Percepções de profissionais do sexo sobre o cuidado recebido no contexto assistencial à saúde

Introduction: sex workers are configured as a historically marginalized group for deviate of the moral and social behavior pattern dictated by conservative dogmas on which Brazil was built. Such exclusion is also expressed in public health policies, where the group is mentioned only in actions and programs aimed at sexually transmitted infections (STIs), which violates basic principles proposed by SUS (Brazilian Unified Health System). This paper aims to analyze the care received in the context of health care from the perspective of sex workers. Methods: this is a descriptive and exploratory study, with a qualitative approach, that have as referential of analysis the Collective Subject Discourse (CSD), built from a half-structured interview realized with the group in question and a socioeconomic questionnaire. The DSC is a method that assemble opinions and individual expressions in a unique testimony, written in first person singular, that gives voice to this collectivity. The collect was helped by community health agents of Family Health Unit that includes the brothel’s territory. Results and Discussion: were interviewed 22 sex workers, being 19 cis woman and 3 trans woman, most of whom in a situation of social vulnerability – brown or black, little schooling and low rent. The speeches identified the existence of health care that does not meet the specific demands of this population, in addition to the presence of fragmented care and focused on sexual and gynecological health. The trans or cis interviewed, moreover, strong resistance to gender identity and respect for the social name by the team. In addition, there were expressions of fear in revealing the profession during medical appointment, due to the stigma and preconception that fell on them. Even so, these professionals understand that their health needs are met in SUS, which connotes a resigned view of the gaps in the care network, requiring specific health actions, programs and policies for this population. Final Considerations: the sex workers are a society’s cutout that suffer daily with stigma on their pattern of sexual behavior, living an important condition of social vulnerability. This reflects on fear to seek medical services and to reveal their profession, resulting in gaps on the access and right to health in this population. It is necessary, therefore, creation of health programs and policies specifics and requalification of the health teams for the management of this patients. Introdução: as profissionais do sexo se configuram como um grupo historicamente marginalizado por se desviarem do padrão de comportamento moral e social ditado pelos dogmas conservadores sobre os quais o Brasil foi erguido. Tal exclusão está expressa também nas políticas públicas de saúde, nas quais o grupo é citado apenas em ações e programas voltados às infecções sexualmente transmissíveis (ISTs), o que fere os princípios doutrinários e organizativos propostos pelo SUS. O presente trabalho objetiva analisar o cuidado recebido no contexto assistencial à saúde a partir da ótica das profissionais do sexo. Método: Trata-se de um estudo descritivo e exploratório, de abordagem qualitativa, que teve como referencial de análise o Discurso do Sujeito Coletivo (DSC), construído a partir de entrevista semiestruturada realizada com o grupo em questão. O DSC é um método que reúne as opiniões e expressões individuais semelhantes em um depoimento único, redigido em primeira pessoa do singular, que dá voz a essa coletividade. A coleta foi auxiliada pelos agentes comunitários de saúde (ACS) da Unidade de Saúde da Família que abrange o território das casas de prostituição do município. Resultados e Discussão: Foram entrevistadas 22 prostitutas, sendo 19 mulheres cis e 3 mulheres trans ou travestis, as quais, em sua maioria, encontravam-se em situação de vulnerabilidade social – raça preta ou parda, pouca escolaridade e baixa renda. Identificou-se nos discursos a existência de uma assistência em saúde que não atende as demandas específicas dessa população, além da presença de um cuidado fragmentado e centrado na saúde sexual e ginecológica. As entrevistadas trans ou travestis relataram, além disso, forte resistência quanto à identidade de gênero e respeito ao nome social por parte da equipe. Ademais, houve expressões de medo em revelar a profissão durante as consultas, devido ao estigma e preconceito recaídos sobre elas. Ainda assim, essas profissionais entendem que suas necessidades em saúde são supridas no SUS, o que conota uma visão resignada frente às lacunas da rede de atenção, requerendo ações, programas e políticas de saúde voltadas a esta população. Considerações Finais: As profissionais do sexo fazem parte de um recorte da sociedade que sofre diariamente com estigma sobre seu padrão de comportamento sexual, vivendo em importante condição de vulnerabilidade social. Isto se reflete em medo de buscar atendimento médico e de revelar a profissão, acarretando lacunas no acesso e direito à saúde desta população. Faz-se necessário, portanto, criação de programas e políticas de saúde específicas e (re)qualificação das equipes de saúde para o manejo destas pacientes

ABUSE AND DISRESPECT IN CHILDBIRTH CARE AS A PUBLIC HEALTH ISSUE IN BRAZIL: ORIGINS, DEFINITIONS, IMPACTS ON MATERNAL HEALTH, AND PROPOSALS FOR ITS PREVENTION

Disrespect and abuse (in Brazil called obstetric violence), described by different terms, is increasingly used in social activism, in academic research and public policy formulation, and was recently recognized as a public health issue by the World Health Organization. As an innovative theme, it requires a mapping its origins, definitions, typology, impacts on maternal health and proposals for its preventing and remedy. We presente a critical-narrative review about this issue, including academic literature, productions of social movements and institutional documents, in Brazil and internationally. After a short historical overview, we map the definitions and types of violence. The complex causation of these forms of violence is discussed, including the role of professional training, the organization of health services, and the implications for maternal morbidity and mortality. Finally we present interventions in public health that have been used or proposed to prevent and mitigate obstetric violence, and an agenda for innovation and research in this area

Experiencing care in the birthing center context: the users' perspective

O modelo de assistência ao parto e nascimento no Brasil tem sido tema de muitas discussões e estudos sobre a incorporação de práticas obstétricas que considerem a autonomia da mulher no processo de parturição. O modelo proposto pelas Casas de Parto configura-se como um cenário para esses cuidados. Este estudo voltou-se para a compreensão da vivência da mulher parturiente no contexto de uma Casa de Parto situada em São Paulo. Os dados foram coletados no período de março a outubro de 2007 e analisados à luz do referencial da Fenomenologia Social de Alfred Schütz. Sete mulheres participaram da pesquisa. Os resultados evidenciaram que a mulher que escolhe a Casa de Parto para dar à luz busca pelo cuidado humanizado e que nesse contexto ela passa por experiências positivas e negativas. Faz-se necessário discutir as políticas públicas de assistência ao parto, sua implementação e seu impacto sobre os indicadores de saúde perinatal.El modelo de atención del parto y nacimiento en Brasil ha sido tema de muchas discusiones y estudios sobre la incorporación de prácticas obstétricas que consideren la anatomía de la mujer en el proceso de parición. El modelo propuesto por las Casas de Partos se configura como un escenario para tales cuidados. Este estudio apuntó a la comprensión de la experiencia de la mujer parturienta en el contexto de una Casa de Partos situada en San Pablo. Los datos fueron obtenidos en el período de marzo a octubre de 2007 y analizados a la luz del referencial de la Fenomenología Social de Alfred Schutz. Siete mujeres participaron de la investigación, y los resultados evidenciaron que la mujer que escoge la Casa de Partos para dar a luz lo hace por el cuidado humanizado y, en este contexto, tiene experiencias positivas y negativas.. Se hace necesario discutir las políticas públicas de atención del parto, su implementación y su impacto sobre los indicadores de salud perinatal.In Brazil, the delivery and birth care model in Brazil has been the topic of many studies and discussions about introducing obstetric practices that take women's autonomy into account in the parturition process. Birthing Centers propose models that represent a new scenario to deliver such care. The objective of this was to understand the experience of women in labor in the context of a Birthing Center located in the city of São Paulo. Data was collected from March to October 2007 and analyzed according to the Alfred Schütz social phenomenology framework. Seven women participated in this study. Results showed that women choose the Birthing Center expecting to receive humanized care and that, within this context, they have positive and negative experiences. It is imperative to discuss public policies for delivery care, as well as its implementation and impact on perinatal health indicators

Clinical and epidemiological aspects and acceptability of larval therapy in patients with chronic wounds / Aspectos clínicos e epidemiológicos e aceitabilidade da terapia larval em pacientes com feridas crônicas

Objective: To evaluate the epidemiological and clinical profile of patients with wounds and acceptability to Larval Therapy (LT). Method: Followed 15 patients with chronic wounds and recorded in clinical records. Results: Patients didn’t know LT. Ages varied (45 to 73 y.o.), were black (46.66%), white (26.66%) and yellow (20.00%), predominantly women (73.33%). They had Elementary (53.33%), High (20.00%) and Higher education (26.60%). 60% lived in Rio de Janeiro; Wounds (mean age of 6 years; mean area of 9.4 cm²) in the distal third of the legs (53.00%) and feet (47.00%), with vascular origin (40.88%), pressure (31.69%), diabetic (16.66%) and infectious ulcers (10.77%). Patients had three (20.00%), two (20.00%) or one wound (60.00%), with necrosis (80.00%), infection (37.60%), granulation (50.30%), epithelialization (15.00%), pain (54.00%) and locomotion difficulty (47.00%). Venous insufficiency as the most observed pathological antecedent. Acceptability for LT was 93.33%. Conclusion: LT is an alternative to better quality of life.Objetivo: Evaluar el perfil epidemiológico y clínico de pacientes con heridas y aceptabilidad a Terapia Larvaria (TL).  Método: Seguimiento de 15 pacientes con heridas crónicas y registrados en historias clínicas. Resultados: Pacientes no conocían TL. Edades variaron (45 a 73%), negros (46,66%), blancos (26,66%) y morenos (20,00%), predominantemente mujeres (73,33%). Habían completado la educación primaria (53,33%), media (20,00%) y superior (26,6%). 60% vivían en RJ; Lesiones (edad media de 6 años y superficie media de 9,4 cm²) en el tercio distal de las piernas (53,00%) y pies (47,00%), con origen vascular (40,88%), úlceras por presión (31,69%), diabéticas (16,66%) e infecciosas (10,77%). Pacientes presentaban tres (20,00%), dos (20,00%) o una lesión (60,00%), con necrosis (80,00%), infección (37,60%), granulación (50,30%), epitelización (15,00%), dolor (54,0%) y dificultad locomotiva (47,00%). Insuficiencia venosa como antecedente patológico más observado. Aceptabilidad para TL fue del 93,33%. Conclusión: TL es una alternativa a una mejor calidad de vida.Objetivo: avaliar o perfil epidemiológico e clínico de pacientes com feridas e a aceitabilidade à Terapia Larval (TL).  Método: acompanhados 15 pacientes com feridas crônicas e registrados em fichas clínicas. Resultados: pacientes não conheciam a TL. Idades variaram (45 a 73), pretos (46,66%), brancos (26,66%) e pardos (20,00%), predominantemente mulheres (73,33%). Tinham ensino fundamental (53,33%), médio (20,00%) e superior (26,6%) completos. 60% residiam no RJ; Lesões, (idade média de 6 anos e área média de 9,4 cm²) no terço distal das pernas (53,00%) e nos pés (47,00%), com origem vascular (40,88%), úlceras por pressão (31,69%), diabéticas (16,66%) e infecciosa (10,77%). Pacientes apresentavam três (20,00%), duas (20,00%) ou uma lesão (60,00%), com necrose (80,00%), infecção (37,60%), granulação (50,30%), epitelização (15,00%), dor (54,0%) e dificuldade de locomoção (47,00%). Insuficiência venosa como antecedente patológico mais observado. A aceitabilidade para TL foi 93,33%. Conclusão: TL é alternativa para melhor qualidade de vida.

Antioxidant, antimicrobial and immunostimulant properties of saline extract from Caesalpinia pulcherrima (L.) Swartz (Fabaceae) leaves

281-289Caesalpinia pulcherrima (L.) Swartz is a species that originates in India and Central America and is widely distributed in the world. This plant presents important biological properties, due to the presence of some secondary medicinal metabolites, such as tannins, glycosides, flavonoids and diterpenes. In folk medicine, C. pulcherrima is used in different diseases as bronchitis, asthma, infections, wounds and eye irritations. The aim of this study was to perform a phytochemical screening and evaluate which biological properties the saline extract of leaves from C. pulcherrima have against microorganisms and animal cells. Results showed that 15 majority compounds could be found in saline extract distributed among phenol, coumarin and quercetin groups.Saline extract of leaves from C. pulcherrima also showed good results in antioxidant test and showed significant antifungal property against Candida strains. Moreover, the saline extract did not showed cytotoxicity against mice splenocytes and promoted proliferation in these cells. These results may be predictive for future studies using the saline extract from C. pulcherrima leaves as cell stimulant agent in a pharmaceutical phytotherapic formulation used in cicatricial and in vitro immunostimulant assays

Os Audience Response Systems como instrumento de inovação no ensino e na aprendizagem ativa: aplicações no âmbito de uma comunidade de prática e inovação em ensino e aprendizagem e perceções dos alunos

[Extrato] Introdução A atual geração de alunos universitários, nascida em finais da década de noventa e inícios do novo milénio, cresceu com a internet e as tecnologias digitais, sendo apelidados de "nativos digitais" (Anshari et al., 2017). O smartphone tornou-se indispensável no seu quotidiano, permitindo-lhes estar constantemente ligados à internet e desenvolver diversas atividades ao longo do dia, como verificar o email, navegar na web ou interagir nas redes sociais (Grinols & Rajesh, 2014).[...

Identification of clusters of asthma control: A preliminary analysis of the inspirers studies

This work was funded by ERDF (European Regional Development Fund) through the operations: POCI- -01-0145-FEDER-029130 (“mINSPIRERS—mHealth to measure and improve adherence to medication in chronic obstructive respiratory diseases - generalisation and evaluation of gamification, peer support and advanced image processing technologies”) co-funded by the COMPETE2020 (Programa Operacional Competitividade e Internacionalização), Portugal 2020 and by Portuguese Funds through FCT (Fundação para a Ciência e a Tecnologia).© 2020, Sociedade Portuguesa de Alergologia e Imunologia Clinica. All rights reserved. Aims: To identify distinct asthma control clusters based on Control of Allergic Rhinitis and Asthma Test (CARAT) and to compare patients’ characteristics among these clusters. Methods: Adults and adolescents (≥13 years) with persistent asthma were recruited at 29 Portuguese hospital outpatient clinics, in the context of two observational studies of the INSPIRERS project. Demographic and clinical characteristics, adherence to inhaled medication, beliefs about inhaled medication, anxiety and depression, quality of life, and asthma control (CARAT, >24 good control) were collected. Hierarchical cluster analysis was performed using CARAT total score (CARAT-T). Results: 410 patients (68% adults), with a median (percentile 25–percentile 75) age of 28 (16-46) years, were analysed. Three clusters were identified [mean CARAT-T (min-max)]: cluster 1 [27(24-30)], cluster 2 [19(14-23)] and cluster 3 [10(2-13)]. Patients in cluster 1 (34%) were characterised by better asthma control, better quality of life, higher inhaler adherence and use of a single inhaler. Patients in clusters 2 (50%) and 3 (16%) had uncontrolled asthma, lower inhaler adherence, more symptoms of anxiety and depression and more than half had at least one exacerbation in the previous year. Further-more, patients in cluster 3 were predominantly female, had more unscheduled medical visits and more anxiety symp-toms, perceived a higher necessity of their prescribed inhalers but also higher levels of concern about taking these inhalers. There were no differences in age, body mass index, lung function, smoking status, hospital admissions or specialist physician follow-up time among the three clusters. Conclusion: An unsupervised method based on CARAT--T, identified 3 clusters of patients with distinct, clinically meaningful characteristics. The cluster with better asthma control had a cut-off similar to the established in the validation study of CARAT and an additional cut-off seems to distinguish more severe disease. Further research is necessary to validate the asthma control clusters identified.publishersversionpublishe

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio