Elisabeth Meloni Vieira

Fatores associados à violência física por parceiro íntimo em usuárias de serviços de saúde

OBJETIVO: Estimar a prevalencia de violencia por parceiro intimo contra mulheres e identificar fatores associados. METODOS: Estudo transversal com 504 mulheres de 15 a 49 anos, em cinco unidades basicas e distritais de saude em um municipio paulista em 2008. Foram realizadas entrevistas face a face com uso de questionario com 119 questoes, sobre informacoes sociodemograficas, saude reprodutiva, percepcao sobre papeis de genero no relacionamento conjugal e experiencia de violencia. Analises univariada e multipla por regressao logistica foram realizadas. RESULTADOS: Mais de um terco das mulheres sofreu violencia pelo parceiro intimo. Na analise multipla os fatores positivamente associados a violencia foram: morar em casa alugada, ter sofrido abuso sexual na infância, parceiro agredido fisicamente na infância, o uso de alcool pela entrevistada e pelo parceiro, uso de drogas e percepcao sobre o temperamento do parceiro. CONCLUSOES: As variaveis identificadas compuseram um modelo preditivo que pode ser utilizado para avaliar o risco de sofrer violencia pelo parceiro intimo.OBJECTIVE To estimate the prevalence of intimate partner violence against women and identify factors associated. METHODS Cross-sectional study comprising 504 women aged 15 to 49 years users of five primary care clinics in a municipality in the state of São Paulo, Southeastern Brazil, in 2008. Face-to-face interviews were carried out using a questionnaire consisting of 119 questions on sociodemographic information, reproductive health, perceptions of gender roles in the marital relationship and experience of violence. Univariate and multiple regression analyses were performed. RESULTS More than a third of the women reported intimate partner violence. In the multiple regression analysis factors predisposing to violence included living in rental housing, sexual abuse during childhood, the partners experience of physical violence during childhood, alcohol and drug use by the woman and her partner, and womans perception of her partners temperament. CONCLUSIONS The factors identified produced a predictive model that can be used to assess a womans risk of experiencing intimate partner violence.

Proposed declassification of disease categories related to sexual orientation in the International Statistical Classification of Diseases and Related Health Problems (ICD-11)

Abstract The World Health Organization is developing the 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11), planned for publication in 2017. The Working Group on the Classification of Sexual Disorders and Sexual Health was charged with reviewing and making recommendations on disease categories related to sexuality in the chapter on mental and behavioural disorders in the 10th revision (ICD-10), published in 1990. This chapter includes categories for diagnoses based primarily on sexual orientation even though ICD-10 states that sexual orientation alone is not a disorder. This article reviews the scientific evidence and clinical rationale for continuing to include these categories in the ICD. A review of the evidence published since 1990 found little scientific interest in these categories. In addition, the Working Group found no evidence that they are clinically useful: they neither contribute to health service delivery or treatment selection nor provide essential information for public health surveillance. Moreover, use of these categories may create unnecessary harm by delaying accurate diagnosis and treatment. The Working Group recommends that these categories be deleted entirely from ICD-11. Health concerns related to sexual orientation can be better addressed using other ICD categories.

Imagem corporal de mulheres com câncer de mama: uma revisão sistemática da literatura

Women experience a major process of reshaping their body image when they deal with breast cancer. This article seeks to understand the relationship that breast cancer and its treatment have in the process of (re)construction of a womans body image. The ultimate objective is to promote knowledge to train health professionals to become more aware of a womans quality of life. A systematic review of the literature of scientific articles published between 2004 and 2009 available in three scientific databases was conducted and a total of 56 articles were reviewed and grouped into four thematic categories. There is a pressing need for further studies on the socio-cultural characteristics of women with breast cancer, the differences of (re)construction of body image of young and older women, and Brazilian publications about the personal experience and socio-cultural context of women with breast cancer.

Key aspects of sexual behavior and safer sex practice among men from the city of São Paulo.

Heterosexual relations currently constitute the predominant route of HIV transmission to women in Brazil. Few studies have approached male sexual behavior taking women into account. This study included 597 men ages 21 to 50 in São Paulo city and explored several aspects pertaining to safer sex, such as sexual partners, knowledge of sexually transmitted diseases (STDs)/AIDS, risk perception, and protective practices aimed at AIDS prevention. The results showed that, similar to other countries, the proportion of men who have sex with men is low (5%), that younger men adopt more protective behavior than older men regarding multiple partners and condom use, that knowledge of AIDS is widespread (but that there is still a lack of knowledge concerning STDs in general), and that although risk perception increases protective behavior, presumption of the partners behavior influences this perception, placing men and women in a vulnerable situation.

Conhecimento e atitudes dos profissionais de saúde em relação à violência de gênero

OBJETIVOS: Varias sao as politicas publicas no Brasil para o enfrentamento da violencia contra a mulher. Registra-se na literatura que os profissionais de saude acham o tema de dificil abordagem. Para melhorar o atendimento no SUS em Ribeirao Preto, realizou-se um estudo para avaliar o conhecimento e a atitude dos profissionais de saude em relacao a violencia de genero. METODOS: Contataram-se 278 profissionais de saude, dos quais 221 foram entrevistados utilizando-se um questionario estruturado. RESULTADOS: 51 (23,0%) eram enfermeiras e 170 (77,0%) medicos; 119 (53,8%) homens e 102 (46,2%) mulheres, com idade media de 38,6 anos; 200 (90,5%) consideravam-se brancos ou asiaticos e 21 (9,5%) pretos e pardos. Tinham em media 12,5 anos de vida profissional e 158 (68,8%) eram oriundos de universidade publica. Apenas pouco mais da metade (58,7%) mostrou conhecimento geral adequado (bom e alto) sobre a violencia de genero, o que indica a necessidade de capacitar os profissionais para este atendimento. Em relacao as barreiras para averiguar a violencia, os profissionais citaram a falta de uma politica institucional e o silencio da mulher que nao revela a violencia. Os entrevistados, em particular as mulheres jovens, apresentaram atitudes mais favoraveis para o acolhimento da mulher em situacao de violencia. CONCLUSOES: A maioria dos entrevistados demonstrou atitudes positivas e podemos inferir que ha bom potencial para o manejo adequado dos casos, se receberem capacitacao.

Barreiras, para a notificação pelo pediatra, de maus-tratos infantis

OBJECTIVES: to determine factors interfering with the reporting of child abuse by pediatricians to children protection services. METHODS: cross sectional observation study. A random sample of pediatricians from Porto Alegre was selected among the 990 registered in the local pediatricians society. Social and demographic variables, professional background, knowledge concerning child abuse were obtained through the application of anonymous questionnaires. Descriptive and multivariate analyses were utilized to determine factors associated to the failure in reporting. RESULTS: ninety seven pediatricians were selected and 92 agreed to participate of the study. Of these, 80 (86.9%) identified some case of child abuse, and 63 (78.7%) reported at least one case. The majority of pediatricians admitted fear of legal involvement, demonstrated adequate knowledge of the issue and low confidence in child protection entities. Insufficient knowledge (OR = 3.94), working exclusively in the private sector (OR = 6.33) were the factors associated to the failure in reporting. Following adjustments, insufficient knowledge was significantly associated to result OR = 5.06 (95%CI = 1.45 - 17.59). CONCLUSIONS: a high rate of identification and reporting of child abuse through pediatricians was determined. Continuous education programs, improvement of protection services, professional support to the private sector could increase child abuse identification and reporting.

Adaptação transcultural do Female Sexual Function Index

The epidemiology of female sexual dysfunctions is still not well known. The Female Sexual Function Index (FSFI) is a short questionnaire specially designed to assess female sexual response. This study aimed to evaluate the cross-cultural equivalence of the Portuguese version of the FSFI. The cross-cultural adaptation involved five steps: translation, back-translation, formal equivalence assessment, review by specialists in sexuality, and pre-testing. After identification of semantic problems, agreements, and disagreements, a brief version was proposed, selecting and incorporating items from one of the two Portuguese versions. Some changes were made after pre-testing the questionnaire, most of which to make the Portuguese version more readily comprehensible and acceptable for the target population, using ordinary words as options or to complement the scientific language. Comparing more than one version of the instrument in the process of cross-cultural equivalence allowed detecting problems and difficulties in adapting the language, which would not have been observed otherwise.

Características do uso de métodos anticoncepcionais no Estado de São Paulo

OBJECTIVE: To analyze data on contraceptive use in the State of Sao Paulo, Brazil, collected by the Demographic and Health Survey (DHS) conducted in 1996. METHODS: The study data were compared to 1986 DHS and 1996 data on the Brazilian population. Contraceptive use among married or cohabiting women was evaluated focusing on age, number of children, schooling, and age and timing of female sterilization. Statistical analysis was performed using Student t-test and Kendalls non-parametric test. RESULTS: Unlike data on the Brazilian population, female sterilization rates were steady in the State of Sao Paulo during the studied period. The same contraceptive pattern is seen in both Brazil and Sao Paulo: women aged up to 30 years use largely pills; female sterilization predominates in women over 30, increasing with the number of children and decreasing with years of schooling. Male methods have also increased in recent years, being greater in Sao Paulo than in Brazil. Sao Paulo also shows a greater variety of reversible contraceptive methods. CONCLUSIONS: Although there were some differences, the prevalence of only two contraceptive methods in both Brazil and Sao Paulo suggests a tendency regarding the contraceptive methods offered and in reproductive health in the view of new regulations on family planning.OBJETIVO: Analisar dados coletados pela Pesquisa Nacional de Demografia e Saude, de 1996, sobre o uso de metodos anticoncepcionais no Estado de Sao Paulo, Brasil. METODOS: Os dados obtidos foram analisados comparativamente com os do Brasil e com os de outra pesquisa similar realizada em 1986. Foi examinado o uso de metodos anticoncepcionais entre mulheres nao-solteiras (casadas ou em coabitacao), focalizando-se idade, numero de filhos, escolaridade, idade na esterilizacao feminina e momento da esterilizacao. Para analise estatistica, utilizaram-se o teste t-Student e o teste nao-parametrico de Kendall. RESULTADOS: Diferentemente do Brasil, houve estabilizacao dos indices de esterilizacao feminina no Estado de Sao Paulo no periodo estudado. Observou-se um mesmo padrao de uso de metodos no Brasil e em Sao Paulo: ate os 30 anos, o metodo predominante foi a pilula; e, depois dos 30 anos, predominou a esterilizacao feminina, que aumenta com o numero de filhos e diminui com a escolaridade. O uso de metodos masculinos aumentou nos ultimos anos, sendo maior em Sao Paulo, que tambem apresenta maior diversidade no uso de metodos reversiveis. CONCLUSOES: Apesar das diferencas, o uso predominante de apenas dois metodos anticoncepcionais, em Sao Paulo e no Brasil, reflete distorcoes na oferta do planejamento familiar e na saude reprodutiva no contexto da nova regulamentacao do planejamento familiar.

Validade de construto de uma versão em português do Female Sexual Function Index

This study aimed to evaluate the construct validity of a version of the Female Sexual Function Index (FSFI). The version was inserted into a multidimensional questionnaire and applied face-to-face to 235 sterilized women. Non-response rate was 1.7%. The sample proved to be highly homogeneous, with low income and education. Cronbachs alpha of 0.948 indicated high internal consistency. Factor analysis showed that the instrument was measuring four factors: desire/arousal, lubrication, orgasm/satisfaction, and pain. This may reflect characteristics of the instrument itself, female sexual response, or even the samples cultural peculiarities, which can affect understanding of the questions or concepts with which the instrument deals. This study emphasizes the need for further research in the general population to determine the psychometric properties of the FSFI, such as its factor composition and definition of appropriate cut-off points for the Brazilian population.

A esterilização de mulheres de baixa renda em região metropolitana do sudeste do Brasil e fatores ligados à sua prevalência

A survey carried out in the metropolitan region of S. Paulo between March and July, 1992, shows that of 3,149 low income women aged from 15 to 49, 21.8% had been sterilized. Of those women living in marital union 29.2% had been sterilized and 34.4% were on the pill. Four hundred and seven sterilized women under 40 years old who underwent sterilization at least one year before the interview were asked about their reproductive life, the previous use of contraception, the decision-making process regarding their sterilization, the access to the operation and their adaptation after the operation. The results show that access to sterilization is obtained by means of payment to the doctor even in the case of low income women. The lack of regulation of sterilization and the insufficient provision of family planning methods by the Womens Health Comprehensive Programme are probably encouraging young women to opt for sterilization. The provision of sterilization presents ethical problems. The study shows that the irreversibility of the procedure was not understood by almost 40% of the women sterilized. The acceptability of sterilization as a result of a complex social strategy involving various sectors of Brazilian society associated with the need for the control of fertility felt by women are discussed. The need to regulate and control the procedure is discussed. The regulation of sterilization would create fairer access to sterilization and could safeguard the ethical aspects of its choice.