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RECIIS (Online) ; 13(2): 351-364, abr.-jun. 2019. ilus
Artigo em Português | LILACS | ID: biblio-1005614


O objetivo do estudo que fundamenta este artigo foi identificar e compreender a construção do estigma social relacionado à síndrome de Mayer-Rokitansky-Kuster-Hauser (SMRKH), uma condição que afeta exclusivamente mulheres. Analisou-se o conteúdo de 43 narrativas jornalísticas veiculadas eletronicamente. O desenho metodológico permitiu a identificação de três temas: (a) o tratamento anedótico da SMRKH; (b) a fragmentação anatomopatológica: mulher-útero ou mulher-vagina; e (c) a retórica do sofrimento da mulher redimido pela medicina. Cerca de 80% do corpus estavam centrados em questões biomédicas, além de haver um flerte com tecnologias experimentais e uma perspectiva de medicina paternalista. Concluiu-se, numa aproximação bioética centrada na dignidade humana, que há necessidade de rever a forma como a mídia apresenta as mulheres afetadas (mulher-útero), evitando ao mesmo tempo modelos de perfeição ou de normalidade que subsumam a mulher ao habitus mulher-esposa-mãe. As mulheres com SMRKH não são corpos ocos e sem úteros, são plenas e podem vivenciar a diferença.

This article bases on a study to identify and understand the construction of social stigma related to Mayer-Rokitansky-Kuster-Hauser (MRKH) Syndrome, a condition that exclusively affects women, in 43 electronically transmitted journalistic narratives, using the content analysis, based on Laurence Bardin. The methodological design allowed the emergence of three themes: (a) the anecdotal treatment of MRKH syndrome; (b) the anatomopathological fragmentation: woman-uterus or woman-vagina; and (c) the rhetoric of the suffering of the woman redeemed by doctors in medicine. About 80% of the corpus focused their attention on biomedical issues, and there was a flirtation with experimental technologies and a perspective from paternalistic medicine. Based on a bioethical approach centered on human dignity, it was concluded that there is a need to review the way in which the media presents the affected women (womanwomb), avoiding models of perfection or normality that subsume women to the woman-wife-mother characterization. Women affected by MRKH syndrome are not hollow and without uterus bodies, they have plenitude and can experience the difference.

El objetivo del estudio en el cual se funda este artículo ha sido identificar y comprender la construcción del estigma social relacionado con el síndrome de Mayer-Rokitansky-Kuster-Hauser (MRKH), una condición que afecta exclusivamente a las mujeres. Utilizando el análisis de contenido, basado en Laurence Bardin, fueron analizadas 43 narrativas periodísticas transmitidas electrónicamente. El diseño metodológico permitió la identificación de tres temas: (a) el tratamiento anecdótico del síndrome de MRKH; (b) la fragmentación anatomopatológica: mujer-útero o mujer-vagina; y (c) la retórica del sufrimiento de la mujer redimido por la medicina. Cerca del 80% del corpus estabam centrados en cuestiones biomédicasy mostraron flirteo con tecnologías experimentales y una perspectiva de medicina paternalista. Se concluyó, en una aproximación bioética centrada en la dignidad humana, que existe la necesidad de revisar la forma como los medios presentan a las mujeres afectadas (mujer-útero), evitando modelos de perfección o de normalidad que subsuman a la mujer a la caracterización mujer-esposa-madre. Las mujeres con síndrome de MRKH no son cuerpos huecos y sin úteros, son plenas y pueden experimentar la diferencia.

Humanos , Bioética , Saúde da Mulher , Sexualidade , Pessoalidade , Qualidade de Vida , Reprodução , Útero , Vagina , Jornalismo , Estigma Social
Rev Lat Am Enfermagem ; 27: e3058, 2019 Jul 18.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31340338


OBJECTIVE: to evaluate the process and outcome indicators of the prenatal care developed in primary care, comparing traditional care models and the Family Health Strategy. METHOD: this is a cohort study, conducted with an intentional sample of 273 mothers/babies from the neonatal period and followed up for one year. Donabedian evaluation was adopted and data were discussed based on the Social Determination of Health. The independent variable was the care model. The dependent variables in the process evaluation were related to the quality of prenatal care and to the quality score created and the evaluation of the outcome, to the conditions of birth and the first year of life. The evaluation of the process was performed by estimating the relative risk and the evaluation of the outcome was performed by the Cox Multiple Regression Model. RESULTS: lower income and risk of the low prenatal quality score were identified in the Family Health Units, where there were more puerperium consultation and health education actions. There was no difference in outcome indicators. CONCLUSION: possibly the best quality of prenatal care was able to minimize negative socioeconomic effects found in family health, so the outcome indicators were similar in both models of the primary care.

Cuidado Pré-Natal/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde , Brasil , Saúde da Criança , Saúde da Família , Feminino , Humanos , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Fatores Socioeconômicos , Saúde da Mulher , Adulto Jovem
Rev Lat Am Enfermagem ; 27: e3157, 2019 Jul 18.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31340345


OBJECTIVE: to analyze the relationship between perception of social support and emotional and physical symptoms associated with psychiatric conditions among women. METHOD: a cross-sectional, quantitative study was carried out with a randomized random sample of 141 women attended at a Family Health Unit of the city of Ribeirão Preto/SP. A sociodemographic questionnaire, the Social Support Questionnaire and the Self-Report Questionnaire were used. RESULTS: there was no association between sociodemographic characteristics and mental disorder, but between aspects such as low income and schooling. The exercise of professions culturally considered as of low prestige gave rise to some reflections related to gender inequality. There was a significant difference in the satisfaction scores between the women who reported or not the symptoms of tiredness and sadness and the number of supporters among those who reported or not the symptom of fatigue. Spouses and children were the most mentioned supporters, and having mental disorder was significantly associated with having no friends in the support network. CONCLUSION: issues related to gender equity and satisfaction with social support are important aspects of care. For the promotion of mental health, efforts must be made to make women feel more connected and supported by the supporters available in their social environment.

Transtornos Mentais , Saúde Mental , Apoio Social , Adolescente , Adulto , Idoso , Brasil , Estudos Transversais , Saúde da Família , Feminino , Humanos , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade , Autorrelato , Fatores Socioeconômicos , Inquéritos e Questionários , Saúde da Mulher , Adulto Jovem
BJOG ; 126 Suppl 4: 34-42, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31257668


OBJECTIVES: A diagnosis of hypertensive disorders during pregnancy (HDPs) or gestational diabetes mellitus (GDM) is highly predictive of women at increased risk of developing chronic hypertension, Type 2 diabetes, and cardiovascular disease. This study investigates perceptions of women and healthcare providers in rural India regarding these long-term risks. DESIGN: Qualitative study using modified grounded theory. SETTING: Two states in rural India: Haryana and Andhra Pradesh. POPULATION: Pregnant and postpartum women, community health workers (CHWs), primary care physicians, obstetricians, laboratory technicians, and healthcare officials. METHODS: In-depth interviews and focus group discussions explored: (1) priorities for high-risk pregnant women; (2) detection and management of HDPs and GDM; (3) postpartum management, and (4) knowledge of long-term sequelae of high-risk conditions. A thematic analysis was undertaken. RESULTS: Seven focus group discussions and 11 in-depth interviews (n = 71 participants) were performed. The key priority area for high-risk pregnant women was anaemia. Blood pressure measurement was routinely embedded in antenatal care; however, postpartum follow up and knowledge of the long-term complications were limited. GDM was not considered a common problem, although significant variations and challenges to GDM screening were identified. Knowledge of the long-term sequelae of GDM with regard to an increased risk of Type 2 diabetes and cardiovascular disease among doctors was minimal. CONCLUSIONS: There is a need for improved education, standardisation of testing and postpartum follow up of HDPs and GDM in rural Indian settings. FUNDING: SN is supported by an MRC Clinical Research Training Fellowship (MR/R017182/1). The George Institute for Global Health Global Women's Health programme provided financial support for the research assistant and fieldwork costs in India. TWEETABLE ABSTRACT: Improved education and postpartum care of women with hypertension and diabetes in pregnancy in rural India are needed to prevent long-term risks.

Atitude do Pessoal de Saúde , Diabetes Gestacional/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Pré-Eclâmpsia/psicologia , Adulto , Idoso , Anemia/psicologia , Feminino , Grupos Focais , Teoria Fundamentada , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Cuidado Pós-Natal , Gravidez , Pesquisa Qualitativa , População Rural/estatística & dados numéricos , Saúde da Mulher
BJOG ; 126 Suppl 4: 72-80, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31309706


OBJECTIVE: The National Family Health Survey-4 in India provided the first nationally representative estimates of hysterectomy among women aged 15-49. This paper aims to examine the national and state-level age-specific prevalence of hysterectomy, individual and household level factors associated with the procedure, and state-level indicators that may explain variation across states. DESIGN: Cross-sectional, nationally representative household survey. SETTING: National Family Health Survey was conducted across all Indian states and union territories between 2015 and 2016. POPULATION: The survey covered 699 686 women between the ages of 15 and 49 years. METHODS: Descriptive analyses and multivariate logistic regression. MAIN OUTCOME MEASURES: Women who reported ever having a hysterectomy and age at hysterectomy. RESULTS: Age-specific prevalence of hysterectomy was 0.36% (0.33,0.39) among women aged 15-29; 3.59% (3.45,3.74) among women aged 30-39; and 9.20% (8.94,9.46) among women 40-49 years. There was considerable variation in prevalence by state. Four states reported age-specific prevalence similar to high-income settings. Approximately two-thirds of hysterectomies were conducted in private facilities, with similar patterns across age groups. At the national level, higher age and parity (at least two children); not having had formal schooling; rural residence (adjusted odds ratio [AOR] 1.36; 95% CI 1.27,1.45; P < 0.01) and higher wealth status were associated with higher odds of hysterectomy. Previously sterilised women had lower odds (AOR 0.64; 95% CI 0.61,0,68; P < 0.01) of reporting hysterectomy. Exploratory analyses suggest state-level factors associated with prevalence of hysterectomy include caesarean section, female illiteracy, and women's employment. CONCLUSIONS: Hysterectomy patterns among women aged 15-49 in India indicate the critical need to ensure treatment options for gynaecological morbidity and to address hysterectomy among young women in particular. FUNDING: This study was part of the RASTA initiative of the Population Council's India country office under the Evidence Project supported by USAID. TWEETABLE ABSTRACT: Hysterectomy patterns in India highlight the need for alternatives to treat gynaecological morbidity among younger women.

Histerectomia/estatística & dados numéricos , Saúde da Mulher , Adolescente , Adulto , Distribuição por Idade , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Índia/epidemiologia , Modelos Logísticos , Pessoa de Meia-Idade , Prevalência , Fatores Socioeconômicos , Doenças Uterinas/epidemiologia , Doenças Uterinas/cirurgia , Adulto Jovem
Rev. Bras. Saúde Mater. Infant. (Online) ; 19(2): 447-458, Apr.-June 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1013137


Abstract Objectives: to evaluate prenatal care in Primary Care by identifying the aspects that influence structural and operational adequacy. Methods: evaluation research with analysis of 4,059 municipalities that joined the 2nd cycle of the Program for Improving Access and Quality in Primary Care in 2013-2014. The evaluative model composed of 19 indicators grouped in structural aspects and operational aspects dimensions was validated in a consensus conference. Data analysis was descriptive, with the issuance of value judgment. Results: in structural aspects, 32.6% of the municipalities presented adequacy, whilst in operational ones, only 24.1%. In the general prenatal evaluation, less than a quarter (24.6%) of the municipalities was adequate, those with up to 10 thousand inhabitants had a higher percentage of adequacy (41.6%). The South region presented adequacy of 33.8%, considering all sizes. Conclusions: most municipalities presented low adequacy in prenatal care, with better performance of structural aspects. Smaller municipalities presented better results in all analyzed items. Structural aspects and general evaluation of prenatal care are highlighted in the South region. Adequate attention to prenatal care needs to be comprehensive and equitable, with the strengthening of regional networks geared towards social inclusion.

Resumo Objetivos: avaliar a atenção ao pré-natal na Atenção Básica identificando os aspectos que influenciam a adequação estrutural e operacional. Métodos: pesquisa avaliativa com análise de 4.059 municípios que aderiram ao 2° ciclo do Programa de Melhoria do Acesso e da Qualidade na Atenção Básica em 2013-2014. O modelo avaliativo composto por 19 indicadores agrupados nas dimensões aspectos estruturais e aspectos operacionais foi validado em conferência de consenso. A análise de dados foi descritiva, com emissão de juízo de valor. Resultados: nos aspectos estruturais 32,6% dos municípios apresentaram adequação e nos operacionais, apenas 24,1%. Na avaliação geral do pré-natal menos de um quarto (24,6%) dos municípios ficaram adequados, àqueles com até 10 mil habitantes apresentaram maior percentual de adequação (41,6%). A região Sul apresentou adequação de 33,8%, considerando todos os portes. Conclusões: a maior parte dos municípios apresentou baixa adequação na atenção ao pré-natal, com melhor desempenho dos aspectos estruturais. Municípios de menor porte apresentaram melhores resultados em todos os itens analisados. Destaque para a região Sul nos aspectos estruturais e na avaliação geral do pré-natal. Uma adequada atenção ao pré-natal precisa ser integral e equânime, com fortalecimento das redes regionais voltadas para a inclusão social.

Humanos , Feminino , Gravidez , Cuidado Pré-Natal , Atenção Primária à Saúde , Garantia da Qualidade dos Cuidados de Saúde , Avaliação em Saúde , Administração Municipal , Qualidade da Assistência à Saúde , Brasil , Indicadores de Morbimortalidade , Educação em Saúde , Saúde da Mulher , Serviços de Saúde Materno-Infantil
Lancet ; 393(10190): 2522-2534, 2019 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-31155271


Evidence that gender inequalities and restrictive norms adversely affect health is extensive; however, far less research has focused on testing solutions. We first comprehensively reviewed the peer-reviewed and grey literature for rigorously evaluated programmes that aimed to reduce gender inequality and restrictive gender norms and improve health. We identified four mutually reinforcing factors underpinning change: (1) multisectoral action, (2) multilevel, multistakeholder involvement, (3) diversified programming, and (4) social participation and empowerment. Following this review, because little research has investigated the effects of national-level law and policy reforms, we conducted original quasi-experimental studies on laws and policies related to education, work, and income, all social determinants of health in which deep gender inequalities exist. We examined whether the laws and policies significantly affected health outcomes and gender norms, and whether law-induced and policy-induced changes in gender norms mediated the health effects, in areas for which longitudinal data existed. Laws and policies that made primary education tuition-free (13 intervention countries with the law and/or policy and ten control countries without) and that provided paid maternity and parental leave (seven intervention and 15 control countries) significantly improved women's and their children's health (odds ratios [OR] of 1·16-2·10, depending on health outcome) and gender equality in household decision making (OR 1·46 for tuition-free and 1·45 for paid maternity and parental leave) as a proxy indicator of gender norms. Increased equality partially mediated the positive effects on health outcomes. We conclude by discussing examples of how improved governance can support gender-equitable laws, policies, and programmes, immediate next steps, and future research needs.

Educação/legislação & jurisprudência , Programas Nacionais de Saúde/legislação & jurisprudência , Sexismo/prevenção & controle , Saúde da Mulher/legislação & jurisprudência , Feminino , Política de Saúde , Disparidades nos Níveis de Saúde , Humanos , Masculino , Poder (Psicologia)
BMC Public Health ; 19(1): 725, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31182064


BACKGROUND: Depression, the world's leading cause of disability, disproportionately affects women. Women in India, one of the most gender unequal countries worldwide, face systemic gender disadvantage that significantly increases the risk of common mental disorders. This study's objective was to examine the factors influencing women's participation in psychosocial support groups, within an approach where community members work together to collectively strengthen their community's mental health. METHODS: This community-based qualitative study was conducted from May to July 2016, across three peri-urban sites in Dehradun district, Uttarakhand, Northern India. Set within an NGO-run mental health project, data were collected through focus group discussions with individuals involved in psychosocial support groups including women with psychosocial disabilities as well as caregivers (N = 10, representing 59 women), and key informant interviews (N = 8) with community members and mental health professionals. Data were analyzed using a thematic analysis approach. RESULTS: The principal barrier to participating in psychosocial support groups was restrictions on women's freedom of movement. Women in the community are not normally permitted to leave home, unless going to market or work, making it difficult for women to leave their home to participate in the groups. The restrictions emanated from the overall community's attitude toward gender relations, the women's own internalized gender expectations, and most significantly, the decision-making power of husbands and mothers-in-law. Other factors including employment and education shaped women's ability to participate in psychosocial support groups; however, the role of these additional factors must be understood in connection to a gender order limiting women's freedom of movement. CONCLUSIONS: Mental health access and gender inequality are inseparable in the context of Northern India, and women's mental health cannot be addressed without first addressing underlying gender relations. Community-based mental health programs are an effective tool and can be used to strengthen communities collectively; however, attention towards the gender constraints that restrict women's freedom of movement and their ability to access care is required. To our knowledge, this is the first study to clearly document and analyze the connection between access to community mental health services in South Asia and women's freedom of movement.

Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Liberdade , Relações Interpessoais , Participação do Paciente/psicologia , Participação Social/psicologia , Adulto , Ásia , Atitude , Tomada de Decisões , Depressão/psicologia , Emprego/psicologia , Família , Feminino , Grupos Focais , Identidade de Gênero , Humanos , Índia , Transtornos Mentais/psicologia , Saúde Mental , Pesquisa Qualitativa , Grupos de Autoajuda , Cônjuges , Saúde da Mulher
Artigo em Inglês | PAHO-IRIS | ID: phr-50991


[ABSTRACT]. Objectives. Gender continues to be largely neglected in the global response to the noncommunicable dis-ease epidemic. The objectives of this study were to examine current practice and barriers faced by Latin American and Caribbean (LAC) researchers in addressing gender in research on healthy food environments, and to identify future topics for gender-sensitive and gender-transformative research. Methods. This study involved: 1) a descriptive, three-part survey to investigate to what extent LAC researchers are integrating gender considerations in research for healthier food environments and 2) a participatory workshop to coproduce ideas for future gender-sensitive and gender-transformative research. Results. Fifty-four participants, from 19 countries, attended the workshop. Of those 54, 41 of them responded to at least one section of the three-part survey, including with 26 of the 41 responding to the section on gender. Of these 26, 17 (65.4%) had collected sex-disaggregated data and 14 (53.8%) had conducted gender anal-ysis in recent research on food environments. Few participants had integrated gender-related findings in their recommendations and solutions. Challenges included data and methodological limitations (e.g., lack of preex-isting evidence, working with secondary data), knowledge and capacity gaps, subject sensitivity, and biases. Participants identified research topics for enhancing gender equity that included food preparation norms and domestic responsibilities; differential participation of women and men in food production, distribution, and retail; and employment and school policies. Conclusions. The findings from this study suggest that gender inequity is not being well addressed in food environment research from the LAC region. The analytical framework presented here can serve as an important starting point and resource for catalyzing future gender-transformative research. Complementary efforts are needed to overcome other challenges raised by the participating researchers, including capacity gaps, resource and data limitations, and publishing barriers.

[RESUMEN]. Objetivos. La perspectiva de género se sigue descuidando en gran medida en la respuesta mundial a la epidemia de las enfermedades no transmisibles. Los objetivos de este estudio fueron examinar el procedimiento actual y los obstáculos a los que se enfrentan los investigadores de América Latina y el Caribe al abordar la perspectiva de género en investigaciones sobre entornos propicios a la alimentación saludable y determinar los temas para futuras investigaciones que estén atentas a los temas de género y sean transformadoras de las cuestiones de género. Métodos. Este estudio incluyó: 1) una encuesta descriptiva en tres partes para conocer hasta qué punto los investigadores de America Latina y el Caribe están integrando las consideraciones de género en la investigación de entornos alimentarios más saludables y 2) un taller participativo de coprodución de ideas para futuras investigaciones sensibles al género y transformadoras de género. Resultados. Asistieron al taller 54 participantes de 19 países. De esos 54, 41 de ellos respondieron al menos una de las secciones de la encuesta en tres partes, y 26 de los 41 respondieron a la sección sobre género. De estos 26, 17 (65,4 %) habían recopilado datos desglosados por sexo y 14 (53,8 %) habían realizado análisis de cuestiones de género en investigaciones recientes sobre los entornos de la alimentación. Pocos participantes habían incorporado resultados en materia de género en sus recomendaciones y soluciones. Algunos desafíos habían sido las limitaciones de los datos y la metodología (por ejemplo, falta de evidencia previa, trabajar con datos secundarios), falta de conocimiento y capacitación, sensibilidad de las personas y sesgos. Los participantes señalaron temas de investigación para mejorar la equidad de género, como normas de preparación de alimentos y responsabilidades domésticas; la participación diferenciada de hombres y mujeres en la producción, distribución y venta al por menor de alimentos; y el empleo y las políticas escolares. Conclusiones. Los resultados de este estudio indican que la inequidad de género no se está abordando adecuadamente en la investigación sobre el entorno de la alimentación en América Latina y el Caribe. El marco analítico que se presenta aquí puede servir como un importante punto de partida y como recurso para catalizar investigaciones futuras transformadoras de las cuestiones de género. Se necesitan esfuerzos complementarios para superar otros desafíos que plantean los investigadores participantes, como la falta de capacitación, las limitaciones de los recursos y datos, y los obstáculos para la publicación.

[RESUMO]. não transmissíveis. Este estudo teve por objetivo examinar a conduta e as barreiras atualmente enfrentadas pelos pesquisadores da América Latina e Caribe (ALC) ao comtemplar o gênero em pesquisas sobre ambiente alimentar saudável e identificar tópicos para futuras pesquisas sensíveis ao gênero e transformativas de gênero. Métodos. Este estudo envolveu: 1) uma pesquisa descritiva em três partes para investigar em que medida os pesquisadores da LAC estão integrando considerações de gênero na pesquisa para ambientes alimentares mais saudáveis e 2) um workshop participativo para co-produzir ideias para pesquisas futuras sensíveis a gênero e transformadoras de gênero. Resultados. O seminário contou com 54 participantes provenientes de 19 países. Do número total de participantes, 41 responderam ao menos uma das três partes da pesquisa, sendo que 26 responderam a parte sobre gênero. Dentre estes, 17 (65,4%) haviam conduzido coleta de dados desagregados por sexo e 14 (53,8%) haviam realizado análise de gênero em pesquisas recentes sobre o ambiente alimentar. Um pequeno número informou ter incluído os achados relativos ao gênero em recomendações e soluções. As dificuldades encontradas pelos participantes foram limitação metodológica e de dados (como a falta de evidências preexistentes e o uso de dados secundários), lacunas de conhecimento e capacidade, sensibilidade do assunto e vieses. Os tópicos de pesquisa identificados para melhorar a equidade de gênero foram normas para o preparo dos alimentos e responsabilidades domésticas, participação diferencial de homens e mulheres na produção, distribuição e comércio a varejo de alimentos e políticas escolares e de trabalho. Conclusões. O estudo indicou que a iniquidade de gênero não está sendo devidamente contemplada em pesquisas sobre ambiente alimentar na região da ALC. A estrutura analítica aqui exposta pode servir como um importante ponto de partida e recurso para incentivar futuras pesquisas transformativas de gênero. Outros esforços são necessários para vencer os desafios mencionados pelos pesquisadores que participaram do estudo, como lacunas de capacidade, limitação de dados e recursos e barreiras à publicação dos trabalhos.

Alimentos , Saúde Pública , Doenças não Transmissíveis , Saúde da Mulher , Equidade , América Latina , Região do Caribe , Nutrição em Saúde Pública , Alimentos , Nutrição em Saúde Pública , Doenças não Transmissíveis , Saúde da Mulher , Equidade , América Latina , Região do Caribe , Nutrição em Saúde Pública , Doenças não Transmissíveis , Saúde da Mulher , Equidade , Região do Caribe
Medicine (Baltimore) ; 98(24): e15869, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31192918


Higher trait optimism and/or lower cynical hostility are associated with healthier behaviors and lower risk of morbidity and mortality, yet their association with health care utilization has been understudied. Whether these psychological attitudes are associated with breast cancer screening behavior is unknown. To assess the association of optimism and cynical hostility with screening mammography in older women and whether sociodemographic factors acted as mediators of these relationships, we used Women's Health Initiative (WHI) observational cohort survey data linked to Medicare claims. The sample includes WHI participants without history of breast cancer who were enrolled in Medicare Parts A and B for ≥2 years from 2005-2010, and who completed WHI baseline attitudinal questionnaires (n = 48,291). We used survival modeling to examine whether screening frequency varied by psychological attitudes (measured at study baseline) after adjusting for sociodemographic characteristics, health conditions, and healthcare-related variables. Psychological attitudes included trait optimism (Life Orientation Test-Revised) and cynical hostility (Cook Medley subscale), which were self-reported at study baseline. Sociodemographic, health conditions, and healthcare variables were self-reported at baseline and updated through 2005 as available. Contrary to our hypotheses, repeated events survival models showed that women with the lowest optimism scores (i.e., more pessimistic tendencies) received 5% more frequent screenings after complete covariate adjustment (p < .01) compared to the most optimistic group, and showed no association between cynical hostility and frequency of screening mammograms. Sociodemographic factors did not appear to mediate the relationship between optimism and screenings. However, higher levels of education and higher levels of income were associated with more frequent screenings (both p < .01). We also found that results for optimism were primarily driven by women who were aged 75 or older after January 2009, when changes to clinical guidelines lead to uncertainty about risks and benefits of screening in this age group. The study demonstrated that lower optimism, higher education, and higher income were all associated with more frequent screening mammograms in this sample after repeated events survival modeling and covariate adjustment.

Mamografia/estatística & dados numéricos , Otimismo/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Idoso , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Revisão da Utilização de Seguros , Estudos Longitudinais , Medicare , Fatores Socioeconômicos , Estados Unidos , Saúde da Mulher
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-LISBR1.1-46505


A endometriose é uma doença inflamatória que ataca o tecido do útero, os ovários, a bexiga e até o intestino.

Endometriose , Saúde da Mulher
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-LISBR1.1-46506


Essa capacitação estimula a formação de equipes multidisciplinares, qualificadas e organizadas para o enfrentamento às emergências obstétricas, incentiva a adoção de protocolos para prevenção, diagnóstico e tratamento da hemorragia pós-parto, motiva mudanças nos processos de trabalho e fluxos assistenciais, além de discutir a situação das emergências obstétricas, dos óbitos maternos e da organização da rede materno-infantil em cada estado.

Saúde da Mulher , Hemorragia Pós-Parto , Morte Materna
Rev Bras Epidemiol ; 22: e190035, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31038616


INTRODUCTION: Postpartum weight retention has been found to predict obesity. However, in Brazil, there's no national strategy for nutritional care of postpartum woman. OBJECTIVE: This study aimed to adapt DASH diet (Dietary Approaches to Stop Hypertension) for nutritional counseling of postpartum woman, at primary healthcare. METHOD: Methodological study, carried out in 2016, at low-income urban neighborhood in the city of Rio de Janeiro. It was developed in four steps: translation, food and food groups adaptation, identification of geographic and economic access to food and viability evaluation. RESULTS: The food groups of original diet were structured to Brazilian dietary pattern. After viability analysis, it was observed that the geographical access of food should be accounted to enable greater adherence. A qualitative and illustrated meal plan was elaborated for nutritional counseling. CONCLUSION: The adapted DASH diet for nutritional care of postpartum woman seems to be according to the Brazilian dietary pattern, maintaining nutritional characteristics that provide the health benefits previously demonstrated. Currently, it's being used in interventional study in two primary healthcare unities at the city of Rio de Janeiro.

Abordagens Dietéticas para Conter a Hipertensão/normas , Período Pós-Parto , Atenção Primária à Saúde/normas , Brasil , Feminino , Humanos , Obesidade/dietoterapia , Reprodutibilidade dos Testes , Traduções , Saúde da Mulher
Med Clin North Am ; 103(4): 601-612, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31078195


Women undergo developmental and cyclic changes in hormonal exposures that affect brain function and mental health. Some women are more vulnerable to the effects of these hormonal exposures, for reasons that remain to be determined. Evidence to date indicates that anxiety and mood disorders are the most sensitive to hormonal fluctuations in women but there is also growing evidence for a protective effect of female reproductive hormones on schizophrenia. The hormonal exposures of the menstrual cycle, pregnancy, the postpartum period, lactation, and menopause are quite different and may be associated with at least partially distinct symptom profiles.

Hormônios/metabolismo , Desenvolvimento Humano/fisiologia , Menopausa/metabolismo , Sistemas Neurossecretores/fisiologia , Estrogênios/metabolismo , Feminino , Humanos , Saúde da Mulher
Med Clin North Am ; 103(4): 613-628, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31078196


Premenstrual dysphoric disorder (PMDD) comprises emotional and physical symptoms and functional impairment that lie on the severe end of the continuum of premenstrual symptoms. Women with PMDD have a differential response to normal hormonal fluctuations. This susceptibility may involve the serotonin system, altered sensitivity of the GABAA receptor to the neurosteroid allopregnanalone, and altered brain circuitry involving emotional and cognitive functions. Serotonin reuptake inhibitors are considered the first-line treatment. Second-line treatments include oral contraceptives containing drospirenone, other ovulation suppression methods, calcium, chasteberry, and cognitive-behavioral therapy.

Anticoncepcionais Orais Hormonais/uso terapêutico , Transtorno Disfórico Pré-Menstrual/diagnóstico , Transtorno Disfórico Pré-Menstrual/tratamento farmacológico , Inibidores de Captação de Serotonina/uso terapêutico , Anticoncepcionais Orais/uso terapêutico , Feminino , Humanos , Síndrome Pré-Menstrual/diagnóstico , Síndrome Pré-Menstrual/tratamento farmacológico , Saúde da Mulher
Med Clin North Am ; 103(4): 651-667, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31078198


Windows of vulnerability for depression have been associated with increased sensitivity to hormonal changes experienced by some women during the luteal phase, postpartum, and/or menopause. Increased awareness has resulted in greater adoption of screening tools for mood and behavioral changes and tailored therapies. This article discusses study results and controversies surrounding therapies uniquely designed for menopause-related depression.

Antidepressivos/uso terapêutico , Terapia de Reposição de Estrogênios/estatística & dados numéricos , Menopausa/fisiologia , Transtornos do Humor/etiologia , Adulto , Feminino , Fogachos/tratamento farmacológico , Fogachos/etiologia , Humanos , Transtornos do Humor/diagnóstico , Transtornos do Humor/terapia , Saúde da Mulher