease group follows the same pattern as in other hospital units, with 78% of conditioned fitness related to musculoskeletal injuries. Conclusion: Occupational Medicine plays a crucial role in promoting the health and well-being of employees, preventing absenteeism, and addressing work-related illnesses such as musculoskeletal, psychiatric, respiratory, among others. This study enables Occupational Health Service members to understand the workers with conditional fitness in terms of services, professional classes and ages. This information is essential for supporting management, identifying new occupational risk factors or deficiencies in their management, as well as concentration in the same service or age groups of professionals with work-aggravated illness or non-work-related illness requiring workplace adaptation and potentially causing additional pressure on services and other employees. Investment in this area not only protects workers' health but also strengthens institutions, reducing absenteeism costs and promoting a healthy work environment.

RESUMO Introdução: A especialidade de Medicina do Trabalho estuda o impacto das condições laborais na saúde dos colaboradores, realizando a promoção da saúde e garantindo a proteção da segurança e da saúde no trabalho. As fichas de aptidão condicionadas são cruciais para avaliar a capacidade dos profissionais de saúde para realizar as suas atividades laborais em condições específicas. Este estudo pretende caracterizar os funcionários com resultados de aptidão condicionada, numa população de trabalhadores hospitalares. Métodos: Este estudo observacional descritivo retrospetivo considera as fichas de aptidão com resultado de aptidão condicionada emitidas de janeiro de 2022 a outubro de 2023. A análise inclui a tipologia de exames, a idade média dos profissionais, a categoria profissional, o tempo de serviço, a análise por tipo de serviço e a análise por grupos de doenças. Resultados e discussão: No intervalo de tempo mencionado foram realizados 2172 exames de saúde de Medicina do Trabalho, sendo emitidas 354 fichas de aptidão com resultado de Aptidão Condicionada, representando estas 15,3% dos exames de saúde realizados. Destes, 50% dos profissionais com incapacidades têm idade superior ao valor da mediana de 50 anos. O tipo de exame mais representativo foi por regresso ao trabalho após doença ou incapacidade temporária para o trabalho com período superior a 30 dias. O grupo com maior representatividade foram os assistentes operacionais. O grande subtipo de doenças tem o mesmo padrão representado nas outras unidades hospitalares, com 78% das aptidões condicionadas a serem relacionadas com lesões musculosqueléticas. Conclusão: A Medicina do Trabalho desempenha um papel crucial na promoção da saúde e bem-estar dos colaboradores, prevenindo o absentismo e abordando doenças relacionadas com o ambiente laboral, como as musculoesqueléticas, psiquiátricas, respiratórias, entre outras. O presente estudo permite aos elementos do Serviço de Saúde Ocupacional perceber em que serviços, classes profissionais e idades se concentram os trabalhadores com aptidão condicionada. Esta informação é fundamental para prestar um apoio à gestão, identificar novos fatores de risco ocupacional ou insuficiências na sua gestão, assim como concentração no mesmo serviço ou grupos etários de profissionais com doença agravada pelo trabalho ou doença não relacionada com o trabalho que necessite de adaptação do posto de trabalho e que cause eventual pressão adicional sobre os serviços e outros colaboradores. O investimento nessa área não só protege a saúde dos trabalhadores, como também fortalece as instituições, reduzindo custos associados ao absentismo e promovendo um ambiente de trabalho saudável.

Abstract: Objective: To evaluate the implementation effect of serious illness medical insurance in Guang Xi Zhuang Autonomous Region of western China. Study design: Through the collection of 2017-2021 Guang Xi serious illness medical insurance specific policy making such as fund usage, serious illness compensation, medical expenses data, and data analysis of a serious illness medical insurance effect. Method: Literature research, Policy text analysis, quantitative data collection method, using Excel and SPSS 19.0 data descriptive statistical analysis and comparative analysis. Results: Serious illness medical insurance has had some effect, e.g., from 2017 to 2021, the utilization rate of serious illness medical insurance fund in Guang Xi was 109.49% and 103.87% respectively, the fund balance rate was -9.45% and -8.54% respectively, and the accumulated balance was -2.3871 million CNY and -70.7955 million CNY. Conclusion: The serious illness medical insurance has reduced the burden of large medical expenses of patients to a certain extent, but the fund is under too much pressure, and there is a payment deficit. The coverage and security of serious illness medical insurance need to be expanded and strengthened, and the cooperation mechanism with commercial insurance institutions should be gradually explored to improve the serious illness medical insurance.

Resumo: Objetivo: Avaliar o efeito da implementação de seguro médico para doenças graves na Região Autônoma de Guang Xi Zhuang da China Ocidental. Desenho do Estudo: Através da coleta de políticas específicas de seguro médico para doenças graves de Guang Xi 2017-2021, uso de fundos, compensação por doenças graves, dados de despesas médicas e análise de dados de um efeito de seguro médico para doenças graves. Método: Pesquisa na literatura, análise do texto da política, método de coleta de dados quantitativos usando Excel e SPSS 19.0, análise estatística descritiva de dados e análise comparativa. Resultados: Seguro médico de doenças graves teve um certo efeito. Em 2017 e 2021, a taxa de utilização do fundo de seguro médico para doenças graves em Guang Xi foi 109,49% e 103,87% respectivamente, a taxa de saldo do fundo foi -9,45% e -8,54% respectivamente e o saldo acumulado foi -2,3871 milhões de yuans e -70,7955 milhões de yuans. Conclusão: O seguro médico para doenças graves reduziu o ônus de grandes despesas médicas dos pacientes até certo ponto mas o fundo está sob demasiada pressão e há um déficit de pagamentos. A cobertura e segurança do seguro médico de doenças graves necessitam ser expandidas e fortalecidas, e o mecanismo de cooperação com instituições de seguros comerciais deve ser gradualmente explorado para melhorar o seguro médico para doenças graves.

Resumen: Objetivo: evaluar el efecto de la implementación de seguros médicos para enfermedades graves en la Región Autónoma Guang Xi Zhuang, al oeste de China. Diseño del estudio: a través de la recopilación de pólizas de seguro médico específicas para enfermedades graves de la región de Guang Xi entre 2017-2021, como por ejemplo: uso de fondos, compensación por enfermedades graves, datos de gastos médicos y análisis de datos del efecto de seguros médicos para enfermedades graves. Método: investigación de literatura, análisis de textos de políticas públicas, metodología de recolección de datos cuantitativos utilizando Excel y SPSS 19.0, análisis estadístico descriptivo de datos y análisis comparativo. Resultados: el seguro médico para enfermedades graves ha demostrado tener efectos, tales como: entre 2017 y 2021, la tasa de utilización de fondos de seguros médicos para enfermedades graves en Guang Xi fue de 109,49 % y 103,87 % respectivamente, las tasas de saldo del fondo fue de -9,45 % y -8,54 % respectivamente y el saldo acumulado fue de -2,3871 millones de CNY y -70,7955 millones de CNY. Conclusión: El seguro médico para enfermedades graves ha reducido en cierta medida la carga de los grandes gastos médicos de los pacientes, pero al existir un déficit de pagos está bajo demasiada presión. Por ello, es necesario ampliar y fortalecer la cobertura y seguridad del seguro médico para enfermedades graves, y explorar gradualmente mecanismos de cooperación con instituciones de seguros comerciales.

ABSTRACT Studies on therapeutic itineraries reveal models of care and decisions taken by people in situations of illness and can contribute to the planning of effective health policies and services, especially in emergencies such as the COVID-19 pandemic. The aim of this research was to describe the itineraries of patients hospitalized for COVID-19 in a public hospital in the Federal District and explore associations with social determinants of health. This is an integrated case study, with triangulation of quantitative and qualitative evidence obtained from the analysis of raw data from a cross-sectional observational study with 233 adults hospitalized between May/2020 and December/2021. The majority were men, elderly, black or brown, with low income and education levels and multiple comorbidities, who sought care in specialized care and obtained quick access to the health system. The factors that influenced the choice of the first service sought were: occupation, region of residence, economic class and education. The determinants of ease of access were: type of service first sought, severity of the case and socioeconomic context. The results confirm the influence of social determinants on illness experiences and can support reflections related to the organization of access to the SUS in health emergencies.

RESUMO Os estudos sobre itinerários terapêuticos revelam modelos de cuidado e decisões tomadas pelas pessoas em situações de adoecimento e podem contribuir para o planejamento de políticas e serviços de saúde mais efetivos, especialmente em emergências como a pandemia de covid-19. O objetivo desta pesquisa foi descrever os itinerários terapêuticos de pacientes hospitalizados por covid-19 em um hospital público do Distrito Federal e explorar associações com determinantes sociais da saúde. Trata-se de um estudo de caso integrado, com triangulação de evidências quantitativas e qualitativas obtidas a partir da análise do banco de dados de um estudo observacional transversal com 233 adultos internados entre maio/2020 e dezembro/2021. A maioria homens, idosos, pretos ou pardos, com baixo nível de renda e escolaridade e múltiplas comorbidades, que procuraram atendimento na atenção especializada e conseguiram acesso rápido ao sistema de saúde. Os fatores que influenciaram a escolha do primeiro serviço foram: ocupação, região de moradia, classe econômica e escolaridade. Já os determinantes da facilidade de acesso foram: tipo de serviço buscado primeiro, gravidade do caso e contexto socioeconômico. Os resultados confirmam a influência de determinantes sociais nas experiências de adoecimento e podem subsidiar reflexões relacionadas à organização do acesso ao SUS em emergências sanitárias.