Perception and knowledge of pharmacogenetics among Brazilian psychiatrists.

Pharmacogenetics (PGx) can optimize drug therapy in psychiatry and is particularly important in admixed populations. Here we developed and successfully validated a questionnaire for assessing the perception and knowledge of PGx among Brazilian psychiatrists. Overall, the participants showed some familiarity with PGx. Most psychiatrists reported to have knowledge of PGx and recognized its usefulness in psychiatry; however, they declared concerns regarding PGx education, the request of tests and their interpretation, cost-effectiveness, and ethical issues. PGx testing is relatively prevalent in their clinical practice, but education on the topic is lacking. Bivariate analysis revealed significant associations. Psychiatrists > 40 years of age more frequently had a positive perception of other clinicians' familiarity with PGx. Psychiatrists in private health services showed less self-reported competency in the use of PGx testing. Furthermore, women had better perception of PGx education. The present study adds knowledge about PGx in psychiatry and encourages the development of educational and training resources for PGx to improve its clinical implementation.

"The use of educational strategies for promotion of knowledge, attitudes and contraceptive practices among teenagers - A randomized clinical trial".

OBJECTIVE: To evaluate two educational interventions and identify differences between them in what concerns the promotion of knowledge, attitudes and practices in relation to the pill and male condom. METHODS: A randomized controlled clinical trial was conducted with teenagers, in which two different educational interventions were used, one based on the methodology of problematization (PG) and another on the pedagogy of transmission (TG). Knowledge, attitudes and practices were verified through a questionnaire applied before, one month and three months after the intervention. RESULTS: The two educational interventions promoted positive changes in the answers to questions on the knowledge, attitudes and practices of adolescents, from both groups. In what concerns knowledge, performance when answering the questionnaire was better after the intervention for both. However, only the PG showed improvements in performance over time. The TG showed a higher chance of displaying certain positive attitudes and more chances of correct answers about some practices. CONCLUSION: The two educational interventions, despite having used different methodologies, have generally been proved to be effective for teaching about the pill and condom use, with positive impacts on knowledge, attitudes and practices, but with the methodology of problematization, the maintenance of knowledge in the time period studied was obtained.

Measurement properties of the questionnaire "Mosaic of opinions on induced abortion": a multicenter study in seven Brazilian hospitals.

OBJECTIVE: In Brasil, abortion is legal in cases of rape, when there is a risk of maternal death, and in cases of fetal anencephaly. However, the literature reports that some doctors refuse to care for women with such demands or come to perform it in a discriminatory manner. Pretest, test and evaluate the measurement properties of the "Mosaic of Opinions on Induced Abortion," a questionnaire developed to investigate the perspectives of Brazilian healthcare professionals about the morality of abortion. METHODS: Firstly, the questionnaire was pretested in an intentional sample of specialists. Secondly, it was tested in a randomized sample of 32 healthcare professionals. Finally, we conducted a multi-center study in seven university hospitals to evaluate the measurement properties of the questionnaire. RESULTS: Combined samples of the three phases totalized 430 individuals. In pretest and test, all the evaluated aspects obtained satisfactory results. In the multicenter phase, confirmatory factorial analysis led to an important reduction of the questionnaire, which also obtained good indicators of reliability, beyond the validation of construct and criteria. CONCLUSION: Questionnaire has been validated and is suitable for use in other surveys in Brasil.

Measurement properties of the questionnaire "Mosaic of opinions on induced abortion": a multicenter study in seven Brazilian hospitals

SUMMARY In Brasil, abortion is legal in cases of rape, when there is a risk of maternal death, and in cases of fetal anencephaly. However, the literature reports that some doctors refuse to care for women with such demands or come to perform it in a discriminatory manner. OBJECTIVE: Pretest, test and evaluate the measurement properties of the "Mosaic of Opinions on Induced Abortion," a questionnaire developed to investigate the perspectives of Brazilian healthcare professionals about the morality of abortion. METHODS: Firstly, the questionnaire was pretested in an intentional sample of specialists. Secondly, it was tested in a randomized sample of 32 healthcare professionals. Finally, we conducted a multi-center study in seven university hospitals to evaluate the measurement properties of the questionnaire. RESULTS: Combined samples of the three phases totalized 430 individuals. In pretest and test, all the evaluated aspects obtained satisfactory results. In the multicenter phase, confirmatory factorial analysis led to an important reduction of the questionnaire, which also obtained good indicators of reliability, beyond the validation of construct and criteria. CONCLUSION: Questionnaire has been validated and is suitable for use in other surveys in Brasil.

RESUMO RESUMO: No Brasil, o aborto induzido é permitido por lei em casos de estupro, risco de morte para a gestante e anencefalia fetal. Entretanto, a literatura relata que alguns médicos recusam atender mulheres com tais demandas, ou o fazem de maneira discriminatória. OBJETIVO: Pré-testar, testar e avaliar as propriedades da medida do "Mosaico de opiniões sobre o aborto induzido", um questionário para investigar as perspectivas de profissionais da saúde brasileiros sobre a moralidade do aborto. MÉTODOS: Primeiro, o questionário foi pré-testado em uma amostra intencional de especialistas. Em segundo lugar, foi testado em uma amostra aleatória de 32 profissionais da saúde. Finalmente, conduziu-se um estudo multicêntrico em sete hospitais universitários para avaliar as propriedades da medida do questionário. RESULTADOS: Combinadas, as amostras das três fases totalizaram 430 sujeitos. No pré-teste e no teste, todos os aspectos avaliados obtiveram resultados satisfatórios. Na fase multicêntrica, a análise fatorial confirmatória levou a uma importante redução do questionário, que também obteve bons indicadores de confiabilidade, além da validade de construto e de critério. CONCLUSÕES: O questionário foi validado e encontra-se apto para ser utilizado em outras pesquisas no Brasil.

Perspectives of professionals participating in the Brazilian Network for the Surveillance of Severe Maternal Morbidity regarding the implementation of routine surveillance: a qualitative study.

BACKGROUND: The Brazilian Network for the Surveillance of Severe Maternal Morbidity was developed in Brazil with the participation of 27 centers in different regions of the country. The objective of the network project was to evaluate the frequency of severe maternal morbidity (near-miss and potentially life-threatening conditions) and the factors involved with these clinical conditions. Over the data collection period, this project implemented a surveillance system to identify these cases in the participating institutions. The objective of the present study was to evaluate the perspective of the professionals who participated in this network regarding the surveillance of cases of severe maternal morbidity, the facilities and difficulties encountered in involving colleagues in the process, and participants' proposals to give continuity to this practice of qualifying maternal healthcare. METHODS: A descriptive study with a qualitative approach was conducted in which coordinators, investigators and managers at all the 27 obstetric units participating in the network were interviewed. Data were collected at 6 and 12 months after implementation of the network during semi-structured telephone interviews that were recorded following verbal informed consent. Thematic content analysis was performed of the responses to the open questions in the interviews. RESULTS: In the opinion of 60% of the participants, involving their colleagues in the surveillance process proved difficult, principally because these professionals were not very interested in the research project, but also because they found it difficult to review concepts and professional practices, because they had an excessive workload or due to operational and technical difficulties. The great majority considered that support from government agencies providing financial resources would be crucial to enable surveillance to be maintained or expanded and also to train a larger number of professionals and improve work conditions. The majority of participants found it difficult to define the ideal time interval at which surveillance should be conducted. CONCLUSION: The investigators, coordinators and managers involved in the Brazilian network project mentioned several problems that had to be confronted during this process; however, in their opinion the project should be maintained and even expanded in view of its potential to contribute towards improving obstetric care.

Validação de conteúdo do Mosaico de Opiniões sobre o Aborto Induzido (Mosai) / Content validation of the 'Mosaic of Opinions About Abortion' (Mosai)

OBJETIVO: Desenvolver e validar o conteúdo do Mosaico de Opiniões Sobre o Aborto Induzido (Mosai), um questionário estruturado que se pretende utilizar como instrumento para coletar informações sobre as opiniões de profissionais da saúde acerca da moralidade do aborto induzido. MÉTODOS: O conteúdo da primeira versão do questionário foi desenvolvido com base na técnica de análise temática de conteúdo de livros, artigos, filmes, sites e jornais relatando casos de abortamento e argumentando sobre sua prática. O Mosai ficou composto por 6 dilemas morais (vinhetas) relacionados a casos de abortamento, cujos desfechos devem ser escolhidos pelos respondentes e podem ser justificados mediante a classificação de 15 padrões de argumentos sobre o tema. A fim de validar seu conteúdo, o questionário foi submetido ao crivo de um painel de 12 especialistas, uma amostra intencional constituída de médicos, juristas, bioeticistas, sociólogos, enfermeiros e estatísticos, que avaliaram os critérios de clareza da redação, pertinência, adequação à amostra e aos domínios. As notas atribuídas pelos especialistas foram submetidas ao método da taxa de concordância. Os comentários livres foram analisados mediante a técnica de análise de conteúdo RESULTADOS: Todos os dilemas e argumentos foram considerados válidos segundo a taxa de concordância, entretanto, alguns comentários motivaram a exclusão de um dilema sobre anticoncepção de emergência, dentre outras mudanças CONCLUSÃO: A validação do Mosai poderá contribuir para que as opiniões de profissionais da saúde com relação à moralidade do aborto possam ser avaliadas de maneira abrangente e com maior profundidade.

OBJECTIVE: This study aimed to develop and validate the contents of the Mosaico de Opiniões Sobre o Aborto Induzido (Mosai), a structured questionnaire intended to be used as a tool to collect information about the views of health professionals about the morality of abortion. METHODS: The contents of the first version of the questionnaire was developed based on the technique of thematic content analysis of books, articles, films, websites and newspapers reporting cases of abortion and arguing about their practice. The Mosai was composed of 6 moral dilemmas (vignettes) related to induced abortion, whose outcomes should be chosen by the respondents and could be justified by the classification of 15 patterns of arguments about the morality of abortion. In order to validate its contents, the questionnaire was submitted to the scrutiny of a panel of 12 experts, an intentional sample consisted of doctors, lawyers, ethicists, sociologists, nurses and statisticians, who evaluated the criteria of clarity of writing, relevance, appropriateness to sample and suitability to the fields. These scores were analyzed by the method of concordance rate, while the free comments were analyzed using the analysis technique content. RESULTS: All the moral dilemmas and arguments were considered valid according to the rate of agreement, however, some comments led to the exclusion of a dilemma about emergency contraception, among other changes. CONCLUSION: The content of Mosai was considered valid to serve as a tool to collect the opinions of healthcare professionals regarding the morality of abortion.

Content validation of the 'Mosaic of Opinions About Abortion' (Mosai).

OBJECTIVE: This study aimed to develop and validate the contents of the Mosaico de Opiniões Sobre o Aborto Induzido (Mosai), a structured questionnaire intended to be used as a tool to collect information about the views of health professionals about the morality of abortion. METHODS: The contents of the first version of the questionnaire was developed based on the technique of thematic content analysis of books, articles, films, websites and newspapers reporting cases of abortion and arguing about their practice. The Mosai was composed of 6 moral dilemmas (vignettes) related to induced abortion, whose outcomes should be chosen by the respondents and could be justified by the classification of 15 patterns of arguments about the morality of abortion. In order to validate its contents, the questionnaire was submitted to the scrutiny of a panel of 12 experts, an intentional sample consisted of doctors, lawyers, ethicists, sociologists, nurses and statisticians, who evaluated the criteria of clarity of writing, relevance, appropriateness to sample and suitability to the fields. These scores were analyzed by the method of concordance rate, while the free comments were analyzed using the analysis technique content. RESULTS: All the moral dilemmas and arguments were considered valid according to the rate of agreement, however, some comments led to the exclusion of a dilemma about emergency contraception, among other changes. CONCLUSION: The content of Mosai was considered valid to serve as a tool to collect the opinions of healthcare professionals regarding the morality of abortion.

Opiniões, conhecimento e atitudes de profissionais da saúde sobre o aborto induzido: uma revisão das pesquisas brasileiras publicadas entre 2001 e 2011 / Opinions, knowledge, and attitudes of health professionals on induced abortion: a review of Brazilian studies (2001-2011)

O objetivo deste artigo é apresentar uma revisão das pesquisas brasileiras quantitativas e qualitativas sobre opiniões, conhecimentos e atitudes de profissionais da saúde sobre o aborto induzido publicadas entre 2001 e 2011. Admitiram-se publicações com amostras compostas por profissionais com quaisquer graus de formação. Os trabalhos foram categorizados segundo características metodológicas: abordagem dos dados, técnica e instrumento para coleta de dados, categorias profissionais incluídas, local da pesquisa, tamanho amostral e técnica de amostragem. Na etapa seguinte, categorizaram-se os temas centrais das pesquisas (por exemplo, aconselhamento genético e anticoncepção de emergência). Finalmente, categorizaram-se os resultados das pesquisas: conhecimento técnico e legal, perspectiva moral, opiniões sobre a lei, opiniões sobre o Sistema Único de Saúde, e atitudes hipotéticas e concretas. As publicações identificadas sugerem ampla aprovação dos casos de aborto atualmente permitidos por lei, mas larga rejeição da criminalização em casos de malformações fetais graves. A maioria das publicações relatou ter investigado profissionais de medicina (especialmente gineco-obstetras) ou de enfermagem, sendo poucos ou inexistentes dados sobre assistentes sociais e psicólogos. Não foram identificados quaisquer instrumentos apresentando dados mínimos de validade, análise de confiabilidade ou adaptação transcultural. Acredita-se que, no futuro, o desenvolvimento de instrumentos com essas qualidades possa facilitar a realização de novas pesquisas sobre esse tema, inclusive com maior abrangência e diversificação das categorias profissionais a serem estudadas.

This paper reviews quantitative and qualitative Brazilian research published from 2001 to 2011 on opinions, knowledge, and attitudes of health professionals on abortion. We included publications with samples composed of professionals with some degree of training. The papers were categorized according to methodological characteristics such as data approach and technique and instrument for data collection, and professional categories such as research site, sample size, and sampling technique. Next, we categorized the main themes of research (e.g., genetic counseling and emergency contraception). Finally, we categorized the results of research on technical and legal knowledge, moral perspectives, opinions about the law, opinions about the National Health System, and hypothetical and concrete attitudes. The publications that were identified suggested broad approval of the abortion cases currently allowed by law but high rejection of criminalization in cases of serious fetal malformations. Most articles reported having investigated medical professionals (obstetricians-gynecologists) or nurses, with little or no data on social workers and psychologists. We have not identified any instruments providing minimum data validity, reliability analysis, or cross-cultural adaptation. We believe that, in the future, development of instruments with these qualities could facilitate the implementation of new research on this topic, including greater coverage and diversification of the professional categories to be studied.

[The significance of the removal of the uterus for women: a qualitative study]. / O significado da retirada do útero para as mulheres: um estudo qualitativo.

OBJECTIVE: To identify the myths accepted by women about to undergo hysterectomy regarding the consequences that removal of their uterus might have on their lives. METHODS: A sample of 10 hospitalized women with surgical indication for hysterectomy was used to perform a qualitative study, with semi-structured interviews carried out during the preoperative period. A profile questionnaire was used with questions about personal features and semi-structured inquiries to facilitate deeper questioning. With authorization of the subjects, interviews were recorded and transcribed to perform a thematic analysis of the content. RESULTS: The myths most often mentioned during the interviews were: loss of femininity, frigidity, change in personality, possible change in body appearance (since they would be "hollow", "empty", "have a hole inside their belly"), interference in the affective and sexual life and the belief that their companion might change in relation to them (assuming that they would be hollow, cold, and with no sexual attraction). CONCLUSION: The interviewed women accepted a number of myths about the consequences that removal of their uterus would have on their lives. These myths are related to the social identity of the gender and to a lack of knowledge about their body its organs and functions.

O significado da retirada do útero para as mulheres: um estudo qualitativo / The significance of uterus removal for women

OBJETIVOS: Identificar os mitos de mulheres prestes a serem submetidas à cirurgia de histerectomia quanto ao significado da perda do útero para suas vidas. MÉTODOS: Realizou-se um estudo do tipo qualitativo com entrevistas semi-estruturadas em uma amostra proposital de dez mulheres que estavam hospitalizadas no período pré-operatório com indicação cirúrgica de histerectomia. Utilizou-se uma ficha de caracterização contendo informações pessoais e um roteiro semi-estruturado com perguntas de partida e de aprofundamento para as entrevistas, que foram gravadas mediante autorização das mulheres. As entrevistas foram transcritas e realizou-se análise temática do conteúdo. RESULTADOS: Nas falas das mulheres, os mitos mais recorrentes em relação ao útero referiram-se à perda da feminilidade, frigidez, não ser mais a mesma, à possibilidade da mudança na imagem corporal (ficar oca, vazia, ter um buraco), à interferência na vida afetiva e sexual e à percepção do companheiro a seu respeito (senti-las ocas, frias, sem interesse sexual). CONCLUSÃO: As mulheres apresentam mitos quanto à retirada do útero, relacionados à sua identidade social de gênero e à falta de conhecimento sobre seu corpo, os órgãos e suas funções.

Anticoncepçäo de emergência no Brasil: facilitadores e barreiras / Emergency contraception in Brazil: facilitators and barries

Realizou-se um estudo multicêntrico (Brasil, Chile e México), qualitativo, para avaliar a aceitabilidade da anticoncepçäo de emergência entre potenciais usuárias, possíveis provedores, autoridades e outras pessoas influentes, e identificar, de acordo com a percepçäo dos participantes, facilitadores e barreiras para a utilizaçäo do método no Brasil. Realizaram-se entrevistas semi-estruturadas, grupais e grupos de discussäo, que foram gravados e transcritos para realizaçäo de análise temática. Os participantes manisfestaram-se francamente favoráveis à disseminaçäo da informaçäo, provisäo e uso da anticoncepçäo de emergência no Brasil. Consideraram que näo existem barreiras significativas a sua aceitaçäo pela sociedade brasileira em geral, e que seria mais apropriado adotar-se a estratégia de inseri-la em programas abrangentes de saúde reprodutiva. O método deveria ser oferecido como mais uma alternativa contraceptiva, em meio às demais, enfatizando a sua indicaçäo em situaçöes de emergência. Além disso, apontou-se como essencial que os profissionais de saúde sejam capacitados para proverem a informaçäo e o método.

Laqueadura e representaçöes acerca da sexualidade e do papel reprodutivo / Tubal ligation and representations on sexuality and the reproductive role

Objetivo: Analisar a percepçäo sobre o poder de decisäo em relaçäo ao exercício da sexualidade e papel reprodutivo entre mulheres laqueadas e usuárias de outros métodos contraceptivos que näo desejam mais ter filhos. Métodos: Estudo qualitativo, utilizando a técnica dos depoimentos pessoais, com 12 mulheres que näo desejavam mais ter filhos: seis laqueadas e seis usuárias de outros métodos. As entrevistas, realizadas a partir de roteiro temático, foram gravadas e transcritas. Procedeu-se à análise temática do conteúdo com auxílio do programa The Etnograph v. 5.0. Resultados: As mulheres laqueadas representavam a maternidade como seu papel social mais relevante, enquanto as demais a incluíam em um projeto de vida mais amplo, em que davam especial relevância ao trabalho remunerado. As laqueadas percebiam seu corpo essencialmente como reprodutor e, para elas, o processo reprodutivo acontecia independente de qualquer intervençäo sua. As outras participantes, porém, percebiam seu corpo como sendo para si mesmas e que tinham poder de decisäo para adequar o processo reprodutivo ao seu projeto de vida. Conclusöes: A opçäo pela laqueadura näo representa o exercício de um poder de decisäo sobre o corpo, a sexualidade e o papel reprodutivo, tal como percebidos por mulheres esterilizadas. Antes, ela se impöe pelas circunstâncias vividas, já que essas mulheres näo se percebem como capazes de alterarem o curso da vida reprodutiva. Aponta-se a necessidade das açöes educativas em saúde sexual e reprodutiva incorporarem a abordagem de gênero, para permitirem às mulheres a reflexäo acerca de sua identidade e de seu projeto de vida, viabilizando escolhas, de fato, livres e informadas quanto à regulaçäo da fecundidade.

Paism: um marco na abordagem da saúde reprodutiva no Brasil / The Program for Integrated Women's Health Care (PAISM): a landmark in the approach to reproductive health in Brazil

O Programa de Assistência Integral à Saúde Mulher (PAISM) foi lançado pelo Ministério da Saúde em 1983, sendo anunciado como uma nova e diferenciada abordagem da saúde da mulher. Constituiu-se também na primeira vez em que o Estado brasileiro propôs explicitamente, e implantou um programa que contemplava a regulaçäo da fecundidade. Isso suscitou suspeitas acerca de possíveis intençöes ocultas de controle da natalidade. Conclui-se que o PAISM foi pioneiro ao propor o atendimento à saúde reprodutiva das mulheres, no âmbito da atençäo integral à saúde, e näo mais a utilizaçäo de açöes isoladas em planejamento familiar. Por isso mesmo, os movimentos de mulheres, de imediato, passaram a lutar por sua implementaçäo. Seu conteúdo inclui plenamente a definiçäo de saúde reprodutiva adotada pela Organizaçäo Mundial da Saúde em 1988, ampliada e consolidada no Cairo em 1994 e em Beijing em 1995. Consequentemente, a adoçäo do PAISM representou um passo significativo em direçäo ao reconhecimento dos direitos reprodutivos das mulheres, mesmo antes que essa expressäo ganhasse os diversos foros internacionais de luta.

Paism: um marco na abordagem da saúde reprodutiva no Brasil / The program for integrated women`s health care (PAISM): a landmark in the approach to reproductive health in Brazil

Pretende refletir sobre o significado do Programa de Assistência Integral à Saúde da Mulher (PAISM) para a abordagem da saúde reprodutiva no Brasil. (AU)