Leila Maria Geromel Dotto

Prevalência do exame preventivo de câncer do colo do útero em Rio Branco, Acre, Brasil, e fatores associados à não-realização do exame

The objective of the study was to determine the self-reported prevalence of uterine cervical cancer testing in Rio Branco, Acre State, Brazil, and to analyze factors associated with non-participation in screening. A population-based cross-sectional study with a sample of 772 women 18 to 69 years of age and living in Rio Branco was conducted in 2007 and 2008. Data were analyzed with Stata 10.0, and prevalence rates were estimated with Poisson multivariate regression (95%CI). 85.3% of women reported at least one cervical cancer screening test in the previous three years. The majority of women (72.8%) were screened in the Brazilian Unified National Health System. After adjusting for selected variables, statistically significant prevalence rates for absence of screening were found in women 18-24 and 60-69 years of age, single, and with low income and low schooling. The prevalence rates were consistent with findings from other studies, highlighting the need for greater intervention in the group of women most vulnerable to cervical cancer incidence and mortality.

Assistência pré-natal: competências essenciais desempenhadas por enfermeiros

Pesquisa com objetivo de analisar as competencias essenciais desenvolvidas, na pratica, pelos enfermeiros que atuam na atencao ao pre-natal. Trata-se de estudo descritivo com abordagem quantitativa, realizado em 16 unidades da rede basica de saude do municipio de Rio Branco-AC. A coleta de dados foi realizada por meio de observacao sistematica e nao participante. Dos enfermeiros que realizam a consulta pre-natal, apenas dois (11,76%) cursaram especializacao em obstetricia. Constatamos que a grande maioria das competencias essenciais esperadas na assistencia pre-natal foi desenvolvida; entretanto, algumas foram realizadas com baixa frequencia, ou seja, nao foram realizadas em todas as consultas. Os resultados revelaram que, apesar do bom desempenho dos enfermeiros, e pertinente avaliar a necessidade de esclarecimentos sobre a importância da incorporacao de protocolos assistenciais para a melhoria da qualidade dos servicos, a fim de alcancar um nivel otimo de competencia na atencao pre-natal.

Assistência pré-natal: dificuldades vivenciadas pelas enfermeiras

This study aimed to identify the difficulties nurses experience at the start of their professional life in prenatal care activities. Data were collected through interviews with 25 nurses who accompanied prenatal care in the basic health network of Rio Branco-AC, Brazil and were grouped according to the frequency and level of difficulty they mentioned. We observed that nurses did not demonstrate difficulties in a series of important prenatal care activities at the start of their professional life. However, they reported different levels of difficulties in other activities. Furthermore, the participants pointed out difficulties in activities that require knowledge (knowing) as well as abilities (know-how). This study also indicated flaws in undergraduate formation with respect to prenatal care, involving theoretical aspects as well as exclusively practical activities.La finalidad de este estudio fue identificar las dificultades vividas por las enfermeras en el inicio de su vida profesional, en las actividades relacionadas con la atencion prenatal. Los datos fueron recopilados a traves de entrevistas con 25 enfermeras que acompanaban el prenatal en la red basica de salud del municipio de Rio Branco-AC, Brasil, y fueron agrupados segun la frecuencia y el grado de dificultad mencionado por ellas. Constatamos que las enfermeras no presentaron dificultades en una serie de actividades importantes en la atencion prenatal, en el inicio de su vida profesional. Sin embargo, relataron que enfrentaron dificultades en otras. Estas dificultades se mostraron como siendo de diferentes grados. Senalaron dificultades en actividades que exigen conocimientos (saber), y tambien en actividades que necesitan de habilidades (saber-hacer). El estudio todavia indico fallas en la formacion de pregrado respecto a la atencion al prenatal, tanto para aspectos teoricos como para actividades exclusivamente practicas.

Prenatal care: difficulties experienced by nurses

This study aimed to identify the difficulties nurses experience at the start of their professional life in prenatal care activities. Data were collected through interviews with 25 nurses who accompanied prenatal care in the basic health network of Rio Branco-AC, Brazil and were grouped according to the frequency and level of difficulty they mentioned. We observed that nurses did not demonstrate difficulties in a series of important prenatal care activities at the start of their professional life. However, they reported different levels of difficulties in other activities. Furthermore, the participants pointed out difficulties in activities that require knowledge (knowing) as well as abilities (know-how). This study also indicated flaws in undergraduate formation with respect to prenatal care, involving theoretical aspects as well as exclusively practical activities.La finalidad de este estudio fue identificar las dificultades vividas por las enfermeras en el inicio de su vida profesional, en las actividades relacionadas con la atencion prenatal. Los datos fueron recopilados a traves de entrevistas con 25 enfermeras que acompanaban el prenatal en la red basica de salud del municipio de Rio Branco-AC, Brasil, y fueron agrupados segun la frecuencia y el grado de dificultad mencionado por ellas. Constatamos que las enfermeras no presentaron dificultades en una serie de actividades importantes en la atencion prenatal, en el inicio de su vida profesional. Sin embargo, relataron que enfrentaron dificultades en otras. Estas dificultades se mostraron como siendo de diferentes grados. Senalaron dificultades en actividades que exigen conocimientos (saber), y tambien en actividades que necesitan de habilidades (saber-hacer). El estudio todavia indico fallas en la formacion de pregrado respecto a la atencion al prenatal, tanto para aspectos teoricos como para actividades exclusivamente practicas.

Desempenho das competências obstétricas na admissão e evolução do trabalho de parto: atuação do profissional de saúde

O objetivo deste estudo foi identificar os profissionais de saude e suas competencias no atendimento as parturientes no momento de admissao na maternidade e durante a evolucao do trabalho de parto e discutir as competencias da equipe de enfermagem nesse atendimento. Foi realizado nas duas maternidades de Rio Branco-AC. A coleta de dados foi realizada em julho de 2005, por meio de observacoes das competencias essenciais em obstetricia desenvolvidas pelos profissionais de saude. A estatistica descritiva e o teste exato de Fisher foram usados para analise dos dados. Os resultados evidenciaram que os profissionais de enfermagem de nivel medio e medicos atuam na admissao e no trabalho de parto. O estudo revela que as instituicoes apresentam modelos diferenciados quanto a quem cabe a responsabilidade da execucao de determinadas competencias na atencao a parturiente, nao priorizam a qualificacao profissional para a assistencia a mulher no trabalho de parto.

Prevalence of sexual dysfunction in primigravidae in Rio Branco, Acre State, Brazil

This study aimed to estimate the prevalence of sexual dysfunction prior to and during the first pregnancy. This was a cross-sectional study using postpartum interviews with 778 primigravidae who were married or in stable unions and had given birth at the two maternity hospitals in Rio Branco, Acre State, Brazil, from February 1st to July 31st, 2010. Median age was 20 years, 45% were adolescents, 19% had completed elementary school, 30% had paid jobs, and 86.5% had used public healthcare services (SUS) for childbirth. Prevalence of sexual dysfunction was 23.9% prior to pregnancy and 67.7% during pregnancy. Decreased libido was present in 20.2% prior to pregnancy and 51% during pregnancy. Decreased vaginal lubrication occurred in 29.1% during pregnancy. Dyspareunia was present in 1.2% prior to pregnancy and 14.4% during pregnancy. Some 3.3% reported sexual dissatisfaction prior to pregnancy, as compared to 10.8% during pregnancy. Women with more schooling showed higher prevalence of sexual dysfunction during (as compared to before) their first pregnancy.

Atenção qualificada ao parto: a equipe de enfermagem em Rio Branco, Acre, Brasil

This study aimed at identifying and characterizing nursing care professionals assisting childbirth at maternity hospitals in the city of Rio Branco, State of Acre. It was conducted at the citys two maternity hospitals (one philanthropic institution and one public). The studied population con-sisted of 30 nursing professionals. The data were collected by means of interviews. The results showed that of the 25 (83.3%) nursing professionals who performed natural childbirth, 18 (72%) had been given training to perform childbirth through informal education, that is, by following or being followed by another professional during their work. It was concluded that, according to the World Health Organization criteria, only 7 (28%) nursing professionals giving care to parturient women at Rio Brancos institutions may be considered to be qualified for such care giving practice, thus showing that there is a need to qualify most of the nursing staff assisting women in labor and giving birth and their newborns.Este estudo teve como objetivo identificar e caracterizar os profissionais de enfermagem que prestam assistencia ao parto, nas maternidades do municipio de Rio Branco-AC. Foi realizado nas duas maternidades do Municipio. A populacao estudada foi composta por 30 profissionais de enfermagem. Os dados foram coletados por meio de entrevistas. Os resultados mostraram que, dos 25 (83,3%) profissionais de enfermagem que realizam parto normal, 18 (72%) receberam treinamento por meio de educacao informal, isto e, acompanhando e sendo acompanhados por outro profissional durante a jornada de trabalho. Conclui-se que, segundo criterios da Organizacao Mundial de Saude, apenas sete (28%) profissionais de enfermagem, que prestam assistencia a parturiente, sao considerados qualificados para este atendimento, revelando que existe necessidade de qualificacao de grande parte da equipe que atende as mulheres e seus recem-nascidos durante o parto e nascimento, nas instituicoes de saude de Rio Branco.

Reflexões sobre deambulação e posição materna no trabalho de parto e parto

Este artigo apresenta uma reflexao sobre os fatores determinantes que levaram a mudanca da posicao da mulher de vertical para horizontal no processo de parturicao. A institucionalizacao do processo de parir e nascer promoveu uma serie de mudancas no assistir a mulher e a familia. Muitas das praticas que preservavam o respeito a autonomia e aos valores culturais deram lugar a outros que valorizam a tecnologia, a medicalizacao e a intervencao. Tais mudancas nao efetivaram significativa reducao na mortalidade materna e neonatal, pelo contrario, promoveram a desumanizacao da assistencia. Um novo olhar sobre o efeito da deambulacao e da posicao durante o trabalho de parto e parto esta sendo incentivado e esta dando oportunidade de evidenciar uma serie de vantagens e beneficios para mae e filho.

Prevalência de disfunção sexual em primigestas, no Município de Rio Branco, Acre, Brasil

This study aimed to estimate the prevalence of sexual dysfunction prior to and during the first pregnancy. This was a cross-sectional study using postpartum interviews with 778 primigravidae who were married or in stable unions and had given birth at the two maternity hospitals in Rio Branco, Acre State, Brazil, from February 1st to July 31st, 2010. Median age was 20 years, 45% were adolescents, 19% had completed elementary school, 30% had paid jobs, and 86.5% had used public healthcare services (SUS) for childbirth. Prevalence of sexual dysfunction was 23.9% prior to pregnancy and 67.7% during pregnancy. Decreased libido was present in 20.2% prior to pregnancy and 51% during pregnancy. Decreased vaginal lubrication occurred in 29.1% during pregnancy. Dyspareunia was present in 1.2% prior to pregnancy and 14.4% during pregnancy. Some 3.3% reported sexual dissatisfaction prior to pregnancy, as compared to 10.8% during pregnancy. Women with more schooling showed higher prevalence of sexual dysfunction during (as compared to before) their first pregnancy.

Fatores associados ao uso de medicamentos na gestação em primigestas no Município de Rio Branco, Acre, Brasil

Estudio transversal con 887 primigestas para analizar los factores asociados al consumo de medicamentos durante el embarazo en Rio Branco, Acre, Brasil. La informacion se baso en entrevistas y tarjeta prenatal. Los medicamentos se calificaron de acuerdo con el sistema anatomico terapeutico quimico (ATC), de la Organizacion Mundial de la Salud y con la categoria de riesgo del Food and Drug Administration (Estados Unidos). La media de edad fue de 21 anos; la media del uso de medicamentos fue de un 2,42; los medicamentos mas consumidos fueron los antianemicos (47,5%), los suplementos y vitaminas (18,7%), analgesicos (13,8%) y antibioticos (10,5%). En la clasificacion de riesgo, un 69,3% pertenecian a la categoria A; 22,3% a B; 7,6% a C y 0,8% a la D. La posibilidad de haber estado expuestas al riesgo en el consumo de medicamentos fue mayor en primigestas en la unidad B (OR = 2,10, IC95%: 1,26-3,50), con edades entre 19 y 24 anos (OR = 2,79, IC95%: 1,58-4,93) y con prescripcion (OR = 1,86, IC95%: 1,18-2,95). Los medicamentos esenciales fueron utilizados con menos frecuencia en las mujeres con mayores ingresos de los hogares (OR = 0,63, IC95%: 0,42-0,96) y que realizaron el cuidado prenatal en una red clinica privada (OR = 0,53, IC95%: 0,38- 0,74).This cross-sectional study in a sample of 887 primigravidae in Rio Branco, Acre State, Brazil aimed to analyze factors associated with the use of medicines during the first pregnancy. Information was obtained from interviews and prenatal cards. Medicines were classified according to the Anatomical Therapeutic Chemical (ATC) Classification System of the World Health Organization and risk categories according to the U.S. Food and Drug Administration. Mean age was 21 years and mean number of medicines used was 2.42. The most frequently consumed medicines were antianemics (47.5%), supplements and vitamins (18.7%), analgesics (13.8%), and antibiotics (10.5%). In the risk categorization, 69.3% belonged to category A, 22.3% to B, 7.6% to C, and 0.8% to D. The odds of having used risky medicines were higher among primigravidae in unit B (OR = 2.10; 95%CI: 1.26-3.50), in the 19 to 24-year age bracket (OR = 2.79; 95%CI: 1.58-4.93), and in the presence of a medical prescription (OR = 1.86; 95%CI: 1.18-2.95). Essential drugs were less used by women with higher family income (OR = 0.63; 95%CI: 0.42-0.96) and those who had received private prenatal care (OR = 0.53; 95%CI: 0.38-0.74).Estudo transversal, envolvendo 887 primigestas com o objetivo de analisar os fatores associados ao uso de medicamentos na gestacao no Municipio de Rio Branco, Acre, Brasil. As informacoes tiveram como base uma entrevista e o cartao de pre-natal. Os medicamentos foram classificados de acordo com o Sistema Anatomico Terapeutico Quimico (ATC), da Organizacao Mundial da Saude, e com a categoria de risco do Food and Drug Administration (Estados Unidos). A media de idade foi 21 anos, a media do uso de medicamentos foi 2,42; os medicamentos mais consumidos foram os antianemicos (47,5%), suplementos e vitaminas (18,7%), analgesicos (13,8%) e antibioticos (10,5%). Na categorizacao de risco, 69,3% pertenciam a categoria A; 22,3% a B; 7,6% a C e 0,8% a D. A chance de ter sido exposta a utilizacao de medicamentos de risco foi maior nas primigestas na unidade B (RC = 2,10; IC95%: 1,26-3,50), na faixa etaria de 19 a 24 anos (RC = 2,79; IC95%: 1,58-4,93) e com prescricao medica (RC = 1,86; IC95%: 1,18-2,95). Os medicamentos essenciais foram menos utilizados entre as mulheres com maior renda familiar (RC = 0,63; IC95%: 0,42-0,96), e que realizaram o pre-natal na rede privada (RC = 0,53; IC95%: 0,38-0,74).