Dirce Guilhem

Qualidade de vida em pessoas com lesão medular traumática: um estudo com o WHOQOL-bref

OBJETIVOS: Conhecer a percepcao de qualidade de vida em pessoas com lesao medular traumatica, utilizando a metodologia adotada pela Organizacao Mundial de Saude (OMS). METODOS: Trata-se de uma pesquisa transversal, na qual foi realizado um estudo descritivo para conhecer as caracteristicas sociodemograficas e a distribuicao das lesoes medulares traumaticas na amostra estudada. Em seguida, com o intuito de conhecer a percepcao da qualidade de vida dessa populacao, utilizou-se o WHOQOL - bref. As analises estatisticas realizadas incluiram analises descritivas de frequencia, tendencia central e dispersao e analise inferencial de comparacao entre os dominios. O estudo transcorreu de janeiro de 2005 a maio de 2006 e foi desenvolvido com pessoas no momento de sua admissao no programa de reabilitacao do Hospital Sarah Brasilia. Utilizou-se uma amostra de conveniencia, com 111 entrevistados. RESULTADOS: Os individuos estudados sao, em sua maioria, homens jovens, solteiros, possuidores do ensino fundamental e vitimas de acidentes de trânsito e de armas de fogo. A percepcao da qualidade de vida demonstrou que os dominios que refletiram os piores escores de avaliacao estavam relacionados ao meio ambiente e a saude fisica; e os mais bem avaliados estavam ligados a saude psicologica e as relacoes sociais. CONCLUSAO: O estudo permitiu conhecer a percepcao de qualidade de vida do grupo pesquisado. Recomenda-se estudo que inclua tetra-plegicos e lesados medulares nao traumaticos, com o intuito de se obter uma avaliacao mais global.

Atendimento a gestantes no Sistema Único de Saúde

OBJETIVO: Analisar o atendimento ao pre-natal em unidades de saude, com o intuito de obter uma linha de base que subsidie futuros estudos avaliativos. METODOS: Realizou-se estudo exploratorio para avaliacao da atencao do Sistema Unico de Saude a saude de mulheres gravidas, por meio de inquerito auto-aplicado em gestores municipais de saude sobre amostra probabilistica do tipo aleatoria estratificada de 627 municipios que, submetida a tecnica de expansao, permitiu analises para 5.507 municipios. O periodo de coleta de dados foi de outubro de 2003 a abril de 2004. O questionario captou informacoes sobre a prioridade as distintas modalidades de atencao, alem de dados sobre a oferta de atencao e estimativa declarada de atendimento de demanda. Foram realizados os testes de qui-quadrado e t de Student para verificacao de independencia entre variaveis qualitativas e a igualdade entre medias, respectivamente. RESULTADOS: Dos municipios analisados, 43,8% (n=2.317) nao atendiam ao risco gestacional; 81% (n=4.277) e 30,1% (n=1.592) referiram atender acima de 75% da demanda do pre-natal de baixo e alto risco, respectivamente; 30,1% (n=1.592) atendiam acima de 75% da demanda de alto risco. Atencao ao baixo risco (chi2=282,080; P<0,001 n=4.277) e ao alto risco (chi2=267,924; P<0,001 n=5.280) estiveram associadas a regiao geografica, tamanho do municipio e modalidade de gestao no Sistema Unico de Saude. A garantia de vaga para o parto tambem esteve associada a modalidade de gestao. CONCLUSOES: Houve lacunas relacionadas a oferta e qualidade da atencao ao pre-natal no Sistema Unico de Saude. A municipalizacao amplia a oferta de pre-natal, mas ha desigualdades entre regioes e entre municipios de diferentes dimensoes populacionais.

Planejamento familiar: a autonomia das mulheres sob questão

OBJECTIVES: to investigate womens access to contraceptive methods. METHODS: inquiry through a self-applied survey of a random sample (divided into geographic regions and population size). The study comprised all 5507 Brazilian municipalities. RESULTS: an outstanding number of municipalities place a high priority on family planning in relation to geographic region and size. As for contraception availability, 79.5% of 5358 municipalities do not provide diaphragms, and only 6.6% meet over 75% of the demand. In contrast, more than 75% of the demand for injectable contraceptives is met in 13.4% of 5314 municipalities. Seventy two and nine percent (72.9%) of all Brazilian municipalities does not offer fertility treatment, and only 5.9% of the municipalities provide contraceptives to over 75% of the women seeking this service. CONCLUSIONS: findings indicate inconsistency between education and routines of family planning, quantitative and qualitative access restrictions to contraceptive methods and insufficient care for infertility. This scenario limits women freedom of choice.

Oferta e demanda por média complexidade/SUS: relação com atenção básica

This work aims at investigating the supply and demand of the medium-complexity services from the Federal District and surrounding municipalities from the state of Goias. Our hypothesis is that the services organization offer of primary care (PC) from the Federal District (DF) and its surroundings overloads the medium-complexity services (MC), contributing to less equity in terms of communities access. Our objective is to analyze the demand for MC (medium-complexity) services in DF (Federal District) and its relation with PC (Primary Care); to quantify the origin, health problem, reason, transportation time and performed procedures of the ones who go to the Federal District hospitals; to set up priorities of managerial changes in the Brazilian Health System (SUS) in order to have more access to users. The evaluation was triangulation of methods, and complementing qualitative and quantitative approaches. The study of the offer via the analysis of SUS information systems, and the demand through a survey with 1,585 users of seven hospitals of the Federal District. There is a sub utilization of services offer at the Federal District, with duplicity of basic actions among hospitals and other health centers. It is recommended a revision in the health services regionalization and hierarchy of the Federal District and Goias, as well as more investments on implementation of technology to primary care.

Bioethics in Brazil

In this article, the authors briefly sketch the nature of Brazilian bioethics. Bioethics emerged in Brazil later than in other Western countries and the 1990s were the most important period for the spread of the discipline in the country. It is in this period that some structural elements of bioethics were established, such as research groups, regulation of Local Research Ethics Committees (Comites Locais de Etica em Pesquisa - CEP), the creation of the National Commission of Ethics in Research with Human Beings (Comissao Nacional de Etica em Pesquisa com Seres Humanos - CONEP) and the Brazilian Bioethics Society (Sociedade Brasileira de Bioetica - SBB). With regard to theoretical work, Brazilian bioethics is clearly an importer of theories from countries central to the studies of bioethics, or, in another words, countries where bioethics first emerged and was established. The most commonly used theory among Brazilian researchers is principlism.

Consentimiento informado: algunas consideraciones actuales

Informed consent constitutes a crucial link in research involving human beings. Nevertheless, knowledge limitations which lead to errors of its process and application have been frequently identified by professionals globally. Hence, a brief review of the topic is exposed about the concept and the elements related to adequate process and application, which we belief will allow to clarify the information that professionals who do research involving human beings posses.Informed consent constitutes a crucial link in research involving human beings. Nevertheless, knowledge limita- tions which lead to errors of its process and application have been frequently identified by professionals globally. Hence, a brief review of the topic is exposed about the concept and the elements related to adequate process and application, which we belief will allow to clarify the information that professionals who do research involving human beings posses.

Social Model: A New Approach of the Disability Theme

A experiencia da deficiencia faz parte da vida de pessoas que tem doenca, lesao ou limitacao corporal. A deficiencia e compreendida, ainda, como um fato de ma sorte pessoal e, do ponto de vista social e politico, os deficientes sao vistos como minoria. Este estudo pretende contribuir para o aprofundamento dos conhecimentos sobre o tema deficiencia. A pesquisa traz nova abordagem do tema: o modelo social. Essa abordagem surgiu como alternativa ao modelo medico da deficiencia, que reconhece na lesao, na doenca ou na limitacao fisica a causa primeira da desigualdade social e das desvantagens vivenciadas pelos deficientes, ignorando o papel da sociedade na sua opressao e marginalizacao. O estudo permitiu refletir como as dificuldades e barreiras impostas pela sociedade as pessoas, consideradas diferentes, tornam a deficiencia uma realidade e retratam a injustica social e a situacao de vulnerabilidade vivida por grupos excluidos.The experience of disability is part of the daily lives of people who have a disease, lesion or corporal limitation. Disability is still understood as personal bad luck; moreover, from the social and political points of view, the disabled are seen as a minority. The aim of this study is to contribute to the knowledge about the experience of disability. The research presents a new approach on the theme: the social model. This approach appeared as an alternative to the medical model of disability, which sees the lesion as the primary cause of social inequality and of the disadvantages experienced by the disabled, ignoring the role of social structures in their oppression and marginalization. The study permits reflecting on how the difficulties and barriers society imposed on people considered different make disability a reality and portray social injustice and the vulnerability situation lived by excluded groups.

Jogo (IN)DICA-SUS: estratégia lúdica na aprendizagem sobre o Sistema Único de Saude

This article questions whether educational gaming technology used in learning about the Unified Health System (SUS) benefits imagination, fun, spontaneity and reflection in the training of health professionals. The objectives were to develop the (IN)DICA-SUS board game, centered on the dialog between health policies and play; to analyze the components of fun, pleasure, formative aspects of learning, the emotions and the game tactics in the development of the (IN)DICA-SUS game; and to identify indicator variables for playability in educational technologies for health. This was exploratory, descriptive research with a quantitative and qualitative approach, of the case study type. Test matches were undertaken with 160 participants, involving the administration of a questionnaire, participant observation, content analysis and the Pearson statistical test. The indicator variables for the playability of the educational technologies for health include the pleasure and tension in the game. The (IN)DICA-SUS game brings together inventive and sharing characteristics to optimize multiple learning and goes beyond teaching about the Unified Health System, although it starts from that.This article questions whether educational gaming technology used in learning about the Unified Health System (SUS) benefits imagination, fun, spontaneity and reflection in the training of health professionals. The objectives were to develop the (IN) DICA-SUS board game, centered on the dialog between health policies and play; to analyze the components of fun, pleasure, formative aspects of learning, the emotions and the game tactics in the development of the (IN)DICA-SUS game; and to identify indicator variables for playability in educational technologies for health. This was exploratory, descriptive research with a quantitative and qualitative approach, of the case study type. Test matches were undertaken with 160 participants, involving the administration of a questionnaire, participant observation, content analysis and the Pearson statistical test. The indicator variables for the playability of the educational technologies for health include the pleasure and tension in the game. The (IN)DICA-SUS game brings together inventive and sharing characteristics to optimize multiple learning and goes beyond teaching about the Unified Health System, although it starts from that. DESCRIPTORS: Professional education in public health. Learning. Nursing education.

DEZ ANOS DE EXPERIÊNCIA DO COMITÊ DE ÉTICA EM PESQUISA DA SECRETARIA DE SAÚDE DO DISTRITO FEDERAL, BRASIL

The objective of this article is to relate the experience of the Research Ethics Committee of the Secretary of Health, Federal District, Brazil (CEP/SES/DF) during 10 years (1997-2007) from its creation. It deals with a descriptive and documentary evaluation, in the form of case studies, utilizing all projects subject to protocol in CEP/SES/DF (Number 052/08) during that period. The most frequent conflicts were: terms of free and informed consent (30%), identification page (25%), methodology (20%), curriculum vitae (12%), budget (9%), others (4%). The activity report of CEP/SES/DF in 10 years revealed, as a result of its productivity, legitimacy in the process of ethical analysis of protocols which confirms the protection of research participants.

Percepção sobre qualidade de vida de estudantes de graduação em enfermagem

A pesquisa objetivou conhecer a percepcao sobre a qualidade de vida de graduandos em enfermagem. O estudo transversal foi realizado entre agosto de 2010 a agosto de 2011, com 56 academicos de enfermagem da Faculdade de Ciencias da Saude da Universidade de Brasilia, Brasil. Foi utilizado questionario especifico (perfil sociodemografico, academico e de saude) e o WHOQOL-bref. As analises estatisticas incluiram descricao de frequencia, tendencia central e dispersao e comparacao entre os dominios. Os dominios psicologico e meio ambiente foram avaliados como o melhor e pior, respectivamente. As facetas denominadas capacidade de concentracao, sono, grau de energia diario, capacidade para realizar atividades do dia a dia e para o trabalho, oportunidades de lazer, recursos financeiros e sentimentos negativos demonstraram-se comprometidas. Essas facetas influenciaram negativamente a qualidade de vida dos estudantes, podendo desencadear sentimentos negativos, como mau humor, desespero, ansiedade e depressao.