Showing papers in "Ciencia & Saude Coletiva in 2012"
716 citations
TL;DR: In this paper, an analysis of qualitative research, based on benchmark authors and the author's own experience, is presented, with the hypothesis that in order for an analysis to be considered reliable, it needs to be based on structuring terms of qualitative analysis, namely the verbs "comprehend" and "interpret", and nouns "experience", "common sense" and social action.
Abstract: This essay seeks to conduct in-depth analysis of qualitative research, based on benchmark authors and the author's own experience. The hypothesis is that in order for an analysis to be considered reliable, it needs to be based on structuring terms of qualitative research, namely the verbs 'comprehend' and 'interpret', and the nouns 'experience', 'common sense' and 'social action'. The 10 steps begin with the construction of the scientific object by its inclusion on the national and international agenda; the development of tools that make the theoretical concepts tangible; conducting field work that involves the researcher empathetically with the participants in the use of various techniques and approaches, making it possible to build relationships, observations and a narrative with perspective. Finally, the author deals with the analysis proper, showing how the object, which has already been studied in all the previous steps, should become a second-order construct, in which the logic of the actors in their diversity and not merely their speech predominates. The final report must be a theoretic, contextual, concise and clear narrative.
527 citations
TL;DR: Available data from biomonitoring studies clearly indicate that the general population is exposed to BPA and is at risk from internal exposure to unconjugated BPA, and the two toxicokinetic studies that suggested human BPA exposure is negligible have significant deficiencies, are directly contradicted by hypothesis-driven studies, and are therefore not reliable for risk assessment purposes.
Abstract: Bisphenol A (BPA) is one of the highest-volume chemicals produced worldwide, and human exposure to BPA is thought to be ubiquitous. Thus, there are concerns that the amount of BPA to which humans are exposed may cause adverse health effects. We examined many possibilities for why biomonitoring and toxicokinetic studies could come to seemingly conflicting conclusions. More than 80 published human biomonitoring studies that measured BPA concentrations in human tissues, urine, blood, and other fluids, along with two toxicokinetic studies of human BPA metabolism were examined. Unconjugated BPA was routinely detected in blood (in the nanograms per milliliter range), and conjugated BPA was routinely detected in the vast majority of urine samples (also in the nanograms per milliliter range). In stark contrast, toxicokinetic studies proposed that humans are not internally exposed to BPA. Available data from biomonitoring studies clearly indicate that the general population is exposed to BPA and is at risk from internal exposure to unconjugated BPA. The two toxicokinetic studies that suggested human BPA exposure is negligible have significant deficiencies, are directly contradicted by hypothesis-driven studies, and are therefore not reliable for risk assessment purposes.
410 citations
TL;DR: In this paper, the authors discuss the different approaches, analyze the context and policies for special groups on access, marking an analysis model delineated by the above aspects, from readings on the topic in question, revealing a diversity of approaches to access the formulation and implementation of public policies and their potential for changing the organization of the health system.
Abstract: Access to health services is a multifaceted and multidimensional issue involving political, economic, social, organizational, technical and symbolic aspects in establishing access to universal healthcare. This theoretical review paper intends to discuss the different approaches, analyze the context and policies for special groups on access, marking an analysis model delineated by the above aspects, from readings on the topic in question. This analysis reveals a diversity of approaches to access the formulation and implementation of public policies and their potential for changing the organization of the health system. We identified progress in reducing inequalities in health and increased access to the network of the Unified Health System (SUS), especially in primary care. There were also limitations related to accessibility, fragmentation, decentralization and regionalization of the service network, with inadequacies in the process of care and attention to specific groups, and regional disparities. Finally, the analysis model proposed seeks to develop a critical stance to reflect and intervene in health practices and services, with the objective goal being responsible, comprehensive, effective, equitable and quality healthcare.
188 citations
TL;DR: The rationale for the choice of participants in qualitative research in contrast with that of probability sampling principles in epidemiological research is presented and concepts of nomothetic and ideographic generalizability and transferability and reflexivity are proposed.
Abstract: This paper presents the rationale for the choice of participants in qualitative research in contrast with that of probability sampling principles in epidemiological research. For a better understanding of the differences, concepts of nomothetic and ideographic generalizability, as well as those of transferability and reflexivity, are proposed, Fundamentals of the main types of sampling commonly used in qualitative research, and the meaning of the concept of saturation are mentioned. Finally, some reflections on the controversies that have arisen in recent years on various paradigmatic perspectives from which to conduct qualitative research, their possibilities of combination with epidemiological research, and some implications for the study of health issues are presented.
166 citations
TL;DR: The role of independent waste gatherers who have been conducting work of great environmental importance is highlighted in this paper, where the authors propose public policies to ensure that waste gathering is a more respected and less risky activity that guarantees an income, so as to move towards more healthy, equitable and sustainable development.
Abstract: Strategies to reconcile development with the protection of ecosystems will yet again be discussed at the forthcoming Rio +20 Summit. The management of solid urban waste is an issue which has barely been touched upon in such discussions. Given the institutionalization of the National Solid Waste Policy, this paper seeks to contribute to this debate and to single out alternatives to tackle this issue with an emphasis on social inclusion. For this purpose, specialized scientific literature was consulted as well as information on solid waste management. It is clearly seen that inadequate management of solid waste has immediate impacts on the environment and health, and contributes to climate change. Considering the limitations of the current options for waste disposal, it is essential to minimize the quantities produced by reducing, reusing and recycling. In this context, the role of independent waste gatherers who have been conducting work of great environmental importance is highlighted. Given the vulnerabilities of this population, it is necessary to devise public policies to ensure that waste gathering is a more respected and less risky activity that guarantees an income, so as to move towards more healthy, equitable and sustainable development.
152 citations
TL;DR: In this paper, the authors used the Dahlgren and Whitehead model as a conceptual guide to identify the social determinants of health in the elderly, and the effects of demographic changes in the aging process and morbidity profile were approached at structural level.
Abstract: Health is affected throughout the course of life by characteristics of social context, which produce inequalities in terms of exposure and vulnerability. These social determinants interfere with the well-being, functional independence and quality of life of the elderly, but are generally overlooked in interventions and policies. Therefore, the aim of this study was to systematize the knowledge of the social determinants of health in the elderly, using the Dahlgren and Whitehead model as a conceptual guide. The effects of demographic changes in the aging process and morbidity profile were approached at the structural level. The conditions of life and work with impact on current and future health and the role of social cohesion were studied at the intermediate level. Lastly, the behavior and lifestyles of major risk were examined at close quarters. It was detected that equity in health requires attention to social determinants during the course of life in order to minimize chronic diseases and deficiencies of the elderly, which reflect their social positions in early life.
129 citations
TL;DR: The scope of this article is to elicit a debate among different stakeholders in the evaluation in the hope that it can contribute to the reflection on the real usefulness of evaluations in which the political component in management has been increasingly prevalent.
Abstract: The management of health services is a complex administrative practice due to the breadth of the field of health and the need to reconcile individual, corporate and collective interests that are not always convergent. In this context, the evaluation needs to have specific characteristics in order to fulfill its role. The scope of this study was to establish the characteristics that the evaluation for the management of health services should have to contribute to decision-making. Usefulness, opportunity, feasibility, reliability, objectivity and directionality represent the set of principles upon which the evaluation should be based. Evaluations should lead to decisions that guarantee not only their efficiency and effectiveness but also their implementation. The evaluation process should ensure that decisions involve all stakeholders in order to render the implementation of decisions feasible, and take into account the health needs of the population and the goals set for the services. The scope of this article is to elicit a debate among different stakeholders in the evaluation in the hope that it can contribute to the reflection on the real usefulness of evaluations in which the political component in management has been increasingly prevalent.
118 citations
TL;DR: In this article, the knowledge of health managers and professionals who work in primary health care about phytotherapy in the cities of Cascavel and Foz do Iguacu in the State of Parana was analyzed.
Abstract: Phytotherapy and the use of medicinal plants are part of the practice of folk medicine, which complements treatment traditionally employed for the lower income population. This work analyzed the knowledge of health managers and professionals who work in primary health care (PHC) about phytotherapy in the cities of Cascavel and Foz do Iguacu in the State of Parana. An exploratory, descriptive, and qualitative study using a structured questionnaire was conducted between February and July 2009. A health manager manifested interest in introducing the program. The other professionals interviewed did not receive training during undergraduate studies or within the Basic Health Units (BHU) where they work. Six professionals (60%) reported having access to information on phytoterapy through folk wisdom, one (10%) via training in a BHU, two (20%) from journals, four (40%) from the media and four mentioned more than one source. In Foz do Iguacu, in the BHU where the therapy is deployed, the professionals were not consulted before its implementation. To include phytotherapy in the BHUs of these two cities, it is necessary to train the professionals on the topic, including cultivation and prescription, thereby enhancing the rational use of these medicines.
116 citations
TL;DR: The codification and data analysis revealed that the Unified Health System and especially the Family Health Strategy, should be considered facilitating and stimulating strategies of the process of expansion and consolidation of nursing care as a social entrepreneurial practice.
Abstract: The scope of this paper is to take a retrospective look at the professional role of the nurse in the Brazilian Unified Health System and understand the meaning of their social practice in this field of discussions and theoretical-practical meanings. The Grounded Theory was used as a methodological reference and interviews were the technique for data collection, conducted between May and December of 2007, with 35 health professionals and others. The codification and data analysis revealed that the Unified Health System and especially the Family Health Strategy, should be considered facilitating and stimulating strategies of the process of expansion and consolidation of nursing care as a social entrepreneurial practice, since they pave the way to a new approach in community intervention, through seeing the human being as a multi-dimensional and singular being, inserted in a real and concrete context.
101 citations
TL;DR: In this article, the authors analyzed groundwater and rainwater contamination by pesticides in two municipalities (Lucas do Rio Verde and Campo Verde) of Mato Grosso state.
Abstract: This study sought to analyze groundwater and rainwater contamination by pesticides in two municipalities (Lucas do Rio Verde and Campo Verde) of Mato Grosso state. The area is Brazil's mid-west situated among the major soybean, corn and cotton producers in the state and the country. The analytical methodology combined chromatographic techniques on groundwater and rainwater samples with eco-toxicological analyses of the impacts of contamination by pesticide on bio-indicator species. The results revealed the presence of different pesticide residues in the groundwater and rainwater samples collected in the two municipalities. In conjunction with this data, results of the eco-toxicological tests revealed the presence of anomalies in a bio-indicator species collected in one of the two study sites compatible with exposure to pesticides. The results presented and discussed here highlight the degradation of water resources in the region, caused by the intensive use of pesticides in agriculture, including the contamination of drinking water sources and rain, broadening the risk of contamination beyond the cultivated areas.
TL;DR: Empirical evidence outside the AHS remains limited with respect to most of the observed associations, but animal toxicity data support the biological plausibility of relationships observed six pesticides.
Abstract: We reviewed epidemiologic evidence related to occupational pesticide exposures and cancer incidence in the Agricultural Health Study (AHS) cohort. Studies were identified from the AHS publication list available on a Medline/PubMed database search in March 2009. Findings related to lifetime-days and/or intensity-weighted lifetime-days of pesticide use are the primary focus of this review, because these measures allow for the evaluation of potential exposureresponse relationships. Most of the 32 pesticides examined were not strongly associated with cancer incidence in pesticide applicators. Increased rate ratios and positive exposureresponse patterns were reported for 12 pesticides currently registered in Canada and/or the United States. Exposure misclassification is also a concern in the AHS and may limit the analysis of exposureresponse patterns. Epidemiologic evidence outside the AHS remains limited with respect to most of the observed associations, but animal toxicity data support the biological plausibility of relationships observed six pesticides. Continued follow-up is needed to clarify associations reported to date. In particular, further evaluation of registered pesticides is warranted.
TL;DR: A estetica, a autoestima e a saude sao os motivos that mais influenciam a insatisfacao com a IC, para prevenir possiveis problemas futuros de disturbios alimentares (anorexia, bulimia e vigorexia).
Abstract: OBJETIVO: Verificar os motivos e a prevalencia de insatisfacao com a imagem corporal (IC) em adolescentes. Metodos: Participaram do estudo 641 adolescentes de 11 a 17 anos. A imagem corporal foi autoavaliada atraves da escala de nove silhuetas corporais. Resultados: A prevalencia de insatisfacao com a IC foi de 60,4% (masculino = 54,5%, feminino = 65,7%; p < 0,05). Os rapazes (26,4%) apresentaram maior desejo em aumentar o tamanho da silhueta corporal, enquanto as mocas (52,4%) desejavam diminuir. Prevalencia mais elevada de insatisfacao com a IC foi encontrada nos adolescentes urbanos. Os motivos indicados pelos adolescentes para a insatisfacao foram similares entre os sexos (p = 0,156). Quando ao domicilio, a estetica foi o motivo indicado pelos adolescentes urbanos e a autoestima pelos adolescentes rurais. Foi encontrada associacao entre a percepcao da imagem corporal e os motivos de insatisfacao. Conclusoes: A estetica, a autoestima e a saude sao os motivos que mais influenciam a insatisfacao com a IC. Mais da metade dos adolescentes esta insatisfeita com sua silhueta corporal. Neste sentido, intervencoes por profissionais e servicos de saude sao necessarias nessa fase da vida, para prevenir possiveis problemas futuros de disturbios alimentares (anorexia, bulimia e vigorexia).
TL;DR: In this context, disaster risk reduction and resilience-building policies are priorities in the sustainable development agenda, featuring among the topics selected for the Rio+20 Summit as mentioned in this paper, and from examples of disasters in countries with different development levels, namely the Haiti earthquake and the torrential rains in the mountain range close to Rio de Janeiro in Brazil, demonstrate how socio-environmental vulnerability creates conditions for disasters, while at the same time limiting strategies for their prevention and mitigation.
Abstract: Data on disasters around the world reveal greater seriousness in countries with lower social and economic development levels. In this context, disaster risk-reduction and resilience-building policies are priorities in the sustainable development agenda, featuring among the topics selected for the Rio+20 Summit. By means of a contribution of a conceptual nature and from examples of disasters in countries with different development levels, namely the Haiti earthquake and the torrential rains in the mountain range close to Rio de Janeiro in Brazil, the scope of this article is to demonstrate how socio-environmental vulnerability creates conditions for disasters, while at the same time limiting strategies for their prevention and mitigation. Lastly, some of the measures that disaster risk reduction and resilience-building demand in a socio-environmental vulnerability context are highlighted. These involve changes in the current patterns of social, economic and environmental development geared toward ecological sustainability and social justice as pillars of sustainable development.
TL;DR: Community-geared experiences in many countries in the campaign against cardiovascular diseases through health promotion and primary prevention of risk factors are described, and in Brazil the vigilance actions of the risk factors of non-transmissible chronic diseases are identified, stressing the strategic challenges facing the Family Health Program in tackling cardiovascular diseases.
Abstract: Cardiovascular diseases are currently the most common causes of morbimortality worldwide. In the context of disease prevention, actions creating favorable health environments and promoting healthy choices prove fundamental. Intervention programs with a community basis have been introduced in different countries since the beginning of the 1970s, aiming to modify cardiovascular risk factors and decrease morbidity and mortality due to cardiovascular diseases. In such experiences, the importance of public policies and cardiovascular risk vigilance systems needs to be stressed, permitting a more accurate assessment of the magnitude of the problem and the development of more cost-effective actions. The scope of this bibliographical study was to describe community-geared experiences in many countries in the campaign against cardiovascular diseases through health promotion and primary prevention of risk factors, as well as to identify in Brazil the vigilance actions of the risk factors of non-transmissible chronic diseases, stressing the strategic challenges facing the Family Health Program in tackling cardiovascular diseases.
TL;DR: In this paper, a critical analysis of the bibliographical output in Brazil from 1989 to 2009 was conducted regarding acceptance of implementation and qualification of SUS in primary healthcare (PHC).
Abstract: The public policies adopted by the Unified Health System (SUS) in Brazil have gone through successive transformations, striving to reassert health as a universal right. The user acceptance of the guidelines of the National Humanization Policy for Care and Management of the SUS - Humanize SUS - is taking shape and relevance in Primary Healthcare (PHC) to ensure humanized access and resolution of the health demands of users and communities in Brazil. A critical analysis of the bibliographical output in Brazil from 1989 to 2009 was conducted regarding acceptance of implementation and qualification of SUS in PHC. The databases consulted were SciELO, Lilacs and Medline. The results revealed progress in broadening access to PHC services and health professionals more sensitive to the needs of users and communities. However, lack of coordination in integrated networks, excess demand, the hegemonic biomedical model, lack of training and democratic and reflexive spaces to reorganize the work process have been raising increasingly more incisive questions about the potential of this guideline for the implementation and qualification of SUS.
TL;DR: In this paper, the authors provide an overview of the nuclear themes in the debate about the qualitative health research approach in the Brazilian scientific context and more specifically in the public health field.
Abstract: This article provides an overview of the nuclear themes in the debate about the qualitative health research approach in the Brazilian scientific context and more specifically in the public health field The author begins by defining some central concepts in the analysis conducted Then, combining the literature on the subject with her academic praxis, she examines the current status of this research tradition, highlighting an extensive set of challenges The discussion focuses on each challenge, moving between the different epistemic, ethical and operational planes in relation to the scientific status of this approach to public health Considering various questions and based on empirical examples, analysis shows that, despite the expansion observed in qualitative research and its contributions to public health, this approach still faces many challenges before consolidating its status The situation demands investments in dialogue with the other approaches which form the core area Despite these challenges, the paper concludes by pointing to the possibility of new pacts in the public health field in order to incorporate innovations to address the diversity and complexity of this field
TL;DR: This article strives to analyze the conceptions that health professionals have about the specific demands and behaviors of the male population served by the healthcare services, and to evaluate the initial actions of the implementation of PNAISH.
Abstract: In 2009, the Brazilian Comprehensive Healthcare Policy for Men (PNAISH) was launched in Brazil, seeking to reduce morbidity and mortality in this population group. This article strives to analyze the conceptions that health professionals have about the specific demands and behaviors of the male population served by the healthcare services. The data analyzed are part of a larger research project, the objective of which was to evaluate the initial actions of the implementation of PNAISH. Ethnographic observations in 11 health services and semi-structured interviews were conducted with 21 health professionals. From the perspective of health professionals, the presence of men in the healthcare services is still limited. According to them, it is comprised of two types of clients: workers and the elderly. The male behavior characteristics - haste, objectivity, fear and resistance - and the difficulty faced by health services in receiving this population are the main factors that drive men away from health services. Although the concept of gender is central to PNAISH, it is only triggered by healthcare professionals in order to justify the social standards expected in terms of men's behavior. The attribution of men's behavior to cultural factors ultimately obscures the relations of power that underlie gender relations.
TL;DR: A review of the Dimension Matrix for Evaluation of the Brazilian Health System, as well as a conceptual update of some of the sub-dimensions for the evaluation of health service performance, namely effectiveness, access, efficiency and appropriateness of health care.
Abstract: This paper presents a review of the Dimension Matrix for Evaluation of the Brazilian Health System that was initially developed in 2003, as well as a conceptual update of some of the sub-dimensions for the evaluation of health service performance, namely effectiveness, access, efficiency and appropriateness of health care. It also describes the indicator selection process as well as the results obtained in each performance dimension. The behavior of the indicators used to assess the performance of health services in Brazil, with respect to each sub-dimension, was not uniform. Areas of marked improvement were found in indicators that are influenced by activities in the field of primary care. The most significant improvements were seen in the sub-dimensions of Effectiveness and Access. With respect to the Efficiency of health services, situations of high efficiency coexist with others with substandard performance. The performance of health services in the sub-dimension of Appropriateness of Health Care was the lowest of all indicators.
TL;DR: In this article, the authors outline the scenario of domestic, sexual and other forms of violence against children (0-9 years old) in Brazil for the year 2010, based on data from reports of domestic and sexual violence registered with SINAN - Information System for Notifiable Diseases (Continuous VIVA).
Abstract: The scope of this article is to outline the scenario of domestic, sexual and other forms of violence against children (0-9 years old) in Brazil for the year 2010. It is based on data from reports of domestic, sexual and other forms of violence registered with SINAN - Information System for Notifiable Diseases (Continuous VIVA). Absolute and relative numbers are presented, derived from reported violence, discriminating between children under 1 year of age and those between 1-9 years old, due to the specificities that exist in these age groups. Throughout the country, the number of reports among those under 10 years of age is low (17.1%). Differences were found for the distribution of reports in the different Brazilian States. Few municipalities and few services reported violence to SINAN-Net in 2010 in the country. Some differences were found between children under 1 year of age and those between 1 and 9 years of age, as for instance the relationship between the profile of the violence, the victim and the perpetrator, and the handling of the case. The quality of the reported information is discussed showing the high level of unreported data in some spaces of the reporting form. Lack of information may prejudice comprehension of the phenomenon, interfering with the planning, organization and operation actions of the health services in the country.
TL;DR: A creative focus should be directed to the care of the elderly, who are the ones who suffer the effects of their own weakness and demand more health services.
Abstract: The profound socio-economic transformation occurring in Brazil is also driven by the demographic changes. Health expenditures will increase due to the aging population and increased use of health services. The National Agency for Supplementary Health published a resolution that encourages the participation of beneficiaries in health insurance programs for active aging, with the possibility of discounts in fees. Thus, the elderly now receive cash benefits to adhere to preventive health programs and early detection of diseases. We assessed the programs in the U.S. and UK, analyzing their successes and failings, which may assist in the formulation of health policies that are more appropriate and more cost-effective for the Brazilian elderly. This Opinion article seeks to demonstrate to Brazilian operators that it is time to change and to elicit discussions about the need for new strategies. A creative focus should be directed to the care of the elderly, who are the ones who suffer the effects of their own weakness and demand more health services.
TL;DR: Analysis of the perceptions of users with chronic diseases and monitored by the Family Health Program with respect to empowerment found that adherence and practices of care were linked to differentiated service, based on trust and respect for the wishes of users.
Abstract: Empowerment is a process whereby people achieve mastery over their lives, acquiring knowledge to make decisions about their health. Chronic diseases are increasingly common in the health service, requiring the attention of health professionals and empowering those affected by them. The scope of this study was to analyze the perceptions of users with chronic diseases and monitored by the Family Health Program with respect to empowerment. This was a qualitative study in which open interviews and systematic observations were conducted and NVIVO software was used for data analysis. Users indicate the existence of some geographical barriers in access to health, which caused fatigue, discouragement and low continuity of care. It was noted that adherence and practices of care were linked to differentiated service, based on trust and respect for the wishes of users. This includes healthcare guidance and education as key elements to encourage the practice of self-care. It is necessary to restructure the conduct of health professionals involved in the Family Health Strategy because its function is to promote health in a logical intersectoral and interdisciplinary manner.
TL;DR: The development of studies to find new ways of assessing SINASC is highlighted as a privileged strategy for the enhancement of the quality of the system.
Abstract: The scope of this study was to carry out a review of scientific literature about the quality of data from the Information System on Live Births (SINASC). Studies in the Medline, Lilacs and SciELO databases were then reviewed. The articles were characterized according to journal of publication, location and period of the study, evaluation parameters, methodology and main results. A total of thirteen articles were reviewed. Eight studies analyzed coverage, four assessed completeness and seven evaluated reliability. Coverage higher than 90% was presented in the majority of the studies, indicating its viability for the calculation of indicators. However, the under-reporting of births in SINASC prevailed with variation between 75.8% and 99.5%. The mother's educational level, number of prior childbirths and frequency of prenatal visits were the variables that led to greater inconsistency. For its part, the parity variable was the one that led to greater incompleteness. In conclusion, the development of studies to find new ways of assessing SINASC is highlighted as a privileged strategy for the enhancement of the quality of the system.
TL;DR: A educacao em saude torna-se a principal estrategia para melhorar a adesao dos usuarios, como tambem a participacao de profissionais na Equipe Saude da Familia, come: o farmaceutico, o nutricionista e o educador fisico.
Abstract: Arterial hypertension and diabetes mellitus are among the most chronic diseases prevalent in Brazil. The study sought to evaluate the socioeconomic profile and the therapeutic adherence of users registered in the HIPERDIA Program in Teresina in the State of Piaui. This research was conducted in the Primary Healthcare Units, where a questionnaire was given to four hundred people evaluating their adherence based on the Batalla and Morisky-Green tests. The socioeconomic profile of interviewees was as follows: senior citizens, women, married with 1 to 4 years of study, pensioners and salaried employees. Only 22.5% of hypertensive and 30.7% of diabetic interviewees were considered adherents according to Batalla, and among all of them only 26.75% were adherents according to Morisky-Green. There was no association between sociodemographic and clinical variables and adherence according to Morisky-Green, however there was an association with the type of morbidity presented. In light of these results, health education is the main strategy to improve adherence of users as well as the participation of professionals in the Family Healthcare Team, including the pharmacist, the nutritionist and the physical trainer.
TL;DR: The results of the structured interview phase of the National Abortion Survey (PNA-interviews) are presented, describing the itineraries, methods and social and demographic profile of women who had at least one illegal abortion.
Abstract: This paper presents the results of the structured interview phase of the National Abortion Survey (PNA-interviews), describing the itineraries, methods and social and demographic profile of women who had at least one illegal abortion. Structured interviews were conducted during the years 2010 and 2011 in five state capitals (Belem, Brasilia, Porto Alegre, Rio de Janeiro and Salvador) with 122 women aged between 18 and 39 who had abortions. It is a non-probabilistic sample controlled by six parameters in accordance with level of education and age to reflect the social and demographic structure found in the PNA ballot-box questionnaire phase. The majority of women interviewed had had only one abortion, but 1 in every 4 had two abortions and 1 in every 17 had a third one. The majority of abortions are among women under 19 years of age who already had children and a higher incidence is found among black women. The most common test for pregnancy is beta-HCG blood test, the pharmacy urine test and ultrassound. The prevailing method for induction is a combination of teas and misoprostol (called Cytotec in Brazil), followed by hospital assistance after induction. Women are usually helped by a relative or their partners and several women reported helping other women to have abortions.
TL;DR: In this paper, a presente artigo reflete sobre as praticas de educacao alimentar e nutricional vigentes no contexto atual, and reconhece a existencia de um hiato entre as formulacoes das politicas e as acoes desenvolvidas no âmbito local.
Abstract: O presente artigo reflete sobre as praticas de educacao alimentar e nutricional vigentes no contexto atual. Sao discutidas no âmbito das politicas publicas de alimentacao e nutricao partindo de uma analise sobre as acoes governamentais empreendidas e de suas acoes no âmbito local, particularmente na nutricao clinica ambulatorial e/ou na atencao a grupos especificos, buscando identificar as tendencias teoricas e metodologicas que norteiam as praticas educativas. Considera-se que a educacao alimentar e nutricional tem sido alvo de debates na busca de concebe-la como uma acao governamental. Entretanto, em que pese seus avancos, se reconhece a existencia de um hiato entre as formulacoes das politicas e as acoes desenvolvidas no âmbito local. Permanece tambem um hiato entre discursos e as praticas em seu torno das acoes educativas. Conclui-se que a educacao alimentar e nutricional e menos um instrumento do que um dispositivo de acoes conjugadas que devem envolver diferentes setores e disciplinas, entretanto, demanda investimentos na formacao profissional e na producao de conhecimento no campo.
TL;DR: Spatial analysis revealed risk clusters for RTA and motorcyclists and pillion riders with an increase between 2000 and 2010 and enlargement of the areas most at risk in the Northeast.
Abstract: OBJETIVO: Analisar a tendencia temporal da mortalidade por Acidentes de Transporte Terrestre (ATT) e identificar a existencia e a localizacao de aglomerados de alto risco de mortes por ATT. METODOLOGIA: Estudo descritivo de tendencia da mortalidade por ATT, pedestre, ocupante de motocicleta e de veiculo, de 2000 a 2010 e analise espacial para 2000 e 2010. Os dados foram obtidos do Sistema de Informacoes sobre Mortalidade; calcularam-se as taxas padronizadas por idade, para Unidades Federadas (UF) e municipios por porte populacional. RESULTADOS: A taxa de mortalidade por ATT entre 2000 e 2010 variou de 18 para 22,5 obitos/100 mil habitantes. O risco de morte para pedestre reduziu, os de ocupantes de veiculos e de motocicletas apresentaram crescimento. O maior risco de morte por ATT ocorreu nos municipios com ate 20 mil habitantes e nos de 20 a 100 mil. A analise espacial mostrou os aglomerados de risco para ATT e para ocupantes de motocicletas com aumento destes entre 2000 e 2010 e ampliacao das areas com maior risco na regiao Nordeste. CONCLUSAO: Aumento das taxas de mortalidade por ATT principalmente na regiao Nordeste. Faz-se necessario uma atuacao coordenada do governo, da sociedade civil e dos proprios cidadaos no enfretamento desta realidade.
TL;DR: Comprehensive care, technological reorganization and expanded clinical care can foster closer approximation between professionals and users, at the same time as actions come to be dictated by the individuals and the community, breaking with the vertical imposition of conduct.
Abstract: Despite the marked achievements of the Unified Health System (SUS), implementation of its principles and guidelines has not yet been fully achieved. Therefore, this article reflects on comprehensiveness and technology reorganization based on soft technologies and expanded clinical care, not only as guidelines, but as core elements for a new way of thinking about health. It involves a literature review that not only seeks an overview of ideas about the subject, but also attempts to establish a dialogue between the authors in reference to reflect on daily services, especially in hospital. We found that most of the obstacles to improvement of the services of the SUS are related to the predominance of curative medical care in the thinking process of health professionals. Breaking with that logic, comprehensive care, technological reorganization and expanded clinical care can foster closer approximation between professionals and users, at the same time as actions come to be dictated by the individuals and the community, breaking with the vertical imposition of conduct. Thus, the traditional 'biologicist' approach to clinical care needs to be deconstructed to break with the logic of manifest suffering and "treat 'em and street 'em" philosophy.
TL;DR: In this article, the authors examined the healthcare regionalization process in the Brazilian states in the period from 2007 to 2010, seeking to identify the conditions that favor or impede this process.
Abstract: This article examines the healthcare regionalization process in the Brazilian states in the period from 2007 to 2010, seeking to identify the conditions that favor or impede this process. Referential analysis of public policies and especially of historical institutionalism was used. Three dimensions sum up the conditioning factors of regionalization: context (historical-structural, political-institutional and conjunctural), directionality (ideology, object, actors, strategies and instruments) and regionalization features (institutionality and governance). The empirical research relied mainly on the analysis of official documents and interviews with key actors in 24 states. Distinct patterns of influence in the states were observed, with regionalization being marked by important gains in institutionality and governance in the period. Nevertheless, inherent difficulties of the contexts prejudice greater advances. There is a pressing need to broaden the territorial focus in government planning and to integrate sectorial policies for medium and long-term regional development in order to empower regionalization and to overcome obstacles to the access to healthcare services in Brazil.
TL;DR: Reports of violence against the elderly reported in the Information System for Notifiable Diseases - net version (Sinan Net) in 2010 are described, identifying characteristics of vulnerability in which support networks may intervene.
Abstract: The scope of this study was to describe reports of violence against the elderly (e" 60 years) reported in the Information System for Notifiable Diseases - net version (Sinan Net) in 2010. We conducted a descriptive, retrospective study with data analyzed by Stata version 11. We estimated proportion ratios (PR) of violence according to selected variables. Of the 3,593 reports of violence against the elderly, 52.3% were against females. Physical violence was significantly more frequent against males (PR=0.82) in the group aged 60 to 69 years, out of the home, committed by offenders who were not sons and were suspected of drinking alcohol. Psychological violence was more common among elderly people (PR=2.17), in the home, inflicted by sons, with suspected chronic alcohol abuse. Negligence was predominant among females (P R=1.24), in the group above 70 years of age, in the home, recurrently perpetrated by sons. Sexual violence was more common against females (PR=5.21), by offenders who were not children, but who consumed alcohol. The knowledge of the different manifestations of violence against the elderly supports actions to combat them, identifying characteristics of vulnerability in which support networks may intervene.