Severina Alice da Costa Uchôa

Determinants of sexual dysfunction among middle-aged women

To assess the determinants of sexual dysfunction among middle‐aged women.

Influência dos sintomas climatéricos sobre a função sexual de mulheres de meia-idade

PURPOSE: To evaluate the influence of climacteric symptoms on the sexual function in middle-aged women. METHODS: A cross-sectional population study was conducted on a sample of 370 middle-aged women, aged 40 to 65 years-old, cared for at the Basic Health Units in Natal, in the state of Rio Grande do Norte, Brazil. We used a questionnaire containing questions on sociodemographic, clinical, and behavioral characteristics. Sexual function was evaluated by the Female Sexual Function Index (FSFI), while the menopause symptoms by the Menopause Rating Scale (MRS). RESULTS: In the studied group, 67% of the women reported risk for sexual dysfunction (FSFI≤26.5). All FSFI domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) were lower in women with risk for sexual dysfunction (p<0.001). The arousal, orgasm, and pain domains were most likely to contribute to lower FSFI scores. All somatovegetative, urogenital, and psychological MRS symptoms were more elevated in women with risk for sexual dysfunction, being significant for all comparisons (p<0.001). Logistic regression analysis revealed that the likelihood of women with risks of sexual dysfunction to present hot flushes, depression, sexual problems, and vaginal dryness was, respectively, 2.1 (95%CI 1.2–3.5); 2.4 (95%CI 1.5–4.1); 2.3 (95%CI 1.4–3.8), and 2.2 (95%CI 1.3–3.6) times higher, respectively, compared to those without any risk. CONCLUSION: Climacteric symptoms seem to influence the sexual function inPURPOSE To evaluate the influence of climacteric symptoms on the sexual function in middle-aged women. METHODS A cross-sectional population study was conducted on a sample of 370 middle-aged women, aged 40 to 65 years-old, cared for at the Basic Health Units in Natal, in the state of Rio Grande do Norte, Brazil. We used a questionnaire containing questions on sociodemographic, clinical, and behavioral characteristics. Sexual function was evaluated by the Female Sexual Function Index (FSFI), while the menopause symptoms by the Menopause Rating Scale (MRS). RESULTS In the studied group, 67% of the women reported risk for sexual dysfunction (FSFI≤26.5). All FSFI domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) were lower in women with risk for sexual dysfunction (p<0.001). The arousal, orgasm, and pain domains were most likely to contribute to lower FSFI scores. All somatovegetative, urogenital, and psychological MRS symptoms were more elevated in women with risk for sexual dysfunction, being significant for all comparisons (p<0.001). Logistic regression analysis revealed that the likelihood of women with risks of sexual dysfunction to present hot flushes, depression, sexual problems, and vaginal dryness was, respectively, 2.1 (95%CI 1.2 - 3.5); 2.4 (95%CI 1.5 - 4.1); 2.3 (95%CI 1.4 - 3.8), and 2.2 (95%CI 1.3 - 3.6) times higher, respectively, compared to those without any risk. CONCLUSION Climacteric symptoms seem to influence the sexual function in middle-aged women.

Avaliação da qualidade da prescrição de medicamentos de um hospital de ensino

Os erros provenientes das prescricoes medicas podem provocar serios danos a saude dos pacientes; por isso, e imprescindivel que sejam identificados e prevenidos. O objetivo deste trabalho foi avaliar a presenca dos requisitos legais e institucionais da prescricao medica de um hospital pediatrico publico de ensino, a fim de se obter um diagnostico da situacao, para entao serem aplicadas as medidas corretivas. A partir da autorizacao do comite de pesquisa, foi feito um estudo observacional do tipo transversal, quantitativo, no qual foram analisadas, durante tres meses, todas as segundas vias das prescricoes dos pacientes hospitalizados. Foram analisadas 1.590 prescricoes, cada uma tendo em media 4,47 medicamentos, e obtiveram-se os seguintes dados: quanto a legibilidade, 32,39% das prescricoes eram pouco legiveis, 49,81% continham medicamentos prescritos por nome comercial, 5,25% dos medicamentos prescritos nao eram padronizados. A qualidade da prescricao do hospital em estudo precisa ser melhorada, a fim de que sejam evitados erros de medicacao e o processo de assistencia a saude se torne mais seguro. A falta de clareza nas prescricoes pode confundir os profissionais de saude e causar danos ao paciente.The errors from doctor prescriptions can cause damage to the patients health, consequently it is necessary to identify and to prevent them. This work aimed to evaluate if the legal and institutional aspects that are present in doctor prescription at the public and university pediatric hospital to make a diagnosis from the situation, and then to correct the problems. A survey was made was made using a cross-sectional method, where copies of 1,590 prescriptions were studied after the University Committee of Research approved the survey. The average was 4.47 drugs per prescription and following data were detectable: readable--32.39% of the prescriptions were unreadable, 49.81% presented only the commercial name, 5.25% of the drugs were not standardized. Quality of prescription in the chosen hospital needs to be better to avoid medication errors and the health care process gets safer. When prescription is unreadable, they can confuse health professionals and damage patients.

Physical activity and sexual function in middle-aged women

OBJECTIVE To investigate the relationship between physical activity level and sexual function in middle-aged women. METHODS A cross-sectional study with a sample of 370 middle-aged women (40-65 years old), treated at public health care facilities in a Brazilian city. A questionnaire was used containing enquiries on sociodemographic, clinical and behavioral characteristics: the International Physical Activity Questionnaire (IPAQ), short form, and the Female Sexual Function Index (FSFI). RESULTS The average age of the women studied was 49.8 years (± 8.1), 67% of whom exhibited sexual dysfunction (FSFI ≤ 26.55). Sedentary women had a higher prevalence (78.9%) of sexual dysfunction when compared to active (57.6%) and moderately active (66.7%) females (p = 0.002). Physically active women obtained higher score in all FSFI domains (desire, arousal, lubrication, orgasm, satisfaction and pain) and total FSFI score (20.9), indicating better sexual function than their moderately active (18.8) and sedentary (15.6) counterparts (p <0.05). CONCLUSION Physical activity appears to influence sexual function positively in middle-aged women.

Medication prescription by nurses and the case of the Brazil: what can we learn from international research?

The role of the nurse in the process of medication scription and ordering diagnostic tests and clinical minations has intensified worldwide. For the Internaal Council of Nursing (ICN), these actions are innovaelements that contribute to advanced nursing practice , 2011). The term prescription by nurses encompasses versity of practices within which we can highlight three dels: the independent or substitute prescriber, the i-autonomous or complementary prescriber, and the up protocol (Patient Group Directions) (Consejo Genl de Enfermerı́a, 2006; Kroezen et al., 2011). Among the ntries where prescription and the requisition of clinical minations by nurses is already consolidated, the United gdom (UK), Sweden, United States, Canada, Australia, Zealand, South Africa and Ireland stand out (Van Ruth l., 2008; Krozen et al., 2012; Latter et al., 2010). The UK particular, has both an extensive form of nurse scribing, embracing all three models above, and a well eloped evidence base from research into its acceptlity and effectiveness. But not all countries have progressed so far. In this torial we consider the implications of this evidence base countries where the practice is still developing. We us on our country, Brazil, as an example and use the rnational evidence and reviews to illuminate the rent situation of nurses in Brazil and offer recommenions for progress. The prescription of medication through group protocols nurses is a legally permissible practice in Brazil within ary health care, following authorization from the istry of Health. Prescribing protocols are designed to be d in strategic areas (child health, women’s health, onic and acute diseases), where nurses are normally cticing. Examples of protocols that are inclusive of scribing for diseases or injuries include: tuberculosis; rosy; hypertension and diabetes mellitus; prenatal e; child nutrition; and HIV and other Sexually nsmitted Diseases (STD). Medicines that can be ivered by nurses include antibiotics, analgesics, antiammatory agents and bronchodilators. The evolution of the use of Patient Group Directions by nurses in Brazil coincides with the growth of the availability of health care services and the public’s lack of access to medical professionals in many areas in primary health care, in a context of reduction of expenditure on health care (Oguisso and Freitas, 2007). Whilst improvement in care for patients and better use of nurses’ skills has ostensibly driven the expansion of prescribing in countries such as the UK, in Brazil, like other countries such as Canada and Australia, forces external to the nursing profession have motivated the introduction of prescription by nurses. These include reduction of health care expenditure, efficient use of time and resources (Van Ruth et al., 2008; Consejo General de Enfermerı́a, 2006), reduction of doctors’ workload, resolution of the problem of lack of doctors and to assist with coverage of patients in remote areas (Kroezen et al., 2011). The fact that these are externally driven forces may have contributed to the situation that, despite the legislation enabling nurses to prescribe using Patient Group Directions in Brazil, the current context is problematic and in practice the extent to which nurses are prescribing remains very limited. A study on prenatal care performed by nurses in São Paulo found that only 40 of a total of 131 nurses used therapeutic protocols to treat infections of pregnant women and their partners (Narchi, 2010). Other studies show that nurses demonstrate fear and insecurity in prescriptive actions (Ximenes Neto et al., 2007) or that they do not prescribe for fear of complaints (Moura et al., 2007). There may be several possible reasons for this lack of prescribing. Firstly, there is no requirement for nurse training prior to the initiation of prescriptive practice. In contrast, the ICN recommends specialized knowledge, clinical experience and registration as a prescriber, as pre-requisites for prescribing. This acquisition of specialized knowledge through educational preparation varies internationally with respect to the duration and the level of training. In the UK, qualified nurses with at least three years’ experience undertake a degree level training programme of 26 days, with 12 days supervision

Avaliação da atenção humanizada ao abortamento: um estudo de avaliabilidade

No Brasil, estima-se que ocorram anualmente 1.443.350 abortos, que levam milhares de mulheres, com abortamento incompleto, a buscar atendimento nos servicos publicos de saude. Em 2005, o Ministerio da Saude publicou a Norma Tecnica de Atencao Humanizada ao Abortamento como resposta a este desafio. Este artigo objetiva discutir se o conjunto de intervencoes da norma constitui um programa avaliavel e propor um modelo de avaliacao. A pesquisa, realizada em 2010, caracteriza-se como estudo de avaliabilidade. Utilizaram-se as tecnicas de analise documental e entrevista com informantes-chave. Para validacao dos indicadores, foi aplicada a tecnica do grupo nominal. Como resultados, foram elaborados e pactuados o modelo logico, a matriz dos indicadores e as perguntas avaliativas que traduzem os pilares da atencao: acolhimento, atencao clinica com qualidade tecnica, etica e legal, planejamento reprodutivo, integracao com a rede de saude e com coletivos de mulheres. Conclui-se que a atencao humanizada ao abortamento e um programa avaliavel com elaboracao de um modelo de avaliacao no momento oportuno. A pre-avaliacao demonstrou ser adequada e mais bem compreendida pelo gestor e profissionais. Houve concordância quanto a clareza e pertinencia das metas, necessidades de recursos e acoes, questoes eticas para orientar mudancas. O estudo aumentou o conhecimento dos atores envolvidos com participacao decisiva da direcao clinica. Para avaliacoes subsequentes, o estudo recomenda o foco em estrutura e processos dos cinco componentes do programa com priorizacao dos aspectos subjetivos da humanizacao, infraestrutura, alem da prevalencia do aborto no servico publico de saude.

Os protocolos e a decisão médica: medicina baseada em vivências e ou evidências?

The main purpose of this study is to understand the concepts and interests concerning the transformation of the practical quotidian knowledge produced by experience into probabilistic epistemological models. The object is the argumentation and practices surrounding consensus-forming which knowledge criteria are valid for diagnostic and therapeutic decisions. Our starting point is Ludwik Flecks work, which states that facts are not objectively given but collectively and contingently created so as to adjust themselves to a style of thought. Our research strategy was an ethnographic observation of medical rounds and clinical meetings in a cardiology ICU in Rio de Janeiro. The analysis was based on the works of Knorr-Cetina (transepistemic arenas) and Perelmans argumentation theory. It revealed the consolidation of a tendency to incorporate explicit cost-benefit criteria and the interests of different agents such as doctors, government and the medical-industrial complex in the introduction of protocols. The observation demonstrated an ambivalent use: protocols/scientific studies and clinical experience as well. A certain skepticism of the clinicians and their relative inability in the usage of the analytic tools of the epidemiological thought style were particularly remarkable.

Spatial clustering and local risk of leprosy in São Paulo, Brazil

Background Although the detection rate is decreasing, the proportion of new cases with WHO grade 2 disability (G2D) is increasing, creating concern among policy makers and the Brazilian government. This study aimed to identify spatial clustering of leprosy and classify high-risk areas in a major leprosy cluster using the SatScan method. Methods Data were obtained including all leprosy cases diagnosed between January 2006 and December 2013. In addition to the clinical variable, information was also gathered regarding the G2D of the patient at diagnosis and after treatment. The Scan Spatial statistic test, developed by Kulldorff e Nagarwalla, was used to identify spatial clustering and to measure the local risk (Relative Risk—RR) of leprosy. Maps considering these risks and their confidence intervals were constructed. Results A total of 434 cases were identified, including 188 (43.31%) borderline leprosy and 101 (23.28%) lepromatous leprosy cases. There was a predominance of males, with ages ranging from 15 to 59 years, and 51 patients (11.75%) presented G2D. Two significant spatial clusters and three significant spatial-temporal clusters were also observed. The main spatial cluster (p = 0.000) contained 90 census tracts, a population of approximately 58,438 inhabitants, detection rate of 22.6 cases per 100,000 people and RR of approximately 3.41 (95%CI = 2.721–4.267). Regarding the spatial-temporal clusters, two clusters were observed, with RR ranging between 24.35 (95%CI = 11.133–52.984) and 15.24 (95%CI = 10.114–22.919). Conclusion These findings could contribute to improvements in policies and programming, aiming for the eradication of leprosy in Brazil. The Spatial Scan statistic test was found to be an interesting resource for health managers and healthcare professionals to map the vulnerability of areas in terms of leprosy transmission risk and areas of underreporting.

Assessment of the coordination of integrated health service delivery networks by the primary health care: COPAS questionnaire validation in the Brazilian context

BackgroundHealth systems organized as networks and coordinated by the Primary Health Care (PHC) may contribute to the improvement of clinical care, sanitary conditions, satisfaction of patients and reduction of local budget expenditures. The aim of this study was to adapt and validate a questionnaire - COPAS - to assess the coordination of Integrated Health Service Delivery Networks by the Primary Health Care.MethodsA cross sectional approach was used. The population was pooled from Family Health Strategy healthcare professionals, of the Alfenas region (Minas Gerais, Brazil). Data collection was performed from August to October 2013. The results were checked for the presence of floor and ceiling effects and the internal consistency measured through Cronbach alpha. Construct validity was verified through convergent and discriminant values following Multitrait-Multimethod (MTMM) analysis.ResultsFloor and ceiling effects were absent. The internal consistency of the instrument was satisfactory; as was the convergent validity, with a few correlations lower then 0.30. The discriminant validity values of the majority of items, with respect to their own dimension, were found to be higher or significantly higher than their correlations with the dimensions to which they did not belong.ConclusionThe results showed that the COPAS instrument has satisfactory initial psychometric properties and may be used by healthcare managers and workers to assess the PHC coordination performance within the Integrated Health Service Delivery Network.

LEGALIZATION OF NURSE PRESCRIBING OF MEDICATION IN BRAZIL: HISTORY, TRENDS AND CHALLENGES

Objetivou-se identificar os contornos legais e normativos da prescricao de medicamentos por enfermeiros no Brasil apontando sua historia, tendencias e desafios. Estudo exploratorio, realizado por meio de pesquisa documental da legislacao da enfermagem, normatizacoes do Ministerio da Saude e do setor saude que abordam a questao. Seguiram-se as etapas do estudo documental e a analise de conteudo dos dados. A categoria da enfermagem contribuiu para a legalizacao da prescricao, porem nao para a sua legitimacao; na Atencao Basica, essa atribuicao esta consolidada por meio de protocolos e legislacao, embora sem estrategia clara de acompanhamento pelo Ministerio da Saude; observa-se resistencia em algumas normatizacoes dentro do setor saude. Conclui-se que ha tendencia da prescricao de medicamento, por enfermeiros, permanecer apenas na legalidade e o principal desafio e alcancar a legitimidade.Se objetivo identificar contornos legales y normativos de la prescripcion de medicinas por enfermeros en Brasil apuntando su historia, tendencias y desafios. Es un estudio exploratorio, realizado por medio de investigacion documental de la legislacion de la enfermeria, las normas del Ministerio de la Salud y del sector salud que abordan esta cuestion. Se siguieron etapas del estudio documental y el analisis de contenido de los datos. La categoria de enfermeria contribuyo para legalizacion de la prescripcion, pero no para su legitimacion; en Atencion Basica, esa atribucion esta consolidada por medio de protocolos y legislacion, mismo sin estrategia clara de acompanamiento por el Ministerio de Salud; se observa resistencia en algunas normas dentro del sector salud. Se concluye que hay tendencia de la prescripcion de medicinas, por enfermeros, permanecer solo en la legalidad y el principal desafio es alcanzar la legitimidad.