Maternal health during the COVID-19 pandemic: Experiences of health workers in three Brazilian municipalities.

OBJECTIVE: To analyze the experiences of maternal health workers in three Brazilian cities, located in the Northeast (São Luís), Southeast (Niterói), and South (Pelotas) regions during the first year of the COVID-19 pandemic. METHODS: Qualitative research carried out between December 2020 and February 2021. Interviews were conducted, in person or remotely, with 30 health workers, doctors and nurses, working in maternity hospitals of different degrees of complexity. RESULTS: Sociodemographic characteristics, employment relationships and professional qualification of the interviewees were described. Two thematic axes were identified: 1) changes in hospital organization and dynamics in the pandemic; 2) Illness and suffering of health workers. The majority of respondents were women. Most physicians had work relationships in the public and private sectors. In Niterói, health workers had better professional qualifications and more precarious work relationships (as temporary hires), compared to São Luís and Pelotas. In the context of the uncertainties resulting from the pandemic, this situation generated even more insecurity for those workers. The statements at the beginning of the pandemic covered topics such as changes in the organizational dynamics of services, healthcare, telemedicine, and interaction between health workers and users. In the health workers' perception, the initial period of the health emergency, which resulted in intense changes in the provision of services, was marked by an increase in preterm births, perinatal mortality, and fetal losses. Work overload, fear of contamination, concern for family members and uncertainties regarding the new disease caused intense suffering in health workers who had little institutional support in the cities studied. The suffering experienced by health workers went beyond the work dimension, reaching their private life. CONCLUSION: Changes caused by the pandemic required immediate adjustments in professional practices, generating insecurities in healthcare regardless of the location studied. The method of hiring health workers remained the same as the previously practiced one in each city. Due to the risk of disease transmission, measures contrary to humanization practices, and more restrictive in São Luís, were reported as harmful to obstetric care. The Covid-19 pandemic was a huge challenge for the Brazilian health system, aggravating the working conditions experienced by health workers. In addition to the work environment, it was possible to briefly glimpse its effects on private life.

Experiences of women in prenatal, childbirth, and postpartum care during the COVID-19 pandemic in selected cities in Brazil: The resignification of the experience of pregnancy and giving birth.

The COVID-19 pandemic has impacted public and private health systems around the world, impairing good practices in women's health care. However, little is known about the experiences, knowledge, and feelings of Brazilian women in this period. The objective was to analyze the experiences of women, seen at maternity hospitals accredited by the Brazilian Unified Health System (SUS, acronym in Portuguese), regarding health care during pregnancy, childbirth, and postpartum periods, their interpersonal relationships, and perceptions and feelings about the pandemic. This was a qualitative, exploratory research, carried out in three Brazilian municipalities with women hospitalized in 2020, during pregnancy, childbirth, or postpartum period, with COVID-19 or not. For data collection, semi-structured individual interviews (in person, by telephone, or by digital platform) were conducted, recorded and transcribed. The content analysis of thematic modalities was displayed as per the following axes: i) Knowledge about the disease; ii) Search for health care in prenatal, childbirth, and postpartum periods; iii) Experience of suffering from COVID-19; iv) Income and work; and v) Family dynamics and social support network. A total of 46 women were interviewed in São Luís-MA, Pelotas-RS, and Niterói-RJ. Use of media was important to convey information and fight fake news. The pandemic negatively impacted access to health care in the prenatal, childbirth, and postpartum periods, contributing to worsening of the population's social and economic vulnerabilities. Women experienced diverse manifestations of the disease, and psychic disorders were very frequent. Social isolation during the pandemic disrupted the support network of these women, who found social support strategies in communication technologies. Women-centered care-including qualified listening and mental health support-can reduce the severity of COVID-19 cases in pregnant, parturient, and postpartum women. Sustainable employment and income maintenance policies are essential to mitigate social vulnerabilities and reduce risks for these women.

Avaliação da dimensão estrutura no atendimento ao pré-natal na Estratégia Saúde da Família: potencialidades do PMAQ-AB / Structure Evaluation of Prenatal Care in the Family Health Strategy: PMAQ-AB strengths

RESUMO Esta pesquisa analisou a dimensão estrutura das unidades para a atenção pré-natal em Niterói, realizada pela Estratégia Saúde da Família (ESF). O banco de dados foi o da avaliação externa do 1º ciclo do Programa Nacional de Melhoria do Acesso e Qualidade da Atenção Básica (PMAQ-AB) do Ministério da Saúde. Foram entrevistados 69 profissionais, em 27 unidades de saúde. Com base nos resultados, propõe-se melhorar as condições de acessibilidade, qualificar os profissionais, estimular a permanência e o vínculo, ampliar a capacitação das equipes quanto ao gerenciamento do território e dos protocolos de risco. O PMAQ-AB foi corroborado como uma ferramenta para avaliações em saúde.

ABSTRACT This research evaluated the structure dimension of primary care centers offering prenatal care in the Family Health Strategy (ESF) of Niterói. The database came from an external National Program for Access and Quality Improvement in Primary Care (PMAQ-AB) evaluation, conducted by the Federal Ministry of Health, between 2012 and 2013. Data came from 69 interviews with health professionals, spread throughout all 27 primary health units of the ESF. Based on results, we propose the improvement of accessibility in health units, professional training, binding between patients and the team, and increase the health team's knowledge of territory management and risk guidelines. We corroborated PMAQ-AB as a tool for health evaluation.

Oferta de vagas de graduação e residência médicas no estado do Rio de Janeiro a partir do Programa Mais Médicos (2013-2015) / Offering medical degree and residency positions in the state of Rio de Janeiro from Program More Doctors (2013-2015)

O Programa Mais Médicos (PMM) se apresenta como uma das principais políticas federais para o fortalecimento da Atenção Primária à Saúde (APS). Entretanto, a dimensão da formação profissional foi pouco avaliada pela literatura. Este artigo teve como objetivo descrever os resultados iniciais do PMM no Estado do Rio de Janeiro em relação ao eixo da formação médica, desde a implantação do PMM. Foi realizada uma análise descritiva a partir de dados coletados do Portal Mais Médicos; do E-MEC e do IBGE. Observamos a tendência crescente de privatização da graduação médica identificada também em outros estudos nacionais. O processo de interiorização das vagas de graduação no Estado é evidente, mas não está clara sua contribuição para a fixação dos médicos nos municípios. A expansão dos programas de residência médica no interior, em especial de MFC, pode diminuir a concentração de médicos na capital do Estado e facilitar a fixação no interior.

The More Doctors Program (PMM) is one of the main federal policies in order to improve Primary Health Care (PHC). However, its professional education aspect was few evaluated by medical literature. This article aims to describe the initial results of PMM in Rio de Janeiro State, related to the medical education during the first two years of the program implementation. A descriptive analysis using secondary data collected from PMM website, Education Ministry and IBGE was realized. As results, we have observed a progressive tendency of privatization on the medical colleges, also identified by other national studies. The increase of graduation vacancies outside the capital was evident, but it may not contribute to the physicians setting on those cities; neither guarantee their future insertion into PHC programs. The expansion of residence programs outside the capital, specially Family Practice programs, may reduce the physicians concentration in the capital

Cues of paternal uncertainty and father to child physical abuse as reported by mothers in Rio de Janeiro, Brazil.

OBJECTIVE: Paternity is uncertain, so if paternal feelings evolved to promote fitness, we might expect them to vary in response to variables indicative of paternity probability. We therefore hypothesized that the risk of lapses of paternal affection, including abusive assaults on children, will be exacerbated by cues of non-paternity. METHODS: Cross-sectional study of 331 Brazilian mothers, interviewed about 1 focal child (age 1-12) residing with her and the putative father. Child physical abuse was assessed using the Conflict Tactic Scales: Parent Child (CTSPC). Two potential cues of (non) paternity were (1) whether the parents co-resided when the child was conceived, and (2) whether third parties allegedly commented on father-child resemblance. Data were analyzed through multiple logistic regressions. RESULTS: Mothers reported child physical abuse by 15.9% (95% CI 4.6-27.1) of fathers who had not cohabited with them at conception, compared to 5.9% (95% CI 3.1-8.7) of those who had. The odds ratio for abuse by fathers who had not cohabited at conception in relation to those who had-adjusted for income, education, age, sex of child, whether child was first born, household size, time father spent with child, and alcohol abuse and drug use by father-was 4.3 (95% CI 1.4-13.8). Mothers reported abuse of 7.0% (95% CI 4.0-10.0) of children who purportedly resembled their fathers, versus 8.7% (95% CI 0.2-17.1) of those who did not. CONCLUSION: According to maternal reports, not having co-resided at conception quadrupled the chance of child physical abuse by currently co-residing Brazilian fathers. The reported prevalence of abuse was unrelated to reported allegations of father-child resemblance.

The presence of a stepfather and child physical abuse, as reported by a sample of Brazilian mothers in Rio de Janeiro.

OBJECTIVE: Substitute fathers are often reported to commit child abuse at higher rates than birth (i.e., putative genetic) fathers. Due to the paucity of studies, especially in developing countries, and to some conflicting results from developed countries regarding the identity of perpetrators of less extreme forms of physical abuse of children in stepfamilies, the aim of this study was to assess whether the presence of a stepfather would constitute a risk factor for violence against Brazilian children, as reported by their mothers. METHODS: Three hundred eighty five women with a current male partner and a child aged 1-12 years were interviewed. Child physical abuse was assessed using the Conflict Tactic Scales Parent Child. Data were analyzed through multiple logistic regressions. RESULTS: Physical abuse (including severe physical abuse) was reported for 34.0% of the children with stepfathers (N=54) versus 17.6% of those living with putative genetic fathers (N=331). When adjusted for income, education, ages, whether the child was the first born, number of siblings, number of people in the household, how much time the man spent with the child, how many years he resided with the mother, and alcohol abuse and drug use by the mother and her partner, the adjusted odds ratio was 2.7 (95% CI: 1.2-5.9) for stepfather households over 2 genetic parent households. Surprisingly, the elevated risk to stepchildren was due to alleged abuse by the interviewee herself rather than her partner. CONCLUSION: Brazilian mothers professed to abuse their own children at substantially higher rates when their male partners were stepfathers to the focal child as compared to genetic fathers.

Psicologia evolucionista e violência doméstica contra a criança / Evolutionary psychology and domestic violence against children

Teóricos Evolucionistas têm argumentado que a criação de um filho não genético pode ser entendida como um “custo do galanteio” já que o padrasto ou a madrasta conquista a(o) parceira(o) desejada(o), mas que a magnitude do investimento que ele ou ela fará neste filho geralmente permanecerá uma fonte constante de conflito nestes relacionamentos. Vários estudos têm demonstrado que padrastos cometem abuso infantil em taxas muito maiores do que supostos pais genéticos, mas a maioria dessa evidência engloba abuso grave (letal), vem de países desenvolvidos e utiliza dados deregistros oficiais. Teóricos Evolucionistas também apontaram que a paternidade pode ser erradamente atribuída, então, se as emoções e motivações paternas evoluíram parapromover aptidão (i.e., o sucesso reprodutivo dos genes de um indivíduo, em relação a outros genes), deve-se esperar que pais genéticos sejam sensíveis a pistas de paternidade. Foi então hipotetizado que o risco de lapsos na afeição paternal, como ataques físicos abusivos contra crianças, seria exacerbado por pistas de não paternidade. Neste contexto, esta tese tem duas metas: 1) Avaliar se a presença de um padrasto, quando comparada à do pai genético constituiria um fator de risco para episódios de abuso contra crianças; 2) Avaliar se o risco de lapsos na afeição paternal,como episódios de abuso físico contra crianças seria exacerbado por pistas de não paternidade. Foi realizado um inquérito transversal no ambulatório de pediatria de dois serviços públicos de saúde no Rio de Janeiro, de setembro de 2006 a janeiro de 2007. As entrevistas face-a-face foram realizadas com 385 mulheres que possuíam um parceiro atual e um filho entre um e doze anos de idade. Avaliou-se o abuso físico infantil usando a “Conflict Tactic Scales: Parent Child”. Uma pista potencial de nãopaternidade era o pai não morar com a mãe na época em que a criança foi concebida...

Evolutionary theorists have argued that human step parenting may be understoodas a “courtship expense” whereby the stepparent gains access to a desired partner, but that the magnitude of investment in a stepchild often remains a source of conflict in remarriages. Many studies have shown that substitute fathers commit child abuse at much higher rates than birth (i.e. putative genetic) fathers, but most such evidenceconcerns severe (e.g. lethal) abuse, comes from developed countries, and uses officially recorded case data.Evolutionary theorists have also pointed out that paternity can be misattributed,so if paternal motives and emotions have evolved to promote fitness, we may expect putative fathers to be sensitive to paternity cues. It was therefore hypothesized that the risk of lapses of paternal affection, such as abusive assaults on children, will beexacerbated by cues of nonpaternity.Therefore, this thesis had two aims: 1) To assess whether the presence of astepfather, as compared to a birth father, would constitute a risk factor for abusive physical assaults on children; 2) To assess whether the risk of lapses of paternal affection, such as abusive physical assaults on children would be exacerbated by cues of no paternity.A cross-sectional survey was carried out at two pediatric public services throughface-to-face interviews with 385 women who had a current male partner and a child aged 1 to 12. Child physical abuse was assessed using the Conflict Tactic Scales: Parent Child (CTSPC). One potential cue of no paternity was that the father and mother were not co residing when the child was conceived. Another was that (according to the...

[Prevalence and factors associated with dental pain that prevents the performance of routine tasks by civil servants in Rio de Janeiro, Brazil]. / Prevalência e fatores associados à ocorrência da dor de dente que impediu a realização de tarefas habituais em uma população de funcionários públicos no Rio de Janeiro, Brasil.

The aims of this study were to estimate the prevalence of dental pain preventing the performance of routine tasks and to assess its association with socioeconomic factors, minor psychiatric disorders, number of missing teeth, and dental consultation patterns. A cross-sectional study was conducted using a self-completed questionnaire answered by 4,030 administrative employees at a university in Rio de Janeiro, Brazil (the Pró-Saúde Study). Data were analyzed using multiple logistic regression. Prevalence of toothache preventing the performance of routine tasks in the two weeks prior to the interview was 2.9% (95%CI: 2.5-3.6). Men (OR = 1.6; 95%CI: 1.1-2.4), individuals with minor psychiatric disorders (OR = 1.7; 95%CI: 1.2-2.6), individuals with extensive tooth loss (OR = 3.4; 95%CI: 1.5-7.8), and those failing to appear for regular dental checkups (OR = 2.5; 95%CI: 1.8-17.3) showed increased odds of experiencing dental pain. Dental pain was an important problem in this population. Unfavorable living conditions and lack of regular dental checkups increased the odds of dental pain.

Prevalência e fatores associados à ocorrência da dor de dente que impediu a realizacão de tarefas habituais em uma populacão de funcionários públicos no Rio de Janeiro, Brasil / Prevalence and factors associated with dental pain that prevents the performance of routine tasks by civil servants in Rio de Janeiro, Brazil

Nesse estudo, objetivou-se estimar a prevalência da dor de dente que impedisse a realizacão de tarefas habituais e testar sua associacão com fatores sócio-econômicos, transtornos mentais comuns, número de dentes perdidos e padrão de visita ao dentista. Realizou-se estudo transversal, com questionário autopreenchível, aplicado em 4.030 funcionários de uma universidade no Rio de Janeiro, Brasil ¡ Estudo Pró-Saúde. As análises foram conduzidas por meio de regressão logística multivariada. A prevalência da dor de dente que impediu a realizacão de tarefas habituais, nas duas semanas que antecederam o preenchimento do questionário, foi de 2,9 por cento (IC95 por cento: 2,5-3,6). Ser do sexo masculino (OR = 1,6; IC95 por cento: 1,1-2,4), apresentar transtorno mental comum (OR = 1,7; IC95 por cento: 1,2-2,6), ter perdido muitos dentes (OR = 3,4; IC95 por cento: 1,5-7,8) e não visitar o dentista para uma revisão de rotina (OR = 2,5; IC95 por cento: 1,8-17,3), aumentaram a chance de ter tido dor de dente. A dor de dente foi um problema importante nessa populacão. Circunstâncias desfavoráveis de vida e não visitar o dentista para uma revisão de rotina aumentaram as chances de ter dor de dente.

Fatores associados à ocorrência da dor de dente: evidência do estudo Pró-Saúde / Factors associate of dental pain: evidence of study Pró-Saúde

A dor de dente é um sintoma comum e possui um reflexo substancial na saúde pública, porque sua intensidade é suficientemente grande para causar, freqüentemente, impacto na qualidade de vida dos indivíduos. Objetivos: Estimar a prevalência da dor de dente e avaliar sua associação com variáveis sócio-demográficas, morbidade psiquiátrica menor, a freqüência e o padrão da visita de rotina ao dentista. Metodologia: O presente estudo utilizou dados (transversais) de um censo realizado em uma universidade do Estado do Rio de Janeiro. A população final do estudo foi constituída de 3.477 indivíduos adultos. A coleta de informações foi realizada através de um questionário autopreenchível, multidimensional, abrangendo morbidade física e mental, acesso e utilização dos serviços de saúde, rede e apoio social, aspectos sócio-demográficos e diversos outros fatores. Na análise dos dados, foram construídas tabelas de distribuição de freqüências e realizada regressão logística. Resultados: A prevalência da dor de dente, nas duas semanas anteriores ao estudo, foi de 2,6% (IC95%: 2,1 - 3,2). Os homens apresentaram 2,0 vezes mais chance de dor de dente do que as mulheres (OR=2,0; IC95%: 1,3 - 3,1). Os indivíduos que relataram morbidade psiquiátrica menor apresentaram 2,3 vezes mais chance de dor de dente (OR=2,3; IC95%: 1,5 - 3,5). A razão de chances de dor de dente foi de 2,3 (IC95%: 1,0 - 5,6) entre os indivíduos que só freqüentavam o dentista quando tinham problema e os que nunca foram ao dentista em relação aos que freqüentavam para um check-up. Intervalos de 2 anos ou maiores entre os check-ups não aumentaram as chances de dor de dente em relação a intervalos anuais ou menores.Conclusão: Apesar desta população possuir estabilidade de emprego e, possivelmente, maior renda, acesso à informação e a serviços de saúde quando comparada à maioria da população adulta brasileira, 3 em cada 100 indivíduos apresentaram dor de dente recentemente que impedisse a realização de suas tarefas habituais. Além disso, a dor de dente não foi igualmente distribuída na população, indicando que há circunstâncias de vida que aumentam as chances das pessoas apresentaram dor de dente. Intervalos maiores entre as visitas de rotina ao dentista parecem não aumentar as chances de dor de dente entre os indivíduos.

A importância do exame radiográfico na dilaceração radicular de incisivos centrais superiores permanentes após traumatismo dentário / The importance of radiographic examination in root dilaceration of permanent maxillary central incisors after dental traumatism

Este trabalho é uma revisão de literatura que tem por objetivo alertar os Cirurgiões-Dentistas, principalmente os odontopediatras, quanto à importância do diagnóstico precoce da dilaceração radicular e do acompanhamento clínico e radiográfico do paciente para evitar ou, pelo menos, minimizar suas seqüelas. São apresentadas imagens radiográficas de dois pacientes portadores de dilaceração radicular nos incisivos centrais superiores permanentes, causada por traumatismo dentário. Com base nestas imagens e na literatura consultada, pôde-se concluir que um traumatismo dentário sobre o incisivo decíduo pode trazer repercussões ao seu sucessor em formação; a radiografia cefalométrica de perfil neste tipo de alteração é essencial; o tratamento de um incisivo dilacerado requer a atenção de uma equipe multidisciplinar

Luxaçäo intrusiva de dentes decíduos / Inclusive luxation in primary teeth

Este trabalho visa identificar as causas mais comuns da luxaçäo intrusiva e determinar sua freqüência em dentes decíduos, com base na análise de 180 prontuários odontológicos de pacientes com traumatismo dentário, atendidos na clínica de Odontopediatria da FOUERJ. Relata também as conseqüências desse tipo de traumatismo para os dentes sucessores, enfatizando a importância do tratamento precoce e do acompanhamento do paciente