Ondina Fachel Leal

Desenvolvimento da versão em português do instrumento de avaliação de qualidade de vida da OMS (WHOQOL-100)

A Organizacao Mundial da Saude desenvolveu um instrumento para avaliacao de qualidade de vida atraves de um projeto colaborativo multicentrico. Sao descritas a metodologia e as diferentes etapas de desenvolvimento do instrumento original. A seguir, e apresentado o desenvolvimento da versao em portugues. Atraves de uma metodologia propria foi realizada a traducao, discussao em grupos focais com membros da comunidade, pacientes e profissionais de saude, seguida de retrotraducao. O objetivo dos grupos focais foi discutir a adequacao da traducao e da selecao de itens para avaliar qualidade de vida em uma cidade brasileira (Porto Alegre). O trabalho em grupo focal mostrou que o Instrumento de avaliacao de Qualidade de Vida da Organizacao Mundial da Saude (WHOQOL-100) apresenta condicoes para aplicacao no Brasil em sua versao original em portugues.

Unwanted caesarean sections among public and private patients in Brazil: prospective study

Abstract Objective: To assess and compare the preferences of pregnant women in the public and private sector regarding delivery in Brazil. Design: Face to face structured interviews with women who were interviewed early in pregnancy, about one month before the due date, and about one month post partum. Setting: Four cities in Brazil. Participants: 1612 pregnant women: 1093 public patients and 519 private patients. Main outcome measures: Rates of delivery by caesarean section in public and private institutions; womens preferences for delivery; timing of decision to perform caesarean section. Results: 1136 women completed all three interviews; 476 women were lost to follow up (376 public patients and 100 private patients). Despite large differences in the rates of caesarean section in the two sectors (222/717 (31%) among public patients and 302/419 (72%) among private patients) there were no significant differences in preferences between the two groups. In both antenatal interviews, 70-80% in both sectors said they would prefer to deliver vaginally. In a large proportion of cases (237/502) caesarean delivery was decided on before admission: 48/207 (23%) in women in the public sector and 189/295 (64%) in women in the private sector. Conclusions: The large difference in the rates of caesarean sections in women in the public and private sectors is due to more unwanted caesarean sections among private patients rather than to a difference in preferences for delivery. High or rising rates of caesarean sections do not necessarily reflect demand for surgical delivery. What is already known on this topic In Brazil, one quarter of all women deliver in the private sector The rate of caesarean deliveries in the private sector is extremely high (70%) and more than twice that in the public sector, where rates have recently fallen due to a new policy Previous studies in which women were interviewed after birth showed that a substantial proportion of private patients who have caesarean sections would have preferred normal delivery What this study adds In two antenatal interviews, preferences regarding type of delivery were nearly identical among public and private patients and strongly favoured vaginal births Contrary to popular belief, middle and upper class women in Brazil do not want to deliver by caesarean section

Frustrated demand for postpartum female sterilization in Brazil

During the last three decades, Brazilians have relied almost exclusively on two contraceptive methods, the pill and female sterilization, with sterilization use increasing over time. Until a new law was passed in 1997, sterilization was virtually illegal and not covered by either public or private health insurance. It was, however, frequently provided in public and private hospitals in conjunction with a cesarean section. The new law regulating sterilization provided for reimbursement for interval sterilizations by public health insurance, but placed restrictions on availability intended to reduce the use of cesareans. These restrictions included the prohibition of postpartum sterilizations. This paper focuses on womens sterilization intentions during pregnancy and their experiences postpartum. In a prospective study of 1612 pregnant women carried out in four Brazilian cities, there was substantial demand for postpartum sterilization in both the private and public sectors among women who wanted no more children. However, public patients were much less likely to be sterilized than private patients. Thus, the new law may not have reduced inequities in access or, paradoxically, the incentive for unnecessary cesarean sections.

A banalização da AIDS

This paper discusses the impact of the AIDS epidemic in the social representations and behavior of a population living in the neighborhood (bairro) that concentrates the highest mortality rates for AIDS in Porto Alegre, Brazil. We suggest that, with the increased number of infected individuals, there is a familiarization with the disease that affects social representations and practices associated with AIDS. In this case, the high incidence turns AIDS into something “normal”, even banal, part of people’s everyday lives. We argue that such “familiarity”, instead of increasing awareness and preventive attitudes, ends up producing the opposite effect. It may result in lack of credibility for preventive action and, in some cases, procrastinate the seeking of medical support and therapy either because people tend to minimize the threat of the problem itself, or because they have seen cases where “nothing can actually be done to avoid it”.

Levante a mão aqui quem nunca tirou criança!: revisitando dados etnográficos sobre a disseminação de práticas abortivas em populações de baixa-renda no Brasil

Based on recently published research findings on abortion rates, this paper re-examines original ethnographic data on abortion in order to open a discussion on the dissemination of abortion, its possible cultural configurations and its social legitimacy among low-income populations in Brazil. It refers retrospectively to two works of empirical research studies and presents an estimate of the prevalence of abortion of around of 34%; it describes abortion practices and the social representation of what abortion means in a given context. The studies presented here seek to contribute to the understanding of womens decision-making regarding this reproductive choice in a context where abortion is illegal. The data allow us to construct an abortion typology, classifying it as tolerated, unacceptable and recommended and point to a fluidity of meanings regarding pregnancy interruption practices. It is possible to infer that the magnitude of the problem of abortion, both with regard to number of cases and the existing diversity of abortion practices and methods, has not changed over a period of 20 years in Brazil.

As políticas globais de governança e regulamentação da privacidade na internet

Este trabalho tem como pano de fundo o contexto das politicas globais de propriedade intelectual, conjunto de acordos e ordenamentos juridicos que, em grande medida, entre outras coisas, regulam tambem o fluxo de informacao na internet. Atraves de uma descricao densa de impasses, disputas e estrategias a respeito da regulamentacao da rede, busca-se compreender como se conforma um arcabouco comum as politicas globais de regulacao da privacidade e da governanca das trocas na internet, as quais impactam diretamente o uso que se faz nos e dos meios e tecnologias digitais. Neste artigo, partindo-se da descricao do contexto mais geral da producao de politicas globais, foca-se especificamente nos casos norte-americano e brasileiro de regulamentacao da internet, com o objetivo de desvendar a racionalidade subjacente a esse sistema de producao de regras que atua sobre aquilo que estamos tomando como uma esfera publica, a internet e/ou as redes sociais digitais.

Do etnografado ao etnografável: “o Sul” como área cultural

I approach few authors (Darwin, Mantegazza, Herskovits, Willems and Bastide) as key-anthropologists in taking the Brazilian state of Rio Grande do Sul as an ethnographic field. Presenting original texts from these early anthropologists, I analyze the main features of what came to be identified as a cultural area. The issue of cultural difference in contrast with a alleged homogeneous national culture is the central point that organizes and identifies the South as an anthropological construct.