Chizuru Misago

Características sócio-demográficas, reprodutivas e médicas de mulheres admitidas por aborto em hospital da Região Sul do Brasil

No Brasil, a inducao do aborto e legalmente permitida somente quando necessaria para salvar a vida da mulher ou quando a concepcao ocorreu de estupro. Apesar das restricoes legais, morais e religiosas, a inducao do aborto e amplamente praticada. Com o objetivo de identificar as caracteristicas do aborto incompleto nas mulheres admitidas na maternidade publica de Florianopolis, foram entrevistadas 620 mulheres, entre 1o de julho de 1993 e 30 de junho de 1994. Com base em dados coletados por meio de questionario estruturado, sao apresentadas caracteristicas socio-demograficas, reprodutivas e medicas dos abortos, classificados como certamente provocados, possivelmente provocados e espontâneos. Entre os 141 casos de aborto provocado, cerca de 50% das mulheres reportaram uso isolado do Cytotec® (misoprostol), ou deste associado a outro metodo abortivo. Os resultados revelam que na populacao estudada a inducao do aborto e pratica comum entre mulheres jovens, solteiras ou sem parceiro estavel, de bom nivel de escolaridade e nao usuarias de metodos anticonceptivos. Foi tambem registrada uma reducao do numero de complicacoes graves relacionadas ao aborto provocado admitido ao hospital.

Determinantes do aborto provocado entre mulheres admitidas em hospitais em localidade da região Nordeste do Brasil

Com o objetivo de identificar os determinantes do aborto provocado entre mulheres admitidas por complicacoes decorrentes dos abortos, nos hospitais-maternidades publicos em Fortaleza, CE (Brasil) foram entrevistadas 4.359 pacientes entre 1o de outubro de 1992 e 30 de setembro de 1993. Os dados foram coletados atraves de questionario estruturado. Sao apresentados os determinantes dos abortos provocados em 2.084 (48%) mulheres classificadas como tendo induzido aborto. Dois tercos (66%) das mulheres relataram a inducao do aborto com o uso isolado do Cytotec(R) (misoprostol) ou associado a outro meio abortivo. Os resultados indicam que, na populacao estudada, a inducao do aborto e pratica comum entre jovens, solteiras (ou que vivem sem um parceiro estavel), de baixa paridade, com escolaridade incipiente e nao-usuarias de metodos contraceptivos. Recomenda-se a realizacao de estudos que investiguem os conhecimentos relacionados a percepcoes, conceitos culturais do aborto, e as razoes por que mulheres pobres fracassam na adocao de metodos de planejamento familiar.

Uso da aspiração manual a vácuo na redução do custo e duração de internamentos por aborto incompleto em Fortaleza, CE, Brasil

INTRODUCAO: O uso de aspiracao a vacuo (AV) no tratamento do aborto incompleto e pratica bastante difundida em paises desenvolvidos. Varios estudos nesses paises indicam que o uso da tecnica de aspiracao manual a vacuo (AMV) pode conservar recursos do sistema de saude e melhorar a qualidade do tratamento do aborto. No Brasil, o uso da AMV e procedimento de rotina nos hospitais e clinicas privados. Entretanto, na maioria dos hospitais da rede publica e utilizada somente a tecnica de dilatacao e curetagem (D&C). METODOLOGIA: Foram utilizados metodos de avaliacao rapida para estimar a variacao do custo medio do tratamento e duracao da estadia hospitalar, em um grupo de 30 pacientes admitidas com aborto incompleto em hospital publico de Fortaleza, CE (Brasil). Participantes foram alocadas, randomicamente, em um dos dois grupos de tratamento investigados (AMV ou D&C). RESULTADOS E CONCLUSOES: Os resultados sugerem que o uso da AMV, em substituicao a D&C, no tratamento do aborto incompleto, pode reduzir em ate 41% o custo medio do tratamento e em 77% o tempo medio de hospitalizacao. Recomenda-se a realizacao de estudos confirmatorios, como tambem que se aprofunde os conhecimentos sobre a percepcao do aborto e seu tratamento por parte do pessoal de saude e da populacao feminina.INTRODUCAO: O uso de aspiracao a vacuo (AV) no tratamento do aborto incompleto e pratica bastante difundida em paises desenvolvidos. Varios estudos nesses paises indicam que o uso da tecnica de aspiracao manual a vacuo (AMV) pode conservar recursos do sistema de saude e melhorar a qualidade do tratamento do aborto. No Brasil, o uso da AMV e procedimento de rotina nos hospitais e clinicas privados. Entretanto, na maioria dos hospitais da rede publica e utilizada somente a tecnica de dilatacao e curetagem (D&C). METODOLOGIA: Foram utilizados metodos de avaliacao rapida para estimar a variacao do custo medio do tratamento e duracao da estadia hospitalar, em um grupo de 30 pacientes admitidas com aborto incompleto em hospital publico de Fortaleza, CE (Brasil). Participantes foram alocadas, randomicamente, em um dos dois grupos de tratamento investigados (AMV ou D&C). RESULTADOS E CONCLUSOES: Os resultados sugerem que o uso da AMV, em substituicao a D&C, no tratamento do aborto incompleto, pode reduzir em ate 41% o custo medio do tratamento e em 77% o tempo medio de hospitalizacao. Recomenda-se a realizacao de estudos confirmatorios, como tambem que se aprofunde os conhecimentos sobre a percepcao do aborto e seu tratamento por parte do pessoal de saude e da populacao feminina.INTRODUCTION In most developed countries vacuum aspiration has been shown to be safer and less costly than sharp curettage (SC) for uterine evacuation. In many of the developing countries, including Brazil, sharp curettage (SC) is the most commonly used technique for treating cases of incomplete abortion admitted to hospital. The procedure often involves light to heavy sedation for pain control and an overnight hospital stay for patient recuperation and monitoring. Two hypotheses are examined: the first, that the use of manual vacuum aspiration (MVA)--a variation of the vacuum aspiration, would be less costly than SC for the treatment of cases of incomplete abortion admitted to hospital; and the second, that the treatment of incomplete abortion with MVA would substantially reduce the length of hospital stay. METHODOLOGY Thirty women with diagnosis of first trimester incomplete abortion were randomly allocated to the SC or MVA group. Rapid-assessment data collection techniques were used to identify factors that contributed to cost reduction and hospital stay. RESULTS AND CONCLUSION The results of the study show that, overall, patients treated for incomplete abortion with MVA spent 77% less time in the hospital and consumed 41% fewer resources than similarly diagnosed patients treated with SC. Recommendations are made as to the need of certain changes in patient management. Particularly necessary is information regarding cultural perception and concepts of abortion treatment.INTRODUCTION: In most developed countries vacuum aspiration has been shown to be safer and less costly than sharp curettage (SC) for uterine evacuation. In many of the developing countries, including Brazil, sharp curettage (SC) is the most commonly used technique for treating cases of incomplete abortion admitted to hospital. The procedure often involves light to heavy sedation for pain control and an overnight hospital stay for patient recuperation and monitoring. Two hypotheses are examined: the first, that the use of manual vacuum aspiration (MVA) - a variation of the vacuum aspiration, would be less costly than SC for the treatment of cases of incomplete abortion admitted to hospital; and the second, that the treatment of incomplete abortion with MVA would substantially reduce the length of hospital stay. METHODOLOGY: Thirty women with diagnosis of first trimester incomplete abortion were randomly allocated to the SC or MVA group. Rapid-assessment data collection techniques were used to identify factors that contributed to cost reduction and hospital stay. RESULTS AND CONCLUSION: The results of the study show that, overall, patients treated for incomplete abortion with MVA spent 77% less time in the hospital and consumed 41% fewer resources than similarly diagnosed patients treated with SC. Recommendations are made as to the need of certain changes in patient management. Particularly necessary is information regarding cultural perception and concepts of abortion treatment.

Adoption of manual vacuum aspiration for treatment of incomplete abortion reduces costs and duration of patient's hospital stay in an urban area of Northeastern Brazil

INTRODUCAO: O uso de aspiracao a vacuo (AV) no tratamento do aborto incompleto e pratica bastante difundida em paises desenvolvidos. Varios estudos nesses paises indicam que o uso da tecnica de aspiracao manual a vacuo (AMV) pode conservar recursos do sistema de saude e melhorar a qualidade do tratamento do aborto. No Brasil, o uso da AMV e procedimento de rotina nos hospitais e clinicas privados. Entretanto, na maioria dos hospitais da rede publica e utilizada somente a tecnica de dilatacao e curetagem (D&C). METODOLOGIA: Foram utilizados metodos de avaliacao rapida para estimar a variacao do custo medio do tratamento e duracao da estadia hospitalar, em um grupo de 30 pacientes admitidas com aborto incompleto em hospital publico de Fortaleza, CE (Brasil). Participantes foram alocadas, randomicamente, em um dos dois grupos de tratamento investigados (AMV ou D&C). RESULTADOS E CONCLUSOES: Os resultados sugerem que o uso da AMV, em substituicao a D&C, no tratamento do aborto incompleto, pode reduzir em ate 41% o custo medio do tratamento e em 77% o tempo medio de hospitalizacao. Recomenda-se a realizacao de estudos confirmatorios, como tambem que se aprofunde os conhecimentos sobre a percepcao do aborto e seu tratamento por parte do pessoal de saude e da populacao feminina.INTRODUCAO: O uso de aspiracao a vacuo (AV) no tratamento do aborto incompleto e pratica bastante difundida em paises desenvolvidos. Varios estudos nesses paises indicam que o uso da tecnica de aspiracao manual a vacuo (AMV) pode conservar recursos do sistema de saude e melhorar a qualidade do tratamento do aborto. No Brasil, o uso da AMV e procedimento de rotina nos hospitais e clinicas privados. Entretanto, na maioria dos hospitais da rede publica e utilizada somente a tecnica de dilatacao e curetagem (D&C). METODOLOGIA: Foram utilizados metodos de avaliacao rapida para estimar a variacao do custo medio do tratamento e duracao da estadia hospitalar, em um grupo de 30 pacientes admitidas com aborto incompleto em hospital publico de Fortaleza, CE (Brasil). Participantes foram alocadas, randomicamente, em um dos dois grupos de tratamento investigados (AMV ou D&C). RESULTADOS E CONCLUSOES: Os resultados sugerem que o uso da AMV, em substituicao a D&C, no tratamento do aborto incompleto, pode reduzir em ate 41% o custo medio do tratamento e em 77% o tempo medio de hospitalizacao. Recomenda-se a realizacao de estudos confirmatorios, como tambem que se aprofunde os conhecimentos sobre a percepcao do aborto e seu tratamento por parte do pessoal de saude e da populacao feminina.INTRODUCTION In most developed countries vacuum aspiration has been shown to be safer and less costly than sharp curettage (SC) for uterine evacuation. In many of the developing countries, including Brazil, sharp curettage (SC) is the most commonly used technique for treating cases of incomplete abortion admitted to hospital. The procedure often involves light to heavy sedation for pain control and an overnight hospital stay for patient recuperation and monitoring. Two hypotheses are examined: the first, that the use of manual vacuum aspiration (MVA)--a variation of the vacuum aspiration, would be less costly than SC for the treatment of cases of incomplete abortion admitted to hospital; and the second, that the treatment of incomplete abortion with MVA would substantially reduce the length of hospital stay. METHODOLOGY Thirty women with diagnosis of first trimester incomplete abortion were randomly allocated to the SC or MVA group. Rapid-assessment data collection techniques were used to identify factors that contributed to cost reduction and hospital stay. RESULTS AND CONCLUSION The results of the study show that, overall, patients treated for incomplete abortion with MVA spent 77% less time in the hospital and consumed 41% fewer resources than similarly diagnosed patients treated with SC. Recommendations are made as to the need of certain changes in patient management. Particularly necessary is information regarding cultural perception and concepts of abortion treatment.INTRODUCTION: In most developed countries vacuum aspiration has been shown to be safer and less costly than sharp curettage (SC) for uterine evacuation. In many of the developing countries, including Brazil, sharp curettage (SC) is the most commonly used technique for treating cases of incomplete abortion admitted to hospital. The procedure often involves light to heavy sedation for pain control and an overnight hospital stay for patient recuperation and monitoring. Two hypotheses are examined: the first, that the use of manual vacuum aspiration (MVA) - a variation of the vacuum aspiration, would be less costly than SC for the treatment of cases of incomplete abortion admitted to hospital; and the second, that the treatment of incomplete abortion with MVA would substantially reduce the length of hospital stay. METHODOLOGY: Thirty women with diagnosis of first trimester incomplete abortion were randomly allocated to the SC or MVA group. Rapid-assessment data collection techniques were used to identify factors that contributed to cost reduction and hospital stay. RESULTS AND CONCLUSION: The results of the study show that, overall, patients treated for incomplete abortion with MVA spent 77% less time in the hospital and consumed 41% fewer resources than similarly diagnosed patients treated with SC. Recommendations are made as to the need of certain changes in patient management. Particularly necessary is information regarding cultural perception and concepts of abortion treatment.

Factors related to child care increase the risk of pneumonia among children living in a poor community in northeast Brazil.

A case-control study in a Brazilian city looked at the increased risk of pneumonia faced by children under age 2 who stayed in day care centers while their mothers were employed. The 650 cases received a radiological diagnosis of pneumonia from the main pediatric hospitals and the 650 controls were of the same age and neighborhood as the cases. It was found that mothers paid employment outside of the house independently increased the occurrence of pneumonia. Risk increased 1.8 times for children whose mothers worked 75% more of the time since the birth than other mothers and attendance at a day care center increased risk more than five times. This may be caused by stress experienced by the child as well as by inappropriate child care practices and increased exposure to pathogens. Since the number of children attending day care centers is increasing it is urgent to devise ways to design and manage day care centers to minimize the risk of pneumonia.

Out-patient drug treatment of pneumonia among children under two years of age in Fortaleza, Brazil

Results are reported from a study on drug use in treatment of children with pneumonia in a pediatric hospital in the city of Fortaleza, Northeastern Brazil. There were 171 out-patients; prescription details were obtained for 149. The most commonly prescribed antimicrobial drug was procaine penicillin, accounting for 33% of antimicrobial prescriptions, followed by benzathine penicillin (31%), ampicillin or amoxicillin (12%), and cotrimoxazole (8%). Benzathine penicillin was frequently given with other drugs, but was the sole antimicrobial agent for 31 children. Compliance with antimicrobial treatment was 52% overall and was higher for the injectables. Prescription patterns varied from child to child, and children were often prescribed more than one antimicrobial in the same or repeat prescriptions; combining this information with compliance, 81 (54%) of the children were estimated to have received 5 or more days of appropriate antimicrobial treatment for pneumonia. This percentage is not high, and five days were often reached after using more than one antimicrobial and after repeat visits. The authors concluded that the need remains for simple antimicrobial regimes, attractive to comply with, that can be expected to be consistently used. Other drugs were chiefly analgesics and bronchodilators.

Creating safety with the social model of birth

Since 1987 the Safe Motherhood Initiative has been the central theme of international work on maternal care. When taken up by the WHO it was hoped that maternal mortality rates would be halved by the year 2000. In view of this many strategies at national levels worldwide relied on the medical model of birth highlighting hospital-based care for pregnant women. However it is noted that this model had unfortunate consequences. In several settings it has led to the exclusion of the skills of the traditional midwife and of birth technologies that work with the women to ensure a better birth outcome. Hence it is argued that the social model of birth in its many locally diverse forms can lead to far more effective support for women at critical moments in pregnancy and labor and thus fully support womens overall well-being. Use of evidence-based care in documentations supports this logic by underlining the importance of the social model of birth. Thus it is believed that there is a need for a close examination of workable carefully assessed strategies that are used in nonmedical settings by community-based caregivers and a reintegration of these strategies into Safe Motherhood approaches.

Revista de Saúde Pública

INTRODUCAO: O uso de aspiracao a vacuo (AV) no tratamento do aborto incompleto e pratica bastante difundida em paises desenvolvidos. Varios estudos nesses paises indicam que o uso da tecnica de aspiracao manual a vacuo (AMV) pode conservar recursos do sistema de saude e melhorar a qualidade do tratamento do aborto. No Brasil, o uso da AMV e procedimento de rotina nos hospitais e clinicas privados. Entretanto, na maioria dos hospitais da rede publica e utilizada somente a tecnica de dilatacao e curetagem (D&C). METODOLOGIA: Foram utilizados metodos de avaliacao rapida para estimar a variacao do custo medio do tratamento e duracao da estadia hospitalar, em um grupo de 30 pacientes admitidas com aborto incompleto em hospital publico de Fortaleza, CE (Brasil). Participantes foram alocadas, randomicamente, em um dos dois grupos de tratamento investigados (AMV ou D&C). RESULTADOS E CONCLUSOES: Os resultados sugerem que o uso da AMV, em substituicao a D&C, no tratamento do aborto incompleto, pode reduzir em ate 41% o custo medio do tratamento e em 77% o tempo medio de hospitalizacao. Recomenda-se a realizacao de estudos confirmatorios, como tambem que se aprofunde os conhecimentos sobre a percepcao do aborto e seu tratamento por parte do pessoal de saude e da populacao feminina.INTRODUCAO: O uso de aspiracao a vacuo (AV) no tratamento do aborto incompleto e pratica bastante difundida em paises desenvolvidos. Varios estudos nesses paises indicam que o uso da tecnica de aspiracao manual a vacuo (AMV) pode conservar recursos do sistema de saude e melhorar a qualidade do tratamento do aborto. No Brasil, o uso da AMV e procedimento de rotina nos hospitais e clinicas privados. Entretanto, na maioria dos hospitais da rede publica e utilizada somente a tecnica de dilatacao e curetagem (D&C). METODOLOGIA: Foram utilizados metodos de avaliacao rapida para estimar a variacao do custo medio do tratamento e duracao da estadia hospitalar, em um grupo de 30 pacientes admitidas com aborto incompleto em hospital publico de Fortaleza, CE (Brasil). Participantes foram alocadas, randomicamente, em um dos dois grupos de tratamento investigados (AMV ou D&C). RESULTADOS E CONCLUSOES: Os resultados sugerem que o uso da AMV, em substituicao a D&C, no tratamento do aborto incompleto, pode reduzir em ate 41% o custo medio do tratamento e em 77% o tempo medio de hospitalizacao. Recomenda-se a realizacao de estudos confirmatorios, como tambem que se aprofunde os conhecimentos sobre a percepcao do aborto e seu tratamento por parte do pessoal de saude e da populacao feminina.INTRODUCTION In most developed countries vacuum aspiration has been shown to be safer and less costly than sharp curettage (SC) for uterine evacuation. In many of the developing countries, including Brazil, sharp curettage (SC) is the most commonly used technique for treating cases of incomplete abortion admitted to hospital. The procedure often involves light to heavy sedation for pain control and an overnight hospital stay for patient recuperation and monitoring. Two hypotheses are examined: the first, that the use of manual vacuum aspiration (MVA)--a variation of the vacuum aspiration, would be less costly than SC for the treatment of cases of incomplete abortion admitted to hospital; and the second, that the treatment of incomplete abortion with MVA would substantially reduce the length of hospital stay. METHODOLOGY Thirty women with diagnosis of first trimester incomplete abortion were randomly allocated to the SC or MVA group. Rapid-assessment data collection techniques were used to identify factors that contributed to cost reduction and hospital stay. RESULTS AND CONCLUSION The results of the study show that, overall, patients treated for incomplete abortion with MVA spent 77% less time in the hospital and consumed 41% fewer resources than similarly diagnosed patients treated with SC. Recommendations are made as to the need of certain changes in patient management. Particularly necessary is information regarding cultural perception and concepts of abortion treatment.INTRODUCTION: In most developed countries vacuum aspiration has been shown to be safer and less costly than sharp curettage (SC) for uterine evacuation. In many of the developing countries, including Brazil, sharp curettage (SC) is the most commonly used technique for treating cases of incomplete abortion admitted to hospital. The procedure often involves light to heavy sedation for pain control and an overnight hospital stay for patient recuperation and monitoring. Two hypotheses are examined: the first, that the use of manual vacuum aspiration (MVA) - a variation of the vacuum aspiration, would be less costly than SC for the treatment of cases of incomplete abortion admitted to hospital; and the second, that the treatment of incomplete abortion with MVA would substantially reduce the length of hospital stay. METHODOLOGY: Thirty women with diagnosis of first trimester incomplete abortion were randomly allocated to the SC or MVA group. Rapid-assessment data collection techniques were used to identify factors that contributed to cost reduction and hospital stay. RESULTS AND CONCLUSION: The results of the study show that, overall, patients treated for incomplete abortion with MVA spent 77% less time in the hospital and consumed 41% fewer resources than similarly diagnosed patients treated with SC. Recommendations are made as to the need of certain changes in patient management. Particularly necessary is information regarding cultural perception and concepts of abortion treatment.