George Dantas de Azevedo

Violência física contra a mulher na perspectiva de profissionais de saúde

OBJETIVO: Compreender a percepcao de profissionais de saude sobre a violencia fisica cometida contra a mulher por parceiro intimo. PROCEDIMENTOS METODOLOGICOS: Trata-se de estudo qualitativo com 30 profissionais de tres unidades de saude vinculadas ao Sistema Unico de Saude no municipio de Natal (RN), realizado em 2006. Foram conduzidas entrevistas semi-estruturadas em tres nucleos tematicos: ideias associadas a violencia fisica sofrida pela mulher, atuacao dos profissionais de saude e papel dos servicos de saude. O roteiro das entrevistas incluiu questoes referentes a percepcao dos profissionais sobre relacoes de genero, violencia fisica, atuacao como profissional de saude e papel dos servicos de saude. Foram extraidas categorias desses nucleos pela tecnica de analise de conteudo tematica categorial. RESULTADOS: Os profissionais de saude indicaram varios fatores que influenciam situacoes de violencia domestica, dentre os quais machismo, baixas condicoes economicas, alcoolismo e experiencias anteriores de violencia no âmbito familiar. Foram relatadas falta de capacitacao para discutir a tematica com a populacao e a necessidade de os servicos de saude desenvolverem atividades educativas com essa finalidade. CONCLUSOES: Os resultados indicam a necessidade de sistematizacao e efetivacao de acoes voltadas para humanizacao da assistencia as mulheres em situacao de violencia.OBJECTIVE To comprehend the perception of health professionals regarding physical violence against women by an intimate partner. METHODOLOGICAL PROCEDURES This is a qualitative study performed in 2006 on 30 health professionals from three National Health System units in the city of Natal, Northeastern Brazil. Semi-structured interviews were conducted on three thematic topics: ideas associated to physical violence suffered by women; action of the health professional; and the role of health services. The series of interviews included questions on the perception of professionals about gender relations, physical violence, action as a health professional, and the role of health services. Categories were formed from these topics using the thematic content analysis. RESULTS Health professionals pointed several factors that influence domestic violence situations, among which are machismo, poor economic conditions, alcoholism, and previous experiences of violence in the family environment. The study group reported they did not feel qualified to discuss the subject with the population and stressed the need that health services promote educational activities with this aim. CONCLUSIONS The results suggest the need for systematized and effective actions aimed at humanizing health care for the battered woman.

Efeito da Idade Materna sobre os Resultados Perinatais

Purpose: to investigate the interactions between maternal age and adverse perinatal outcomes in the State of Rio Grande do Norte. Methods: we analyzed official records of 57,088 infants in the State of Rio Grande do Norte, from January 1997 to December 1997. Data were obtained from the Information System of the Health Ministry, Brazil. The sample was divided into three Groups I, II and III according to maternal age range: 10 to 19 years, 20 to 34, and 35 or more, respectively. The main outcome variables were: length of pregnancy, birth weight and mode of delivery. Statistical analysis was performed using c2 test. Results: preterm deliveries were 4.3% in the adolescent group vs 3.7% in Group II (p = 0.0028). The incidence of cesarean section was higher in Group II than in the other Groups (p<0.001). Low birth weight was significantly higher in Groups I (8.4%) and III (8.3%) when compared with Group II (6.5%) (p<0.0001). Conclusions: we found a higher incidence of lower birth weight and preterm delivery in the adolescent group. In women ³35 years old there was a high incidence of low birth weight and macrosomia. Results suggest that cesarean sections are more common in women aged 20-34 years than in adolescent and older mothers.

Prevalência de transtornos mentais comuns e avaliação da qualidade de vida no climatério

OBJECTIVE: To evaluate prevalence of mental distress and health-related quality of life (HRQoL) in climacteric women. METHODS: A total of 191 women (45 to 65 years of age) were included in this cross-sectional study. A questionnaire about personal information, habits/health, and demographic data was administered in association with the two validated instruments to measure HRQoL, SF-36, Medical Outcomes Study 36-item Short-Form Health Survey and to estimate prevalence of common mental distress (20-item SRQ, Self Reporting Questionnaire). RESULTS: By using the 20-item SRQ for assessing mental distress, and establishing a cut-off level of at least 8 items, 39.8% of the women were categorized as having mental distress. A higher prevalence of mental distress and lower SF-36 scores were found in women in the perimenopause, particularly those with poor education and low family income who did not work outside the home. All SF-36 domains were significantly lower in women with mental distress than those in women without mental distress. CONCLUSION: Prevalence of mental distress is high in this sample of climacteric women and is associated with negative repercussions on the quality of life. This shows that psychosocial factors are significantly involved and psychological support strategies should be instituted in the form of health policies for climacteric women.

Índices de obesidade central e fatores de risco cardiovascular na síndrome dos ovários policísticos

FUNDAMENTO: A obesidade abdominal apresenta elevada prevalencia em mulheres com sindrome dos ovarios policisticos (SOP) e esta associada a um aumento do risco cardiovascular. OBJETIVO: Verificar a acuracia da circunferencia da cintura (CC), da relacao cintura-quadril (RCQ), da relacao cintura-estatura (RCEST) e do indice de conicidade (indice C), no que se refere a deteccao de fatores de risco cardiovascular (FRCV) em mulheres com SOP. METODOS: Por meio de estudo transversal, foram alocadas 102 mulheres (26,5 ± 5 anos) com diagnostico de SOP, de acordo com o consenso de Rotterdam. O colesterol total (CT), os triglicerideos (TG), o LDL-colesterol (LDL-C), o HDL-colesterol (HDL-C), a glicemia de jejum, a glicemia apos teste oral de tolerância a glicose (TOTG) e a pressao arterial (PA) foram avaliados em todas as pacientes, alem das variaveis antropometricas. RESULTADOS: A relacao cintura-estatura foi o marcador que apresentou correlacoes positivas significativas com o maior numero de FRCV (PA, TG e glicemia apos TOTG), destacando-se ainda a correlacao negativa com HDL-C. Todos os marcadores antropometricos avaliados se correlacionaram positivamente com PA, enquanto CC e RCQ apresentaram correlacao positiva tambem com TG. No tocante a acuracia para deteccao de FRCV, os indicadores antropometricos considerados apresentaram taxas de sensibilidade superiores a 60%, com destaque para a RCEST, que apresentou sensibilidade superior a 70%. CONCLUSAO: A RCEST demonstrou ser o indicador antropometrico com a melhor acuracia para a predicao de FRCV. Nesse sentido, propoe-se a inclusao desse parâmetro de facil mensuracao na avaliacao clinica para o rastreamento de mulheres com SOP e FRCV.BACKGROUND Women with polycystic ovary syndrome (PCOS) present a high prevalence of abdominal obesity, which is associated with an increased cardiovascular risk. OBJECTIVE To verify the accuracy of the waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and the conicity index (CI) in the detection of cardiovascular risk factors (CVRF) in women with PCOS. METHODS The present transversal study allocated 102 women (26.5 +/- 5 years) with a diagnosis of PCOS, according to the Rotterdam criteria. Total cholesterol (TC), triglycerides (TG), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), fasting glucose, glucose after the oral glucose tolerance test (OGTT) and blood pressure (BP) were evaluated in all patients, in addition to the anthropometric variables. RESULTS The WHtR was the marker that presented significant positive correlations with the highest number of CVRF (BP, TG and post-OGTT glucose), whereas there was a negative correlation with HDL-C. All the evaluated anthropometric markers were positively correlated with BP, whereas WC and WHR also presented a positive correlation with TG. Regarding the accuracy for the detection of CVRF, the anthropometric markers presented a sensibility > 60%, especially the WHtR, which had a sensibility > 70%. CONCLUSION The WHtR showed to be the most accurate anthropometric indicator for the prediction of CVRF. In this sense, we propose the inclusion of this easily-measured parameter in the clinical assessment for the screening of women with PCOS and CVRF.

Uterine leiomyoma: understanding the impact of symptoms on womens' lives.

BackgroundMost women report negative experience about the symptoms of uterine leiomyoma (UL) in their lives, such as abnormal uterine bleeding and pelvic pain. Many studies have been conducted about efficacy of UL treatment, but little research has been performed about womens health related quality of life (HRQL).MethodsThis is a semi-structured, descriptive, observational, qualitative study that was performed during eight months. Focus group (FG) interviews were performed with women attending at a tertiary hospital in Brazil, who were consecutively included in the study. Seventy women with symptomatic UL were recruited to this study. FG duration was one hour with mediators with 5-6 women at each group. Collected data from discussions was processed according to thematic analysis and stored at a qualitative software.ResultsWomen were negatively influenced by the presence of symptomatic UL. The major themes that were noticed during analysis were: beliefs and attitudes towards UL; limitation to social and professional activities; sensation of fear/unfairness/discouragement towards the symptoms and adverse effects during treatment with GnRH analogs.ConclusionsSymptomatic UL has a negative impact on womens HRQL. Health providers should consider such impact when counseling women on their treatment options, since it may have an important influence in these patients’ decision-making process. While current pharmacological treatments may improve disease specific outcomes, such as bleeding intensity and tumor volume, they fail on actually improving quality of life.

Metabolic syndrome in systemic lupus erythematosus: lower prevalence in Brazil than in the USA

We read with great interest the recent article by Chung et al on the high prevalence of metabolic syndrome (MetS) in patients with systemic lupus erythematosus (SLE).1 This topic is extremely relevant as regards the current clinical management of patients with SLE, since findings from several studies point to increased cardiovascular risk associated with this disease.2–4 As with most previous research on the incidence of MetS, this study was conducted in the American population where the prevalence of obesity is higher than in other countries.1 However, it is very important to consider the results from studies conducted in different populations when analysing the influence of obesity and other …

Surgical site infection in a university hospital in northeast Brazil

We examined prevention of surgical site infection (SSI) in a tertiary teaching hospital in northeast Brazil, from January 1994 to December 2003. The survey included 5,742 patients subjected to thoracic, urologic, vascular and general surgery. The criteria for diagnosing SSI were those of the Centers for Disease Control, USA, and the variables of the National Nosocomial Infection Surveillance risk index were used. Data analysis revealed that anesthetic risk scores, wound class and duration of surgery were significantly associated with SSI. A total of 296 SSIs were detected among the 5,742 patients (5.1%). The overall incidence of SSI was 8.8% in 1994; it decreased to 3.3% in 2003. In conclusion, the use of educational strategies, based on guidelines for SSI prevention reduced SSI incidence. Appropriate management of preoperative, intraoperative, and postoperative incision care, and a surveillance system based on international criteria, were useful in reducing SSI rates in our hospital.

Analysis of heart rate variability in polycystic ovary syndrome

Objective. To compare the modulation of heart rate in a group of volunteers with polycystic ovary syndrome (PCOS) to that of a group of healthy ovulatory women on the basis of R-R interval variability and analyze the relationships between heart rate variability (HRV) and other cardiovascular risk factors. Methods. In a cross-sectional study, HRV and anthropometric, biochemical and hormonal parameters were measured in 23 women with PCOS and 23 age-matched controls. Mean outcomes measures: HRV indexes in the time (SDNN and rMSSD) and frequency domain (low frequency–LF and high frequency–HF). Differences between groups and correlation analysis were performed. Results. Intergroup analysis showed significant differences (p < 0.05) between groups, with lower SDNN, rMSSD, LF and HF indexes in PCOS women when compared to the control group. There was significant negative correlation between BMI and SDNN, LF and HF, indicating a decrease in the autonomic modulation of heart rate with increasing weight. A negative correlation was also found between the high-sensitivity C-reactive protein level and the rMSSD index. Conclusion. Our results show that PCOS is associated with alterations in the autonomic modulation of heart rate, possibly due to the influence of weight gain.

Estresse e ansiedade em mulheres inférteis

OBJETIVO: avaliar a frequencia de estresse e niveis de ansiedade em mulheres inferteis, de forma a obter subsidios para uma orientacao psicologica especifica. METODOS: estudo transversal envolvendo 152 mulheres inferteis (media de idade 30,3±5,4anos), e 150 controles saudaveis (25,7±7,9 anos). Todas as voluntarias foram avaliadas com a aplicacao do Inventario de Sintomas de Estresse de Lipp e Inventario de Ansiedade Traco-Estado. As variaveis dependentes foram: frequencia de estresse e escores de ansiedade (estado e traco). A analise estatistica compreendeu a utilizacao dos testes c2 e Mann-Whitney, alem de regressao logistica para testar associacoes entre as variaveis dependentes e fatores de risco considerados. O nivel de significância adotado foi de 5%. RESULTADOS: a frequencia de estresse foi maior no grupo infertilidade em relacao ao grupo controle (61,8 e 36,0%, respectivamente), no entanto, nao foram observadas diferencas significativas entre os grupos com relacao as fases do estresse e tipo de sintomatologia predominante. Em relacao a ansiedade, nao houve diferencas significativas entre os grupos infertilidade e controle quanto as medianas dos escores de estado (39,5 e 41,0, respectivamente) e traco (44,0 e 42,0, respectivamente) de ansiedade. No grupo infertilidade, os fatores de risco associados significativamente com estresse ou ansiedade foram: desconhecimento do fator causal, fase de investigacao diagnostica e ausencia de filhos advindos de outros casamentos. CONCLUSOES: as mulheres inferteis estao mais vulneraveis ao estresse, no entanto, sao capazes de responder aos eventos estressores de forma adaptativa, sem comprometimentos mais serios nas areas fisica e psicologica.

A humanização e a formação médica na perspectiva dos estudantes de medicina da UFRN - Natal - RN - Brasil

This study used a qualitative approach to understand the perspective of medical students at the Federal University in Rio Grande do Norte, Brazil, concerning humanization in the context of medical training. A focus group technique was used, involving a multidisciplinary team from anthropology, psychology, and medicine that studied two groups of nine students each from the last year of medical school. Data were submitted to categorical thematic content analysis, revealing three categories: the student-patient, teaching-learning, and student-professor relationships. The first category showed that the students experience of contact with patients is essential for constructing a humanized professional identity. In the second category, professors with no training in inherent pedagogical practices, plus the dichotomy between theory and practice, hinder the autonomous formation of knowledge and a comprehensive view of the individual. Two opposing sub-categories emerged from the third category (model professor and asymmetric relations) that reflect the importance of the professors ethical-humanist stance rather than an authoritarian attitude in the construction of the students professional identity. These data highlight aspects of medical training that can substantiate a discussion of humanization in the context of the new curricular guidelines.