Claudia Bonan

Gravidez recorrente na adolescência e vulnerabilidade social no Rio de Janeiro (RJ, Brasil): uma análise de dados do Sistema de Nascidos Vivos

Repeated pregnancy (RP) among adolescents is seldom researched in Brazil, even tough the debate on the reproductive rights is important for this extract of population. A transversal study was developed with data from the Declaration of Live Births of adolescent mothers, living in Rio de Janeiro (RJ, Brazil), in 2005. The aim was to estimate the magnitude and features associated with RP. Prevalence ratios (PR) of RP, with 95% confidence interval (CI) for selected variables, were estimated through log-binomial multivariate regression. Among 12,168 adolescents, a RP prevalence of 29.1% was identified and the principal factors associated were: age 15-19 anos (PR=5.42; RI 95% 3.72-7.81); not doing prenatal consultation (RP=2.36; CI 95% 2.16-2.58); educational status<4anos (PR=1.48; CI 95% 1.25-1.76); housewife job (PR=1.8; CI 95% 1.57-2.15) or other (PR=1.9; CI 95%; 1.73-2.10). Giving birth by cesarean section and low birth weight were negatively associated to repeated pregnancy with RP equal to 0,94 (CI 95%; 0,86-0,99) and 0.69 (CI 95%; 0.62-0.77). The adolescents with RP had worst socioeconomic and assistance indicators than those on their first pregnancy. Specific social policies for adolescent mothers, in vulnerable situation, will enable them to have better conditions to exercise their reproductive rights.

Transcranial sonography as a diagnostic tool for Parkinson’s disease a pilot study in the city of Rio de Janeiro, Brazil

UNLABELLED In Brazil there is no systematic study on Transcranial Sonography (TCS), a neuroimaging method that depicts echogenic deep brain structures using ultrasound. OBJECTIVE To establish the percentage of subjects with permissive temporal windows and to address the ability of TCS of the substantia nigra (SN) to distinguish parkinsonian patients in a Brazilian sample. METHOD We performed TCS using the Acuson X300 (Siemens, Germany) in 37 individuals: 23 with Parkinsons disease (PD) and 14 healthy controls. RESULTS 10.8% of subjects had insufficient temporal acoustic bone windows. SN echogenic areas were larger in patients (mean ± SD, 0.31 ± 0.08 cm(2)) compared to controls (mean ± SD, 0.17 ± 0.02 cm(2)). TCS accurately identified 88.2% of PD patients. CONCLUSION A large proportion of Brazilians seem to be eligible for TCS. An expressive number of PD patients could be diagnosed by TCS based on an expanded SN echogenic area. However, the current data is preliminary and must be corroborated by larger studies.

Avaliação da implementação da assistência ao planejamento reprodutivo em três municípios do Estado do Rio de Janeiro entre 2005 e 2007

Objectives: to evaluate the implementation of family planning (FP) assistance in three municipalities in the State of Rio de Janeiro, Brazil, along with contextual factors. Methods: the evaluation was carried out between 2005 and 2007. Interviews were conducted with health workers and managers, the provision of services was observed, and documents consulted. The degree of implementation of the program was assessed by developing an evaluation matrix comprising three components – assistance, education and management – and standards and criteria were established. Oral and documentary sources of information allowed for analysis of the context to the implementation to be carried out. Results: the implementation of FP in the metropolitan municipality was at an advanced stage and in the rural municipalities in its initial stages. Educational activities conformed better to the established criteria than clinical care. Weaknesses included irregular methods of contraception, problems with the availability of contraceptive surgery, the lack of infertility care and male reproductive health. The teams include a range of different professionals, but there is a need for further training. In the metropolitan municipality, program management is a strong point, but in the others management falls short of expectations. Conclusions: the degree of implementation of FP care is related to geopolitical inequalities and contextual factors associated with the Brazilian National Health System–lack of integration of care networks and limited regionalization. This study may help to encourage institutionalization of the practice of monitoring and evaluating family planning assistance.

Reproductive risks and comprehensive care of pregnant women with hypertensive syndromes: a transversal study

Aims: To analyze the socio-demographic and reproductive risk profiles of pregnant women with a history of hypertensive syndromes, as well as their clinical and obstetric conditions and the characteristics of the care given during prenatal, labor and post-labor care in maternity hospitals caring for women at high risk. Method: transversal and quantitative study using the medical records of 164 pregnant women. Results: The predominance of adult and black women, with low education levels, low income, multiple pregnancies and multiple reproductive risk factors. Insufficient prenatal clinical and nutritional care, the presence of hypertension at the moment of the labor and little attention given to reproductive planning during post-labor period have been were also observed. Discussion: The care given at the maternity hospital is insufficient to meet the health needs of the women, which indicates fragmentation and discontinuity. Most of the women’s situations were characterized by a combination of individual, social and programmatic vulnerability factors. Conclusion: Meeting the reproductive health needs of these women demands comprehensiveness, coordination and continuity of health care; professional capacity to handle the risks; transformation of vulnerability situations.

Contraceptive practices of Brazilian adolescents: social vulnerability in question

This article seeks to analyze contraceptive practices of Brazilian adolescents and to discuss associated vulnerability situations. A cross-sectional study was conducted, using the database of the National Survey on Demography and Health of Women and Children _ PNDS 2006. Factors associated with the current use of contraceptive methods were investigated. The analysis included 986 sexually-active adolescents. Bivariate analysis between the outcome and each of the socioeconomic, demographic and reproductive characteristics of women was performed. The associations between variables were evaluated using multivariate logistic regression. Four factors related to outcome were identified in the multivariate analysis: having completed junior high school (aOR=2.29; CI 95% 1.07_4.85); being married or cohabiting with a partner (aOR=2.85; CI 95% 1.45_5.59); having used contraceptives during the first sexual intercourse (aOR=2.77; CI 95% 1.36_5.63); and having access to transportation to get to health center services (aOR=3.33; CI 95% 1.42_7.80). Adolescents with higher social vulnerability are at a disadvantage regarding adoption of contraceptive methods. This points to the need to establish intersectoral articulations of public policies, which could ensure their reproductive rights.

Absorção e metabolização dos hormônios sexuais e sua transformação em tecnologias contraceptivas: percursos do pensamento médico no Brasil

The article analyses knowledge assimilation and the development of clinical and research practices relating to sex hormones among Brazilian gynaecologists. It discusses the paths taken by medical thought from the reception of the hormones to their transformation into contraceptives. Our objective is to comprehend styles of introducing and disseminating medical technologies in the area of reproductive health in Brazil. It uses methods of historical analysis and takes as its source the Anais Brasileiros de Ginecologia, a journal published between 1936 and 1970. From the outset, the accompaniment of scientific breakthroughs in relation to sex hormones and their use to treat diverse female illnesses played a key role in the rapid medical acceptance of hormonal contraception. Scientific and technical questions (side effects, dosages) and the demographic issue formed part of the majority of the debates. Objections from the Catholic Church were considered but did not set the agenda of medical thought on contraceptives. The quest to consolidate gynaecology as a scientific, modern and cosmopolitan area of expertise, along with sanitary and demographic motives that allowed contraceptives to be classed as ethical drugs, are identified as processes underlying the assimilation and metabolization of sex hormones as hormonal contraceptives.The article analyses knowledge assimilation and the development of clinical and research practices relating to sex hormones among Brazilian gynaecologists. It discusses the paths taken by medical thought from the reception of the hormones to their transformation into contraceptives. Our objective is to comprehend styles of introducing and disseminating medical technologies in the area of reproductive health in Brazil. It uses methods of historical analysis and takes as its source the Anais Brasileiros de Ginecologia, a journal published between 1936 and 1970. From the outset, the accompaniment of scientific breakthroughs in relation to sex hormones and their use to treat diverse female illnesses played a key role in the rapid medical acceptance of hormonal contraception. Scientific and technical questions (side effects, dosages) and the demographic issue formed part of the majority of the debates. Objections from the Catholic Church were considered but did not set the agenda of medical thought on contraceptives. The quest to consolidate gynaecology as a scientific, modern and cosmopolitan area of expertise, along with sanitary and demographic motives that allowed contraceptives to be classed as ethical drugs, are identified as processes underlying the assimilation and metabolization of sex hormones as hormonal contraceptives.

Organizações Não Governamentais na área da Saúde da Criança - revisão da literatura

The second half of the twentieth century saw the emergence of organizations that reflected the mobilization of civil society for more effective participation in questions in the public interest and of a social nature. These became known as non-governmental organizations (NGOs) and they assumed their place as partners with public and private sectors to develop actions in different areas, including healthcare. Based on a review of the literature, the scope of this paper was to assess the status of scientific knowledge on the participation of NGOs in child healthcare and, by identifying and classifying their activities, establish if they are in line with the agenda of the field. Analysis of the publications took into consideration where the authors were from, the journal in question, the origins and area of activity of the NGOs and the source of the funds applied to the projects implemented. The nature of activities varied with the degree of development of the region where the NGOs operated and the themes, partnership between government and private sector agencies, sustainability and impact of actions on the favored communities were the main topics highlighted by the authors. The conclusion reached was that the performance of NGOs in child health is in the early stages and is a knowledge field to be explored.

Complicações do abortamento e assistência em maternidade pública integrada ao Programa Nacional Rede Cegonha

Objetivou-se descrever o perfil sociodemografico, obstetrico e assistencial de todas as internacoes de abortamento em maio-agosto/2012, em emergencia, em estudo transversal. Resultado: 20,5% eram adolescentes, 79,5% tinham mais de 20 anos de idade e 48,7% tinham a pele parda; 84,7% foram abortos nao especificados e o tempo foi apropriado entre a classificacao de risco e a internacao em 36,6% dos casos. Ha mudancas no perfil das complicacoes, com reducao das infeccoes e aumento na porcentagem de adolescentes (20,5%). Na atencao diferenciada do Programa Rede Cegonha, a avaliacao de risco acolheu 90% das mulheres em 30 minutos. O sub-registro do processo de abortamento persiste pela condicao de ilegalidade e por dilemas etico-morais dos profissionais.

Planejamento reprodutivo na clínica da família de um Teias: condições facilitadoras e limites à assistência

Apresenta-se um estudo de caso com abordagem qualitativa que analisou a assistencia ao planejamento reprodutivo de uma clinica da familia inserida em um Territorio Integrado de Atencao a Saude e que utilizou como referencia teorico-analitica a continuidade, a coordenacao e integracao de cuidados em saude reprodutiva e o potencial da assistencia na promocao de direitos. A conjugacao da Estrategia Saude da Familia com o Territorio Integrado de Atencao a Saude apresentou avancos na assistencia ao planejamento reprodutivo no que tange a organizacao de aspectos de infraestrutura e provisao de insumos, entretanto os avancos alcancados nao foram suficientes para promover uma assistencia que garanta direitos.

Itinerários de cuidados à saúde de mulheres com história de síndromes hipertensivas na gestação

O artigo teve como objetivo analisar itinerarios de cuidados a saude de mulheres com historia de sindromes hipertensivas na gestacao. O metodo foi o estudo de relatos orais, cujos resultados de 35 entrevistas foram agrupados em quatro categorias tematicas: compreensoes de saude e doenca; percepcoes do risco; interacoes institucionais; e interacoes afetivo-familiares envolvidas na busca de cuidados. Multiplas situacoes de vulnerabilidade afetam o itinerario de cuidados, incluindo dificuldades de acesso a servicos especializados e a relacao com os profissionais de saude. Saberes e praticas de saude compartilhados na comunidade sao recursos importantes na construcao do cuidado, que tambem pode ser afetado, positiva ou negativamente, pelas dinâmicas de interacao na rede afetivo-familiar e com o apoio social recebido.O artigo teve como objetivo analisar itinerarios de cuidados a saude de mulheres com historia de sindromes hipertensivas na gestacao. O metodo foi o estudo de relatos orais, cujos resultados de 35 entrevistas foram agrupados em quatro categorias tematicas: compreensoes de saude e doenca; percepcoes do risco; interacoes institucionais; e interacoes afetivo-familiares envolvidas na busca de cuidados. Multiplas situacoes de vulnerabilidade afetam o itinerario de cuidados, incluindo dificuldades de acesso a servicos especializados e a relacao com os profissionais de saude. Saberes e praticas de saude compartilhados na comunidade sao recursos importantes na construcao do cuidado, que tambem pode ser afetado, positiva ou negativamente, pelas dinâmicas de interacao na rede afetivo-familiar e com o apoio social recebido.