As knowledge has accumulated, COVID-19 has come to be considered a disease of the respiratory system that can also cause multisystemic involvement. This study analyzed the prevalence of deep venous thrombosis (DVT) in the lower limbs of patients with COVID-19 by conducting an integrative review of the literature published from 2019 to 2022. The procedures involved in article selection were identification of keywords, definition of the search strategy, consultation of databases, and exclusion of duplicate articles and others that did not meet the review objectives. Exclusion of articles was based on the following exclusion criteria: articles on arterial vascular complications involving the lower limbs, laboratory experiments, cases reports describing venous and arterial complications involving other sites, and articles unrelated to the outcome of interest: DVT. A total of 284 articles were identified, 42 of which were included. There was considerable variability in the prevalence of DVT among patients with COVID-19 (range: 0.43 to 60.87%). The findings suggest that occurrence of DVT in patients with COVID-19 is associated with disease severity. In December of 2019, a new coronavirus strain was identified in patients presenting with pneumonia of unknown etiology and was named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by the International Committee on Taxonomy of Viruses (ICTV). The same month, the first case of coronavirus disease 2019 (COVID-19) was confirmed in the city of Wuhan, in China. The disease caused a global outbreak that was designated as a pandemic by the World Health Organization (WHO) on March 11, 2020.Coronaviruses (CoVs) are single-stranded ribonucleic acid (RNA) viruses that cause diseases in humans and animals. demonstrating high rates of contagion, morbidity, mortality, and lethality, provoking a major overload of health care systems.This pandemic spread rapidly, with more than 199 million confirmed cases and more than 4 million deaths worldwide during 2021, The incubation period of SARS-CoV-2 can be considered as from 2 to 14 days, with a mean period of 5 days, and it is diagnosed by testing nasopharyngeal swab samples with reverse transcriptase followed by polymerase chain reaction (RT-PCR).Transmission of COVID-19 occurs person-to-person by direct contact, by aerial transmission in aerosols, and during medical procedures. 15% progress to a more severe form; and 5% develop acute respiratory distress syndrome (ARDS) and require ventilatory support.Around 80% of confirmed cases of COVID-19 are asymptomatic or mildly symptomatic;Patients considered to have mild to moderate severity exhibit the following clinical manifestations: fever (88.7%), coughing (67.8%), tiredness (38.1%), productive expectoration (33.4%), dyspnea (18.7%), sore throat (13.9%), and headache (13.6%). and may induce sepsis, ARDS, bilateral interstitial pneumonia, multiple organ failure, and disseminated intravascular coagulation (DIC), and can lead to fatal outcomes. The activation of blood coagulation provokes a prothrombotic state with significant elevation of fibrin, of fibrin degradation products (including D-dimer [DD]) and fibrinogen. The resulting state is known as COVID-19 associated coagulopathy (CAC). The pathophysiology of CAC includes cytokine storm, causing activation of endothelial cells and pulmonary microvasculature injury, causing local microthrombosis, and a hypercoagulable state that can result in thrombosis of large vessels.Severe infection is characterized by uncontrolled multisystemic inflammatory and immune response, with cardiovascular, respiratory, neurological, intestinal, hepatic, pancreatic, renal, cutaneous, and hematological involvement. This response is mediated by direct viral action, with endothelial dysfunction, inflammation, and thrombosis of the microcirculation of organs, such as deep venous thrombosis (DVT), pulmonary embolism (PE), arterial thrombosis, pulmonary thrombosis (PT), unusual thrombosis of central lines or arterial catheters, and premature thromboses of extrarenal hemodialysis filters and extracorporeal membrane oxygenation (ECMO) cannulae.From this perspective, the procoagulatory nature of COVID-19, combined with other risk factors, such as immobility, mechanical ventilation, and infection, predisposes patients to thromboembolic complications,Considering the importance of the vascular involvement related to COVID-19 and the need for data to support decision making on the most effective forms of thromboprophylaxis, it is essential to discuss the impact of these complications and the different treatment approaches, justifying a wide-ranging review of the literature.In view of the above, the objective of this study was to analyze the prevalence of DVT in the lower limbs of patients with COVID-19.This is an integrative review of the literature on COVID-19-related DVT in lower limbs, written up in accordance with the PRISMA protocol.The procedures employed to identify and select scientific output were based on consultations of the SciELO, PubMed, Cochrane, Scopus, Web of Science, and LILACS databases, considering publications from December 2019, when the pandemic started, to September 2022.Relevant keywords were selected and the following search strategy was defined: COVID19 OR COVID-19 Viral Disease OR 2019-nCoV Disease OR Coronavirus 2019 Disease OR 2019-nCoV Coronavirus Disease OR Coronavirus-19 Disease OR Novel Coronavirus 2019 Disease OR COVID-19 Virus Disease OR Wuhan Coronavirus Pneumonia Epidemic OR Wuhan 2019-2020 Coronavirus Pneumonia Epidemic OR Coronavirus from Wuhan Pneumonia Epidemic OR Coronavirus from Wuhan 2019-2020 Pneumonia Epidemic OR Novel Coronavirus 2019-2020 Pneumonia Epidemic OR Wuhan Coronavirus Epidemic OR Coronavirus from Wuhan Epidemic OR Novel Coronavirus 2019 Epidemic OR 2019-nCoV Epidemic OR Wuhan Coronavirus Epidemic OR Coronavirus from Wuhan Epidemic OR Novel Coronavirus 2019 Epidemic OR Wuhan Coronavirus Pneumonia Fever OR COVID-19 Viral Infection OR Infection by the 2019-nCoV Coronavirus OR Infection by the Wuhan Coronavirus OR Infection by the SARS-CoV-2 OR 2019-nCoV Infection OR 2019-nCoV Coronavirus Infection OR Wuhan Coronavirus Infection OR Novel Coronavirus 2019 Infection OR SARS Coronavirus 2 Infection OR SARS-CoV-2 Infection OR COVID-19 Virus Infection OR SARS-CoV-2 Infections OR COVID-19 Pandemic OR COVID-19 Pandemics OR Wuhan Seafood Market Pneumonia OR Wuhan Coronavirus Pneumonia OR Novel Coronavirus 2019-2020 Pneumonia OR Wuhan Coronavirus Outbreak OR 2019-2020 Chinese Pneumonia Outbreak OR Pneumonia Outbreak in China 2019-2020 OR 2019-nCoV Coronavirus Outbreak OR Wuhan Coronavirus Outbreak OR Wuhan Coronavirus 2019-2020 Outbreak OR Novel Coronavirus 2019 Outbreak OR 2019-nCoV Outbreak OR 2019-nCoV Coronavirus Outbreak OR Wuhan Coronavirus Outbreak OR Wuhan Coronavirus 2019-2020 Outbreak OR Novel Coronavirus 2019 Outbreak OR COVID-19 Virosis) AND (Deep Venous Thrombosis lower limbs OR Deep Venous Thrombosis lower limb OR Deep Vein Thrombosis lower limbs OR Deep Vein Thrombosis lower limb OR Thrombosis of lower limbs deep veins OR Thrombosis of lower limb deep veins OR Deep Vein Thrombosis lower extremities OR Deep Vein Thrombosis lower extremity).The review included cross-sectional, case-control, and cohort studies that were directly related to the subject of interest. The first step in analysis of the articles was reading the titles and abstracts to classify them by study type and eliminate duplicated publications. The full texts of articles were then read to identify the characteristics, objectives, and results of each study. Data were extracted from each article and input to a dedicated spreadsheet containing title, authors, year of publication, country in which the study was conducted, periodical, objective, type of study, sample, tests used for diagnosis, main results, and evidence level. An analysis was conducted to determine the degree of evidence of each article using the SORT (Strength of Recommendation Taxonomy) protocol. This classification stratifies evidence levels as: A) consistent and good quality patient-oriented evidence; B) inconsistent or limited quality patient-oriented evidence; or C) consensus, usual practice, opinion, disease-oriented evidence, or case series for studies of diagnosis, treatment, prevention, or screening.The review included articles related to the primary outcome of interest - symptomatic and asymptomatic DVT - and also cases diagnosed incidentally or systematically in the lower limbs of patients with confirmed COVID-19. Case reports and articles on arterial and venous vascular complications located in other anatomic sites were excluded. A total of 284 articles were identified, 42 of which were analyzed.This integrative review found that many different studies have been conducted in different parts of the world to investigate the signs and symptoms of COVID-19 and its systemic complications, such as DVT in the lower limbs. Clinical and epidemiological data are essential to guide planning and implementation of provision of health care for patients with these diseases.It was observed that the majority of these studies were conducted in countries in Europe and America and just one study was conducted in Africa. In view of this, it is clearly important to conduct studies with different populations, considering the diversity of ethnicities, cultures, and social and economic conditions, with the objective of better understanding the multisystemic characteristics of the disease and identifying possible factors that could be associated with occurrence of DVT in the lower limbs of patients with COVID-19.This review found that the incidence of cases of DVT in the lower limbs of patients with COVID-19 was investigated in different population groups, with mild, moderate, and severe forms of COVID-19, and it is possible that these factors have influenced the variability in the data reported by the studies analyzed.A study conducted at the Wuhan Union Hospital, in China, with 88 patients admitted with confirmed COVID-19 pneumonia, 31 of which were critical cases, 33 severe cases, and 24 mild cases, identified DVT in the lower limbs of 19 patients (21.59%), 12 in critical patients and 7 in severe cases. This therefore suggests that occurrence of DVT in patients with COVID-19 may be related to disease severity, since it is more frequent in patients admitted to intensive care units in respiratory distress with respiratory rate ≥ 30 breaths/minute; peripheral oxy-hemoglobin saturation ≤ 93% at rest; ratio of partial pressure of oxygen/fraction of inspired oxygen ≤ 300 mmHg; respiratory failure requiring mechanical ventilation; shock; or failure of other organs.It is important to point out that, although the possible mechanisms and factors related to thromboembolic changes found in patients with COVID-19 have not been completely elucidated, the literature has demonstrated that formation of proinflammatory cytokines, induction of procoagulatory factors, and hemodynamic changes that predispose to ischemia and thrombosis can contribute to development of DVT in the lower limbs of these patients. Furthermore, changes that can be detected with laboratory tests, such as lymphopenia, neutrophilia, elevated prothrombin time, and elevated DD, have been observed in patients who develop venous thromboembolism.Recent studies have shown that patients hospitalized for COVID-19 are at high risk of development of thromboembolic events, and, consequently, there was a massive increase in requests for computed tomography and color Doppler ultrasonography (CDUS), with the objective of identifying cases of PE and DVT in these patients. The present review found that CDUS was the diagnostic method most used to identify DVT in the lower limbs of patients with COVID-19. Early diagnosis of DVT in the lower limbs of patients with COVID-19 is of fundamental importance for good prognosis. It should be stressed that examinations to investigate vascular changes are important regardless of the presence of signs or symptoms of DVT, especially in patients with severe cases of COVID-19, admitted to intensive care units, and/or on ventilatory support, with the purpose of diagnosis and monitoring of the problem, considering that the prevalence of DVT in lower limbs was higher in more severe cases and in the presence of immobilization.Analysis of the treatments employed for management of DVT in the lower limbs of patients with COVID-19 suggests that early administration of prophylactic anticoagulant is beneficial to the prognosis of critical patients with COVID-19 pneumonia and will probably reduce the rates of thromboembolic events. However, there are inconsistencies in the literature.The studies included in this review describe patients with COVID-19 of varying degrees of severity and from different population groups. The lack of additional detailed information about the health conditions of these patients was a factor that made in-depth analysis of these issues difficult, which can be considered a limitation of the study. Moreover, the analysis conducted in this review should be updated constantly, considering that different periods of time since the disease emerged may yield different findings. It is clear that further studies are needed to confirm the applicability and effectiveness in specific population groups of the diagnostic methods and treatments used to treat DVT in the lower limbs of patients with COVID-19. The disease’s extreme transmissibility and lethality meant that scientific efforts and resources were initially directed towards discovering preventative methods, with emphasis on development of vaccines for SARS-CoV-2, while the disease’s multisystemic characteristics are now being better understood.There was major variability in the prevalence of DVT in patients with COVID-19 and DVT in the lower limbs appears to be associated with more severe cases of COVID-19, such as in patients admitted to intensive care units with respiratory distress with respiratory rate ≥ 30 breaths/minute; peripheral oxy-hemoglobin saturation ≤ 93% at rest; ratio of partial pressure of oxygen/fraction of inspired oxygen ≤ 300 mmHg; respiratory failure requiring mechanical ventilation; shock; or failure of other organs.  . Em dezembro de 2019, foi descoberta uma nova cepa de coronavírus em pacientes que apresentavam uma pneumonia de etiologia desconhecida, nomeado coronavírus 2 da síndrome respiratória aguda grave (SARS-CoV-2) pelo Comitê Internacional de Taxonomia de Vírus (ICTV) . Nesse mesmo mês, foi confirmado o primeiro caso da doença do coronavírus 2019 (covid-19) na cidade de Wuhan, na China . Essa doença gerou um surto global que, em 11 de março de 2020, foi considerada uma pandemia pela Organização Mundial da Saúde (OMS) .Os coronavírus (CoVs) são vírus de ácido ribonucleico (RNA) de fita simples que causam doenças em humanos e animais , demonstrando altas taxas de contágio, morbimortalidade e letalidade, o que gerou uma grande sobrecarga para os sistemas de saúde .A pandemia teve uma rápida progressão, tendo sido registrados mais de 199 milhões de casos confirmados e mais de 4 milhões de mortes ao longo de 2021 mundialmente . O período de incubação do SARS-CoV-2 pode ser considerado entre 2 e 14 dias, com média de 5 dias , e o diagnóstico é realizado através do exame de swab nasofaríngeo com reação de transcriptase reversa seguida de reação em cadeia da polimerase (RT-PCR) .A transmissão da covid-19 ocorre de pessoa para pessoa, por meio de contato direto, por transmissões aéreas por meio de aerossóis e durante procedimentos médicos ; 15% apresentam uma forma mais grave; e 5% desenvolvem síndrome da angústia respiratória aguda (SARA) e necessitam de suporte ventilatório .Cerca de 80% dos casos confirmados de covid-19 são assintomáticos ou sintomáticos leves .Os pacientes considerados com gravidade de leve a moderada apresentam as seguintes manifestações clínicas: febre , tosse , fadiga , produção de expectoração , dispneia , dor de garganta  e dor de cabeça  , podendo ocorrer sepse, SARA, pneumonia intersticial bilateral, falência múltipla de órgão e coagulação intravascular disseminada (CID), cujo curso pode ser fatal . Essa ativação da coagulação sanguínea gera um estado pró-trombótico com elevação significativa de fibrina, de produtos de degradação de fibrina (incluindo o dímero-D [DD]) e fibrinogênio. Esse estado é denominado coagulopatia associada à covid-19 (CAC). A fisiopatologia da CAC inclui uma tempestade de citocinas, causando ativação das células endoteliais e lesão na microvasculatura pulmonar que leva à microtrombose local e a um estado de hipercoagulabilidade que pode causar trombose de grandes vasos .A infecção grave é caracterizada por resposta imunológica e inflamatória multissistêmica descontrolada, com comprometimento cardiovascular, respiratório, neurológico, intestinal, hepático, pancreático, renal, cutâneo e hematológico. Essa resposta é mediada por ação direta do vírus, com disfunção endotelial, inflamação e trombose da microcirculação dos órgãos , como trombose venosa profunda (TVP), embolia pulmonar (EP), trombose arterial, trombose pulmonar (TP) , trombose incomum de linhas centrais ou cateteres arteriais, tromboses precoces de filtros de hemodiálise extrarrenal e cânulas de oxigenação por membrana extracorpórea (ECMO) .Nesta perspectiva, a natureza pró-coagulante da covid-19 associada a fatores de risco, como imobilidade, ventilação mecânica e infecção, predispõem o paciente a complicações tromboembólicasConsiderando a importância do acometimento vascular relacionado à covid-19 e da necessidade de dados para tomada de decisão sobre as formas mais eficazes de tromboprofilaxia, é necessário discutir o impacto dessas complicações, assim como as diferentes formas de abordagem terapêutica, justificando uma busca ampla na literatura.Diante do exposto, o objetivo deste estudo foi analisar a prevalência de TVP em membros inferiores de pacientes acometidos pela covid-19. .Tratou-se de uma pesquisa de revisão integrativa de literatura sobre TVP em membros inferiores relacionada à covid-19, escrita de acordo com o protocolo PRISMAQuanto aos procedimentos empregados para o levantamento e a seleção da produção científica, foram consultadas as bases de dados SciELO, PubMed, Cochrane, Scopus, Web of Science e LILACS, considerando o período de dezembro de 2019, início da pandemia, a setembro de 2022.Foram selecionadas as palavras-chave, sendo definida a seguinte estratégia de busca: COVID19 or Doença Viral COVID-19 or Doença por 2019-nCoV or Doença por Coronavírus 2019 or Doença por Coronavírus 2019-nCoV or Doença por Coronavírus-19 or Doença por Novo Coronavírus de 2019 or Doença por Vírus COVID-19 or Epidemia de Pneumonia por Coronavírus de Wuhan or Epidemia de Pneumonia por Coronavírus de Wuhan de 2019-2020 or Epidemia de Pneumonia por Coronavírus em Wuhan or Epidemia de Pneumonia por Coronavírus em Wuhan de 2019-2020 or Epidemia de Pneumonia por Novo Coronavírus de 2019-2020 or Epidemia pelo Coronavírus de Wuhan or Epidemia pelo Coronavírus em Wuhan or Epidemia pelo Novo Coronavírus 2019 or Epidemia por 2019-nCoV or Epidemia por Coronavírus de Wuhan or Epidemia por Coronavírus em Wuhan or Epidemia por Novo Coronavírus 2019 or Febre de Pneumonia por Coronavírus de Wuhan or Infecção Viral COVID-19 or Infecção pelo Coronavírus 2019-nCoV or Infecção pelo Coronavírus de Wuhan or Infecção pelo SARS-CoV-2 or Infecção por 2019-nCoV or Infecção por Coronavírus 2019-nCoV or Infecção por Coronavírus de Wuhan or Infecção por Novo Coronavírus de 2019 or Infecção por SARS Coronavírus 2 or Infecção por SARS-CoV-2 or Infecção por Vírus COVID-19 or Infecções por SARS-CoV-2 or Pandemia COVID-19 or Pandemia por COVID-19 or Pandemias por COVID-19 or Pneumonia do Mercado de Frutos do Mar de Wuhan or Pneumonia por Coronavírus de Wuhan or Pneumonia por Novo Coronavírus de 2019-2020 or Surto de Coronavírus de Wuhan or Surto de Pneumonia da China 2019-2020 or Surto de Pneumonia na China 2019-2020 or Surto pelo Coronavírus 2019-nCoV or Surto pelo Coronavírus de Wuhan or Surto pelo Coronavírus de Wuhan de 2019-2020 or Surto pelo Novo Coronavírus 2019 or Surto por 2019-nCoV or Surto por Coronavírus 2019-nCoV or Surto por Coronavírus de Wuhan or Surto por Coronavírus de Wuhan de 2019-2020 or Surto por Novo Coronavírus 2019 or Virose COVID-19) and . De acordo com essa classificação, os níveis de evidência são estratificados em: A) evidência consistente e de boa qualidade orientada para o paciente; B) evidência inconsistente ou de qualidade limitada orientada para o paciente; ou C) consenso, evidência orientada para a doença, prática usual, opinião de especialistas ou série de casos para estudos de diagnóstico, tratamento, prevenção ou triagem.Foram incluídos na pesquisa os artigos relacionados ao desfecho principal considerado, TVP sintomática e assintomática, bem como casos diagnosticados incidentalmente ou de forma sistemática em membros inferiores de pacientes confirmados para covid-19. Foram excluídos os artigos do tipo relatos de caso e cuja temática era sobre complicações vasculares arteriais e venosas localizadas em outros sítios anatômicos. Do total de 284 artigos encontrados, 42 foram analisados.A A Nesta pesquisa de revisão integrativa, verificou-se que vários estudos têm sido realizados em diferentes regiões do mundo com o intuito de investigar sinais e sintomas da covid-19, bem como complicações sistêmicas, como a TVP de membros inferiores. Os dados clínicos e epidemiológicos são fundamentais para aprimorar o planejamento e a execução dos cuidados assistenciais nos serviços de saúde disponibilizados aos pacientes acometidos pelas doenças.Nota-se que a maioria das pesquisas foram desenvolvidas em países dos continentes europeu e americano, enquanto apenas um estudo foi conduzido no continente africano. Neste contexto, evidencia-se a importância da realização de estudos com diferentes populações, considerando a diversidade de etnias, culturas, condições sociais e econômicas, com o objetivo de melhor compreender a característica multissistêmica da doença e identificar possíveis fatores que podem estar associados à ocorrência de TVP de membros inferiores em pacientes acometidos pela covid-19.Na presente pesquisa, verificou-se que a incidência de casos de TVP de membros inferiores em pacientes com covid-19 foi investigada em diferentes grupos populacionais, com níveis leve, moderado e grave de acometimento pela covid-19, de modo que é possível que esses fatores tenham influenciado a variabilidade de informações reportadas pelos estudos analisados. .Em pesquisa realizada no Union Hospital de Wuhan, na China, com 88 pacientes internados com pneumonia confirmada por covid-19, sendo 31 casos críticos, 33 casos graves e 24 casos leves, verificou-se a ocorrência de TVP em membros inferiores em 19 pacientes , sendo 12 em casos críticos e 7 em casos graves. Assim, sugere-se que a ocorrência de TVP em pacientes com covid-19 pode estar relacionada com a gravidade da doença, sendo maior em pacientes internados em unidades de tratamento intensivo que apresentem desconforto respiratório com frequência respiratória ≥ 30 respirações/minuto; saturação periférica da oxi-hemoglobina ≤ 93% em repouso; relação pressão parcial de oxigênio/fração inspirada de oxigênio ≤ 300 mmHg; insuficiência respiratória que requer ventilação mecânica; choque; ou falência de outros órgãos .É importante ressaltar que, embora os possíveis mecanismos e fatores relacionados às alterações tromboembólicas encontradas em pacientes com covid-19 não estejam totalmente elucidados, a literatura tem demonstrado que a formação de citocinas pró-inflamatórias, a indução de fatores pró-coagulantes e as alterações hemodinâmicas que predispõem à isquemia e à trombose podem contribuir para o desenvolvimento de TVP de membros inferiores nesses pacientes. Além disso, alterações detectadas por meio de exames laboratoriais complementares, como linfopenia, neutrofilia, aumento do tempo de protrombina e elevação do DD, têm sido encontradas em pacientes que apresentam tromboembolismo venoso .Estudos recentes têm revelado que os pacientes hospitalizados devido à covid-19 possuem alto risco de desenvolvimento de eventos tromboembólicos, e, consequentemente, houve um aumento massivo no requerimento de tomografias computadorizadas e eco-Doppler colorido (EDC), com o intuito de identificar casos de EP e TVP nesses pacientes. Nesta revisão, verificou-se que o método diagnóstico mais utilizado para a identificação da TVP de membros inferiores em pacientes com covid-19 foi o EDC. O diagnóstico precoce da TVP de membros inferiores em pacientes com covid-19 é fundamental para um bom prognóstico. Convém salientar que, independentemente da presença de sinais ou sintomas de TVP, a realização de exames para investigar alterações vasculares mostra-se importante, principalmente em pacientes com casos graves de covid-19, internados em unidades de tratamento intensivo e/ou que estejam utilizando suporte ventilatório, com finalidade diagnóstica e de monitoramento da evolução do problema, considerando que a prevalência de TVP em membros inferiores foi maior em casos mais graves, em situação de imobilização .A análise dos tratamentos empregados para o manejo da TVP de membros inferiores em pacientes com covid-19 sugere que a administração precoce de anticoagulante profilático beneficiaria o prognóstico de pacientes críticos com pneumonia por covid-19 e, provavelmente, reduziria as taxas de eventos tromboembólicos. Entretanto, há controvérsias na literaturaOs estudos incluídos na pesquisa envolvem pacientes com variados níveis de gravidade da covid-19 e de grupos populacionais distintos. A falta de informações adicionais mais detalhadas sobre as condições de saúde dos pacientes foi um fator dificultador para o aprofundamento da questão, o que pode ser considerada uma limitação do estudo. Ademais, a análise realizada nesta revisão deve ser constantemente atualizada, considerando que os diferentes períodos de tempo após o surgimento da doença podem resultar em achados diferentes. Ressalta-se, portanto, a necessidade da realização de novos estudos para verificar a aplicabilidade e a efetividade dos métodos diagnósticos e terapias utilizadas no tratamento da TVP de membros inferiores em pacientes com covid-19, em grupos populacionais específicos. Reforça-se que, devido à alta transmissibilidade e letalidade da doença, os esforços e recursos científicos foram inicialmente direcionados à descoberta de métodos preventivos, com ênfase no desenvolvimento de imunizantes para o SARS-CoV-2, enquanto a característica multissistêmica da doença vem sendo melhor compreendida atualmente.Houve grande variabilidade na prevalência de TVP em pacientes com covid-19, e a TVP em membros inferiores parece estar associada a casos mais graves da covid-19, como em pacientes internados em unidades de tratamento intensivo que apresentem desconforto respiratório com frequência respiratória ≥ 30 respirações/minuto; saturação periférica da oxi-hemoglobina ≤ 93% em repouso; relação pressão parcial de oxigênio/fração inspirada de oxigênio ≤ 300 mmHg; insuficiência respiratória que requer ventilação mecânica; choque; ou falência de outros órgãos.


Scientific Reports 10.1038/s41598-023-34820-6, published online 10 May 2023Correction to: The Acknowledgments section in the original version of this Article was omitted. The Acknowledgments section now reads:“A.C.G. was supported by the “Beca de Iniciación a la Investigación para estudiantes de Máster” of the University of Granada (Spain). L.R.M. was supported by the Oficina de Asuntos Internacionales y Cooperación Externa (OAICE) of the Universidad de Costa Rica, Ministerio de Ciencia, Tecnología y Telecomunicaciones (MICITT) of the Government of Costa Rica and Fundación Carolina (Spain). TϋCAD2 is funded by the Federal Ministry of Education and Research (BMBF) and the Baden-Württemberg Ministry of Science as part of the Excellence Strategy of the German Federal and State Governments EXC 2180–390900677.www.allgenetics.eu).Transmission electron microscopy and atomic force microscopy were performed at the “Centro de Instrumentación Científica”, and nanoparticle tracking analysis was performed at the “Departamento de Física Aplicada” of the Faculty of Sciences, both at the University of Granada. RNA-seq analysis was carried out by AllGenetics & Biology SL . Instituto Carlos III, Ministerio de Sanidad, Gobierno de España; Fundación Ramón Areces “Interactoma de las exovesículas de T. cruzi y de los inmunocomplejos que forman con las células del hospedador: implicaciones en la patología de la enfermedad de Chagas (2019)”. Ministerio de Ciencia y Tecnología of the government of Spain funded the project PGC2018-099424-B-I00 and the financial support given by the proyect A-BIO-350-UGR18 I+D+i Proyect “Programa Operativo FEDER de Andalucía JJAA” 2014-2020.”The original Article has been corrected.


To validate a proposal for an autobiographical interview oriented to the typical older adult.Questions for a semi-structured autobiographical memory interview were designed and a protocol for its application was developed. Fourteen Speech and Language Pathologists judges and 14 older adults were used. Additionally, 2 interviews were conducted. Subsequently, content validity was obtained by means of Lawshe's classic procedure. Also, using a complementary evaluation for comprehensibility and length of the interview, as well as a data triangulation procedure with the judges and participants of the pilot experience.Of the 22 items evaluated, only 4 were above the critical reference value (0.49).The need to incorporate this measure of analysis in the context of respect, identity and agency of older adults is discussed as part of a change in thinking under the gaze of person-centered care and a communicative competence model. As well as the need to incorporate different cultural paradigms and the use of digital technologies. Important reference works on the subject have been described, from medicine and psychology, advancing on time in standardization processes to determine the degree of competence of the person who acts as an evaluator, as well as its importance for clinical decision-making.Every professional recognizes the importance of the interview and has no objections to categorizing it as a fundamental clinical tool when obtaining information and data from a patient, a fundamental element to comply with quality standards suggested by the evidence-based practice in speech-language therapy and that also highlights the dialogical nature of the relationship that this professional establishes with the beneficiaries of his services.In this context and specifically for speech-language therapy, the generation of an effective and quality communication link is a fundamental premise for the clinician-person/patient relationship. The guidelines, organization, and structure of clinical interviews are quickly implemented as part of the most basic competencies of undergraduate training, incorporating various mechanisms to ensure the standardization and quality of this toolIn general, clinical interviews have been hegemonized by guidelines of the biomedical model, focusing on the quantification of symptoms and signs specific to different possible pathological conditions, with little implementation of a specific tool based on the exploration of the phenomenological connotations that people attribute to the different autobiographical elements experienced throughout the life cycle and its impact on the present and future life situation.. This starts with the interview process, the facilitations granted by the conversational tenor of an interview with an autobiographical orientation favor the naturalness of the personal story, the specific emphasis that each one gives to the facts/events, in which the phenomena become valid, interest and value in a unique way, a situation that traditional procedures cover since they are usually conducted under a questioning format.Effective communication between clinician and patient is the basis to establish collaborative goals and negotiate relevant therapeutic objectives for all of them.In this context, an autobiographical interview collects potentially relevant information about situations, contexts, and experiences that the person has experienced. Although various researchers and clinicians have developed instruments based on these traditions, it is essential to differentiate the objectives pursued by each instrument, as well as their characteristics, orientations, and limitations. Consequently, the objective of this work was to validate a proposal for an Autobiographical Interview for older adults.Although in recent years the use of narrative interviews has increased when exploring more phenomenological dimensions of the lives of people who assume the role of patients, their use continues to be infrequent, despite representing a positive way of reconstructing how current conditions they can be interpreted in the context of that person's lifeThis research has a psychometric approach, assigned to a quantitative observational study, with a non-experimental cross-sectional design. Organizationally, it was structured in 4 stages: design, validation, preparation of the interview administration protocol, and its pilot application.,9, maintaining attention on the interaction that takes place within the dialogic format. In particular, the elaboration of the instrument was adapted to the hermeneutics of interpretive phenomenological analysis.A semi-structured interview format was developed, based on theoretical references that consider life history as a significant axis for developmentThe original autobiographical interview consisted of a pool of 22 questions that were assigned to inquire about the experiences, 11 for life review and 11 for future prospecting.The designed questions were submitted for validation by a total of 28 judges, made up of a group of professional speech-language therapists  and a group of older adults from the community .The inclusion criteria for the group of professionals were:● To be certified speech-language therapists.● To have at least five years of direct work experience with older adults, with a workload of no less than 11 hours; or● To participate for at least five years in community volunteer activities - groups for older adults.For the group of elderly judges, the inclusion criteria were:● To be older than or equal to 60 years old.● To have at least eight years of education (either continuous or discontinuous).● To be enrolled in the primary health care unit of their community.● Participate actively (at least one year old) in a community social group.● To be retired from their work activities (retired).● To have an auditory and visual acuity according to the requested activities or, failing that, to have the corresponding adaptations.● To believe in a cognitive, functional, and emotional status within typical values:.Score 1 on the Global Deterioration Scale - GDS.Scores greater than or equal to 23 points on the Mini-mental State Examination - MMSE.Scores less than or equal to 6 on the Pfeffer Functional Activities Questionnaire - PFAQ.Scores less than or equal to 4 on the Goldberg General Health Questionnaire-12No medical history of cerebrovascular accident, brain injury, progressive neurological diseases - neurodegenerative and/or neuropsychiatric disorders.Without being in treatment with psychotropic drugs.● To participate for at least three years in community volunteer activities and/or in groups for the elderly in the community..To quantify the representativeness of the items proposed in the previous step, the content validity ratio (CVR) was calculated, according to the classic procedure described by Lawshe (1975), using a three-item evaluation scale, essential; useful but expendable; and unnecessary. The CVR is an indicator that is easy to calculate and interpret, being able to provide information both at the item level and the proposed instrument. The CVR oscillates between -1 and +1, with positive scores indicating greater representativeness of the itemsAfter selecting the items with the procedure indicated above, an application protocol for the autobiographical interview was developed, as a circumscribed orientation for the interviewer. As it is a dialogical situation, the idea is to maintain the generic structure without falling into the stereotype of a clinical interview., contextualization of the process; Exploration of the interview, with two subcomponents - (a) Exploration of the relevance of memories for the present - future; and (b) Exploration of the relevance of the future in the present and its prospecting - and Closing Process. An approximate time of 50 minutes - one hour was considered, protecting not to exceed the characteristic temporality of the cognitive stimulation activities that older adults receive in community centers.The protocol describes the execution of the interview in three phases. This is intended to ensure coherence and organization when administering it since it is possible to verify that as the person progresses in the questions, a “natural deepening” of the information appears, from the appreciation of a general order to memories properly autobiographical. The interviewer must always maintain a role of neutrality and active listening, ruling out the formulation of judgments and intervening minimally, so as not to hinder or bias the interviewee's narrative.The structuring of the interview protocol constitutes a guarantor of systematization to ensure its replicabilityIt considers the opening of the interview, the execution of a lifeline as activities, which incorporate the reference to life stages and/or significant events in the life stages, and a contextualization question.The opening to the subject initiates a framing, focusing on the figure of the elderly person in the present society, favoring the naturalness of the interaction by remaining permeable to dialogue and/or to different types of emerging comments.The construction of the lifeline and its references to events were defined to reinforce the idea of continuity and direction of time, in addition to rescuing the framing that everyone defines and recognizes as relevant (life stages - life events). This allows us to appreciate the attribution of time that each person establishes for events - stages and even provides a form of estimation for what the person defines as “the rest of life,” which is particularly interesting when contrasting this proportion with the concrete estimate that people make of their future time in figures. This graph must always be available as a form of support or visual reinforcement during the interview., it is necessary to respect the connotation given by the person and also reveal the constructive meaning of the experiences lived, arguing that the perspective of time allows us to see how a negative situation does not lose its condition of negativity, but has contributed to building values, resilience, foresight, self-care, among others, as the case may be.Although the positive valence of memories should always be emphasized, people evoke both positive and negative aspects in their stories, even going as far as to share them spontaneously. Although the literature reports this situation and since it is impossible to establish control of the affective valence of the memory“turning a negative memory positive.” The objective is to observe the memory in its context and with a temporal perspective. In any case, follow-up measures are incorporated during the closure that will be discussed later to identify and propose actions to manage any rumination behavior.It is not about The phase of exploration - projection of memories begins by requesting the identification of the oldest memory. It is asked directly about the memory and narration is requested. Subsequently, the central questions of the interview are asked, emphasizing the greatest possible specificity, and inviting to deepen into the relevance that memories reflect in temporal contexts., according to the taxonomy of the classic Conway Memories model:To explore the relationship of reminiscences with both the present and the future, a visual analog scale from 1 to 10 is used as support . All information is coded for subsequent analysisExtended Memory: They refer to extended periods of life that last much more than one day, such as childhood or school days.Categorical Memory: Actions that are repeated or similar event categories without specifying any specific moment , such as Christmas, birthdays, or summer vacations.Specific Memory: They describe specific moments that occur in a specific space and time and that can last from a few seconds to a few hours, such as an exam, the birth of a child, or a particular celebration. These memories are exceptionally longer than one day.Memory generalization: The inability to retrieve specific memories in the situations in which they are needed is called memory generalization. More than a memory, it is information of a semantic nature, value judgments, comments, or opinions regarding a situation, for example: “My childhood was very sad - I only have happy memories of my marriage, people from before were calmer.”When deepening into the role of the future and its prospecting, reminiscences and previously made assessments are used as contextualization elements. It is requested to specifically quantify the future space of time that the interviewee visualizes, as well as an exploration that is as precise as possible and avoiding staying in comments of the type “whatever God wants,” “as long as my health lasts.” It is urged to deep into how relevant the value of past events (reminiscences) is in prospecting, which can be supported with the previously mentioned visual analog scale.This phase of the interview is a space where the interviewer's interventions should be limited only to facilitating the detailed exploration of each memory.In this phase, a self-evaluation of what the interviewee has reflected during the interview is facilitated. As the participation is more or less active, the process is encouraged, rescuing the fundamental concepts that the interviewee developed in the previous phase.Since recalling certain life episodes or memories could generate some feelings of discomfort or emotionality in the interviewee, it is essential to give the interviewee a safe space and the opportunity to express themselves. The use of the telephone is specifically instructed in the event of any query or doubt regarding the feelings or emotions that may be experienced after the interview. The interviewee is informed at the time of consent, as well as two follow-up calls that are made after 48 hours and one week, respectively.During the telephone contact, a brief questionnaire is applied, made up of questions that guide the general state of the interviewee. The results of the questions guide two decisions, visit to the center for specialized referral or follow-up control by the community program. It is always insisted that, in case of any doubt or consultation, the person can approach the clinical center during office hours or call by phone with their concerns and/or request an appointment.To increase the validity of the results, a methodological triangulation was performed. Specifically, for the final proposal, in addition to considering the opinion and recommendations of the specialist and non-specialist judges, the interview was tested in a pilot application for a sample of 2 typical older adults, who met the inclusion criteria described in the section on non-specialist judges. It should be noted that each participant was duly informed and gave their consent.A simple questionnaire was used as input to know the appreciation of the interviewees about the 4 questions and comments validated by the judges, through a Likert-type scaling and a section for comments. The comprehensibility and the length of the protocol were evaluated. The comprehensibility analysis considered the following categories: (i) clear and understandable, (ii) difficult to understand, and (iii) incomprehensible. Also, the extension considered an assessment of 5 degrees, from very extensive-strenuous, to very brief-insufficient.This Autobiographical Interview proposal was applied after the approval granted by the Universidade Federal de Santa María, Research Ethics Committee, Brasil, Folio No. 3.000.149. All participants also signed an informed consent form.. Contrasting this index with the proposed questions, a structure composed of the 4 questions that exceeded the indicator was defined. These 4 questions were incorporated into the instrument, specifically in the interview phase  From the most classical theory, Ricoeur (1991) argued that stories fragment experiences into smaller units, establishing beginnings, developments, and purposes that create a significant temporal landscape, a narrative goes beyond the chronology of the facts exposed since it is a way of conferring a sense of completeness on experiences. Also, the qualitative methodological tradition has been particularly enriched by interpretive phenomenological analysis (IPA), given its flexibility and orientation to the participant. The IPA offers the opportunity for the latter to commit to the story of the experiences lived, without being subject to restrictions or prosecutions. These participation formats permeate the dialogical interaction of the interview but also keep the narratives within the personal space of the person who remembers since he becomes the protagonist and agent of his story, a crucial relationship between memory and the perception of a development identity process, consistent and multidimensional.2) The interest in personal narratives constitutes a vast opportunity framework for qualitative research in health sciences to develop and integrate social, clinical, and interpersonal contexts that are beyond quantifiable standards and values3) Unlike any other memory exploration task, the evaluations of its autobiographical component require an important and rigorous protocolization since by their nature they escape the control conditions that intervene in other types of evaluations.; the established stories are recreated interpretively, therefore, the logic of the facts passes to a paraphrase where there will be connotative decisions, of value, character, and depth along with many others before even delving into the most formal linguistic aspects of the organization of the discourse.The communality in all the autobiographical interviews is in requesting the narration of memory and its circumstantial elements, described in the most detailed way possible, emphasizing the quality of aspects such as its emotional valence, time-space coordinates, a perspective from which it is evoked , among others. This also considers how complex it is to bring this very intimate and personal activity to the experimental paradigm that exists behind any laboratory condition. In addition, given that the narratives are based on the phenomenology of the stated memories, it is plausible to deepen and directly overlap with the individual and manifest conceptions that the experiences of individuals reveal about themselves over time and about how these memories tell us about those who they are, of the construction of their identity and their state of subjective well-being.It is also relevant to remember that autobiographical stories represent a “travel in time”, that is, a displacement of consciousness towards another moment of the temporal continuum, and that in addition to performing its function  it will materialize in an act of communication that will depend on specific rules for its co-construction, recursiveness, and form, as the models of communicative competence are understood. The work of McAdams and others marks a transition between narrative conceptions focused on quasi-archetypal universals and studies of identities focused on the processes, contexts, and culture of individuals. It makes sense, then, to understand how social representations and stereotypes work, as well as to emphasize the different communicative and contextual aspects that occur in the interaction of the interview and the context of reminiscence as an activity. An example of this comes from the narratives of people with disabilities, where the events trace a process of acquiring a new identity.4) Despite not being a unanimous fact, most researchers maintain that the narrative has a universal character; however, it is also recognized that narrative forms are culturally dependent; culture and temporal contexts generate interpretative frameworks that are unique. This landmark work expands the reflection on procedures that validate the interrelationship and mutual influence between the researcher and the investigated individual, also emphasizing the profound need for an ethical and respectful act when inquiring into and with otherness, a motivation that has inspired us to procure the design of our instrument, rigorously complying with the methodological processes described for such purposes, reflecting since its creation the interest in the participation, leadership and their validation in the elderly people.5) It is worth noting the importance of increasing culturally diverse studies that detach from the Anglo-Saxon tradition. The experiences related to the use of personal narratives in socio-anthropological contexts are important, such as the proposals of Brazilian authors such as Ecléa Bosi in Colombia, allowed us to reflect on the undeniable clinical contribution of structured instruments to exhaustively characterize the quantification of autobiographical events in the reports of normal typical populations of institutionalized and non-institutionalized older adults, during defined periods of life, establishing a counterpoint concerning the scope of less hegemonic qualitative approaches, such as the one in this proposal. Also, the phenomenological studies of Lolich in Argentina enrich the perspectives with other qualitative aspects, such as the use of an interpretive paradigm under the principles of the theory based on the narrative of events. There is still an interesting line of work that is relatively more recent, which has ventured into the exploration of digital channels and computerized social networks, being a fact that the adult population, far from remaining static in the face of modern advances, is increasingly permeable to technology and the different digital resources as emerging media in the expression of identity.On the other hand, works such as that of Campo. The communality of autobiographical interviews comes from requesting narratives of memories contextualized by circumstantial elements, emphasizing the quality of aspects such as their emotional valence, the time-space coordinates, the perspective from which they are evoked , among others. This shows an important challenge for the discipline of speech-language therapy, interested in moving towards an appreciation of communication as a constitutive and integral element of the human being while recognizing the complexity of carrying out an activity as intimate and personal as remembering the paradigm that it exists behind any condition of traditional clinical care.Finally, it is recognized that establishing a communicative relationship of warmth and closeness generates a solid therapeutic bond, which facilitates deepening into the dimensions that affect the individual, which results as an adherence factor for this bond, allowing better management tools that impact people's quality of life. This study has limitations related to being more deeply embedded in the assessment of subjective well-being involved in the dialogical act of remembering, as well as not deepening more directly into elements of community participation and/or those of the relationship with other dimensions of interest in health, such as the experience of illness, mourning or physical painAutobiographical interviews are positioned as tools of interest for professionals who work with elderly people, given the versatility and comprehensiveness that this instrument grants to exploration; Its clinical use may be limited, among others, due to lack of knowledge, apprehensions regarding its extension or fear of being overwhelmed by information, which is not traditionally oriented towards impediments and disabilities, which may lead the clinician to prefer to dismiss them. In this case, the facilitations granted by the conversational tenor of an interview with an autobiographical orientation favor the naturalness of the personal story, the specific emphasis that each one gives to the facts/events, in which the phenomena gain validity, interest, and value of a unique way, a situation that traditional procedures mask since they are usually conducted under an interrogation format.However, there are professionals in Speech-language therapy who have been sufficiently visionary to build disciplinary knowledge based on the different contributions that the concepts of functionality, well-being, and participation have meant for the beneficiaries, along with a strong incorporation of a practice each time more evidence-based. This promising scenario allows the Autobiographical Interview to be an alternative that enables highly desirable clinical competencies such as the capacity for self-reflection and empathy in clinicians, as well as allowing our beneficiaries a truly comprehensive linguistic-communicative intervention, incorporating into the tradition of practice, the concern to offer scaffolding for the self-determination of identity, collective empowerment, the search for generativity, transcendence, and life purpose in the older age population. . Se han descrito importantes obras de referencia sobre el tema, principalmente desde la medicina y la psicología avanzando oportunamente en procesos de estandarización para la determinación del grado de competencia de quien actúa como evaluador, así como su importancia para la toma de decisiones clínicas.Sin duda todo profesional reconoce la importancia de la entrevista y no tiene inconvenientes en categorizarla como una herramienta clínica fundamental al momento de obtener información y datos de un paciente, elemento fundamental para cumplir con estándares de calidad sugeridos por la práctica basada en la evidencia en la actuación fonoaudiológica y que además releve el carácter dialógico de la relación que dicho profesional establece con los beneficiarios de sus prestaciones.En este contexto y específicamente para la Fonoaudiología, la generación de un vínculo de comunicación efectivo y de calidad es una premisa fundamental para la relación clínico - persona/paciente. Los lineamientos, organización y estructura de las entrevistas clínicas son rápidamente implementados como parte de las competencias más básicas de la formación de pregrado, incorporado diversos mecanismos para asegurar la estandarización y calidad de esta herramientaEn general, las entrevistas clínicas han sido hegemonizadas por lineamientos del modelo biomédico, centrándose en la cuantificación de síntomas y signos propios a diferentes condiciones patológicas posibles, siendo escasa la implementación de una herramienta específica basada en la exploración de las connotaciones fenomenológicas que las personas atribuyen a los diferentes elementos autobiográficos vivenciados a lo largo del ciclo vital y su impacto en la situación de vida presente y futura.. Esto parte con el proceso de entrevista: las facilitaciones otorgadas por el tenor conversacional de una entrevista con orientación autobiográfica favorecen la naturalidad del relato personal, el énfasis especifico que cada uno les da a los hechos/acontecimientos, con lo que los fenómenos cobran vigencia, interés y valor de un modo único, situación que los procedimientos tradicionales enmascaran, pues suelen ser conducidos bajo un formato de interrogación.Una comunicación efectiva entre clínico y paciente constituye la base sobre la que será factible establecer metas colaborativas y negociar objetivos terapéuticos relevantes para todos los interesados.En este contexto, una entrevista autobiográfica recaba información potencialmente relevante sobre situaciones, contextos y experiencias que la persona ha vivenciado. Si bien varios investigadores y clínicos han desarrollado instrumentos basados en desde estas tradiciones, es fundamental diferenciar claramente los objetivos perseguidos por cada instrumento, así como sus características, orientaciones y limitaciones. En consecuencia, el objetivo de este trabajo consistió en validar una propuesta de Entrevista Autobiográfica para adultos mayores.Aunque en los últimos años ha aumentado el uso de entrevistas narrativas al momento de explorar dimensiones más fenomenológicas de la vida de las personas que asumen el rol de pacientes, su uso sigue siendo infrecuente, pese a representar una positiva forma de reconstruir cómo las condiciones actuales pueden ser interpretadas en el contexto de vida de esa personaEsta investigación posee un enfoque psicométrico, inscribiéndose a un estudio observacional cuantitativo, con un diseño no experimental de corte transversal. Organizacionalmente, se estructuró en 4 etapas: diseño, validación, preparación del protocolo de administración de la entrevista y su aplicación piloto.,9, manteniendo la atención sobre la interacción que se cumple dentro del formato dialógico. En particular, la elaboración del instrumento se adecuó a la hermenéutica del análisis fenomenológico interpretativo.Se desarrolló un formato de entrevista semiestructurada, apoyándose en los referentes teóricos que consideran la historia de vida como eje significativo para el desarrolloLa entrevista autobiográfica original constaba de un pool de 22 preguntas que se adscribían a inquirir sobre las experiencias; 11 para revisión de vida y 11 para la prospección de futuro.Las preguntas diseñadas fueron sometidas a validación por un total de 28 jueces, conformado por un grupo de profesionales fonoaudiólogos  y un grupo de adultos mayores de la comunidad .Los criterios de inclusión para el grupo de profesionales fueron:● Ser fonoaudiólogos titulados.● Poseer al menos cinco años de experiencia de trabajo directo con personas mayores, con una carga horaria no menor a 11 horas; o● Participar por al menos cinco años en actividades de voluntariado comunitarias - agrupaciones para personas mayores.Para el grupo de jueces adultos mayores, los criterios de inclusión fueron:● Tener una edad mayor o igual a 60 años;● Contar con al menos ocho años de escolaridad (ya sea continua o discontinua);● Estar inscrito en la unidad de atención primaria de salud de su comuna;● Participar activamente (por lo menos con un año de antigüedad) en alguna agrupación social comunitaria;● Encontrarse retirado de sus actividades laborales (jubilados);● Poseer una acuidad auditiva y visual acorde a las actividades solicitadas o en su defecto, contar con las adaptaciones correspondientes;● Acreditar un estatus cognitivo, funcional y emocional dentro de valores típicos:.Puntaje 1 en la Global Deterioration Scale - GDS.Puntuaciones mayores o iguales a 23 puntos en el Minimental State Examination - MMSE.Puntuaciones menores o iguales a 6 en el Pfeffer Functional Activities Questionnaire - PFAQ.Puntuaciones menores o iguales a 4 en el Cuestionario de Salud General de Goldberg-12Sin antecedentes médicos de: accidente cerebrovascular, traumatismo encéfalo-craneano, enfermedades neurológicas progresivas - neurodegenerativas y/o trastornos neuropsiquiátricos.Sin encontrarse en tratamiento con psicofármacos.● Participar por al menos tres años en actividades de voluntariado comunitarias y/o en agrupaciones para personas mayores de la comunidad..Para cuantificar la representatividad de los ítems propuestos en el paso anterior, se calculó la razón de validez de contenido (RVC), según el procedimiento clásico descrito por Lawshe (1975), empleando una escala de evaluación de tres elementos: esencial; útil pero prescindible; e innecesario. Se destaca que la RVC es un indicador fácil de calcular e interpretar, siendo capaz de aportar información tanto a nivel de ítem como del instrumento propuesto. La RVC oscila entre -1 y +1, siendo las puntuaciones positivas las que indican una mayor representatividad de los ítemsDespués de seleccionar los ítems con el procedimiento indicado anteriormente, se desarrolló un protocolo de aplicación para la entrevista autobiográfica, como una orientación circunscrita para el entrevistador. Al tratarse de una situación dialógica, la idea es mantener la estructura genérica sin caer en el estereotipo de una entrevista clínica.El protocolo describe la ejecución de la entrevista en tres fases: 1. contextualización del proceso; 2. Exploración propiamente tal de la entrevista, con dos subcomponentes: (a) Exploración de la relevancia de los recuerdos para el presente - futuro; y (b) Exploración de la relevancia del futuro en el presente y su prospección y 3. Proceso de Cierre. Se consideró un tiempo aproximado de 50 minutos - una hora, resguardando así, no superar la temporalidad característica de las actividades de estimulación cognitiva que reciben los adultos mayores en los centros comunitarios.. Con esto se pretende asegurar la coherencia y organización al momento de administrarla, puesto que es posible constatar que en la medida en que la persona avanza en las preguntas, aparece una “profundización natural” de la información, desde apreciaciones de orden general hacia los recuerdos propiamente autobiográficos. Debe destacarse además que el entrevistador ha de mantenerse siempre en un papel de neutralidad y escucha activa, descartando la formulación de juicios e interviniendo de modo mínimo, a fin de no entorpecer ni sesgar la narrativa del entrevistado.La estructuración del protocolo de la entrevista constituye un garante de sistematización a fin de asegurar su replicabilidadConsidera como actividades la apertura de la entrevista, la ejecución de una línea de vida, que incorpora la referencia a etapas de vida y/o a eventos significativos en las etapas de vida y una pregunta de contextualización.La apertura al tema inicia un encuadre, enfocando a la figura del adulto mayor en la sociedad presente, favoreciendo la naturalidad de la interacción al mantenerse permeable al diálogo y/o a diferentes tipos de comentarios emergentes.La construcción de la línea de vida y sus referencias a eventos se definió para reforzar la idea de continuidad y dirección del tiempo, además de rescatar el encuadre que cada individuo define y reconoce como relevante (etapas de vida - eventos de vida). Esto permite apreciar la atribución de tiempo que cada persona establece para los eventos - etapas e incluso, entrega una forma de estimación para lo que la persona define como “el resto de la vida”, lo que es particularmente interesante al contrastar dicha proporción con la estimación concreta que las personas hacen de su tiempo futuro en cifras. Esta gráfica ha de estar siempre disponible como forma de apoyo o reforzamiento visual durante la entrevista., es necesario respetar la connotación otorgada por la persona y además relevar el sentido constructivo de las experiencias vividas, aduciendo que la perspectiva del tiempo permite ver cómo una situación negativa no pierde su condición de negatividad, sino que ha aportado a construir valores, resiliencia, previsión, autocuidado, entre otros, según sea el caso.Cabe destacar que, aunque siempre se debe enfatizar en la valencia positiva de los recuerdos, las personas evocan tanto aspectos positivos como negativos en sus historias, llegando incluso a compartirlos espontáneamente. Aunque la literatura reporta esta situación y dado que es imposible establecer un control de la valencia afectiva del recuerdoDebe aclararse que no se trata de “volver positivo un recuerdo negativo”. El objetivo es observar el recuerdo en su contexto y con perspectiva temporal. De todos modos, se incorporan medidas de seguimiento durante el cierre que se discutirán más adelante, a fin de identificar y proponer acciones para manejar cualquier posible conducta de rumia.En la fase de exploración - proyección de recuerdos se parte solicitando la identificación del recuerdo más antiguo del que se tiene memoria. Se pregunta directamente por dicho recuerdo y se solicita su narración. Posteriormente, se realizan las preguntas centrales de la entrevista, enfatizando en la mayor especificidad posible e invitando a adentrarse en la relevancia que reflejan los recuerdos en los contextos temporales., según la taxonomía del modelo clásico de Recuerdos de Conway, a saber:Para explorar la relación de las reminiscencias tanto con el presente como con el futuro se utiliza como apoyo una escala analógica visual de 1 a 10 (nada relevante - muy relevante - cambió mi vida). Toda la información es codificada para su posterior análisisRecuerdo Extendido: refieren a períodos extensos de vida que duran mucho más de un día, como pueden ser la infancia o la época del colegio.Recuerdo Categórico: acciones que se repiten o a categorías de eventos similares sin especificar ningún momento concreto , como pueden ser las navidades, los cumpleaños o las vacaciones de verano.Recuerdo Específico: describen a momentos concretos que se dan en un espacio y tiempo específicos y que pueden durar desde unos segundos hasta unas horas, como un examen, el nacimiento de un hijo o una celebración en particular. Generalmente estos recuerdos excepcionalmente tienen una extensión mayor a un día.Generalización del recuerdo: la incapacidad para recuperar recuerdos específicos en las situaciones en las que se necesitan es lo que se llama generalización del recuerdo. Más que un recuerdo, se trata de información de carácter semántico, juicios de valor, comentarios u opiniones respecto a una situación, por ejemplo: “mi infancia fue muy triste - solo tengo recuerdos felices de mi matrimonio, la gente de antes era más tranquila”.Al adentrarse en el papel del futuro y su prospección, se utilizan como elementos de contextualización las reminiscencias y las valoraciones previamente hechas. Se solicita cuantificar específicamente el espacio de tiempo futuro que el entrevistado visualiza, así como una exploración lo más precisa posible y evitando quedarse en comentarios del tipo “lo que dios quiera”, “hasta donde me dure la salud”. Se insta a profundizar en cuan relevante es el valor de los eventos pasados (reminiscencias) en la prospección, lo que puede apoyarse con la escala analógica visual mencionada previamente.Cabe destacar que esta fase de la entrevista es un espacio donde las intervenciones del entrevistador deben limitarse solo a facilitar la exploración detallada de cada recuerdo.En esta fase se facilita una autoevaluación de que es lo que el entrevistado ha reflexionado de sí mismo durante la entrevista. En la medida que la participación es más o menos activa se incentiva el proceso, rescatando los conceptos fundamentales que el entrevistado desarrolló en la fase anterior.Dado que rememorar ciertos episodios de vida o recuerdos podría generar algunos sentimientos de incomodidad o emocionalidad en el entrevistado es fundamental dar al entrevistado un espacio de seguridad y la oportunidad de expresarse. Se instruye específicamente en el uso del teléfono ante cualquier consulta o duda que se tenga respecto a los sentimientos o emociones que pudiese experimentar después de la entrevista. El entrevistado es informado al momento del consentimiento de esto, así como de dos llamadas de seguimiento que se realizan a las 48 horas y una semana respectivamente.Durante el contacto telefónico se aplica un breve cuestionario conformado por preguntas que orientan sobre el estado general del entrevistado. Los resultados de las preguntas orientan dos decisiones: visita al centro para derivación especializada o seguimiento de control por parte del programa comunitario. Se insiste siempre en que, ante cualquier duda o consulta, la persona puede acercarse en horarios de oficina al centro clínico o llamar por teléfono por sus inquietudes y/o solicitar una cita.Con el fin de aumentar la validez de los resultados, se realizó una triangulación metodológica. Concretamente, para la propuesta definitiva además de considerar la opinión y recomendaciones de los jueces especialistas y no especialistas, la entrevista fue testeada en una aplicación piloto para una muestra de 2 adultos mayores típicos, los que cumplían con los criterios de inclusión descritos en el apartado de jueces no especialistas. Cabe destacar que cada participante fue debidamente informado y dio su consentimiento.Se utilizó como insumo un cuestionario simple para conocer la apreciación de los entrevistados acerca de las 4 preguntas y comentarios validados por los jueces, mediante un escalamiento tipo Likert y un apartado para comentarios. Se evaluó la comprensibilidad por una parte y la extensión del protocolo por otra. El análisis de la comprensibilidad consideró las siguientes categorías: (i) clara y comprensible, (ii) difícil de entender y (iii) incomprensible. Por su parte, la extensión consideró una valoración de 5 grados, desde muy extensa-extenuante, hasta muy breve - insuficiente.Esta propuesta de Entrevista Autobiográfica se aplicó después de la aprobación otorgada por el Comité de Ética en Pesquisa de la Universidade Federal de Santa Maria, Brasil, Folio Nº 3.000.149. Todos los participantes firmaron además un formulario de consentimiento libre e informado.. Contrastado dicho índice con las preguntas propuestas, se definió una estructura compuesta por las 4 preguntas que superaron tal indicador. Estas 4 preguntas fueron incorporadas al instrumento, específicamente en la fase de entrevista propiamente tal  Desde la teoría más clásica, Ricoeur (1991) argumentaba que las historias fragmentan las experiencias en unidades menores, estableciendo inicios, desarrollos y finalidades que crean un paisaje temporal significativo, una narrativa va más allá de la cronología de los hechos expuestos, ya que se trata de una forma de conferirle sentido de completitud a las experiencias. Asimismo, la tradición metodológica cualitativa se ha visto particularmente enriquecida con el análisis fenomenológico interpretativo (AFI), dada su flexibilidad y orientación al participante. En sí, el AFI ofrece la oportunidad de que este se comprometa con el relato de las experiencias vividas, sin ser sujeto de restricciones o enjuiciamientos. Estos formatos de participación permeabilizan la interacción dialógica de la entrevista, pero también mantienen las narrativas dentro del espacio personal del que rememora, pues es él quien se hace protagonista y agente de su historia, relación crucial entre el recuerdo y la percepción de un proceso desarrollo identitario consistente y multidimensional.2º) El interés por las narrativas personales constituye un amplísimo marco de oportunidad para la investigación cualitativa en ciencias de la salud, a fin de desarrollar e integrar los contextos sociales, clínicos e interpersonales que están más allá de los estándares y valores cuantificables3º) A diferencia de cualquier otra tarea de exploración de la memoria, las evaluaciones de su componente autobiográfico requieren de una importante y rigurosa protocolización, puesto que por su naturaleza escapan ampliamente de las condiciones de control que intervienen en otro tipo de evaluaciones.; los relatos establecidos son recreados interpretativamente, por tanto, la lógica de los hechos pasa a una paráfrasis donde existirán decisiones connotativas, de valor, carácter y profundidad junto a muchas otras antes de siquiera adentrarse en los aspectos lingüísticos más formales de la organización del discurso.La comunalidad en todas las entrevistas autobiográficas está en solicitar la narración de un recuerdo y sus elementos circunstanciales, descritos del modo más detallado posible, enfatizando en la calidad de aspectos tales como su valencia emocional, coordenadas de tiempo - espacio, perspectiva desde donde se evoca , entre otras. Esto también considera lo complejo que es llevar esta actividad tan íntima y personal al paradigma experimental que existe detrás de cualquier condición de laboratorio. Además, dado que las narrativas se sustentan bajo la fenomenología de los recuerdos enunciados, es plausible profundizar e imbricarse directamente con las concepciones individuales y manifiestas que las experiencias de los individuos develan sobre sí mismos en el tiempo y sobre cómo dichos recuerdos nos hablan de quienes son, de la construcción de su identidad y de su estado de bienestar subjetivo.También es relevante recordar que los relatos autobiográficos representan un “viaje en el tiempo”, es decir, un desplazamiento de la conciencia hacia otro momento del continuo temporal y que además de desempeñar una función propia  se materializará en un acto de comunicación que dependerá de reglas específicas para su co-construcción, recursividad y forma, como se comprenden los modelos de competencia comunicativa. El trabajo de McAdams y otros marca una transición entre las concepciones narrativas enfocadas en universales casi arquetípicos y los estudios de identidades focalizadas en los procesos, los contextos y la cultura de los individuos. Tiene sentido entonces comprender cómo actúan las representaciones y estereotipos sociales, así como recalcar en los diferentes aspectos comunicativos y contextuales que se dan en la interacción de la entrevista y en el contexto de la reminiscencia como actividad. Un ejemplo de esto proviene de las narrativas de personas en situación de discapacidad, donde los eventos trazan un proceso de adquisición de una nueva identidad.4º) Pese a no ser un hecho completamente unánime, la mayoría de los investigadores sostiene que la narrativa posee un carácter universal; no obstante, también se reconoce que las formas narrativas son culturalmente dependientes; la cultura y los contextos temporales generan marcos interpretativos que son únicos. Este trabajo señero, expande la reflexión sobre procedimientos que validen la interrelación y mutua influencia entre investigador e individuo investigado, enfatizando además en la profunda necesidad de un actuar ético y respetuoso al momento de indagar en y con las alteridades, motivación que nos ha inspirado al procurar el diseño de nuestro instrumento, cumpliendo rigurosamente con los procesos metodológicos descritos para tales fines, reflejando desde su creación el interés por la participación, protagonismo y validación de los mismos de los adultos mayores.5º) Cabe destacar la importancia de incrementar estudios culturalmente diversos, que se desapeguen de la tradición anglosajona. Son importantes las experiencias relacionadas con el uso de narrativas personales en contextos socio-antropológicos como las propuestas de autores brasileños como Ecléa Bosi en Colombia, permitieron reflexionar sobre el innegable aporte clínico de instrumentos estructurados para caracterizar exhaustivamente la cuantificación de eventos autobiográficos en los relatos de poblaciones normales o típicas de adultos mayores institucionalizados y no institucionalizados, durante periodos definidos de vida, estableciendo un contrapunto respecto a los alcances de los enfoques cualitativos, menos hegemónicos, como el de la presente propuesta. Asimismo, los estudios de corte fenomenológico de Lolich en Argentina, enriquecen las perspectivas con otras vertientes cualitativas, como lo es el uso del paradigma interpretativo bajo los principios de la teoría fundamentada en el relato de eventos. Todavía hay una interesante línea de trabajo relativamente más reciente, que ha incursionado en la exploración de los canales digitales y redes sociales informatizadas, siendo un hecho que la población adulta, lejos de permanecer estática ante los avances de la modernidad, está cada vez más permeable ante la tecnología y los diferentes recursos digitales como medios emergentes en la expresión de la identidad.Por otra parte, trabajos como el de Campo. La comunalidad de entrevistas autobiográficas deviene de solicitar narrativas de recuerdos contextualizados por elementos circunstanciales, enfatizando en la calidad de aspectos tales como su valencia emocional, las coordenadas de tiempo - espacio, la perspectiva desde donde se evocan , entre otros. Esto plantea un importante desafío para la disciplina de la fonoaudiología, interesada en transitar hacia una valoración de la comunicación como elemento constitutivo e integral del ser humano, reconociendo a la vez lo complejidad de llevar una actividad tan íntima y personal como el rememorar al paradigma que existe detrás de cualquier condición de atención clínica tradicional.Finalmente, se reconoce que entablar una relación comunicativa de calidez y cercanía, genera un vínculo terapéutico sólido, que facilita el profundizar en las dimensiones que afectan al individuo, lo que redunda como un factor de adherencia para dicho vínculo, permitiendo así gestionar de mejor modo herramientas que impacten sobre la calidad de vida de las personas. Este estudio presenta limitaciones relacionadas con imbricarse con mayor profundidad en la valoración del bienestar subjetivo involucrado en el acto dialógico de recordar, así como también por no profundizar de un modo más directo en elementos de participación comunitaria y/o propios de la relación con otras dimensiones de interés en salud, como lo es la vivencia de la enfermedad, el duelo o el dolor físicoLas entrevistas autobiográficas se sitúan como herramientas de interés para los profesionales que trabajan con personas mayores, dada la versatilidad e integralidad que este instrumento otorga a la exploración; su uso en clínica puede verse limitado entre otros por falta de conocimiento, aprehensiones respecto a su extensión o por temor a verse sobrepasado por información, que no al no está tradicionalmente orientada hacia los impedimentos y dishabilidades pueden hacer que el clínico prefiera desestimarlas. En este caso, las facilitaciones otorgadas por el tenor conversacional de una entrevista con orientación autobiográfica favorecen la naturalidad del relato personal, el énfasis especifico que cada uno les da a los hechos/acontecimientos, con lo que los fenómenos cobran vigencia, interés y valor de un modo único, situación que los procedimientos tradicionales enmascaran, pues suelen ser conducidos bajo un formato de interrogación.No obstante, hay profesionales en la Fonoaudiología que han sido lo suficientemente visionarios para construir conocimiento disciplinar basado en los diferentes aportes que las concepciones de funcionalidad, bienestar y participación han significado para los beneficiarios, a la par de una fuerte incorporación de una práctica cada vez más basada en la evidencia. Este promisorio escenario permite que la Entrevista Autobiográfica sea una alternativa que habilite competencias clínicas altamente deseables como son la capacidad de autorreflexión y empatía en los clínicos, así como permitirle a nuestros beneficiarios una intervención lingüístico - comunicativa verdaderamente integral, incorporando a la tradición de práctica, la preocupación de ofrecer un andamiaje para la autodeterminación de la identidad, el empoderamiento colectivo, la búsqueda de generatividad, trascendencia y propósito de vida en la población etaria más envejecida.


In the recent article by Schloesing et al. , the autElodie Schloesing| Alexandre Caron | Rémi Chambon| Nicolas Courbin| Morgane Labadie| Roch Nina | Frida Mouiti Mbadinga | Wilfrid Ngoubili |Danficy Sandiala | N'Kaya Tobi | Mathieu Bourgarel | Hélène M. De Nys | Julien Cappelle.The online version has been corrected online.