Maria da Graça Garcia Andrade

Violência doméstica na gravidez: prevalência e fatores associados

OBJETIVO: Identificar los factores asociados a la violencia domestica contra gestantes. METODOS: Se entrevistaron 1.379 gestantes usuarias del Sistema Unico de Salud que frecuentaban las unidades basicas de salud en el municipio de Campinas (Sureste de Brasil). Se analizaron las primera y segunda entrevistas de un estudio de cohorte, aplicandose cuestionario estructurado sobre violencia domestica valido en Brasil, de julio de 2004 a julio de 2006. Se realizaron analisis descriptiva y regresion logistica multiple de los datos. RESULTADOS: Del total de las gestantes, 19,1% (n=263) reportaron violencia psicologica y 6,5% (n=89) violencia fisica/sexual. Los factores asociados a la violencia psicologica fueron: pareja intima adolescente (p<0,019) y gestante que ha presenciado agresion fisica antes de los 15 anos (p<0,001). Se asociaron a la violencia fisica/sexual: dificultad de la gestante para acudir a las consultas de pre-natal (p<0,014), pareja intima que hace uso de drogas (p<0,015) y no poseer empleo (p<0,048). Los factores asociados a la violencia psicologica y fisica/sexual fueron: bajo nivel de escolaridad de la gestante (p<0,013 y p<0,020, respectivamente), ser la gestante responsable por la familia (p<0,001 y p=0,017, respectivamente), gestante que ha padecido agresion fisica en la infancia (p<0,029 y p<0,038, respectivamente), presencia de trastorno mental comun (p<0,001) y consumo de bebida alcoholica, por parte de la pareja intima, dos o mas veces por semana (p<0,001). CONCLUSIONES: Se pudo constatar alta prevalencia de las diferentes categorias de violencia domestica practicada por la pareja intima durante el periodo gestacional, asi como, con los diversos factores asociados a las mismas. Mecanismos apropiados para la identificacion y abordaje de la violencia domestica en la gestacion son necesarios, especialmente en la atencion primaria.OBJECTIVE To identify the factors associated with domestic violence against pregnant women. METHODS Interviews were conducted with 1,379 pregnant women undergoing antenatal care in basic health care units of the Brazilian Health System, within the municipality of Campinas (Southeastern Brazil). A structured questionnaire on domestic violence, validated in Brazil, was applied between July 2004 and July 2006. The first and second interviews in a cohort study were analyzed. Descriptive and multiple logistic regression analysis of the data were conducted. RESULTS Psychological violence was reported by 19.1% (n=263) of the total sample of pregnant women and physical/sexual violence was reported by 6.5% (n=89) of them. The factors associated to psychological violence were: adolescent intimate partner (p<0.019) and the pregnant woman had witnessed physical aggression before she was 15 years old (p<0.001). The factors associated to physical/sexual violence were: difficulties encountered by the pregnant woman in attending her antenatal appointments (p<0.014), intimate partner uses drugs (p<0.015) and does not work (p<0.048). The factors associated to psychological and physical/ sexual violence were: low level of education of the interviewee (p<0.013 and p<0.020, respectively), the pregnant woman being responsible for the family (p<0.001 and p=0.017, respectively) pregnant woman had suffered physical aggression during childhood (p<0.029 and p<0.038, respectively), presence of common mental disorder (p<0.001) and intimate partner consumes alcoholic beverage twice or more weekly. (p<0.001). CONCLUSIONS A high prevalence of different categories of domestic violence by an intimate partner during pregnancy was found as well as different factors associated with them. Appropriate mechanisms are necessary, particularly in primary health care, to identify and deal with domestic violence during pregnancy.

A Atenção Básica à Saúde e a construção das redes temáticas de saúde: qual pode ser o seu papel?

The enhancement of primary healthcare has been a core strategy for the empowerment of the Brazilian Unified Health System (SUS). Recent guidelines issued by OPAS and the Ministry of Health highlight the role it has played as a thematic communication network center, a regulating agent for the access and use of services required for comprehensive healthcare. Sponsored by PPSUS/Fapesp, this study examines the possibilities of the primary healthcare network exercising such a strategic function. Life narratives involving 15 regular users were produced in two cities of ABC Paulista, which have adopted the Family Health Strategy for the organization of their primary healthcare networks. The study presents three main findings: the primary healthcare network serves as an outpost of SUS by producing user values even for high complexity service users; the primary network is perceived is a place for simple care needs; there is shared impotence between users and teams when it comes to the network functioning as the coordinator of care, indicating that it does not possess the technological, operational and organizational material conditions or symbolic conditions (values, meanings, and representations) to be in a central position in the coordination of thematic healthcare networks.

Violence against pregnant women: prevalence and associated factors.

OBJETIVO: Identificar los factores asociados a la violencia domestica contra gestantes. METODOS: Se entrevistaron 1.379 gestantes usuarias del Sistema Unico de Salud que frecuentaban las unidades basicas de salud en el municipio de Campinas (Sureste de Brasil). Se analizaron las primera y segunda entrevistas de un estudio de cohorte, aplicandose cuestionario estructurado sobre violencia domestica valido en Brasil, de julio de 2004 a julio de 2006. Se realizaron analisis descriptiva y regresion logistica multiple de los datos. RESULTADOS: Del total de las gestantes, 19,1% (n=263) reportaron violencia psicologica y 6,5% (n=89) violencia fisica/sexual. Los factores asociados a la violencia psicologica fueron: pareja intima adolescente (p<0,019) y gestante que ha presenciado agresion fisica antes de los 15 anos (p<0,001). Se asociaron a la violencia fisica/sexual: dificultad de la gestante para acudir a las consultas de pre-natal (p<0,014), pareja intima que hace uso de drogas (p<0,015) y no poseer empleo (p<0,048). Los factores asociados a la violencia psicologica y fisica/sexual fueron: bajo nivel de escolaridad de la gestante (p<0,013 y p<0,020, respectivamente), ser la gestante responsable por la familia (p<0,001 y p=0,017, respectivamente), gestante que ha padecido agresion fisica en la infancia (p<0,029 y p<0,038, respectivamente), presencia de trastorno mental comun (p<0,001) y consumo de bebida alcoholica, por parte de la pareja intima, dos o mas veces por semana (p<0,001). CONCLUSIONES: Se pudo constatar alta prevalencia de las diferentes categorias de violencia domestica practicada por la pareja intima durante el periodo gestacional, asi como, con los diversos factores asociados a las mismas. Mecanismos apropiados para la identificacion y abordaje de la violencia domestica en la gestacion son necesarios, especialmente en la atencion primaria.OBJECTIVE To identify the factors associated with domestic violence against pregnant women. METHODS Interviews were conducted with 1,379 pregnant women undergoing antenatal care in basic health care units of the Brazilian Health System, within the municipality of Campinas (Southeastern Brazil). A structured questionnaire on domestic violence, validated in Brazil, was applied between July 2004 and July 2006. The first and second interviews in a cohort study were analyzed. Descriptive and multiple logistic regression analysis of the data were conducted. RESULTS Psychological violence was reported by 19.1% (n=263) of the total sample of pregnant women and physical/sexual violence was reported by 6.5% (n=89) of them. The factors associated to psychological violence were: adolescent intimate partner (p<0.019) and the pregnant woman had witnessed physical aggression before she was 15 years old (p<0.001). The factors associated to physical/sexual violence were: difficulties encountered by the pregnant woman in attending her antenatal appointments (p<0.014), intimate partner uses drugs (p<0.015) and does not work (p<0.048). The factors associated to psychological and physical/ sexual violence were: low level of education of the interviewee (p<0.013 and p<0.020, respectively), the pregnant woman being responsible for the family (p<0.001 and p=0.017, respectively) pregnant woman had suffered physical aggression during childhood (p<0.029 and p<0.038, respectively), presence of common mental disorder (p<0.001) and intimate partner consumes alcoholic beverage twice or more weekly. (p<0.001). CONCLUSIONS A high prevalence of different categories of domestic violence by an intimate partner during pregnancy was found as well as different factors associated with them. Appropriate mechanisms are necessary, particularly in primary health care, to identify and deal with domestic violence during pregnancy.

Training medical students to improve the management of people with epilepsy

PURPOSE To evaluate the knowledge, attitude and perception of medical students prior to and after a training course about epilepsy. METHODS We used a KAP questionnaire with sixty-one questions which assesses knowledge, attitude and practice of epilepsy. Questionnaires were completed by 185 medical students, before and after epilepsy training. We compared the answers to see whether the lecture had changed the knowledge, attitude and practice in epilepsy. RESULTS One hundred and six students completed the questionnaire before an eight hour course on epilepsy and 79 students completed the questionnaire one year after the course. Comparison of the knowledge scores prior to (mean=53.9, standard deviation=11.4) and after the course (mean=63.8, standard deviation=11.9) showed that students had improved knowledge after the course (t-test=5.6, p<0.001). DISCUSSION Training course on epilepsy for medical students can promote improvement in the knowledge, attitudes and perception regarding epilepsy, which is maintained one year later. These results highlight the importance of continuous educational programs within the Medical Curriculum.

Prevalência de dermatoses na rede básica de saúde de Campinas, São Paulo - Brasil

BACKGROUND: Skin lesions are often noted by the individuals bearing them, as well as by their relatives. There is a significant number of patients with skin complaints who search for medical care. OBJECTIVES: To determine the frequency of dermatological complaints and/or findings in users of the primary health care system of the city of Campinas, Brazil. METHODS: Five units were chosen by the Municipal Health Department to participate in this research. All the patients assisted by health professionals of these units were evaluated regarding the presence or absence of dermatological symptoms/ signals in a time period of twenty working days. RESULTS: The acquired data demonstrated that 358 (24.01%) out of 1,491 assisted patients displayed dermatological complaints and/or findings, with a greater prevalence among the younger patients. Of all the users assisted by health professionals who participated in the study and had their records adequately filled out, 9.98% sought the primary care unit primarily because of a dermatological complaint. CONCLUSIONS: These results, in accordance to those of similar surveys carried out in other countries, show the importance of the specialty for the performance of non-dermatologist physicians, pediatricians in particular, and provide elements for the discussion surrounding the curricular reform, concerning the amount of time dedicated to the teaching of dermatology.

Avaliação de um programa de controle do câncer cérvico-uterino em rede local de saúde da Região Sudeste do Brasil

This study considers the possibility of expanding the roles of the local health care system to respond to demands by the population. Focusing on the problem of cervical cancer, the study evaluated the results obtained by a preventive program conducted in a municipal health system with the objective of evaluating its case-resolving capacity and patient compliance. Variables were related to diagnosis and follow-up of 465 women enrolled in the program from 1987 to 1994. For purposes of comparison, the study used the results from a specialized regional referral service during the same period. The programs case-resolving capacity was similar to that of the referral service; in addition, on average the cervical lesions were less severe and the treatment drop-out rate was lower among patients from the local health care system, reflecting better follow-up compliance. It is important to train local health personnel in order to improve care, including treatment for more complex diseases.

O agir leigo e o cuidado em saúde: a produção de mapas de cuidado

O estudo teve como objetivo caracterizar que outras logicas de regulacao, para alem da governamental, resultam na producao do cuidado, por meio de pesquisa qualitativa realizada em dois municipios do ABCD Paulista, Sao Paulo, Brasil, em duas etapas. Na primeira, foram realizadas entrevistas com atores estrategicos (gestores e politicos) e atores-trabalhadores-chave. Na segunda, foram coletadas historias de vida de 18 pessoas com elevada frequencia de utilizacao de servicos de saude. A analise de implicacao dos pesquisadores com o campo permitiu uma melhor compreensao das narrativas. Foram caracterizados quatro regimes de regulacao (governamental, profissional, clientelistico e leigo), indicando que a regulacao e campo em permanente disputa, e uma producao social. Com o seu agir, os usuarios produzem mapas de cuidado que nos indicam como ha outros arranjos possiveis de sistemas de saude, representando um convite para experimentarmos a cogestao do cuidado entre equipes e usuarios, como caminho promissor para a inadiavel necessidade de reinvencao da saude.

Sorologia para sífilis: os médicos estão capacitados a interpretá-la?

Resumo: O ensino da dermatologia e pouco valorizado no curriculo medico, e as doencas sexualmente transmissiveis, em geral, sao apresentadas de forma nao sistematizada. Em estudo sobre o ensino da dermatologia, de 83 medicos que participaram do projeto apenas 10 acertaram uma questao sobre sorologia de lues. Mais pesquisas sobre o ensino das doencas sexualmente transmissiveis sao necessarias no Brasil, e os dermatologistas devem aproveitar a oportunidade, trazida pelas reformas curriculares, para reassumir a responsabilidade do ensino dessas doencas. Palavras-chave: Dermatologia; Doencas sexualmente transmissiveis; Ensino; Eritema multiforme; Sifilis

The perception of domestic violence of pregnant and not pregnant women in the city of Campinas, São Paulo

This study sought to compare the perception of domestic violence of women, victims of this kind of violence, with the perception of pregnant women, victims or not of domestic violence, as well as to search for elements allowing for the planning and execution of a cohort study on domestic violence among pregnant women. A qualitative exploratory research was conducted using the technique of convenience sampling for selecting a focal group. The subjects were twenty four women divided into two groups: (1) thirteen women from a follow-up group from a Referral Center for victims of domestic violence, and (2) eleven pregnant women that were participating in the pre-natal care program in a primary care unit, selected independently of suffering domestic violence or not. The data collected were transcribed, conceptually decoded and qualified for qualitative analysis. The contents of the womens discourse were analyzed on the basis of thematic categories. It was observed that domestic violence was perceived in a similar way by both studied groups, independently from the fact of having or not experienced a situation of this kind. The understanding and discussion of the topics proposed for the groups allowed developing a more appropriate approach to the studied women. The way the questions were formulated in the questionnaire was considered of easy understanding by both groups of women.

Percepção da violência doméstica por mulheres gestantes e não gestantes da cidade de Campinas, São Paulo

This study sought to compare the perception of domestic violence of women, victims of this kind of violence, with the perception of pregnant women, victims or not of domestic violence, as well as to search for elements allowing for the planning and execution of a cohort study on domestic violence among pregnant women. A qualitative exploratory research was conducted using the technique of convenience sampling for selecting a focal group. The subjects were twenty four women divided into two groups: (1) thirteen women from a follow-up group from a Referral Center for victims of domestic violence, and (2) eleven pregnant women that were participating in the pre-natal care program in a primary care unit, selected independently of suffering domestic violence or not. The data collected were transcribed, conceptually decoded and qualified for qualitative analysis. The contents of the womens discourse were analyzed on the basis of thematic categories. It was observed that domestic violence was perceived in a similar way by both studied groups, independently from the fact of having or not experienced a situation of this kind. The understanding and discussion of the topics proposed for the groups allowed developing a more appropriate approach to the studied women. The way the questions were formulated in the questionnaire was considered of easy understanding by both groups of women.