Greice Maria de Souza Menezes

Adolescência e reprodução no Brasil: a heterogeneidade dos perfis sociais

This study aims to estimate the prevalence of adolescent pregnancy (AP) in three Brazilian cities Salvador, Rio de Janeiro, and Porto Alegre and to examine the profiles of pregnant girls and their partners in relation to pregnancy outcomes. Data for a retrospective assessment of AP were collected using an interview-based household survey applied to a stratified sample of males and females aged 18-24. A total of 4,634 individuals were interviewed (85.2 % of the eligible individuals). 21.4% of males and 29.5% of females aged 20-24 reported AP, but few such pregnancies had taken place before age 15 (0.6% and 1.6%). Pregnancy between adolescent partners was reported by 55.1% of males and 27.9% of females. 79.8% of the latter became pregnant while involved in a stable relationship with an older partner. AP levels varied inversely to schooling and income levels. 72.2% of females and 34.5% of males carried their first AP to completion, and more cases of induced abortion were reported by male partners in pregnancies (41.3%) than by females (15.3%). With the birth of the first child, 25.0% of women interrupted their studies temporarily and 17.3% definitively. However, 42.1% of primiparous mothers were already outside school before pregnancy.

Aspectos psicossociais do trabalho e distúrbios psíquicos entre trabalhadoras de enfermagem

OBJECTIVE To evaluate the association between psychological demand and job control and demand with psychological distress among nurses. METHODS A cross-sectional study included 502 female nurses working in a public hospital at the city of Salvador, state of Bahia, Brazil. The Demand-Control Model proposed by Karasek to evaluate the association between job control-demand and psychological distress was adopted. The SRQ-20 was used to measure psychological distress. RESULTS The prevalence of psychological distress was 33.3%, ranging from 20.0% among lady nurses to 36.4%, among nurse assistants. Strong dose-response gradients were observed between demand and psychological distress and the negative association between job control and psychological distress. Prevalence of psychological distress was higher (PR=2.6; 95% CI: 1.81-3.75) among professionals in high-strain jobs (high demand, low control) when compared to professionals in low-strain jobs (low demand, high control), after adjustment by potential confounders in a logistic multiple regression model. CONCLUSIONS Study findings reinforce the relevance of intervening in the organizational structure in order to increase control upon job and adjust the levels of psychological demands.

Research on abortion in Brazil: gaps and challenges for the public health field

This paper provides a review of abortion studies produced in the field of public health in Brazil, highlighting current research gaps and challenges. Most studies focus on women admitted to public hospitals for treatment of incomplete abortion, so their scope is limited to abortions presenting complications. Womens profiles, abortion methods, motives, and immediate consequences for womens physical health are also included. However, there remains a need for studies on the following aspects: measuring abortion incidence; investigating cases of post-abortion complications and death; analyzing the relationship between abortion and contraception; investigating the impact of abortion on womens mental health; and incorporating mens perspectives. There is an urgent need for evaluative research on abortion care in public services. Research results should be disseminated widely, so as to help overcome any ideological bias in the current debate on abortion rights in the country.

Cobertura do teste de Papanicolaou e fatores associados à não-realização: um olhar sobre o Programa de Prevenção do Câncer do Colo do Útero em Pernambuco, Brasil

This research aimed to assess coverage of Pap smear screening in the State of Pernambuco, Brazil, during the three years prior to the study, among women 18 to 69 years of age, and to identify factors associated with womens lack of participation in screening. This was a cross-sectional, population-based study, using data from a survey in 2005-2006 with 640 women, selected by three-stage cluster sampling. Information on 258 women was analyzed. Pap smear coverage was 58.7% for women 18 to 69 years of age and 66.2% for those 25 to 59. Single marital status, no history of childbirth, and not having consulted a physician in the previous year were associated with lack of Pap smear screening. In the multivariate analysis, low schooling also showed a significant effect. Pap smear coverage in Pernambuco was satisfactory, but insufficient to impact the epidemiological profile of cervical cancer. It is necessary to strengthen and upgrade health promotion activities in order to reduce the inequalities and encourage womens active participation in cervical cancer prevention.

Abortion in Brazil: a demographic approach

PURPOSE To evaluate the prevalence of spontaneous and induced abortion reported by a sample of Brazilian women interviewed in the National Demographic Health Survey of 1996. METHODS This was a secondary analysis of the Brazilian DHS-96 database, with information from interviews with a representative sample of 12,612 women about their reproductive life, focusing on the prevalence of spontaneous and induced abortion in the last five years and the associated factors for the various regions of the country and for Brazil as a whole. The sampling method was implemented with a strategy selection in two stages, one for the households and the other for women. The prevalence of spontaneous and induced abortion was estimated for Brazil and regions, and the socio-demographic characteristics of the women were analyzed as a function of the abortions experience. A multinomial regression model analysis was used for the identification of factors independently associated with both types of abortion; their OR and respective 95% CI are reported. RESULTS The prevalence of reported spontaneous abortion was 14% and the prevalence of induced abortion was 2.4% for the country as a whole. The state with the highest prevalence of induced abortion was Rio de Janeiro with 6.5%, followed by the Northeast region with 3.1%. The places with the lowest prevalence were the state of São Paulo and the South region. Both spontaneous and induced abortion showed higher prevalences with increasing age of the women studied. Being from the urban area (OR=1.5; 95%CI=1.0-2.3), having had more than one live child (OR=2.2; 95%CI=1.5-3.2) and being non-white (OR=1.4; 95%CI=1.0-1.8) were the main risk factors for induced abortion. CONCLUSIONS The non-modifiable risk factors for induced abortion identified in this study indicate the need for improvement of educational and contraceptive actions, with priority for these specific demographic groups.

Induced abortion during youth: social inequalities in the outcome of the first pregnancy

This study aimed to identify the factors associated with induced abortion in the first pregnancy in young women and in the first time young men got their partners pregnant. The methodology was a household survey with face-to-face interviews in a probabilistic sample in three stages with 4,634 subjects, aged 18 to 24 years of age residing in the cities of Salvador, Rio de Janeiro, and Porto Alegre, Brazil. Logistic regression analysis was used with a hierarchical strategy for entering variables into the model. Abortion was the reported outcome of the first pregnancy for 16.7% of the women and 45.9% of the men (in relation to their partners). Key factors associated with abortion included higher schooling and the occasional nature of the relationship with the male or female partner in the respective pregnancy. Inclusion of males in the study provided new elements for understanding the abortion phenomenon, including in the gender issues in discussion of the theme. The authors recommend greater public investment to warrant access to information and means for young people to achieve their reproductive plans in a security and healthy way, respecting their sexual and reproductive rights.

Gênero e saúde no Brasil: considerações a partir da Pesquisa Nacional por Amostra de Domicílios

A mulher brasileira tem vivido mais que o homem, como ocorre em paises industrializados centrais. Nesses paises, paradoxalmente, as mulheres apresentam indicadores de morbidade mais altos que os homens. O conhecimento sobre o padrao nacional pode ajudar a compreender os determinantes de sua propria realidade, permitindo antecipar tendencias futuras e adequar os servicos de saude. Com esta perspectiva foi feito um estudo de morbidade, a partir de dados da Pesquisa Nacional por Amostra de Domicilios (PNAD/IBGE) de 1986, em dez Estados brasileiros, construindo-se coeficientes de prevalencia de morbidade, de demanda e de utilizacao de servicos segundo sexo, e padronizados por idade pelo metodo direto. Como medida dos diferenciais, usou-se razoes entre os sexos. A sobremorbidade feminina foi constante em todas as regioes. Os diferenciais de uso de servicos apresentaram variacao regional, sugerindo relacao com a oferta de servicos de saude. Os diferenciais foram nulos na infância; assumiram seus mais altos valores na idade reprodutiva das mulheres, diminuindo depois dos 60 anos. O padrao foi quase constante em todo o pais. Parte do fenomeno pode ser explicada por fatores de ordem metodologica. Contudo, os resultados foram semelhantes aos de outros paises. As transformacoes profundas no padrao reprodutivo e na insercao social da mulher brasileira tem seu impacto sobre a saude e o consumo de servicos ainda nao avaliado. Recomenda-se a realizacao de estudos mais especificos que contribuam para a reorganizacao do sistema de saude de modo equânime e universal.

Estratégias e desenvolvimento de garantia e controle de qualidade no ELSA-Brasil

The ELSA-Brasil (Estudo Longitudinal de Saude do Adulto - Brazilian Longitudinal Study for Adult Health) is a cohort study composed of 15,105 adults followed up in order to assess the development of chronic diseases, especially diabetes and cardiovascular disease. Its size, multicenter nature and the diversity of measurements required effective and efficient mechanisms of quality assurance and control. The main quality assurance activities (those developed before data collection) were: careful selection of research instruments, centralized training and certification, pretesting and pilot studies, and preparation of operation manuals for the procedures. Quality control activities (developed during data collection and processing) were performed more intensively at the beginning, when routines had not been established yet. The main quality control activities were: periodic observation of technicians, test-retest studies, data monitoring, network of supervisors, and cross visits. Data that estimate the reliability of the obtained information attest that the quality goals have been achieved.

Qualidade da atenção ao aborto no Sistema Único de Saúde do Nordeste brasileiro: o que dizem as mulheres?

Abortion is a serious health problem in Brazil and complications can be avoided by adequate and timely care. The article evaluates the quality of care given to women admitted for abortion in hospitals operated by the Unified Health System, in Salvador, Recife and Sao Luis, the benchmarks being Ministry of Health norms and user satisfaction. The article analyzes 2804 women admitted to hospital for abortion complications in 19 hospitals, between August and December 2010. Four dimensions were defined: reception and guidance; inputs and physical environment; technical quality and continuity of care. There was a closer fit to norms on reception and guidance. Social support and the right to information were not well rated in all three cities. The technical quality of care was rated poor. With respect to inputs and physical environment, cleanliness was the least adequate criterion. Continuity of care was the most critical situation in all three cities, due to the lack of scheduled follow-up appointments, information about care available after hospital discharge, the risk of further pregnancy and family planning. Abortion care falls short of that advocated under Brazilian norms and by international agencies.

Saúde e trabalho de mulheres profissionais de enfermagem em um hospital público de Salvador, Bahia

Nursing work is developed mainly by women and includes many risk factors for several diseases. Nevertheless, in Brazil, the studies about health conditions of the occupational group are almost inexistent. This cross-sectional study was carried out in order to investigate the health and work conditions of R.N. and auxiliary nurses of a public hospital. The data collection included interviews and measures of weight, height and blood pressure, in 495 employed nurses and auxiliary nurses. Specially among the auxiliary nurses, the results revealed very high prevalences of acute (45%) and chronic conditions, such as backache (71 %), varices (57,5%), arterial hypertension (24,9%), mental disorders (36,7%), obesity (16%), digestive (34,5%) and respiratory problems (31%). Both groups have too long a professional workday. However, the auxiliary nurses are overloaded by homework, that contribute to worsen their health conditions.