Silvia Maria Santiago

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 institucionalização médica do parto no Brasil

Trata-se de abordar o conceito de institucionalizacao da atencao a saude, em especial da Saude da Mulher, como forma de poder hegemonico na atencao, especificamente na assistencia institucional ao parto. O trabalho descreve as estrategias de implantacao da hegemonia institucional sobre o corpo feminino, exercidas atraves das politicas de saude e das praticas de atencao medica. O poder do Estado na institucionalizacao da atencao e registrado no decurso da reconstrucao historica dos programas de saude materno infantil das decadas de 1920 a 1980, na qual se identificou que o controle ideologico sobre a saude das mulheres traduziu-se em formas de controle da sua sexualidade como veiculo da reproducao. Nas praticas de atencao medica, abordam-se as questoes da hegemonia do poder medico e a medicalizacao do corpo feminino. O processo de hospitalizacao do parto foi fundamental para a apropriacao do saber nesta area e para o desenvolvimento do saber medico, culminando com o estabelecimento da medicalizacao do corpo feminino.

Prenatal care in an university hospital: evaluating the process

The objective of this study was to evaluate the prenatal care process referring to the Prenatal Assistance to Low Risk Pregnant Women Program of the University Hospital of Maringá, Paraná State, Brazil. It was made a selection of quality criteria which evaluate the precocity in the process and the adequacy in the number of consultation during prenatal period, measured by the Humanization Program of Prenatal and Birth of the Health Ministry and the adequacy on the use of the prenatal care. The study showed that 44.5% of pregnant women started late the prenatal care suggest of the low offer and search to better quality care, which is manifested by spontaneous transference of pregnant women to other services to the program. The prenatal consultations were confirmed and the results showed a mean of 9.8 consultations per pregnant woman--higher than the recommended national parameters. The indicators used and developed to the evaluation of process still present some obstacles to the organizational access and need to define strategies which guarantee this fundamental policy of the Brazilian Unified Health System.

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.

The association between domestic violence during pregnancy and low birth weight or prematurity

OBJECTIVE To investigate whether domestic violence during pregnancy is associated with unfavorable infant health outcomes, measured by low birth weight or prematurity. METHODS This was a prospective cohort study enrolling pregnant women whose prenatal care was provided by 10 basic health units in the city of Campinas, SP, Brazil, between 2004 and 2006. A structured questionnaire was employed that had previously been validated for use in Brazil. Each mother attended a minimum of two and a maximum of three interviews during the prenatal and postnatal periods. Data were analyzed using descriptive statistics. Students t test was used to compare means for birth weight and gestational age between mothers who had suffered domestic violence during the current pregnancy and those who had not. Logistic regression analysis was employed to identify factors associated with low birth weight or prematurity. RESULTS During the prenatal and postnatal periods, 89.1% (n = 1,229) of the pregnant women were followed up, 10.9% being lost to follow-up, basically due to changes of address. Mean birth weight was 3,233 g; mean gestational age was 38.56 weeks. A total of 13.8% of the infants had low birth weight or were premature. Conditions associated with risk of low birth weight or prematurity were: mothers who had previously given birth prematurely (p < 0.005), who smoked (p < 0.001), who delivered by caesarian (p < 0.001) and whose partners had a low educational level (p < 0.008). CONCLUSIONS In this study, no statistically significant association was observed between domestic violence perpetrated by partners and low birth weight or prematurity.

Adverse health events associated with domestic violence during pregnancy among Brazilian women

BACKGROUND domestic violence during pregnancy remains an unsolved and neglected social problem despite the recognised adverse physical and mental health consequences. OBJECTIVE to examine the association between domestic violence (psychological violence and physical or sexual violence) and health problems self-reported by pregnant women. METHODS a cross-sectional analysis from a cohort study of 1,379 pregnant women attending prenatal care in public primary care units in Campinas, São Paulo, Brazil. Data were collected by interviewing women when they enroled for prenatal care. Domestic violence and alcohol abuse were ascertained by validated questionnaires. Referred morbidities, undesirable behaviours and sociodemographic characteristics were also recorded. Univariate analyses were used to estimate prevalence and unadjusted odd ratios. Multivariate logistic regression was used to identify the independent association between psychological violence and physical or sexual violence during pregnancy and womens health outcomes. FINDINGS psychological violence and physical or sexual violence were reported by 19.1% (n=263) and 6.5% (n=89) of the pregnant women, respectively. Psychological violence was significantly associated with obstetric problems [odds ratio (OR) 1.95; 95% confidence interval (CI) 1.39-2.73], premature rupture of membranes (OR 1.64, 95% CI 1.01-2.68), urinary tract infection (OR 1.71, 95% CI 1.19-2.42), headache (OR 1.75, 95% CI 1.25-2.40) and sexual risk behaviours (OR 2.28, 95% CI 1.18-4.41). Physical or sexual violence was significantly associated with: obstetric problems (OR 1.72, 95% CI 1.08-2.75), premature rupture of membranes (OR 2.11, 95% CI 1.14-3.88), urinary tract infection (OR 2.05, 95% CI 1.26-3.34), vaginal bleeding (OR 1.95, 95% CI 1.10-3.43) and lack of sexual desire (OR 3.67, 95% CI 2.23-6.09). CONCLUSION domestic violence during pregnancy was associated with adverse clinical and psychological outcomes for women. These results suggest that a well-organised health-care system and trained health professionals, as well as multisectorial social support, are necessary to prevent or address the negative influence of domestic violence on womens health in Brazil.

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.

Associação entre violência doméstica na gestação e peso ao nascer ou prematuridade

OBJETIVO: Avaliar se a violencia domestica na gestacao esta associada a desfechos desfavoraveis na saude do lactente, medidos pelo baixo peso ao nascer ou prematuridade. METODO: Estudo de coorte prospectiva, realizado com gestantes que fizeram pre-natal em 10 Unidades Basicas de Saude do municipio de Campinas (SP), durante os anos de 2004 a 2006. Foi utilizado questionario estruturado e validado no Brasil. As gestantes tiveram, no minimo, duas e, no maximo, tres entrevistas realizadas durante pre e pos-natal. Foi utilizada analise descritiva dos dados. O teste t de Student foi utilizado para comparar as medias do peso ao nascer e da idade gestacional entre os grupos de gestantes que sofreram, durante a atual gestacao, violencia domestica e aqueles que nao sofreram. A analise de regressao logistica foi utilizada para verificar os fatores associados ao baixo peso ou prematuridade. RESULTADOS: Foram acompanhadas durante o periodo de pre-natal e pos-natal (n = 1.229) 89,1% das gestantes; 10,9% representam as perdas de acompanhamento, basicamente por mudanca de endereco. O peso medio ao nascer foi de 3.233 g; idade gestacional foi em media 38,56 semanas. Apresentaram baixo peso ao nascer ou prematuridade 13,8% dos recem-nascidos. Condicoes de risco para baixo peso ao nascer ou prematuridade foram: gestante ter tido recem-nascido prematuro em outra gestacao (p < 0,005), ser tabagista (p < 0,001), ter tido parto por cesarea (p < 0,001), ser baixa a escolaridade do parceiro (p < 0,008). CONCLUSAO: Neste estudo, nao foi observada associacao estatisticamente significativa entre violencia domestica perpetrada pelo parceiro e baixo peso ao nascer ou prematuridade.

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.