Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 47
Filtrar
1.
Rev Bras Epidemiol ; 26: e230008, 2023.
Artigo em Português, Inglês | MEDLINE | ID: mdl-36629620

RESUMO

OBJECTIVE: To identify spatial variability of mortality from breast and cervical cancer and to assess factors associated in the city of São Paulo. METHODS: Between 2009 and 2016, 10,124 deaths from breast cancer and 2,116 deaths from cervical cancer were recorded in the Mortality Information System among women aged 20 years and over. The records were geocoded by address of residence and grouped according to Primary Health Care coverage areas. A spatial regression modeling was put together using the Bayesian approach with a Besag-York-Mollié structure to verify the association of deaths with selected indicators. RESULTS: Mortality rates from these types of cancer showed inverse spatial patterns. These variables were associated with breast cancer mortality: travel time between one and two hours to work (RR - relative risk: 0.97; 95%CI - credible interval: 0.93-1.00); women being the head of the household (RR 0.97; 95%CI 0.94-0.99) and deaths from breast cancer in private health institutions (RR 1.04; 95%CI 1.00-1.07). The following variables were associated with mortality from cervical cancer: travel time to work between half an hour and one hour (RR 0.92; 95%CI 0.87-0.98); per capita household income of up to 3 minimum wages (RR 1.27; 95%CI 1.18-1.37) and ratio of children under one year of age related to the female population aged 15 to 49 years (RR 1.09; 95%CI 1.01-1.18). CONCLUSION: The predicted RR for mortality from these cancers were calculated and associated with the socioeconomic conditions of the areas covered.


OBJETIVO: Identificar a variabilidade espacial da mortalidade por câncer de mama e colo do útero e avaliar fatores associados à mortalidade por esses cânceres no município de São Paulo. MÉTODOS: Entre 2009 e 2016 foram registrados, no Sistema de Informações sobre Mortalidade, 10.124 óbitos por câncer de mama e 2.116 óbitos por câncer do colo do útero em mulheres com 20 anos e mais. Os registros foram geocodificados por endereço de residência e agregados segundo território adstrito. Foram realizadas modelagens de regressão espacial utilizando-se a abordagem bayesiana com estrutura de Besag-York-Mollié para verificar a associação dos óbitos com indicadores selecionados. RESULTADOS: As taxas de mortalidade por esses cânceres apresentaram padrões espaciais inversos. As variáveis associadas à mortalidade por câncer de mama foram: tempo de deslocamento para o trabalho entre uma e duas horas (risco relativo ­ RR 0,97; intervalo de credibilidade ­ IC95% 0,93­1,00); mulheres responsáveis pelo domicílio (RR 0,97; IC95% 0,94­0,99) e óbitos por câncer de mama ocorridos em estabelecimentos privados (RR 1,04; IC95% 1,00­1,07). À mortalidade por câncer do colo do útero, estiveram associados: tempo de deslocamento para o trabalho entre meia e uma hora (RR 0,92; IC95% 0,87­0,98); rendimento domiciliar até três salários-mínimos (RR 1,27; IC95% 1,18­1,37); e razão de menores de um ano em relação à população feminina de 15 a 49 anos (RR 1,09; IC95% 1,01­1,18). CONCLUSÃO: Foram calculados os RR preditos para a mortalidade por esses cânceres, que estiveram associados às condições socioeconômicas das áreas de abrangência.


Assuntos
Neoplasias da Mama , Neoplasias do Colo do Útero , Criança , Humanos , Feminino , Teorema de Bayes , Brasil/epidemiologia , Cidades/epidemiologia , Fatores Socioeconômicos
2.
Glob Public Health ; 17(11): 3175-3188, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34710333

RESUMO

We revisit the debates on reproductive health and rights (RHR) and public policies in Brazil, with focus on contraception, abortion and maternity care. These were part of a broader political agenda for re-democratisation, and for health sector reform, with the creation of the Women's Integral Health Program (PAISM) in 1983, and of the Universal Health System (SUS) in 1988. The momentum created by ICPD in Cairo (1994) was essential to institutionalise the language of RHR. Not without resistance and organised activism, recent years of right-wing governments brought a disinvestment in most public policies for women's rights. Some components of the RHR agenda are more mainstreamed, such as fertility regulation, especially hormonal and long term-methods. The limited legal rights to abortion are poorly institutionalised and constantly threatened. Maternal care tends to be highly medicalised and frequently abusive. The covid-19 pandemic accelerated social and public health disruption. The article addresses notions such as reproductive justice and institutional violence, present in the early days of women's health movement, in order to highlight important premises that were diluted in the debate on reproductive rights and autonomy. The historical analysis of how these concepts evolved locally and globally can allow a better understanding of present challenges.


Assuntos
COVID-19 , Serviços de Saúde Materna , Feminino , Gravidez , Humanos , Saúde Reprodutiva , COVID-19/epidemiologia , Brasil/epidemiologia , Pandemias , Política Pública , Direitos da Mulher , Direitos Sexuais e Reprodutivos
3.
Cad Saude Publica ; 37(11): e00149620, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34816950

RESUMO

Breast cancer is the most frequently diagnosed type of cancer and is the leading cause of death from cancer in the female population. Screening mammograms and early treatment are the most frequently used means to attempt to reduce this mortality and are promoted during Pink October, an annual awareness-raising campaign. However, recent studies have correlated the increase in screening with higher morbidity and mortality, due to overdiagnosis and overtreatment. The current study assessed searches related to breast cancer and mammogram in Google Trends from 2004 to 2019 in terms of trend, seasonality, and distribution in Brazilian states. The study also evaluatedH the correlation between the number of searches in Google Trends and the number of screening mammograms. The two series showed a seasonal pattern with peaks in October, and there was an excess in tests performed outside the recommended age bracket. Pink October transmitted and popularized health information and induced behaviors related to this information, which are three desirable aspects in health communication and education. However, the campaign also generated an excess in screening mammograms and did not encourage autonomy and free and informed consent. Pink October revealed both the potential of mass communication in health and the need for messages to be aligned with the best available scientific evidence.


O câncer de mama é o tipo de câncer mais diagnosticado e a principal causa de morte por câncer na população feminina. As mamografias de rastreamento e o tratamento precoce são geralmente os meios mais utilizados na tentativa de reduzir essa mortalidade e são incentivados no Outubro Rosa, uma campanha de divulgação anual. Contudo, estudos recentes têm relacionado o aumento do rastreamento com uma maior morbimortalidade em razão do sobrediagnóstico e do sobretratamento. No presente estudo, avaliaram-se as buscas relativas ao câncer de mama e à mamografia no Google Trends, entre 2004 e 2019, em termos da tendência, da sazonalidade e da distribuição nas Unidades Federativas brasileiras. Avaliou-se também a correlação entre a quantidade de buscas no Google Trends e a quantidade de exames de rastreamento mamográfico. As duas séries tiveram um padrão sazonal com picos em outubro, e houve excesso de exames realizados fora da faixa etária recomendada. O Outubro Rosa transmitiu informações de saúde, as popularizou e induziu comportamentos relativos a informações transmitidas; três aspectos desejáveis na comunicação e na educação em saúde. Porém, gerou um excesso de mamografias de rastreamento e não incentivou a autonomia e o consentimento livre e esclarecido. O Outubro Rosa mostrou o potencial da comunicação em saúde para massas e a necessidade de que as mensagens sejam alinhadas com as melhores evidências científicas.


El cáncer de mama es el tipo de cáncer más diagnosticado y la principal causa de muerte por cáncer en la población femenina. Las mamografías de rastreo y el tratamiento precoz son generalmente los medios más utilizados en la tentativa de reducir esa mortalidad, y son incentivados en el Octubre Rosa, una campaña de divulgación anual. No obstante, estudios recientes han relacionado el aumento del rastreo con una mayor morbimortalidad, debido al sobrediagnóstico y al sobretratamiento. En el presente estudio se evaluaron las búsquedas relativas al cáncer de mama, y a la mamografía en Google Trends entre 2004 y 2019, en términos de tendencia, de estacionalidad y de su distribución en las Unidades Federativas brasileñas. Se evaluó también la correlación entre la cantidad de búsquedas en Google Trends y la cantidad de exámenes de rastreo mamográfico. Las dos series tuvieron un patrón estacional con picos en octubre, y hubo un exceso de exámenes realizados fuera de la franja etaria recomendada. Octubre Rosa transmitió información de salud, la popularizó e indujo a comportamientos relacionados con la información transmitida; tres aspectos deseables en la comunicación y educación en salud. Sin embargo, generó un exceso de mamografías de rastreo y no incentivó la autonomía y el consentimiento libre e informado. Octubre Rosa mostró el potencial de la comunicación en salud para las masas y la necesidad de que los mensajes estén alineados con mejores evidencias científicas.


Assuntos
Comunicação em Saúde , Brasil , Feminino , Humanos , Mamografia , Sobrediagnóstico , Sobretratamento
4.
JMIR Res Protoc ; 10(5): e25016, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-33945496

RESUMO

BACKGROUND: In Brazil and other low- and middle-income countries, excess interventions in childbirth are associated with an increase in preterm and early-term births, contributing to stagnant morbidity and mortality of mothers and neonates. The fact that women often report a negative experience with vaginal childbirth, with physical pain and feelings of unsafety, neglect, or abuse, may explain the high acceptability of elective cesarean sections. The recognition of information needs and of the right to informed choice during childbirth can help change this reality. The internet has been the main source of health information, but its quality is highly variable. OBJECTIVE: This study aimed to develop and evaluate an information and communication strategy through a smartphone app with respect to childbirth, to facilitate informed choices for access to safer and evidence-based care in the context of the COVID-19 pandemic. METHODS: A randomized controlled trial, with 2 arms (intervention and control) and a closed, blind, parallel design, will be conducted with a smartphone app designed for behavior and opinion research in Brazil, with women of reproductive age previously registered on the app. After completing an entry questionnaire to verify the eligibility criteria and obtaining ethical consent, approximately 20,000 participants will be randomly allocated to the intervention and control groups at a 1:1 ratio. Participants allocated to the intervention group will be invited to engage in a digital information and communication strategy, which is designed to expand evidence-based knowledge on the advantages and disadvantages of options for labor and childbirth and the safety of the care processes. The information is based on the guidelines of the Ministry of Health and the World Health Organization for a positive childbirth experience and has been updated to include the new challenges and disruptions in maternity care within the context of the COVID-19 pandemic. The control group will receive information regarding disposable and reusable diapers as a placebo intervention. The groups will be compared in their responses in generating the birth plan and the entry and exit questionnaires, regarding responses less or more aligned with the guidelines for a positive childbirth experience. A qualitative component to map information needs is included. RESULTS: The digital trial started recruiting participants in late October 2020, and data collection has been projected to be complete by December 2020. CONCLUSIONS: This study will evaluate an innovative intervention that has the potential to promote better communication between women and providers, such that they can make better choices using an approach suitable for use during the COVID-19 pandemic. TRIAL REGISTRATION: The Brazilian Clinical Trials Registry U1111-1255-8683; http://www.ensaiosclinicos.gov.br/rg/RBR-3g5f9f/. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/25016.

5.
Med Teach ; 43(1): 19-26, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32672483

RESUMO

Disrespectful and abusive treatment of women during childbirth is a worldwide problem. This research aimed to develop and implement a Mother Baby-Friendly Hospital Initiative (MBFHI) in an academic maternity hospital in Brazil and evaluate how change could be sustained. Change Laboratory principles guided a process of action research, which was conducted between 2017 and 2019. Clinicians and managers joined the researchers in discussion sessions to redesign routines and care pathways. Observation, interviews, focus groups, and historical and documentary analysis provided information about the existing activity system, which we analysed qualitatively using MBFHI criteria to identify themes. Evidence of inappropriate obstetric interventions and impersonal interactions between clinicians and patients stimulated us to devise innovative solutions. The challenges identified by this exercise included: poor infrastructure and ambience; difficulty adhering to evidence-based protocols; social and professional hierarchies; and clinicians being poorly educated about women's rights. Although challenges remained, positive changes included a friendlier environment, improved patient privacy, and fewer unnecessary procedures. Resources released by these changes allowed us, collaboratively, to track the further implementation and sustainability of change. We conclude that the Change Laboratory can help motivated clinicians and managers humanise patients' experiences, make care more evidence-based, and expand learning of mother-friendly maternity care. Tensions and contradictions between education and patient care reported here may resonate in settings other than maternity care.


Assuntos
Serviços de Saúde Materna , Mães , Atitude do Pessoal de Saúde , Brasil , Feminino , Humanos , Laboratórios , Gravidez , Relações Profissional-Paciente , Pesquisa Qualitativa
6.
Cad. Saúde Pública (Online) ; 37(11): e00149620, 2021. graf
Artigo em Português | LILACS | ID: biblio-1350408

RESUMO

O câncer de mama é o tipo de câncer mais diagnosticado e a principal causa de morte por câncer na população feminina. As mamografias de rastreamento e o tratamento precoce são geralmente os meios mais utilizados na tentativa de reduzir essa mortalidade e são incentivados no Outubro Rosa, uma campanha de divulgação anual. Contudo, estudos recentes têm relacionado o aumento do rastreamento com uma maior morbimortalidade em razão do sobrediagnóstico e do sobretratamento. No presente estudo, avaliaram-se as buscas relativas ao câncer de mama e à mamografia no Google Trends, entre 2004 e 2019, em termos da tendência, da sazonalidade e da distribuição nas Unidades Federativas brasileiras. Avaliou-se também a correlação entre a quantidade de buscas no Google Trends e a quantidade de exames de rastreamento mamográfico. As duas séries tiveram um padrão sazonal com picos em outubro, e houve excesso de exames realizados fora da faixa etária recomendada. O Outubro Rosa transmitiu informações de saúde, as popularizou e induziu comportamentos relativos a informações transmitidas; três aspectos desejáveis na comunicação e na educação em saúde. Porém, gerou um excesso de mamografias de rastreamento e não incentivou a autonomia e o consentimento livre e esclarecido. O Outubro Rosa mostrou o potencial da comunicação em saúde para massas e a necessidade de que as mensagens sejam alinhadas com as melhores evidências científicas.


El cáncer de mama es el tipo de cáncer más diagnosticado y la principal causa de muerte por cáncer en la población femenina. Las mamografías de rastreo y el tratamiento precoz son generalmente los medios más utilizados en la tentativa de reducir esa mortalidad, y son incentivados en el Octubre Rosa, una campaña de divulgación anual. No obstante, estudios recientes han relacionado el aumento del rastreo con una mayor morbimortalidad, debido al sobrediagnóstico y al sobretratamiento. En el presente estudio se evaluaron las búsquedas relativas al cáncer de mama, y a la mamografía en Google Trends entre 2004 y 2019, en términos de tendencia, de estacionalidad y de su distribución en las Unidades Federativas brasileñas. Se evaluó también la correlación entre la cantidad de búsquedas en Google Trends y la cantidad de exámenes de rastreo mamográfico. Las dos series tuvieron un patrón estacional con picos en octubre, y hubo un exceso de exámenes realizados fuera de la franja etaria recomendada. Octubre Rosa transmitió información de salud, la popularizó e indujo a comportamientos relacionados con la información transmitida; tres aspectos deseables en la comunicación y educación en salud. Sin embargo, generó un exceso de mamografías de rastreo y no incentivó la autonomía y el consentimiento libre e informado. Octubre Rosa mostró el potencial de la comunicación en salud para las masas y la necesidad de que los mensajes estén alineados con mejores evidencias científicas.


Breast cancer is the most frequently diagnosed type of cancer and is the leading cause of death from cancer in the female population. Screening mammograms and early treatment are the most frequently used means to attempt to reduce this mortality and are promoted during Pink October, an annual awareness-raising campaign. However, recent studies have correlated the increase in screening with higher morbidity and mortality, due to overdiagnosis and overtreatment. The current study assessed searches related to breast cancer and mammogram in Google Trends from 2004 to 2019 in terms of trend, seasonality, and distribution in Brazilian states. The study also evaluatedH the correlation between the number of searches in Google Trends and the number of screening mammograms. The two series showed a seasonal pattern with peaks in October, and there was an excess in tests performed outside the recommended age bracket. Pink October transmitted and popularized health information and induced behaviors related to this information, which are three desirable aspects in health communication and education. However, the campaign also generated an excess in screening mammograms and did not encourage autonomy and free and informed consent. Pink October revealed both the potential of mass communication in health and the need for messages to be aligned with the best available scientific evidence.


Assuntos
Humanos , Feminino , Comunicação em Saúde , Brasil , Mamografia , Sobremedicalização
7.
Rev Saude Publica ; 54: 142, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33331488

RESUMO

OBJECTIVE: To verify the spatial pattern of mortality from breast and cervical cancer in areas of primary health care, considering socioeconomic conditions. METHODS: This is an ecological study, from January 2000 to December 2016. The study area is the municipality of São Paulo, Brazil, and its 456 coverage areas of primary health units. Information on deaths of women aged 20 years or over were geocoded according to residence address. We calculated mortality rates, standardized by age, and smoothed by the local empirical Bayesian method, and grouped into three or two years to reduce the random fluctuation of the data. In addition, bivariate global and local Moran indexes were calculated to verify the existence of spatial agglomeration of standardized mortality rates with a domain of socioeconomic condition, elaborated based on the Índice Paulista de Vulnerabilidade Social (IPVS - São Paulo Index of Social Vulnerability). RESULTS: The success rate of geocoding was 98.9%. Mortality from breast cancer, without stratification by time, showed a pattern with higher rates located in central regions with better socioeconomic conditions. It showed a decrease at the end of the period and a change in spatial pattern, with increased mortality in peripheral regions. On the other hand, mortality from cervical cancer remained with the highest rates in peripheral regions with worse socioeconomic conditions, despite being reduced over time. CONCLUSION: The spatial pattern of mortality from the studied cancers, over time, suggests association with the best socioeconomic conditions of the municipality, either as protection (cervical) or risk (breast). This knowledge may direct resources to prevent and promote health in the territories.


Assuntos
Neoplasias da Mama , Neoplasias do Colo do Útero , Adulto , Teorema de Bayes , Brasil/epidemiologia , Neoplasias da Mama/mortalidade , Cidades/epidemiologia , Feminino , Humanos , Análise Espacial , Neoplasias do Colo do Útero/mortalidade , Adulto Jovem
8.
Rev. saúde pública (Online) ; 54: 142, 2020. tab, graf
Artigo em Inglês | LILACS, BBO - Odontologia, Sec. Est. Saúde SP | ID: biblio-1145051

RESUMO

ABSTRACT OBJECTIVE To verify the spatial pattern of mortality from breast and cervical cancer in areas of primary health care, considering socioeconomic conditions. METHODS This is an ecological study, from January 2000 to December 2016. The study area is the municipality of São Paulo, Brazil, and its 456 coverage areas of primary health units. Information on deaths of women aged 20 years or over were geocoded according to residence address. We calculated mortality rates, standardized by age, and smoothed by the local empirical Bayesian method, and grouped into three or two years to reduce the random fluctuation of the data. In addition, bivariate global and local Moran indexes were calculated to verify the existence of spatial agglomeration of standardized mortality rates with a domain of socioeconomic condition, elaborated based on the Índice Paulista de Vulnerabilidade Social (IPVS - São Paulo Index of Social Vulnerability). RESULTS The success rate of geocoding was 98.9%. Mortality from breast cancer, without stratification by time, showed a pattern with higher rates located in central regions with better socioeconomic conditions. It showed a decrease at the end of the period and a change in spatial pattern, with increased mortality in peripheral regions. On the other hand, mortality from cervical cancer remained with the highest rates in peripheral regions with worse socioeconomic conditions, despite being reduced over time. CONCLUSION The spatial pattern of mortality from the studied cancers, over time, suggests association with the best socioeconomic conditions of the municipality, either as protection (cervical) or risk (breast). This knowledge may direct resources to prevent and promote health in the territories.


RESUMO OBJETIVOS Verificar o padrão espacial da mortalidade pelos cânceres de mama e do colo do útero, em áreas da atenção primária à saúde, levando em consideração as condições socioeconômicas. MÉTODOS O estudo é ecológico, de janeiro de 2000 a dezembro de 2016. A área de estudo é o município de São Paulo, Brasil, e suas 456 áreas de abrangência das unidades básicas de saúde. As informações sobre óbitos de mulheres com 20 anos ou mais de idade foram geocodificadas segundo endereço de residência. Foram calculadas as taxas de mortalidade, padronizadas por idade, e suavizadas pelo método bayesiano empírico local, além de agrupadas em três ou dois anos para reduzir a flutuação aleatória dos dados. Além disso, foram calculados os índices de Moran global e local bivariados, para verificar a existência de aglomeração espacial das taxas de mortalidade padronizadas com um domínio de condição socioeconômica, elaborado a partir do Índice Paulista de Vulnerabilidade Social. RESULTADOS A taxa de sucesso da geocodificação foi de 98,9%. A mortalidade por câncer de mama, sem estratificação por tempo, apresentou um padrão com maiores taxas localizadas nas regiões centrais e com melhores condições socioeconômicas. Apresentou queda ao final do período e mudança de padrão espacial, com aumento da mortalidade nas regiões periféricas. Já a mortalidade por câncer do colo do útero manteve-se com as maiores taxas nas regiões periféricas e com piores condições socioeconômicas, apesar de apresentar redução ao longo do tempo. CONCLUSÃO O padrão espacial da mortalidade pelos cânceres do estudo, ao longo do tempo, sugere associação com as melhores condições socioeconômicas do município, seja como proteção (colo) ou risco (mama). Esse conhecimento pode direcionar recursos para a prevenção e a promoção da saúde nos territórios.


Assuntos
Humanos , Masculino , Adulto , Adulto Jovem , Neoplasias da Mama/mortalidade , Neoplasias do Colo do Útero/mortalidade , Brasil/epidemiologia , Teorema de Bayes , Cidades/epidemiologia , Análise Espacial
9.
Birth ; 46(4): 583-591, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31579979

RESUMO

BACKGROUND: High rates of unnecessary cesareans and interventions in vaginal births contribute to stagnant maternal and neonatal mortality rates in Brazil. We used the Maternity Safety Thermometer (MST) to assess the prevalence of harm during maternity care. METHODS: This secondary analysis of the "Birth in Brazil" survey included a representative sample of 10 155 women who gave birth in public and private hospitals in southeastern Brazil. The main outcomes were perineal and abdominal trauma, maternal infection and hemorrhage, newborn vitality, and women's perception of safety. We calculated the odds ratios (OR) for the number of MST harms (dependent variable). RESULTS: About 81.6% of the women with vaginal births had sutures for perineal trauma (87.7% of these due to episiotomies). Poor perception of safety was reported by 83.1% of women, and 69.5% of all infants not admitted to the NICU were separated from their mother after birth. The overall rate of cesarean birth was 52.6%, and 7.5% of term infants were admitted to the NICU. In public settings, having an intrapartum cesarean significantly increased the chances of one (OR 2.21; 95% CI 1.20-4.07), or two or more (4.08 [2.27-7.32]) harms. In private settings, cesarean deliveries without labor were also associated with higher chances of one (4.26 [2.65-6.85]), or two or more (4.60 [2.35-9.02]) harms. Only 2% of the women had harm-free care. CONCLUSIONS: In southeastern Brazil, there is a high prevalence of preventable harm during maternity care.


Assuntos
Serviços de Saúde Materna , Segurança do Paciente , Qualidade da Assistência à Saúde , Adolescente , Adulto , Brasil/epidemiologia , Cesárea/estatística & dados numéricos , Criança , Estudos de Coortes , Parto Obstétrico , Episiotomia , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Infecções/epidemiologia , Unidades de Terapia Intensiva Neonatal , Admissão do Paciente/estatística & dados numéricos , Períneo/lesões , Períneo/cirurgia , Hemorragia Pós-Parto/epidemiologia , Gravidez , Suturas , Adulto Jovem
10.
Cien Saude Colet ; 24(8): 2811-2824, 2019 Aug 05.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31389530

RESUMO

Excessive interventions during labor in Brazil have been reported as disrespect and abuse and contribute to neonatal and maternal morbidity and mortality. The Senses of Birth exhibition aims to encourage normal birth to promote health and improve the experience of childbirth in the country. This article describes the characteristics of 555 women who visited the exhibition during pregnancy and their perception of obstetric violence in childbirth. Obstetric violence was reported by 12.6% of the women, mostly low-income and unmarried. It was associated to lithotomic position and Kristeller maneuver during childbirth and non-immediate skin-to-skin contact with the baby. The main categories of obstetric violence reported were: not accepted interventions /accepted interventions on the basis of partial information (36.9%), undignified care / verbal abuse (33.0%); physical abuse (13.6%); non-confidential / non-privative care (2.9%) and discrimination (2.9%). Visiting the exhibition significantly increased pregnant women's knowledge about obstetric violence. However, recognition of obsolete or harmful practices as obstetric violence was still low. Initiatives such as Senses of Birth may contribute to increase knowledge and social mobilization to disseminate good practices in childbirth care.


O excesso de intervenções no parto no Brasil tem sido reportado como violência obstétrica e contribui para os índices elevados morbi-mortalidade materna e neonatal. A exposição Sentidos do Nascer busca incentivar o parto normal para promover a saúde e melhorar a experiência de parir e nascer no País. Este artigo analisa o perfil e a experiência de parto de 555 mulheres que visitaram a exposição durante a gestação, com enfoque na percepção sobre violência obstétrica. A violência obstétrica foi reportada por 12,6% das mulheres e associada ao estado civil, à menor renda, à ausência de companheiro, ao parto em posição litotômica, à realização da manobra de Kristeller e à separação precoce do bebê após o parto. Predominaram nos relatos de violência obstétrica: intervenção não consentida/aceita com informações parciais, cuidado indigno/abuso verbal; abuso físico; cuidado não confidencial/privativo e discriminação. A visita à exposição aumentou o conhecimento das gestantes sobre violência obstétrica. Entretanto, o reconhecimento de procedimentos obsoletos ou danosos na assistência ao parto como violência obstétrica foi ainda baixo. Iniciativas como esta podem contribuir para ampliar o conhecimento e a mobilização social sobre as práticas na assistência ao parto e nascimento.


Assuntos
Parto Obstétrico/normas , Serviços de Saúde Materna/normas , Relações Profissional-Paciente , Violência/estatística & dados numéricos , Adolescente , Adulto , Brasil , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Gravidez , Gestantes/psicologia , Violência/psicologia , Adulto Jovem
11.
Ciênc. Saúde Colet. (Impr.) ; 24(8): 2811-2824, ago. 2019. tab
Artigo em Português | LILACS | ID: biblio-1011860

RESUMO

Resumo O excesso de intervenções no parto no Brasil tem sido reportado como violência obstétrica e contribui para os índices elevados morbi-mortalidade materna e neonatal. A exposição Sentidos do Nascer busca incentivar o parto normal para promover a saúde e melhorar a experiência de parir e nascer no País. Este artigo analisa o perfil e a experiência de parto de 555 mulheres que visitaram a exposição durante a gestação, com enfoque na percepção sobre violência obstétrica. A violência obstétrica foi reportada por 12,6% das mulheres e associada ao estado civil, à menor renda, à ausência de companheiro, ao parto em posição litotômica, à realização da manobra de Kristeller e à separação precoce do bebê após o parto. Predominaram nos relatos de violência obstétrica: intervenção não consentida/aceita com informações parciais, cuidado indigno/abuso verbal; abuso físico; cuidado não confidencial/privativo e discriminação. A visita à exposição aumentou o conhecimento das gestantes sobre violência obstétrica. Entretanto, o reconhecimento de procedimentos obsoletos ou danosos na assistência ao parto como violência obstétrica foi ainda baixo. Iniciativas como esta podem contribuir para ampliar o conhecimento e a mobilização social sobre as práticas na assistência ao parto e nascimento.


Abstract Excessive interventions during labor in Brazil have been reported as disrespect and abuse and contribute to neonatal and maternal morbidity and mortality. The Senses of Birth exhibition aims to encourage normal birth to promote health and improve the experience of childbirth in the country. This article describes the characteristics of 555 women who visited the exhibition during pregnancy and their perception of obstetric violence in childbirth. Obstetric violence was reported by 12.6% of the women, mostly low-income and unmarried. It was associated to lithotomic position and Kristeller maneuver during childbirth and non-immediate skin-to-skin contact with the baby. The main categories of obstetric violence reported were: not accepted interventions /accepted interventions on the basis of partial information (36.9%), undignified care / verbal abuse (33.0%); physical abuse (13.6%); non-confidential / non-privative care (2.9%) and discrimination (2.9%). Visiting the exhibition significantly increased pregnant women's knowledge about obstetric violence. However, recognition of obsolete or harmful practices as obstetric violence was still low. Initiatives such as Senses of Birth may contribute to increase knowledge and social mobilization to disseminate good practices in childbirth care.


Assuntos
Humanos , Feminino , Gravidez , Adolescente , Adulto , Adulto Jovem , Relações Profissional-Paciente , Violência/estatística & dados numéricos , Parto Obstétrico/normas , Serviços de Saúde Materna/normas , Violência/psicologia , Brasil , Conhecimentos, Atitudes e Prática em Saúde , Estudos Transversais , Gestantes/psicologia
13.
Cult Health Sex ; 21(11): 1257-1272, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-30633635

RESUMO

The use of reproductive technologies has expanded beyond cases of infertility, and opportunities for individuals of different sexual orientations to use such technologies for conception have increased. The authors examined the challenges and limitations faced by women in same-sex relationships seeking conception services in São Paulo, Brazil. They interviewed 16 women in same-sex relationships who conceived children using reproductive technologies. Access to public health services for conception remains limited and exclusive to infertile heterosexual couples. Women in same-sex relationships are forced to select between costly medical treatments in the private sector, or self-insemination with sperm from a known donor. In this study, individuals reported that they experienced adverse effects of treatments; were treated with technologies for infertility when they were, in fact, fertile; and were exposed to unnecessary and invasive interventions. Growing political conservatism and the reduction of investment in public health services are factors that can directly affect sexual and reproductive health, including that of lesbians. Public policies that enable same-sex couples to conceive have yet to be developed in many countries, and a clearer articulation of the right to evidence-informed, rights-based care, consistent with national and international guidelines is a much-needed next step.


Assuntos
Fertilização/fisiologia , Equidade em Saúde , Acesso aos Serviços de Saúde , Homossexualidade Feminina/psicologia , Técnicas Reprodutivas , Adulto , Brasil , Feminino , Fertilidade , Humanos , Comportamento Sexual
14.
Interface (Botucatu, Online) ; 23: e180074, 2019.
Artigo em Português | LILACS | ID: biblio-1002342

RESUMO

Superar a cultura de imobilização física no trabalho de parto e no parto ainda é um desafio no Brasil. Este trabalho identificou facilitadores e obstáculos para a implementação de maior liberdade de posição, em projeto-piloto da Iniciativa Hospital Amigo da Mulher e da Criança numa maternidade do Sistema Único de Saúde (SUS) de São Paulo, Brasil, usando metodologia orientada pelo Laboratório de Mudança (LM). A percepção de gestores e profissionais de saúde mostrou-se discrepante das opiniões das usuárias e do que foi observado. A liberdade de movimentação pareceu mais respeitada durante o trabalho de parto do que no parto. Frequentemente, as parturientes eram "posicionadas" em litotomia, considerada pelos profissionais "instintiva" ou "preferência" feminina, enquanto as mulheres relatavam não tomar iniciativas por temerem repreensões. Adequações simples da ambiência e treinamento dos profissionais para atender partos em posições não supinas podem contribuir para promover mudanças.


Superar la cultura de inmovilización física en el trabajo de parto y en el parto todavía constituye un desafío en Brasil. Este trabajo identificó facilitadores y obstáculos para la implementación de mayor libertad de posición, en proyecto piloto de la Iniciativa Hospital Amigo de la Mujer y del Niño en una maternidad del Sistema Brasileño de Salud (SUS) en São Paulo (Estado de São Paulo, Brasil) utilizando la metodología orientada por el Laboratorio de Cambio (LM, por sus siglas en portugués). La percepción de gestores y profesionales de salud se mostró discrepante de las opiniones de las usuarias y de lo observado. La libertad de movimiento pareció ser más respetada durante el trabajo de parto que en el parto. Frecuentemente, las parturientas eran "colocadas" en litotomía, considerada por los profesionales "instintiva" o "preferencia" femenina, mientras que las mujeres relataban que no tomaban iniciativas por miedo de reprensiones. Adecuaciones simples del ambiente y de la capacitación de los profesionales para atender partos en posiciones no supinas pueden contribuir para promover cambios.


Overcoming the culture of physical immobilization during labor and birth remains a challenge in Brazil. This study identified facilitators and barriers to implementing freedom of movement throughout labor and birth in a pilot project of the Mother-Baby Friendly Birthing Facilities Initiative in a public maternity facility in São Paulo, Brazil using the Change Laboratory methodology. There was a divergence between health managers' and professionals' perceptions of maternal care practice and those of the service users and the observations made in the facility. Freedom of movement seemed to be more respected during labor than at birth. Birthing mothers were regularly "positioned" in the lithotomy position, considered by health professionals to be an "instinctive" or "preferred" position. Women reported that they failed to take the initiative to move for fear of being reprimanded by health professionals. Simple changes to the ambience and professional training for health professionals in care provision in nonsupine positions could help foster change.


Assuntos
Humanos , Feminino , Saúde Pública , Saúde da Mulher , Humanização da Assistência , Tocologia
17.
Rev Saude Publica ; 51: 101, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29166449

RESUMO

OBJECTIVE: To examine maternal and obstetric factors influencing births by cesarean section according to health care funding. METHODS: A cross-sectional study with data from Southeastern Brazil. Caesarean section births from February 2011 to July 2012 were included. Data were obtained from interviews with women whose care was publicly or privately funded, and from their obstetric and neonatal records. Univariate and multivariate analyses were conducted to generate crude and adjusted odds ratios (OR) with 95% confidence intervals (95%CI) for caesarean section births. RESULTS: The overall caesarean section rate was 53% among 9,828 women for whom data were available, with the highest rates among women whose maternity care was privately funded. Reasons for performing a c-section were infrequently documented in women's maternity records. The variables that increased the likelihood of c-section regardless of health care funding were the following: paid employment, previous c-section, primiparity, antenatal and labor complications. Older maternal age, university education, and higher socioeconomic status were only associated with c-section in the public system. CONCLUSIONS: Higher maternal socioeconomic status was associated with greater likelihood of a caesarean section birth in publicly funded settings, but not in the private sector, where funding source alone determined the mode of birth rather than maternal or obstetric characteristics. Maternal socioeconomic status and private healthcare funding continue to drive high rates of caesarean section births in Brazil, with women who have a higher socioeconomic status more likely to have a caesarean section birth in all birth settings.


Assuntos
Cesárea/estatística & dados numéricos , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Resultado da Gravidez/epidemiologia , Saúde da Mulher/estatística & dados numéricos , Adolescente , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Idade Materna , Pessoa de Meia-Idade , Gravidez , Fatores Socioeconômicos , Adulto Jovem
18.
BMJ Open ; 7(8): e016395, 2017 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-28838894

RESUMO

OBJECTIVE: Identify the factors associated with the age-standardised breast cancer mortality rate in the municipalities of State of São Paulo (SSP), Brazil, in the period from 2006 to 2012. DESIGN: Ecological study of the breast cancer mortality rate standardised by age, as the dependent variable, having each of the 645 municipalities in the SSP as the unit of analysis. SETTINGS: The female resident population aged 15 years or older, by age group and municipality, in 2009 (mid-term), obtained from public dataset (Informatics Department of the Unified Health System). PARTICIPANTS: Women 15 years or older who died of breast cancer in the SSP were selected for the calculation of the breast cancer mortality rate, according to the municipality and age group, from 2006 to 2012. MAIN OUTCOME MEASURES: Mortality rates for each municipality calculated by the direct standardisation method, using the age structure of the population of SSP in 2009 as the standard. RESULTS: In the final linear regression model, breast cancer mortality, in the municipal level, was directly associated with rates of nulliparity (p<0.0001), mammography (p<0.0001) and private healthcare (p=0.006). CONCLUSIONS: The findings that mammography ratio was associated, in the municipal level, with increased mortality add to the evidence of a probable overestimation of benefits and underestimation of risks associated with this form of screening. The same paradoxical trend of increased mortality with screening was found in recent individual-level studies, indicating the need to expand informed choice for patients, primary prevention actions and individualised screening. Additional studies should be conducted to explore if there is a causality link in this association.


Assuntos
Neoplasias da Mama/mortalidade , Setor de Assistência à Saúde , Mamografia , Paridade , Setor Privado , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Bases de Dados Factuais , Demografia , Feminino , Humanos , Modelos Lineares , Pessoa de Meia-Idade , Fatores Socioeconômicos , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...