Maria Alice Tsunechiro

Adequação do conhecimento sobre métodos anticoncepcionais entre mulheres de Campinas, São Paulo

OBJETIVO: Realizou-se uma analise de dados secundarios para avaliar a adequacao do conhecimento sobre metodos anticoncepcionais e sua associacao com caracteristicas socioeconomicas e demograficas. METODO: Foi estudada uma amostra de 472 mulheres da Cidade de Campinas, Estado de Sao Paulo. Aplicou-se o teste qui-quadrado para avaliar diferencas entre as variaveis, e realizou-se analise multipla por regressao logistica para identificar as variaveis independentes associadas a adequacao do conhecimento (medida atraves de um escore). RESULTADOS: Pouco menos da metade das mulheres alcancou um escore de conhecimento dos metodos anticoncepcionais maior que seis, classificado como adequado. A maior escolaridade e a melhor classificacao de estrato socioeconomico associaram-se a um maior escore de conhecimento. CONCLUSAO: Os resultados apontam a necessidade de maiores investimentos na educacao das mulheres de modo geral e, especificamente, quanto a contracepcao. Ao mesmo tempo, e necessario que os profissionais que trabalham nos servicos publicos de saude estejam capacitados para proverem acesso aos metodos e a informacao adequada sobre eles.OBJECTIVE: An analysis of secondary data was carried out to evaluate the knowledge adequacy on contraceptives and its association with socioeconomic and demographic characteristics. METHODS: The sample consisted of 472 women from the city of Campinas, state of Sao Paulo, Brazil. Chi-square test was used to evaluate differences among variables and logistic regression was performed to identify independent variables associated with knowledge adequacy (evaluated through a score). RESULTS: Of the total, 47.6% women reached a score higher than six, which was classified as an adequate knowledge on contraceptives. Higher schooling and better socioeconomic status were associated to higher scores of knowledge. CONCLUSIONS: The results show that it is necessary to improve womens education in general, and on contraceptive methods specifically. In addition, professionals working in public health services should be capacitated to provide contraceptives as well as adequate information on contraceptive methods.

Cuidar e o conviver com o filho prematuro: a experiência do pai

O estudo objetivou descrever e compreender a experiencia do pai de prematuro que nasceu com peso inferior a 1.500g. Adotou-se o referencial metodologico da etnografia e os dados foram coletados por meio da observacao participante e entrevistas. A terapia intensiva neonatal de um hospital de ensino e os domicilios de seis pais constituiram-se no cenario cultural. Os resultados foram apresentados sob a forma de narrativa com analise, segundo o Metodo Biografico Interpretativo. Das oito categorias culturais emergiram dois temas: a capacidade para tornar-se pai - momentos de luta e crescimento e o cuidar e conviver com o filho. As vivencias transformadoras na vida dos homens foram compreendidas em duas situacoes: intra-hospitalar, representadas pelo nascimento precoce, sofrimento imposto na internacao e religiosidade; extra-hospitalar, manifestadas pelo conviver no domicilio e esperanca no futuro da crianca, ambos permeados por experiencias positivas e negativas.This study aimed to understand the experience of fathers of premature newborns weighing less than 1500g. Ethnography provided the methodological framework and data were collected through participant observation and interviews. The cultural scenario was the Intensive Care Unit of a school hospital and the homes of 6 fathers. The results were presented as a narrative and analyzed according to the Interpretative Biographic Method. From the 8 cultural categories, 2 main themes emerged: The ability to become a father: fighting and growing moments, and caring and living with the son. These mens life- transforming experiences were understood in 2 situations: in-hospital, represented by the premature newborn, the suffering imposed by hospitalization and religiosity; and out-hospital, manifested by living at home and hope about the childs future, both of which held a combination of positive and negative experiences.

Formação profissional de obstetrizes e enfermeiras obstétricas: velhos problemas ou novas possibilidades?

Refere-se as transformacoes na formacao profissional de parteiras, obstetrizes e enfermeiras obstetricas no Brasil, desde a criacao dos cursos de parteiras vinculados as escolas medicas, no seculo XIX, ate as mais recentes experiencias, mediante cursos de especializacao em enfermagem obstetrica. Discute os modelos de formacao dos profissionais que existem em outros paises, considerando tanto o ensino independente da obstetricia como a modalidade vinculada aos cursos de enfermagem. Apresenta proposta de um curso de obstetricia para ser oferecido por escolas de enfermagem.

Avaliaçäo do consumo de bebida alcoólica durante a gravidez

Purpose: to check alcohol consumption during pregnancy regarding type of drink, amount ingested, awareness of alcohol consumption risk, and tracking its consumption during prenatal care. Methods: interview of 445 women who had just given birth in a maternity hospital from January to May, 1999. The data analysis was performed using Students t test and Kruskal-Wallis nonparametric test. Results: of the women interviewed, 66.3% did not consume alcohol, 17.8% consumed it throughout pregnancy and 15.9% consumed it until pregnancy was confirmed, which occurred when they were 9.6 weeks pregnant on average; 98.7% of the women consumed it on weekends or at parties, and 1.3% daily. The mean ingestion was 14.74 grams/occasion for those who consumed alcohol throughout pregnancy and 25.83% grams/occasion for those who consumed it until pregnancy was confirmed. There were statistical differences between the mean rates in both groups. The mean intake per occasion was classified as moderate. The most ingested alcoholic beverage was beer (64.0%). Regarding awareness of the risk of alcohol intake, 71.5% believe that it is not good for the fetus health, 15.5% believe that it is not good for their own health. Alcohol consumption tracking was referred to by 48.8% of the women. Conclusion: a great number of women consumed alcoholic drinks at some time during pregnancy, despite being aware of the risks to their fetus. Prenatal care is not used as a favorable occasion for alcohol consumption tracking as well as for discontinuing its intake.

Localização inicial da ponta de cateter central de inserção periférica (PICC) em recém-nascidos

This is a cross-sectional study aiming to identify the initial tip position of peripherally inserted central catheters (PICC) and to verify the prevalence of success in inserting such catheters in neonates. The study was carried out in the neonatal care unit of Hospital das Clinicas, Universidade de Sao Paulo. Data were collected prospectively from March to September 2006. 37 neonates underwent PICC insertion were included in the study. The rate of success for this procedure was 72.3% (27 neonates). Of them, four (14.8%) had the catheter tips placed in the axilary or inominate veins. Three others (11.1%) had them placed in a jugular vein. When these catheters were removed, 13 (48.2%) catheter tip were placed in the right atrium, and they were relocated to the superior vena cava.This is a cross-sectional study aiming to identify the initial tip position of peripherally inserted central catheters (PICC) and to verify the prevalence of success in inserting such catheters in neonates. The study was carried out in the neonatal care unit of Hospital das Clinicas, Universidade de São Paulo. Data were collected prospectively from March to September 2006. 37 neonates underwent PICC insertion were included in the study. The rate of success for this procedure was 72.3% (27 neonates). Of them, four (14.8%) had the catheter tips placed in the axilary or inominate veins. Three others (11.1%) had them placed in a jugular vein. When these catheters were removed, 13 (48.2%) catheter tip were placed in the right atrium, and they were relocated to the superior vena cava.

Food Consumption and Iron Intake of Pregnant and Reproductive Aged Women

Comparar la practica alimentar y el consumo de alimentos fuentes de hierro, naturales y fortificados, de mujeres en edad reproductiva, gestantes o no, constituye el objetivo de esta investigacion. Se trata de un estudio transversal, desarrollado en un centro de salud del municipio de Sao Paulo, en el cual participaron 61 mujeres, siendo 30 gestantes. Se utilizo un cuestionario de frecuencia de consumo alimentar y un recordatorio de 24h. Las principales fuentes naturales de hierro fueron frijoles y hojas verdes. Alimentos fortificados tambien tuvieron participacion importante. Hubo una pequena diferencia estadisticamente significativa entre el consumo alimentar de las gestantes y no gestantes. Se observo inadecuacion del consumo de hierro, folato y calcio en los dos grupos. Las mujeres no gestantes atenderian la demanda de hierro, considerandose el adicional recomendado para la fortificacion de las harinas, sin embargo, las gestantes no. Hay necesidad de implementar estrategias combinadas: fortificacion de los alimentos, suplemento medicamentoso para gestantes y orientacion nutricional para las mujeres en general.Comparar a pratica alimentar e o consumo de alimentos fontes de ferro, naturais e fortificados, de mulheres em idade reprodutiva, gestantes ou nao, constituiu o objetivo desta pesquisa. Estudo transversal, desenvolvido em um centro de saude do municipio de Sao Paulo, envolvendo 61 mulheres, sendo 30 gestantes. Utilizou-se questionario de frequencia de consumo alimentar e recordatorio de 24h. As principais fontes naturais de ferro foram feijao e folhas verdes. Alimentos fortificados tambem tiveram participacao importante. Houve pequena diferenca estatisticamente significativa entre o consumo alimentar das gestantes e nao gestantes. Observou-se inadequacao do consumo de ferro, folato e calcio nos dois grupos. As mulheres nao gestantes atenderiam a demanda de ferro, considerando-se o adicional recomendado para a fortificacao das farinhas, porem, as gestantes nao. Ha necessidade de estrategias combinadas: fortificacao dos alimentos, suplementacao medicamentosa para gestantes e orientacao nutricional para as mulheres em geral.This study compares the eating habits and consumption of natural and fortified iron sources in pregnant and reproductive aged women. This cross-sectional study was developed in a health center located in São Paulo, SP, Brazil. We studied 61 women, of which 30 were pregnant. A food frequency questionnaire and a 24-hour recall instrument were used. The main natural sources of iron were beans and greens, although fortified foods were also an important source. There was little statistically significant difference between the food consumption of pregnant and non-pregnant women. Inadequate intake of iron, folate and calcium was observed in both groups. Non-pregnant women meet the iron recommendation, considering the iron added in fortified foods, though pregnant women do not. These results suggest the need for mixed strategies: food fortification, iron supplements for pregnant women and nutritional instruction for women in general.

O olhar dos usuários de um hospital de ensino: uma análise da qualidade assistencial às gestantes e aos recém-nascidos

The evaluation of health care services, as perceived by the users, is considered to be an important instrument of the management process. The objective of this study is to understand the user’s perception of a university hospital, during their children’s birth and hospital admission in the intensive care unit. This is an ethnographical study. The data was collected through a semi-structured interview. The results were presented as a narrative and twelve categories and the following cultural themes emerged: classifying the experiences, glimpsing the birth process, the capacity to become parents, and care and living with a child. Findings permitted an understanding of the user’s view as relates to the hospital environment, showing positive and negative aspects of this institution. The results were analyzed through the Biographical Interpretative Method. They also showed the need to restructure managerial activities and care according to the evaluation of the structure, process, and result. RESUMEN: La evaluación de los servicios de la salud, subsidiado según la percepción de los usuarios, ha sido considerada como un instrumento importante en el proceso del trabajo gerencial. El estudio tuvo como objetivo comprender la percepción de los usuarios de un hospital escuela, en el momento del nacimiento y de la internación de los hijos en la Unidad de Cuidador Intensivo Neonatal. Es una investigación etnográfica, para la colecta de los datos se empleó la entrevista semi-estructurada. Los resultados fueron presentados de forma narrativa, su análisis fue através del Método Biográfico Interpretativo. De las narrativas surgieron doce categorías y los siguientes temas culturales: clasificando las experiencias vividas, la visión del proceso de nacimiento, la capacidad de ser padres y el cuidar y convivir con el hijo. Los hallazgos permitieron conocer la visión de los usuarios y orientaron las necesidades de una reorganización de las actividades asistenciales y gerenciales en las dimensiones evaluativas de estructura, de proceso y de resultado. Endereço: Daisy M. R. Tronchin Universidade de São Paulo USP Av. Dr. Enéas de Carvalho Aguiar, 419 05.403-000 – Cerqueira César, São Paulo, SP. E-mail: daisyrt@usp.br Artigo original: Pesquisa Recebido em: 02 de fevereiro de 2006. Aprovação final: 12 de junho de 2006. PALAVRAS-CHAVE: Satisfação dos consumidores. Qualidade. Assistência perinatal. Antropologia cultural.La evaluacion de los servicios de la salud, subsidiado segun la percepcion de los usuarios, ha sido considerada como un instrumento importante en el proceso del trabajo gerencial. El estudio tuvo como objetivo comprender la percepcion de los usuarios de un hospital escuela, en el momento del nacimiento y de la internacion de los hijos en la Unidad de Cuidador Intensivo Neonatal. Es una investigacion etnografica, para la colecta de los datos se empleo la entrevista semi-estructurada. Los resultados fueron presentados de forma narrativa, su analisis fue atraves del Metodo Biografico Interpretativo. De las narrativas surgieron doce categorias y los siguientes temas culturales: clasificando las experiencias vividas, la vision del proceso de nacimiento, la capacidad de ser padres y el cuidar y convivir con el hijo. Los hallazgos permitieron conocer la vision de los usuarios y orientaron las necesidades de una reorganizacion de las actividades asistenciales y gerenciales en las dimensiones evaluativas de estructura, de proceso y de resultado.A avaliacao dos servicos de saude, subsidiada pela percepcao de usuarios, vem sendo considerada um importante instrumento do processo de trabalho gerencial. Este estudo objetivou compreender a percepcao de usuarios de um hospital de ensino, por ocasiao do nascimento e da internacao de seus filhos na Unidade de Terapia Intensiva Neonatal. Trata-se de um paper de cunho etnografico, cuja coleta de dados empregou a entrevista semi-estruturada. Os resultados foram apresentados na forma de narrativa, das quais emergiram doze categorias e os seguintes temas culturais: classificando as experiencias vividas, vislumbrando o processo de nascimento, a capacidade de tornarem-se pais e o cuidar e conviver com o filho. Os resultados foram analisados por meio do Metodo Biografico Interpretativo e permitiram conhecer a visao dos usuarios nas dimensoes avaliativas de estrutura, de processo e de resultado, proporcionando aos gerentes, do cenario deste estudo, a revisao de suas praticas assistenciais e administrativas.

Anemia in Brazilian pregnant women before and after flour fortification with iron

OBJECTIVE To compare prevalence of anemia and hemoglobin (Hb) levels in Brazilian pregnant women before and after flour fortification with iron. METHODS A repeated cross-sectional panel study of public health care centers of municipalities in the five Brazilian regions was conducted. Retrospective data were obtained from 12,119 medical records of pregnant women distributed in two groups: before fortification (delivery prior to June 2004) and after fortification (date of last period after June 2005). Anemia was defined as Hb<11.0 g/dl. Hb levels according to gestational age were assessed using two references from the literature. Statistical analysis was carried out using chi-squared tests, Students t tests, and logistic regression, with a significance level of 5%. RESULTS In the total sample, prevalence of anemia fell from 25% to 20% after fortification (p<0.001). However, important regional differences were evident: while significant reductions were seen in the Northeast (37% to 29%) and North (32% to 25%) regions, where pre-fortification prevalence was high, smaller reductions were seen in the Southeast (18% to 15%) and South (7% to 6%) regions, where prevalence was low. Hb levels according to gestational age were slightly higher in the first months of pregnancy and lower after the third or fourth months, depending on the reference used. Logistic regression analysis showed that group, geographic region, marital status, trimester of pregnancy, initial nutritional status, and prior pregnancy were associated with anemia (p<0.05). CONCLUSIONS Prevalence of anemia decreased after fortification, but remains high in the North and Northeast regions. Although fortification may have played a role in this favorable outcome, the contribution of other public policies implemented during the studied period should also be considered.

Anemia em gestantes brasileiras antes e após a fortificação das farinhas com ferro

OBJECTIVE To compare prevalence of anemia and hemoglobin (Hb) levels in Brazilian pregnant women before and after flour fortification with iron. METHODS A repeated cross-sectional panel study of public health care centers of municipalities in the five Brazilian regions was conducted. Retrospective data were obtained from 12,119 medical records of pregnant women distributed in two groups: before fortification (delivery prior to June 2004) and after fortification (date of last period after June 2005). Anemia was defined as Hb<11.0 g/dl. Hb levels according to gestational age were assessed using two references from the literature. Statistical analysis was carried out using chi-squared tests, Students t tests, and logistic regression, with a significance level of 5%. RESULTS In the total sample, prevalence of anemia fell from 25% to 20% after fortification (p<0.001). However, important regional differences were evident: while significant reductions were seen in the Northeast (37% to 29%) and North (32% to 25%) regions, where pre-fortification prevalence was high, smaller reductions were seen in the Southeast (18% to 15%) and South (7% to 6%) regions, where prevalence was low. Hb levels according to gestational age were slightly higher in the first months of pregnancy and lower after the third or fourth months, depending on the reference used. Logistic regression analysis showed that group, geographic region, marital status, trimester of pregnancy, initial nutritional status, and prior pregnancy were associated with anemia (p<0.05). CONCLUSIONS Prevalence of anemia decreased after fortification, but remains high in the North and Northeast regions. Although fortification may have played a role in this favorable outcome, the contribution of other public policies implemented during the studied period should also be considered.

Parteiras-enfermeiras e Enfermeiras-parteiras: a interface de profissões afins, porém distintas

Em 2005, com a criacao do Curso de Graduacao em Obstetricia da Universidade de Sao Paulo, as discussoes em torno dos modelos de formacao de profissionais nao-medicos para a assistencia ao parto foram reaquecidas. O objetivo do estudo e aprofundar a compreensao do significado da retomada do referido Curso no momento atual da assistencia ao parto e nascimento. Os eventos do passado que influenciaram nos modelos de assistencia ao parto por nao-medicos foram considerados: a aprovacao da lei das parteiras na Inglaterra, em 1902, com a inclusao de sua pratica ao sistema de saude oficial, a marginalizacao do trabalho da parteira tradicional nos Estados Unidos da America e os momentos emblematicos das disputas de enfermeiras e obstetrizes (parteiras) no Brasil.In 2005, the Midwifery course at undergraduate level was created at the University of Sao Paulo, which has intensified discussions about educational models for non-medical professionals for delivery care. This study aims at deepen the understanding of meanings related to re-starting the mentioned course at the present moment involving delivery and childbirth care. Past events that have influenced models for delivery care by non-medical personnel were considered: the enactment of a law for midwives in England, in 1902, which included this practice into the official national health system, the traditional midwife work in the U.S.A. considered as peripheral and emblematic moments dispute between nurses and midwives in Brazil.