ABSTRACT Eighty percent of depressed patients in Primary Health Care (PHC) have a comorbidity. It is essential to contribute local evidence on the characteristics of patients with physical and psychiatric comorbidities to better address clinical practice. Aim: To characterize depressed patients from the cardiovascular program (PCV) of eight family health centers (CESFAM) in two communes of the Metropolitan Region. Material and methods: Secondary analysis of data from a cluster-randomized clinical trial recruiting 359 program enrollees aged 18 years or older with a Patient Health Questionnaire 9-item (PHQ-9) score greater than or equal to 15. The inclusion criteria for participants were to be 18 years of age or older, to have a score on the Patient Health Questionnaire 9-item (PHQ-9) greater than or equal to 15, and to be enrolled in the cardiovascular program of the respective health center. Results: These are mainly women users of the cardiovascular program with depressive symptoms of moderate to severe intensity with a previous depressive history (60.39%), previously treated in a (75.69%). Only 17.7% were using antidepressant drugs at the time of the interview.97.1% of the interviewees were using drugs for hypertension and/or diabetes. Conclusions: These are people with depressive episode, hypertension and/or diabetes who, having a personal and family history of depression, are not receiving pharmacological treatment for depression, which probably affects their quality of life. Better adherence to clinical guidelines for the treatment of depression is required.

RESUMEN El 80% de pacientes deprimidos en Atención Primaria de Salud (APS) tienen una comorbilidad. Es fundamental contribuir con evidencia local sobre las características de pacientes con comorbilidades físicas y psiquiátricas para abordar de mejor manera la práctica clínica. Objetivo: Caracterizar a pacientes deprimidos del programa cardiovascular (PCV) de ocho centros de salud familiar (CESFAM) en dos comunas de la Región Metropolitana. Material y métodos: Análisis secundario de datos de un ensayo clínico aleatorio por clústeres en el que se reclutaron 359 personas inscritas en el programa, de 18 años o más con un puntaje en el Patient Health Questionnaire 9-item (PHQ-9) mayor o igual a 15. Los criterios de inclusión para los participantes eran tener 18 o más años, tener un puntaje en el Patient Health Questionnaire 9-item (PHQ-9) mayor o igual a 15 y estar inscrito en el programa cardiovascular del centro de salud respectivo. Resultados: Se trata principalmente de mujeres usuarias del PCV con Hipertensión Arterial (HTA) y/o Diabetes tipo 2, con sintomatología depresiva de intensidad moderada a severa con antecedentes depresivos previos (60,39%), previamente tratadas en un (75,69%). Sólo el 17,7% estaba consumiendo fármacos antidepresivos al momento de la entrevista. 97,1% de las personas entrevistadas consumían fármacos para la hipertensión y/o diabetes. Conclusiones: Se trata de personas con episodio depresivo, HTA y/o diabetes tipo 2 que, teniendo antecedentes personales y familiares de depresión, no están recibiendo tratamiento farmacológico para la depresión lo que probablemente afecta su calidad de vida. Se requiere un mejor cumplimiento de las guías clínicas para el tratamiento de la depresión en este grupo de la población.

ABSTRACT There are different decision levels with distinct decision makers in a decentralized Supply Chain, for example, shippers and carriers. Nevertheless, most studies are conducted considering only one decision-making level. The carrier is the decision-making agent in Dynamic Vehicle Allocation (DVA) problem and allocates vehicles to maximize its profit, usually delaying shipping. It is necessary to respect the partnership principle. This paper presents the DVA problem using bi-level programming. The shipper’s objective is to minimize shipping delays, while the carrier’s objective is to maximize profits. The exact algorithm is used to solve the Bi-level DVA problem. The results show potential applications in logistics, decreasing both transportation delays and costs when synchronizing carrier’s and shippers’ decisions. Chain example carriers Nevertheless decisionmaking making level (DVA profit principle bilevel bi programming shipper s profits Bilevel Bi logistics decisions

Abstract The Brazilian Society of Angiology and Vascular Surgery has set up a committee to provide new evidence-based recommendations for patient care associated with chronic venous insufficiency. Topics were divided in five groups: 1. Classification, 2. Diagnosis, 3. Conservative or non-invasive treatment, 4. Invasive treatment and 5. Treatment of small vessels. This last series is closely related to the activities of Brazilian angiologists and vascular surgeons, who are heavily involved in the treatment of small superficial veins. These guidelines are intended to assist in clinical decision-making for attending physicians and health managers. The decision to follow a guideline recommendation should be made by the responsible physician on a case-by-case basis taking into account the patient's specific condition, as well as local resources, regulations, laws, and clinical practice recommendations. evidencebased evidence based insufficiency groups 1 Classification 2 Diagnosis 3 noninvasive non invasive 4 5 vessels surgeons veins decisionmaking making managers casebycase case patients s condition resources regulations laws

Resumo A Sociedade Brasileira de Angiologia e de Cirurgia Vascular organizou uma comissão para fornecer novas recomendações baseadas em evidências sobre questões críticas de atendimento ao paciente com insuficiência venosa crônica. São abordados aqui os temas de classificação, diagnóstico, tratamento conservador, tratamento invasivo e tratamento de pequenos vasos. Esta última série está muito relacionada à atividade de angiologistas e cirurgiões vasculares, que possuem forte atuação no tratamento de pequenas veias superficiais. Estas diretrizes destinam-se a auxiliar na tomada de decisões clínicas de médicos assistentes e gestores de saúde. A decisão de seguir uma recomendação de diretriz deve ser feita pelo médico responsável caso a caso, levando em consideração a condição específica do paciente, bem como recursos locais, regulamentos, leis e recomendações de prática clínica. crônica classificação diagnóstico conservador vasos vasculares superficiais destinamse destinam se saúde locais regulamentos clínica

Abstract Understanding the influence of fine-scale abiotic filters on plant communities can provide important insights into floristic patterns of the Brazilian Cerrado. We aimed to evaluate the interactions of the soil and the plant community composition with their distribution in different sandy environments of Brazilian Cerrado, the Jalapão region. Eight environments were sampled, each with ten plots of 20 × 50 m. All woody individuals presenting circumference at soil height ≥ 10 cm were sampled. Subplots of 5 × 15 m were demarcated, where woody individuals with a circumference at soil height ≥ 5 and < 10 cm were sampled. Subplots of 2 × 2 m were also demarcated to sample herbaceous individuals. Soil samples varying from 0 to 20 cm of depth were collected for each plot (20 × 50 m). Overall, 20000 individuals that belong to 338 species and 76 families were sampled. The dominant family was Fabaceae. There were significant differences among the environments regarding species richness and soil. The analyzed soils are extremely poor and with a tendency to sandy texture, small chemical and/or physical variations imply differences in the distribution of vegetation. Our study revealed abiotic filters exerted crucial fine-scale effects on plant community in the Jalapão region. finescale fine scale Cerrado region sampled 1 (2 . m) Overall 2000 33 7 Fabaceae texture andor or vegetation ( 200 3

Resumo A ocorrência de anticorpos anti-Toxoplasma gondii e anti-Neospora caninum já foram descritos em cães de praticamente todos os estados brasileiros, entretanto, no estado do Amazonas, há poucos estudos sobre esses coccídios. Neste estudo, a ocorrência de cães domiciliados de Manaus, reagentes a T. gondii e N. caninum, e os fatores de risco para a infecção foram avaliados. Amostras de sangue de 154 cães foram obtidas, e um questionário foi aplicado aos tutores com informações sobre os animais. As amostras foram analisadas quanto à presença de anticorpos anti-T. gondii e N. caninum, pela reação de imunofluorescência indireta, ponto de corte 16 e 50, respectivamente. Associações entre as variáveis estudadas e a presença de anticorpos contra os coccídios foram feitas pelo teste de qui-quadrado, exato de Fisher ou G (p<0,05). Das 154 amostras, 19 (12,3%; IC 95% = 7,1% - 17,5%) foram reagentes a T. gondii, e a associação (p <0,05) foi observada entre a presença de anticorpos e contato com outros cães. A ocorrência de cães reagentes a N. caninum foi de 1,9% (IC 95% = 0,4% - 5,6%) com 3 dos 154 cães positivos. Nenhuma associação (p>0,05) foi observada entre a presença de anticorpos anti-N. caninum e as variáveis estudadas.

Abstract The presence of antibodies anti-Toxoplasma gondii and Neospora caninum have been described in dogs from virtually all Brazilian states, however in the state of Amazonas, there are few studies on these coccidia. In this study the occurrence of antibodies against T. gondii and N. caninum and risk factors were determined in domiciliated dogs of Manaus, AM. Blood samples were collected from 154 dogs and, during the harvest, a questionnaire was applied with questions related to the animals. The samples were analyzed, for the presence of anti-T. gondii and N. caninum antibodies, by indirect fluorescence antibody test, with cutoff of 16 and 50, respectively. Associations between the variables studied and the presence of antibodies were made by chi-square test, fisher's exact test or G test (p<0.05). Of the 154 samples, 19 (12.3% 95% CI = 7.1% - 17.5%) were reagents to T. gondii, and association (p <0.05) was observed between the presence of antibodies and contact with other dogs. The occurrence of dogs reactive to N. caninum was 1.9% (95% CI = 0.4% - 5.6%) with 3 of the 154 dogs positives, and no association (p>0.05) was observed between the presence of N. caninum antibodies, and the variables studied.

ABSTRACT This paper presents a robust deterministic method for the treatment of uncertainty in decision-making systems based on Sonar Method. It introduces uncertainty into mathematical models as interval numbers. This work proposes an interactive approach that identifies the efficient vertices of the Multiobjective Linear Programming (MOLP), where some or all the coefficients of the objective functions, constraints or limits of the constraints are interval of real numbers. The method identifies robust solutions to MOLP under uncertainty, showing how the interactive approach presented in this paper can provide the possibility of exploring in new decision support methodologies.

Abstract Objectives: To describe the hereditary angioedema to improve awareness of this condition and reduce diagnostic delay. Data sources: Relevant articles in the MEDLINE database through PubMed. Data synthesis: Hereditary angioedema is rare and has an autosomal dominant pattern of inheritance. Its onset occurs mainly in childhood, but there is an important delay in the diagnosis. In the most frequent phenotype, there is a quantitative and/or functional deficiency in the C1esterase inhibitor protein, which regulates the activation of the complement, contact and fibrinolysis systems with greater formation of bradykinin, the main mediator of angioedema. There is a third type, the hereditary angioedema with a normal C1 inhibitor level, which is rare in children. Clinical manifestations are characterized by recurrent angioedema attacks, mainly in the extremities, abdomen and upper airways, which can progress to asphyxia and death. The main triggers are mechanical trauma, infections and stress. The diagnosis is attained by patient clinical picture and decreased serum levels of C4 and C1esterase inhibitor or its function. In hereditary angioedema with a normal C1 inhibitor, there is no change in these parameters, thus requiring a genetic study. Treatment is based on the use of attack medications and long and short-term prophylaxis. Conclusions: Hereditary angioedema is little known by pediatricians due to the significant delay in diagnosis of this condition, whose onset usually begins in childhood. The presence of recurrent angioedema that does not respond to treatment with antihistamines, corticosteroids and adrenaline should increase the diagnostic suspicion.

ABSTRACT The present research evaluated the seroprevalence of anti-zika virus (anti-ZIKV) antibodies by virus neutralization test (VNT) in 529 bovines from Andradina city, São Paulo state, Brazil. The reading was performed in an inverted optical microscope, considering reagents when the antibodies were capable to neutralize the ZIKV. Of the 529 samples, 53 (10.01%) were reagents. The animals were healthy at the time of collection. The samples were collected in February 2018, a favorable period for the multiplication of the vector and the highest risk of disease transmission. None of the animals showed anti-bovine viral diarrhea virus (anti-BVDV) antibodies, ruling out a possible cross-reaction, reinforcing the possible contact of the bovine with the ZIKV. In the herd, 88 pregnant females were evaluated; of these, 12 cows were reactive, with no history of reproductive problems or fetal malformations. This is the first research on the seroprevalence of ZIKV in cattle in Brazil, and studies should continue to evaluate cattle as a possible host of this arbovirus and its possible consequences for unique health and agribusiness.

ABSTRACT Objective: To reveal the lived experience of people who perform the double role of caring for a dependent elderly relative and working remuneratively. Methodology: qualitative phenomenological research of 14 people who participated in a family worker-caregiver support program, and were caregivers of a dependent elderly person, from whom the experience was collected through a semi-structured interview. It was interviewed until a saturation of meanings was reached. The analysis was performed through the method proposed by Streubert. Results: the phenomenon was revealed in the comprehensive multiplicity of roles category composed of the subcategories distress/burden and guilt. Conclusions: it is urgent to make visible the consequences of the multiplicity of roles and develop public policies for their reconciliation.

RESUMEN Objetivo: Develar la experiencia vivida de personas que realizan el doble rol de cuidar a un familiar mayor dependiente y trabajar remuneradamente. Metodología: investigación cualitativa fenomenológica. Participaron 14 personas que asistieron a un programa de apoyo al trabajador-cuidador familiar, y que eran cuidadores de una persona mayor dependiente, de quienes se recogió la experiencia a través de una entrevista semiestructurada. Se entrevistó hasta alcanzar la saturación de significados. El análisis se realizó a través del método propuesto por Streubert. Resultados: el fenómeno se develó en la categoría comprensiva multiplicidad de roles compuesta por las subcategorías angustia/agobio y culpa. Conclusiones: resulta urgente visibilizar las consecuencias de la multiplicidad de roles y desarrollar políticas públicas para la conciliación de ellos.

RESUMO O artigo apresenta a análise do processo de aplicação de uma Matriz de Indicadores para a avaliação de políticas públicas de Educação Ambiental nas escolas. Para isso, o estudo se fundamenta no ciclo de políticas (BALL; BOWE, 1992) e na teoria da atuação (BALL; MAGUIRE; BRAUN, 2016). Argumenta-se que a abordagem conceitual do ciclo de políticas e a teoria da atuação deram significado ao instrumento de avaliação construído pelos e para os atores do contexto da prática. Assim também auxiliaram na compreensão das interrelações entre as dimensões contextuais da teoria da atuação e a Matriz de Indicadores de Educação Ambiental construída por diversos sujeitos da política. A interpretação e a análise dos dados gerados a partir da aplicação da Matriz de Indicadores em contextos escolares, com a participação das professoras, apontam que as dimensões que a estruturam tomam sentido quando integradas entre si e relacionadas a contextos apropriadamente situados. Assim, o instrumento demonstra sua relevância, em especial para a etapa de avaliação no ciclo de políticas.

ABSTRACT The article presents the analysis of the application process as an array of indicators for the evaluation of public policies of Environmental Education in schools. In order to do so, the study is based on the policy cycle (BALL; BOWE, 1992) and in the theory of police enactment (BALL; MAGUIRE; BRAUN, 2016). It is argued that the conceptual approach of the policy cycle and the theory of action gave meaning to the evaluation instrument constructed by and for the actors of the context of practice, as well as, helped in understanding the interrelations between the contextual dimensions of the theory of action and the dimensions that make up the Matrix of Indicators of Environmental Education constructed by several subjects of politics. The interpretation and analysis of the data generated from the application of the Matrix of Indicators in school contexts with the participation of teachers points out that the dimensions that structure it take meaning when integrated with each other and related to situated contexts. Thus, the instrument demonstrates its relevance, especially for the evaluation stage in the policy cycle.

RESUMO As crises de angioedema são causas comuns de atendimentos nas emergências, e devido ao potencial de gravidade, é importante que os profissionais que atuam nesses serviços conheçam suas causas e abordagem. Os mecanismos envolvidos no angioedema sem urticas podem ser histaminérgicos ou mediados por bradicinina. As causas mais comuns de angioedema mediado por histamina são alimentos, medicamentos, ferroada de insetos e idiopática. Quando o mediador é a bradicinina, os desencadeantes são os inibidores da enzima conversora de angiotensina e fatores relacionados ao angioedema adquirido com deficiência do inibidor de C1 ou angioedema hereditário que são menos comuns, mas muito importantes pela possibilidade de desfecho fatal. O angioedema hereditário é uma doença rara, caracterizada por crises de edema que acometem o tecido subcutâneo e mucosas de vários órgãos, manifestando-se principalmente por crises de angioedema e dor abdominal. Esse tipo de angioedema não responde ao tratamento usual com adrenalina, anti-histamínicos e corticosteroides. Assim, se não identificados e tratados adequadamente, esses pacientes têm risco de morte por edema de laringe estimado em 25% a 40%. O tratamento do angioedema hereditário mudou drasticamente nos últimos anos, com o desenvolvimento de novos e eficientes fármacos para as crises: inibidor de C1 derivado de plasma, inibidor de C1 recombinante humano, antagonista do receptor B2 da bradicinina (icatibanto) e o inibidor da calicreína (ecalantide). No Brasil, até o momento, estão liberados para uso o inibidor de C1 derivado de plasma e o icatibanto. O manejo correto desses pacientes na emergência evita cirurgias desnecessárias e, principalmente, desfechos fatais.

ABSTRACT Angioedema attacks are common causes of emergency care, and due to the potential for severity, it is important that professionals who work in these services know their causes and management. The mechanisms involved in angioedema without urticaria may be histamine- or bradykinin-mediated. The most common causes of histamine-mediated angioedema are foods, medications, insect sting and idiopathic. When the mediator is bradykinin, the triggers are angiotensin-converting enzyme inhibitors and factors related to acquired angioedema with deficiency of C1-inhibitor or hereditary angioedema, which are less common, but very important because of the possibility of fatal outcome. Hereditary angioedema is a rare disease characterized by attacks of edema that affect the subcutaneous tissue and mucous membranes of various organs, manifesting mainly by angioedema and abdominal pain. This type of angioedema does not respond to the usual treatment with epinephrine, antihistamines and corticosteroids. Thus, if not identified and treated appropriately, these patients have an estimated risk of mortality from laryngeal edema of 25% to 40%. Hereditary angioedema treatment has changed dramatically in recent years with the development of new and efficient drugs for attack management: plasma-derived C1 inhibitor, recombinant human C1-inhibitor, bradykinin B2 receptor antagonist (icatibant), and the kallikrein inhibitor (ecallantide). In Brazil, plasma-derived C1 inhibitor and icatibant have already been approved for use. Proper management of these patients in the emergency department avoids unnecessary surgery and, especially, fatal outcomes.

Resumen: Introducción: Las terapias complementarias se han ido incorporando cada vez más en la atención de salud, especialmente en áreas como la oncología, cuidados paliativos, rehabilitación y obstetricia. En varios países, son los propios profesionales de la salud los que las han incorporado en forma integrada a su práctica clínica, llevándolos a cambiar el paradigma del sistema biomédico actual, permitiendo brindar un cuidado más integral y autónomo. Objetivo: Comprender la experiencia de los profesionales de salud de Chile al incorporar las terapias complementarias en su práctica clínica. Método: Estudio cualitativo fenomenológico. Se invitó a participar a profesionales de la salud, con certificación en una terapia no convencional, la cual integran a su práctica clínica. Tras la firma del consentimiento, se realizaron las entrevistas en profundidad hasta lograr la saturación de los datos. El proceso de investigación se realizó siguiendo las 10 etapas de Streubert. Resultados: Participaron 11 profesionales de salud, quienes desarrollan terapias como el reiki, terapia floral y acupuntura integrada a su práctica clínica. Se develó que la incorporación de Terapias Complementarias le dio mayor sentido a la propia labor como profesional de la salud, sin embargo, hubo facilitadores y obstaculizadores del proceso, lo cual les generó nuevos desafíos para la integración con la medicina alópata. Conclusión: La integración de las Terapias Complementarias ampliaron las herramientas terapéuticas, lo que generó en ellos mayor satisfacción profesional al brindar una atención más humana y centrada en la persona, reconociendo la necesidad de incorporar estos saberes en los currículos de las carreras de la salud.

Abstract: Introduction: Complementary therapies have been increasingly incorporated into health care, especially in areas such as oncology, palliative care, rehabilitation and obstetrics. In several countries, it´s the health professionals themselves who have incorporated them into their clinical practice in an integrated way, leading them to change the paradigm of the current biomedical system, allowing them to provide a more comprehensive and autonomous care. Objective: To comprehend the experience of health professionals in Chile when incorporating complementary therapies in their clinical practice. Method: Qualitative phenomenological study. Health professionals certified in unconventional therapy were invited to participate, which they integrate into their clinical practice. After signing the consent, in-depth interviews were carried out until the data was saturated. The research process was carried out following the 10 steps of Streubert. Results: 11 health professionals participated, who develop therapies such as reiki, flower therapy and acupuncture integrated into their clinical practice. It was revealed that the incorporation of Complementary Therapies gave greater meaning to the work itself as a health professional, however, there were facilitators and obstacles to the process, which generated new challenges for integration with allopathic medicine. Conclusion: The integration of Complementary Therapies expanded the therapeutic tools, which generated in them greater professional satisfaction by providing a more human and person-centered care, recognizing the need to incorporate this knowledge into the curricula of health careers.

Resumo: Introdução: As terapias complementares têm sido cada vez mais incorporadas à assistência à saúde, principalmente em áreas como oncologia, cuidados paliativos, reabilitação e obstetrícia. Em vários países, os próprios profissionais de saúde os incorporaram à prática clínica de forma integrada, levando-os a mudar o paradigma do sistema biomédico vigente, permitindo-lhes uma atenção mais integral e autônoma. Objetivo: compreender a experiência dos profissionais de saúde no Chile ao incorporar as terapias complementares em sua prática clínica. Método: estudo fenomenológico qualitativo. Foram convidados a participar profissionais de saúde com certificação em terapia não convencional, que integram à sua prática clínica. Após a assinatura do Termo de Consentimento Livre e Esclarecido, foram realizadas entrevistas em profundidade até a saturação dos dados. O processo de pesquisa foi realizado seguindo as 10 etapas de Streubert. Resultados: participaram 11 profissionais de saúde, que desenvolvem terapias como reiki, floroterapia e acupuntura integradas à sua prática clínica. Revelou-se que a incorporação das Terapias Complementares deu maior sentido ao próprio trabalho como profissional de saúde, porém, surgiram facilitadores e obstáculos ao processo, o que gerou novos desafios para a integração com a medicina alopática. Conclusão: A integração das Terapias Complementares ampliou os instrumentos terapêuticos, o que gerou nelas maior satisfação profissional por proporcionar um cuidado mais humano e centrado na pessoa, reconhecendo a necessidade de incorporação desse conhecimento nos currículos das carreiras em saúde.

ABSTRACT Introduction: Health’s chronic conditions demand continuous care with an approach to the clinical method focused in the person, which includes physician-patient relation as a cross-sectional element where confidence is the core. This confidence would mediate between the management of the patient’s chronic conditions and their effects. Objective: To identify the effect of confidence in health provider/professional-patient relation in different health contexts. Methods: It was carried out a critical review of related literature from June to August, 2017 in order to understand the role of confidence in health provider- patient relation, and its relation with the results in health. The initial search was with the keywords: ´´confidence´´, ´´physician´´, health provider´´, ´´patient´´ and their equivalents in English and French, in the electronic databases JSTOR (Philosophy), Race Relations Abstracts, SocIndex with Full Text, Social Science Database, PubMed Central, CINAHHL, Nursing & Allied Health Database, Web of Science, Academic Search Complete and ProQuest Central. There were carried out different search strategies with the keywords and the boolean operator ´´AND´´. Conclusions: Confidence is a variable of the patient-health provider relation that has a strategic role in therapeutic processes. Then, it is important to consider it as a part of health care, specially as a point of collaboration and commitment of the patient with his/her health. Thus, it is necessary to create instruments that measure this variable in accordance with the cultural characteristics of Latin American countries and this can be extended to all having a care role in the direct contact with patients.

RESUMEN Introducción: Las condiciones crónicas de salud demandan un cuidado continuo con enfoque en el método clínico centrado en la persona, que incluye la relación médico-paciente como un elemento transversal, siendo la confianza el eje principal. Esta confianza podría mediar entre el manejo de las condiciones crónicas de los pacientes y sus efectos. Objetivo: Identificar el efecto de la confianza en la relación paciente-proveedor de salud en los diversos contextos de salud. Métodos: Se efectuó una revisión crítica de la literatura durante los meses de junio a agosto del 2017, para comprender el rol de la confianza en la relación entre el paciente-proveedor de salud y su relación con los resultados en salud. La búsqueda inicial fue con las palabras clave: “confianza”, “médico”, “proveedor de salud”, “paciente” y sus variantes en inglés y francés, en las bases de datos electrónicas JSTOR (Filosofía), Race Relations Abstracts, SocIndex with Full Text, Social Science Database, PubMed Central, CINAHL, Nursing & Allied Health Database, Web of Science, Academic Search Complete y ProQuest Central. Se aplicaron diferentes estrategias de búsqueda con las palabras claves y el operador boleano “AND”. Conclusiones: La confianza es una variable de la relación paciente-proveedor de salud que tiene un rol estratégico en los procesos terapéuticos. De ahí que sea fundamental considerarla como parte de la atención en salud, en especial como una instancia de colaboración y compromiso del paciente con su salud. Por lo que se hace necesario crear instrumentos que midan esta variable de acuerdo a las características culturales de los países latinoamericanos y que se extienda a todos los que tienen un rol asistencial en el contacto directo con el paciente.

ABSTRACT Introduction: Health’s chronic conditions demand continuous care with an approach to the clinical method focused in the person, which includes physician-patient relation as a cross-sectional element where confidence is the core. This confidence would mediate between the management of the patient’s chronic conditions and their effects. Objective: To identify the effect of confidence in health provider/professional-patient relation in different health contexts. Methods: It was carried out a critical review of related literature from June to August, 2017 in order to understand the role of confidence in health provider- patient relation, and its relation with the results in health. The initial search was with the keywords: ´´confidence´´, ´´physician´´, health provider´´, ´´patient´´ and their equivalents in English and French, in the electronic databases JSTOR (Philosophy), Race Relations Abstracts, SocIndex with Full Text, Social Science Database, PubMed Central, CINAHHL, Nursing & Allied Health Database, Web of Science, Academic Search Complete and ProQuest Central. There were carried out different search strategies with the keywords and the boolean operator ´´AND´´. Conclusions: Confidence is a variable of the patient-health provider relation that has a strategic role in therapeutic processes. Then, it is important to consider it as a part of health care, specially as a point of collaboration and commitment of the patient with his/her health. Thus, it is necessary to create instruments that measure this variable in accordance with the cultural characteristics of Latin American countries and this can be extended to all having a care role in the direct contact with patients.

RESUMEN Introducción: Las condiciones crónicas de salud demandan un cuidado continuo con enfoque en el método clínico centrado en la persona, que incluye la relación médico-paciente como un elemento transversal, siendo la confianza el eje principal. Esta confianza podría mediar entre el manejo de las condiciones crónicas de los pacientes y sus efectos. Objetivo: Identificar el efecto de la confianza en la relación paciente-proveedor de salud en los diversos contextos de salud. Métodos: Se efectuó una revisión crítica de la literatura durante los meses de junio a agosto del 2017, para comprender el rol de la confianza en la relación entre el paciente-proveedor de salud y su relación con los resultados en salud. La búsqueda inicial fue con las palabras clave: “confianza”, “médico”, “proveedor de salud”, “paciente” y sus variantes en inglés y francés, en las bases de datos electrónicas JSTOR (Filosofía), Race Relations Abstracts, SocIndex with Full Text, Social Science Database, PubMed Central, CINAHL, Nursing & Allied Health Database, Web of Science, Academic Search Complete y ProQuest Central. Se aplicaron diferentes estrategias de búsqueda con las palabras claves y el operador boleano “AND”. Conclusiones: La confianza es una variable de la relación paciente-proveedor de salud que tiene un rol estratégico en los procesos terapéuticos. De ahí que sea fundamental considerarla como parte de la atención en salud, en especial como una instancia de colaboración y compromiso del paciente con su salud. Por lo que se hace necesario crear instrumentos que midan esta variable de acuerdo a las características culturales de los países latinoamericanos y que se extienda a todos los que tienen un rol asistencial en el contacto directo con el paciente.