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Objective: To investigate if individual and contextual socioeconomic factors are associated with contraceptive use in Brazilian women from 18 to 49 years old, stratified by parity. Methods: Cross-sectional, population-based study that analyzed data from 16,879 women from 18 to 49 years old, respondents of the 2013 National Health Survey. Individual factors such as reproductive history, access to health services, and sociodemographic characteristics were considered; and as contextual factors, Human Development Index (HDI), Sociodemographic Index (SDI) Primary Health Care Coverage (PHC coverage) and Average Monthly Income were included. Multilevel logistic regression models were estimated, stratified by parity, with women being level 1 and States and Federal District of level 2 units. Results: Nulliparous women had lower prevalence of contraceptive use (77.9 %) when compared with primiparous and multiparous (88.7 %), as well as greater variability in the chance of using contraception (ICC = 2.1 vs. ICC = 1.1, respectively). Women who lived in States with higher levels of HDI, average monthly income and SDI were more likely to use contraception. The greater PHC coverage was positively associated with the use of contraceptives for primiparous/multiparous women and negatively for the nulliparous. Furthermore, higher education increased the chances of using contraception, both for nulliparous and primiparous/multiparous women. Conclusions: The high contraceptive coverage in Brazil hides important inequities in access, highlighting contextual characteristics associated with the use of contraceptives, in addition to individual factors. The lower prevalence and chance of using contraceptives for nulliparous women with greater social vulnerability reveal inequity and priority in public policies. Implications for practice: The need to improve access to contraception is highlighted, considering both the individual and contextual vulnerabilities of women, which implies ensuring timely and qualified access to contraceptive methods, especially for young and nulliparous women who are more socially vulnerable.
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The objective was to analyze the spatial distribution of pregnancy in children under 14 years and six months by Brazilian region and municipality and sociodemographic and health characteristics of pregnant women and live births. Ecological study analyzing the Live Birth Information System (SINASC) from 2011 to 2021 in three age groups (< 14 years and six months, 15-19 years, and 20 years and above) by demographic and birth variables. We applied the Global and Local Moran. A total of 127,022 live births to girls aged 10-14 years were identified during the period, most of whom were Black, 21.1% in common-law or married relationships, with a lower proportion of seven prenatal care appointments and enrollment in the first trimester, a higher proportion of low birth weight and low Apgar score, residing in the North and Northeast. The mean live birth rate for 10-to-14-year-old girls was significantly autocorrelated with space, especially in municipalities of the Midwest and North. Pregnancy from 10 to 14 years of age reveals several vulnerabilities suffered by these girls due to pregnancy at an early age, which is more common among Black women, with implications for morbimortality for them and their children and the presumed violence in these cases, including denied access to legal abortion.
O objetivo foi analisar a distribuição espacial da gravidez em menores de 14 anos e seis meses segundo regiões e municípios brasileiros e características sociodemográficas e de saúde das parturientes e nascidos vivos. Estudo ecológico, analisando o Sistema de Informação sobre Nascidos Vivos (SINASC), 2011-2021, em três grupos etários (<14 anos e 6 meses, 15-19 e 20 anos e mais), segundo variáveis demográficas e do parto. Foram aplicados os Índices Global e Local de Moran. No período foram 127.022 nascidos vivos de meninas 10-14 anos, na maioria negras, 21,1% em união estável ou casadas, com menor proporção de 7 consultas de pré-natal e captação no primeiro trimestre, maior proporção de baixo peso ao nascer e baixo índice de Apgar, residentes nas regiões Norte e Nordeste. A taxa média de nascidos vivos de 10-14 anos mostrou autocorrelação significativa com o espaço, especialmente em municípios do Centro-Oeste e Norte. A gravidez de 10 a 14 revela uma sequência de vulnerabilidades sofridas por essas meninas, pela gravidez em idade precoce, maior frequência entre negras, com implicações na morbimortalidade para ela e seus filhos; e pela violência presumida nesses casos, incluindo o acesso negado ao aborto legal.
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Nacimiento Vivo , Atención Prenatal , Análisis Espacial , Humanos , Brasil , Femenino , Embarazo , Adolescente , Niño , Adulto Joven , Atención Prenatal/estadística & datos numéricos , Recién Nacido de Bajo Peso , Embarazo en Adolescencia/estadística & datos numéricos , Lactante , Recién Nacido , Tasa de Natalidad/tendencias , Factores de Edad , Puntaje de Apgar , Población Negra/estadística & datos numéricos , Factores SocioeconómicosRESUMEN
AIM: The aim of this study is to test the validity and reliability of the shortened version of the Scale for the Environments Evaluation of Professional Nursing Practice (SEE-Nursing Practice). METHODS: This methodological, cross-sectional study was conducted between September and December 2022. The original version of the SEE-Nursing Practice was administered in questionnaire format across 17 hospitals. Exploratory and confirmatory factor analyses were conducted to identify relevant items for the new shortened version of the scale and evaluate its construct validity. RESULTS: The study involved 1713 registered nurses from various regions of Portugal. From the exploratory factor analysis, the SEE-Nursing Practice was condensed to 59 items and 3 subscales. In the structure subscale, 14 items were removed, and the remaining 29 items distributed over four factors; in the process subscale, 18 items were removed, and the remaining 19 items organized into three factors; in the outcome subscale, 2 items were removed, and the remaining 11 items distributed over two factors. The Cronbach's alpha for the three subscales exceeded 0.90, indicating high reliability. Confirmatory factor analyses provided support for the validity of the 59-item model. CONCLUSION: The shortened version of the SEE-Nursing Practice shows adequate validity and reliability, reducing the burden associated with its longer version.
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OBJECTIVES: to evaluate the trends in cesarean sections from 2014 to 2020 across both public and private sectors, utilizing the Robson Classification. METHODS: this time series study analyzed the proportion of women who underwent cesarean sections between 2014 and 2020, considering both the Robson classification and the type of healthcare service. Trend analysis was conducted using the Prais-Winsten regression. RESULTS: higher proportions of cesarean sections were observed in all Robson groups within the private sector compared to the public sector. This was despite a decreasing trend in the private sector and an increasing trend in the public sector. Notably, elevated proportions of cesarean sections were recorded in groups that are typically favorable to normal childbirth (Robson 1, 4, and 5). CONCLUSIONS: although there was a decreasing trend in cesarean sections within the private sector, an increasing trend was observed in the public sector. Additionally, there was a high proportion of cesarean sections among women with conditions favorable to normal childbirth. It is crucial to continuously monitor these indicators to evaluate and implement interventions aimed at reducing unnecessary cesarean sections.
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Cesárea , Sector Privado , Sector Público , Cesárea/estadística & datos numéricos , Cesárea/tendencias , Cesárea/clasificación , Brasil , Humanos , Femenino , Embarazo , Sector Público/estadística & datos numéricos , Sector Público/tendencias , Sector Privado/estadística & datos numéricos , Sector Privado/tendencias , AdultoRESUMEN
OBJECTIVES: To analyze nurses' perspectives on nurses' work methods in the hospital context. METHODS: A descriptive study with a qualitative approach was conducted in a hospital in northern Portugal, involving 17 nurses. Semi-structured interviews were used for data collection. Data collected between May and June 2023 underwent content analysis, supported by Atlas.ti software. RESULTS: Three thematic areas emerged: "Nurses' work methods in a hospital context," highlighting the conception and components of work methods and the methods in use; "Implementation of nurses' work methods," emphasizing influencing factors and challenges to implementation; and "Impact of nurses' work methods on patients, nurses, and institutions." FINAL CONSIDERATIONS: Nurses' work methods constitute the structure of nursing care. Some factors influence and some challenges arise in the implementation of these methods, producing impacts on patients, nurses, and institutions.
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Enfermeras y Enfermeros , Investigación Cualitativa , Humanos , Portugal , Adulto , Femenino , Enfermeras y Enfermeros/psicología , Enfermeras y Enfermeros/estadística & datos numéricos , Actitud del Personal de Salud , Masculino , Persona de Mediana Edad , Entrevistas como Asunto/métodos , PercepciónRESUMEN
PURPOSE: This interlaboratory comparison was conducted to evaluate the performance of the Latin-American Biodosimetry Network (LBDNet) in analyzing digitized images for scoring dicentric chromosomes from in vitro irradiated blood samples. The exercise also assessed the use of weighted robust algorithms to compensate the uneven expertise among the participating laboratories. METHODS: Three sets of coded images obtained through the dicentric chromosome assay from blood samples irradiated at 1.5 Gy (sample A) and 4 Gy (sample B), as well as a non-irradiated whole blood sample (sample C), were shared among LBDNet laboratories. The images were captured using the Metafer4 platform coupled with the AutoCapt module. The laboratories were requested to perform triage scoring, conventional scoring, and dose estimation. The dose estimation was carried out using either their laboratory calibration curve or a common calibration curve. A comparative statistical analysis was conducted using a weighted robust Hampel algorithm and z score to compensate for uneven expertise in dicentric analysis and dose assessment among all laboratories. RESULTS: Out of twelve laboratories, one had unsatisfactory estimated doses at 0 Gy, and two had unsatisfactory estimated doses at 1.5 Gy when using their own calibration curve and triage scoring mode. However, all doses were satisfactory at 4 Gy. Six laboratories had estimated doses within 95% uncertainty limits at 0 Gy, seven at 1.5 Gy, and four at 4 Gy. While the mean dose for sample C was significantly biased using robust algorithms, applying weights to compensate for the laboratory's analysis expertise reduced the bias by half. The bias from delivered doses was only notable for sample C. Using the common calibration curve for dose estimation reduced the standard deviation (s*) estimated by robust methods for all three samples. CONCLUSIONS: The results underscore the significance of performing interlaboratory comparison exercises that involve digitized and electronically transmitted images, even when analyzing non-irradiated samples. In situations where the participating laboratories possess different levels of proficiency, it may prove essential to employ weighted robust algorithms to achieve precise outcomes.
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Aberraciones Cromosómicas , Humanos , Aberraciones Cromosómicas/efectos de la radiación , Algoritmos , Laboratorios/normas , Radiometría/métodos , Procesamiento de Imagen Asistido por Computador/métodosRESUMEN
OBJECTIVES: Women's mortality at a reproductive age has been a global concern, and its decrease has been incorporated as a target of the UN Sustainable Development Goals. The aim of this study was to describe the spatial-temporal evolution of mortality rates among women of reproductive age in Brazilian municipalities by groups of causes and socioeconomic indicators from 2000 to 2018. STUDY DESIGN: Ecological analysis. METHODS: This work was an ecological, descriptive study that analyzed estimates of mortality rates among women of reproductive age (15-49 years) by main groups of causes of death from the Global Burden of Disease (GBD) study in three consecutive trienniums, T1 (2000-2002), T2 (2009-2011), and T3 (2016-2018). To quantify the temporal evolution in mortality rates, the present study calculated the percentage change for each triennium. The spatial analysis of mortality rates was carried out using Moran's index. The Pearson coefficient was used to analyze the correlation between the data. RESULTS: A significant decline in mortality rates was found for all groups of causes in all regions of the country. Despite the downward trend, the percentage change from 2009 to 2011 to 2016 to 2018 showed a decrease in the group of Noncommunicable Diseases (NCDs) and external causes. The decline in mortality rates of women due to external causes showed only a minimal change in the North and Northeast regions from T2 to T3, whereas a cluster of neighboring municipalities with high mortality rates persisted in the municipalities of the South region and in the state of Roraima. The ranking of the main causes of death in Brazilian municipalities showed an increase in neoplasms in detriment to cardiovascular diseases (CVDs). CONCLUSIONS: The main causes of death in women of reproductive age at a more local level could be used to recognize inequalities and to develop interventions aimed at tackling premature and preventable deaths.
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Causas de Muerte , Ciudades , Carga Global de Enfermedades , Mortalidad , Humanos , Brasil/epidemiología , Femenino , Adulto , Adolescente , Persona de Mediana Edad , Adulto Joven , Causas de Muerte/tendencias , Ciudades/epidemiología , Carga Global de Enfermedades/tendencias , Mortalidad/tendencias , Factores Socioeconómicos , Análisis Espacio-TemporalRESUMEN
BACKGROUND: Right ventricular (RV) dysfunction is the main cause of death in patients with normotensive acute pulmonary embolism (PE). The optimal management for this subset of patients remains uncertain. This systematic review and meta-analysis focused on the comparison of diuretics and fluid expansion in patients with acute PE presenting with RV dysfunction and haemodynamic stability. METHODS: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines considering only RTCs. The authors searched the traditional and grey literature through 1 November 2022. Meta-analysis used open source packages in R. Inverse variance fixed-effects models with OR as the effect measure were used for primary analyses. The main outcomes defined in this review protocol included pulmonary arterial systolic pressure (PASP), creatinine value changes and N-terminal pro-B-type natriuretic peptide during the first 24 hours. RESULTS: Four studies with a total of 452 patients met the inclusion criteria. The baseline characteristics of patients were similar across all studies. Overall, patients receiving diuretics had a significant 24 hours reduction in pro-B-type natriuretic peptide (standard mean difference of -41.97; 95% CI -65.79 to -18.15), and PASP (standard mean difference of -5.96; 95% CI -8.06 to -3.86). This group had significantly higher creatinine levels (standard mean difference of 7.74; 95% CI 5.04 to 10.45). The quality of the studies was heterogeneous; two had a low risk of bias, and the other two had a high risk of bias. CONCLUSIONS: Very few studies have compared the efficacy and safety of diuretics and fluid expansion in normotensive patients with acute PE with RV failure. Overall, furosemide appears to reduce RV dysfunction in this subset of patients compared with fluid expansion. Further research is required to confirm these findings.
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Diuréticos , Fluidoterapia , Embolia Pulmonar , Humanos , Enfermedad Aguda , Diuréticos/uso terapéutico , Fluidoterapia/métodos , Péptido Natriurético Encefálico/sangre , Embolia Pulmonar/tratamiento farmacológico , Embolia Pulmonar/fisiopatología , Disfunción Ventricular Derecha/tratamiento farmacológico , Disfunción Ventricular Derecha/fisiopatología , Disfunción Ventricular Derecha/etiologíaRESUMEN
O artigo é fruto de uma pesquisa de doutorado que cartografa o campo da Terapia Ocupacional na interface com o corpo, as artes e a cultura, por meio das trajetórias, ações e mobilizações de 12 terapeutas ocupacionais entrevistadas. Trabalhamos com o método de pesquisa-intervenção da cartografia. A pesquisa integra o acontecimento pandêmico, mapeia as ações desenvolvidas nesse período e analisa as contribuições das práticas com arte e corpo em um contexto de isolamento radical e de enfraquecimento da potência vital. Neste artigo, apresentamos algumas das iniciativas desenvolvidas por duas das profissionais entrevistadas, visibilizando suas reinvenções nesse período e analisando as contribuições das práticas diante dos impactos da pandemia na vida das pessoas. Destaca-se a potência da criatividade, a mobilização de outras formas de afetação por meio das experimentações artísticas, bem como a produção de relações que os dispositivos grupais permitem.
El artículo es fruto de una investigación de doctorado que cartografía el campo de la terapia ocupacional en la interfaz con el cuerpo, las artes y la cultura por medio de las trayectorias, acciones y movilizaciones de 12 terapeutas ocupacionales entrevistadas. Trabajamos con el método de investigación-intervención de la cartografía. La investigación integra el acontecimiento pandémico, mapea las acciones desarrolladas en este período y analiza las contribuciones de las prácticas con arte y cuerpo en un contexto de aislamiento radical y de debilitación de la potencia vital. En este artículo, presentamos algunas de las iniciativas desarrolladas por dos de las profesionales entrevistadas, dando visibilidad a sus reinvenciones en este período y analizando las contribuciones de las prácticas ante los impactos de la pandemia en la vida de las personas. Se destaca la potencia de la creatividad, la movilización de otras formas de afectación por medio de las experimentaciones artísticas, así como la producción de relaciones que los dispositivos grupales permiten.
This article is the result of PhD research that mapped the field of occupational therapy at the intersection of the body, arts, and culture, through the trajectories, actions, and mobilizations of 12 interviewed occupational therapists. We worked with cartography as research-intervention method. The research integrated the pandemic event, mapped the actions developed during this period, and analyzed the contributions of practices involving art and the body in a context of radical isolation and a weakening of vital potency. We present in this article some of the initiatives developed by two of the interviewed professionals, highlighting their reinventions during this period and analyzing the contributions of these practices in the face of the pandemic's impact on people's lives. As results we highlighted the potency of creativity, the mobilization of other forms of affection through artistic experiments, and the production of relationships facilitated by group settings
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RESUMO: Esta pesquisa teve por objetivo compreender os desafios e as possibilidades de tradução e contação em Língua Brasileira de Sinais (Libras) das histórias presentes no livro O homem que Calculava, do escritor modernista brasileiro Malba Tahan. Tratase de uma investigação qualitativa que se debruçou sobre o processo de tradução audiovisual das histórias presentes no livro, as adaptações feitas em suas narrativas, os recursos de preparação para a produção e edição dos vídeos, a implementação de recursos gráficos e visuais e, por fim, sua divulgação como produto da pesquisa. As análises indicam o potencial didático que emerge na interação entre os envolvidos no processo de tradução das histórias: professores, intérpretes e discentes (surdo e ouvinte), possibilitando formas de expressão artísticas que exploram a visualidade inerente da língua de sinais aliada a recursos gráficos, tomando as narrativas como elemento central para o desenvolvimento criativo ancorado no ensino da Matemática por meio da leitura e da interpretação de histórias.
ABSTRACT: This research aimed to understand the challenges and possibilities of translation and storytelling in the Brazilian Sign Language (known by the acronym LIBRAS) of the stories present in the book O homem que calculava [The man who counted] by the Brazilian modernist writer Malba Tahan. This is a qualitative investigation that focused on the audiovisual translation process of the stories present in the book, on the adaptations made in its narratives, the preparation resources for the production and editing of the videos, the implementation of graphic and visual resources and, finally, its dissemination as a research product. The analyzes indicate the didactic potential that emerges in the interaction between those involved in the process of translating the stories: teachers, interpreters and students (deaf and hearing), enabling forms of artistic expression that explore the inherent visuality of sign language combined with graphic resources, taking the narratives as a central element for the creative development anchored in the teaching of Mathematics through the reading and interpretation of stories.
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Objetivo: sintetizar la evidencia disponible relacionada con el acceso y las prácticas de higiene menstrual en América Latina y el Caribe. Método: revisión de alcance de la literatura con protocolo de investigación registrado en el Open Science Framework, realizada en las bases de datos bibliográficas: PubMed, Scopus, Web of Science y Portal Regional da Biblioteca Virtual em Saúde. Los datos fueron analizados mediante estadística descriptiva simple y análisis temático. Resultados: se incluyeron 15 publicaciones, la mayoría de las cuales trataban sobre adolescentes en Brasil: 12 artículos, dos informes técnicos y una monografía de trabajo de conclusión de curso. Como temas recurrentes en las publicaciones se destacan: acceso a condiciones dignas para el manejo de la higiene menstrual; necesidad de acceso a información sobre el manejo de la higiene menstrual; y prácticas para el manejo de la higiene menstrual. Conclusión: adolescentes informan dificultades para acceder a baños, agua y materiales absorbentes, y falta de información sobre la salud menstrual, incluso en las escuelas, lo que lleva al ausentismo escolar. De esta manera, las lagunas en la literatura científica latinoamericana revelan desigualdades y diversidad en las experiencias menstruales interseccionadas por categorías como género, clase social y etnia.
Objective: to synthesize available evidence related to menstrual hygiene access and practices in Latin America and the Caribbean. Method: literature scoping review with research protocol registered in the Open Science Framework, carried out in the bibliographic databases: PubMed, Scopus, Web of Science and Portal Regional da Biblioteca Virtual em Saúde. Data were analyzed using simple descriptive statistics and thematic analysis. Results: 15 publications were included, the majority of which addressed adolescents in Brazil: 12 articles, two technical reports and a course conclusion monograph. As recurring themes in the publications, the following stand out: Access to dignified conditions for managing menstrual hygiene; Need for access to information on menstrual hygiene management; and Practices for managing menstrual hygiene. Conclusion: adolescents report difficulties in accessing toilets, water and absorbent materials, and lack of information about menstrual health, including in schools, leading to school absenteeism. Thus, gaps in the Latin American scientific literature reveal inequalities and diversity in menstrual experiences intersected by categories such as gender, social class and ethnicity
Objetivo: sintetizar evidências disponíveis relacionadas ao acesso e práticas de higiene menstrual na América Latina e Caribe. Método: revisão de escopo da literatura com protocolo de pesquisa registrado no Open Science Framework, realizada nas bases de dados bibliográficas: PubMed, Scopus, Web of Science e Portal Regional da Biblioteca Virtual em Saúde. Os dados foram analisados por estatística descritiva simples e análise temática. Resultados: foram incluídas 15 publicações, cuja maioria abordava adolescentes no Brasil: 12 artigos, dois relatórios técnicos e uma monografia de trabalho de conclusão de curso. Como temas recorrentes nas publicações, destacam-se: acesso a condições dignas para o manejo da higiene menstrual; necessidade de acesso à informação sobre manejo da higiene menstrual; e práticas para manejo da higiene menstrual. Conclusão: adolescentes relatam dificuldades de acesso a sanitários, água e materiais absorventes, e falta de informação sobre saúde menstrual, inclusive nas escolas, levando ao absenteísmo escolar. Assim, lacunas na literatura científica latino-americana revelam desigualdades e diversidade nas experiências menstruais interseccionadas por categorias como gênero, classe social e etnia.
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Humanos , Femenino , Adolescente , Conocimientos, Actitudes y Práctica en Salud , Higiene , Estudios Transversales , Productos para la Higiene Menstrual , MenstruaciónRESUMEN
OBJECTIVE: To estimate the proportions of awareness, treatment, and control of diabetes mellitus (DM) in the Brazilian adult population. METHOD: This is a cross-sectional study, with data from a representative sample of the Brazilian population, taken from the National Health Survey(PNS 2014/2015). Outcomes were defined based on glycated hemoglobin (HbA1c) measurements, self-reported DM diagnosis, and use of hypoglycemic agents or insulin. The proportion of DM awareness, treatment, and control was estimated according to sociodemographic characteristics, health conditions, and access to health services, and their respective 95% confidence intervals. RESULTS: DM prevalence in the Brazilian population was of 8.6% (95%CI: 7.8-9.3): 68.2% (95%CI: 63.9-72.3) were aware of their diagnosis, 92.2% (95%CI: 88.6-94.7) of those who were aware were undergoing drug treatments, and, of these, 35.8% (95%CI: 30.5-41.6) had controlled HbA1c levels. The proportions of DM awareness, control, and treatment were lower in men aged 18 to 39 years, individuals with low education, without health insurance, and beneficiaries of the Bolsa Família program. CONCLUSION: Approximately one in ten Brazilians has DM. A little more than half of this population is aware of their diagnosis, a condition measured by HbA1c dosage and clinical diagnosis. Among those who know, the vast majority are undergoing drug treatments. However, less than half of these have their HbA1c levels controlled. Worse scenarios were found in subgroups with high social vulnerability.
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Diabetes Mellitus , Adulto , Masculino , Humanos , Brasil/epidemiología , Hemoglobina Glucada , Estudios Transversales , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/tratamiento farmacológico , Diabetes Mellitus/epidemiología , Hipoglucemiantes/uso terapéutico , PrevalenciaRESUMEN
OBJECTIVE: To investigate sociodemographic factors, non-communicable diseases and conditions, and behavioral risk factors associated with negative self-rated health among Brazilian women of childbearing age. METHOD: Cross-sectional study with 26,071 Brazilian women of reproductive age. Estimated prevalence of self-rated health according to sociodemographic characteristics, non-communicable diseases and conditions, and behavioral risk factors. Poisson regression was used to estimate adjusted and unadjusted prevalence ratios. RESULTS: Occurrence of two or more of the diseases and conditions presented a prevalence of negative self-rated health almost three times higher than none. There was a positive association between negative self-rated health and older age groups, lower education, black or brown skin color/race, living in the north and northeast regions, physical inactivity, being a smoker, and presence of one or more of the diseases and conditions. CONCLUSION: There are differences in self-rated health, reflecting social inequalities.
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Enfermedades no Transmisibles , Humanos , Femenino , Anciano , Estudios Transversales , Brasil/epidemiología , Escolaridad , ReproducciónRESUMEN
This article aims to evaluate the performance of preconception health indicators according to sociodemographic characteristics among Brazilian women of reproductive age. We conducted a descriptive epidemiological study using data from 21,645 and 25,228 women, respectively, who responded the 2013 and 2019 national health surveys, and data for the period 2010 to 2020 derived from the national health system's Department of Informatics (DATASUS). We calculated the prevalence of indicators according to sociodemographic characteristics and statistical significance of differences was measured using Pearson's chi-squared test. Syphilis and HIV incidence rates were also calculated. There was an increase in the prevalence of access to health service indicators (medical and dental consultations and recent Pap smear). However, there was an increase in the prevalence of hypertension, alcohol use, and obesity. The prevalence of use of contraceptive methods and fertility treatment remained stable. Syphilis incidence increased sevenfold between 2010 and 2020. Black/brown women with a low level of education, higher parity, and living in the North or Northeast performed worse for preconception health indicators. Despite the increase in access to health services, performance on preconception health indicators declined and health inequities continued.
O objetivo deste artigo é avaliar o desempenho de indicadores de saúde pré-concepcional das mulheres brasileiras em idade reprodutiva segundo as características sociodemográficas. Estudo epidemiológico e descritivo com dados de 21.645 e 25.228 mulheres que responderam à Pesquisa Nacional de Saúde de 2013 e 2019 e provenientes do DATASUS de 2010 a 2020. Estimou-se a prevalência de indicadores, segundo características sociodemográficas, e as diferenças estatísticas por meio do teste qui-quadrado de Pearson. Calculou-se a taxa de incidência dos indicadores de sífilis e HIV. Houve aumento da prevalência de indicadores que se referem ao acesso aos serviços de saúde (consultas médica, odontológica e realização de Papanicolau recente). Contudo, houve aumento da hipertensão, do consumo de álcool e da obesidade. Observou-se manutenção da prevalência do uso de contraceptivo e tratamento de fertilidade. Além disso, a taxa de incidência da sífilis aumentou sete vezes entre 2010-2020. Os resultados foram ainda piores entre mulheres de baixa escolaridade, pretas/pardas, com maior paridade e do Norte/Nordeste. Apesar do aumento no acesso aos serviços de saúde, houve piora do desempenho de indicadores de saúde pré-concepcional, e manutenção das iniquidades em saúde.
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Atención Preconceptiva , Sífilis , Embarazo , Humanos , Femenino , Prevalencia , Brasil/epidemiología , AnticoncepciónRESUMEN
Resumo O objetivo deste artigo é avaliar o desempenho de indicadores de saúde pré-concepcional das mulheres brasileiras em idade reprodutiva segundo as características sociodemográficas. Estudo epidemiológico e descritivo com dados de 21.645 e 25.228 mulheres que responderam à Pesquisa Nacional de Saúde de 2013 e 2019 e provenientes do DATASUS de 2010 a 2020. Estimou-se a prevalência de indicadores, segundo características sociodemográficas, e as diferenças estatísticas por meio do teste qui-quadrado de Pearson. Calculou-se a taxa de incidência dos indicadores de sífilis e HIV. Houve aumento da prevalência de indicadores que se referem ao acesso aos serviços de saúde (consultas médica, odontológica e realização de Papanicolau recente). Contudo, houve aumento da hipertensão, do consumo de álcool e da obesidade. Observou-se manutenção da prevalência do uso de contraceptivo e tratamento de fertilidade. Além disso, a taxa de incidência da sífilis aumentou sete vezes entre 2010-2020. Os resultados foram ainda piores entre mulheres de baixa escolaridade, pretas/pardas, com maior paridade e do Norte/Nordeste. Apesar do aumento no acesso aos serviços de saúde, houve piora do desempenho de indicadores de saúde pré-concepcional, e manutenção das iniquidades em saúde.
Abstract This article aims to evaluate the performance of preconception health indicators according to sociodemographic characteristics among Brazilian women of reproductive age. We conducted a descriptive epidemiological study using data from 21,645 and 25,228 women, respectively, who responded the 2013 and 2019 national health surveys, and data for the period 2010 to 2020 derived from the national health system's Department of Informatics (DATASUS). We calculated the prevalence of indicators according to sociodemographic characteristics and statistical significance of differences was measured using Pearson's chi-squared test. Syphilis and HIV incidence rates were also calculated. There was an increase in the prevalence of access to health service indicators (medical and dental consultations and recent Pap smear). However, there was an increase in the prevalence of hypertension, alcohol use, and obesity. The prevalence of use of contraceptive methods and fertility treatment remained stable. Syphilis incidence increased sevenfold between 2010 and 2020. Black/brown women with a low level of education, higher parity, and living in the North or Northeast performed worse for preconception health indicators. Despite the increase in access to health services, performance on preconception health indicators declined and health inequities continued.
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OBJECTIVE: to synthesize available evidence related to menstrual hygiene access and practices in Latin America and the Caribbean. METHOD: literature scoping review with research protocol registered in the Open Science Framework, carried out in the bibliographic databases: PubMed, Scopus, Web of Science and Portal Regional da Biblioteca Virtual em Saúde. Data were analyzed using simple descriptive statistics and thematic analysis. RESULTS: 15 publications were included, the majority of which addressed adolescents in Brazil: 12 articles, two technical reports and a course conclusion monograph. As recurring themes in the publications, the following stand out: Access to dignified conditions for managing menstrual hygiene; Need for access to information on menstrual hygiene management; and Practices for managing menstrual hygiene. CONCLUSION: adolescents report difficulties in accessing toilets, water and absorbent materials, and lack of information about menstrual health, including in schools, leading to school absenteeism. Thus, gaps in the Latin American scientific literature reveal inequalities and diversity in menstrual experiences intersected by categories such as gender, social class and ethnicity. HIGHLIGHTS: (1) Lack of access to hygiene products, toilets and water for personal hygiene. (2) Invisibility of the problem of period poverty in Latin America. (3) Lack of physical structure in schools aggravates and leads to school absenteeism. (4) Menstrual health literacy was insufficient for the demands of adolescents. (5) Primary studies on menstrual hygiene in Latin America are scarce.
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Higiene , Menstruación , Adolescente , Humanos , América Latina , Encuestas y Cuestionarios , Conocimientos, Actitudes y Práctica en Salud , Estudios Transversales , AguaRESUMEN
OBJECTIVES: to understand the ethical problems experienced by primary health care nurses in using nursing teleconsultations for people living with the human immunodeficiency virus during the coronavirus pandemic. METHODS: qualitative research, anchored in Constructivist Grounded Theory. Data was collected between July and September 2020, with 17 participants. RESULTS: the first category highlights the ethical problems in conducting teleconsultations, managing high demand, communication barriers, and risks related to data security. The second emphasizes the potential of teleconsultations in communication and access, by generating changes in the work process and the use of protocols to guide clinical practice. CONCLUSIONS: nurses' work in digital mode requires professional qualification, with a view to stimulating reflection on teleconsultation practice, ethical-moral deliberation and combating stigma, and also adopting data security-centered conduct.
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COVID-19 , Infecciones por VIH , Consulta Remota , Humanos , Pandemias , VIH , Investigación Cualitativa , Infecciones por VIH/complicacionesRESUMEN
This study aims to describe the contraceptive mix and analyze the factors associated with the type of contraceptive used by Brazilian women of reproductive age. This is a cross-sectional, population-based study with data from 19,962 women aged 15 to 49 years. The outcomes were use and type of contraceptive, classified as: short-acting reversible contraceptives (SARC), long-acting (LARC), and permanent. The explanatory variables were characteristics of reproductive history, sociodemographic history, and access to health services. Multinomial logistic regression was used for odds ratio (OR) estimates, with SARC being the reference category. The analyses were performed in the Survey module of the Stata software, which considered the effect of the complex sampling plan of the 2019 Brazilian National Health Survey. The prevalence of contraceptive use was 83.7%. Of the total number of users, 72% used SARC, 23.2% permanent methods, and 4.8% LARC. Women with higher education, health insurance, who had deliveries, and who participated in reproductive planning groups had a higher chance of using LARC when compared with the use of SARC, while registration at the basic health unit was associated with a lower chance of use. Still, the higher the age and parity, in addition to living with the partner, the greater the chance of using permanent methods in relation to the use of SARC. Despite the high coverage of contraception, the contraceptive mix remains obsolete, with a predominance of the use of SARC. In addition, important inequalities in access were observed, with LARC being accessible only to women with better socioeconomic conditions, while permanent methods were associated with a profile of greater social vulnerability.
O objetivo deste estudo é descrever o mix contraceptivo e analisar os fatores associados ao tipo de contraceptivo usado pelas mulheres brasileiras em idade reprodutiva. Trata-se de estudo transversal, de base populacional, com dados de 19.962 mulheres de 15 a 49 anos. Os desfechos foram uso e tipo de contraceptivo, classificados em: contraceptivos reversíveis de curta duração (SARC), longa duração (LARC) e permanentes. As variáveis explicativas foram: características da história reprodutiva, sociodemográficas e de acesso aos serviços de saúde. Utilizou-se a regressão logística multinomial para estimativas da odds ratio (OR), tendo os SARC como categoria de referência. As análises foram realizadas no módulo survey do software Stata, que considerou o efeito do plano amostral complexo da Pesquisa Nacional de Saúde de 2019. A prevalência do uso de contraceptivos foi de 83,7%. Do total de usuárias, 72% usavam SARC, 23,2% métodos permanentes e 4,8%, LARC. Mulheres com maior escolaridade, plano de saúde, que tiveram partos e participaram de grupos de planejamento reprodutivo tiveram maior chance de usar LARC na comparação com o uso de SARC, enquanto o cadastro na unidade básica de saúde se associou a menor chance de uso. Ainda, quanto maior a idade e paridade, além de viver com o companheiro, maior a chance de usar métodos permanentes em relação ao uso de SARC. Apesar da elevada cobertura de contracepção, o mix contraceptivo permanece obsoleto, com predomínio do uso de SARC. Além disso, observou-se importante desigualdade de acesso, sendo os LARC acessíveis apenas por mulheres com melhores condições socioeconômicas, enquanto os métodos permanentes foram associados a um perfil de maior vulnerabilidade social.
El objetivo fue describir la combinación anticonceptiva y analizar los factores asociados al tipo de anticonceptivo usado por las mujeres brasileñas en edad reproductiva. Estudio transversal, de base poblacional, con datos de 19.962 mujeres de 15 a 49 años. Los resultados fueron el uso y el tipo de anticonceptivo, clasificados en: anticonceptivos reversibles de corta duración (SARC), de larga duración (LARC) y permanentes. Las variables explicativas fueron características de la historia reproductiva, sociodemográficas y de acceso a los servicios de salud. Se utilizó la regresión logística multinomial para las estimaciones de la odds ratio (OR), siendo los SARC la categoría de referencia. Los análisis fueron realizados en el módulo survey, del software Stata, que consideró el efecto del sistema de muestreo complejo de la Encuesta Nacional de Salud de 2019. La prevalencia del uso de anticonceptivos fue del 83,7%. Del total de usuarias, 72% usaban SARC, el 23,2% métodos permanentes y el 4,8% LARC. Las mujeres con mayor educación, plan de salud, que tuvieron partos y participaron de grupos de planificación reproductiva tuvieron mayor posibilidad de usar LARC cuando comparados al uso de SARC, mientras que el registro en la unidad básica de salud se asoció con una menor posibilidad de uso. Además, cuanto mayor sea la edad y la paridad, además de vivir con el compañero, mayor será la posibilidad de utilizar métodos permanentes en relación con el uso de SARC. A pesar de la alta cobertura de anticoncepción, la combinación anticonceptiva sigue siendo obsoleta, con un uso predominante de SARC. Además, se observaron importantes desigualdades en el acceso, siendo los LARC accesibles solo para mujeres con mejores condiciones socioeconómicas, mientras que los métodos permanentes se asociaron con un perfil de mayor vulnerabilidad social.
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Anticoncepción , Anticonceptivos , Embarazo , Femenino , Humanos , Estudios Transversales , Brasil , Anticoncepción/métodos , Encuestas y Cuestionarios , Conducta AnticonceptivaRESUMEN
This is a reflective study with the objective of analyzing the possibilities of access to employment by refugees in the Brazilian territory, in view of the socio-legal conditions in Brazil, understanding the relationship between work and health. Refugees experience the penalty of restricted access to employment, which has a significant impact on their lives. By remaining disconnected from work, they are pushed to the margins of society. In addition to this, they face difficulties in accessing adequate housing, healthcare services, education, healthy food, among others, all of which deeply affect their way of life in a foreign country with a different culture. The work becomes relevant in the discussion about access to health, goods and services necessary to live with dignity, and its implications in the work-health-disease relationship. Collaborative actions at a global level are necessary to ensure that employment opportunities are available for refugees. In this regard, this reflection articulates two basic ideas: the recognition of the importance of work in social life and living conditions, and the understanding that the determination of the health-disease process goes beyond the biological and individual choices, having historicity and a social and cultural character.