Aproveitar a vida, juventude e gravidez

Este artigo propõe demonstrar que a concepção de aproveitar a vida tem significados importantes no universo investigado. A expressão surgiu no contexto de uma pesquisa de abordagem qualitativa, realizada em Pelotas, durante os anos de 2001-2002, com 23 jovens de 18-19 anos que já tinham filho(s) e com 10 de suas mães. O objetivo inicial do estudo era compreender o contexto da gravidez na adolescência em jovens das camadas popular e média, pertencentes a um estudo de coorte de nascimento/1982. Durante o trabalho de campo, o conceito de aproveitar a vida ganhou grande destaque nas narrativas, ajudou a qualificar, classificar e, principalmente, justificar os comportamentos afetivo-sexuais juvenis. As análises demonstram que a juventude deve se posicionar na vida de uma forma proveitosa, endossando positivamente os seus valores sociais. A gravidez das jovens, para as mães, é vista como um dos efeitos da inconseqüência e da modernidade e, para as jovens da camada popular, como algo que estava previsto, favorecendo o menor controle parental. Para as jovens da camada média, a gravidez interrompe temporariamente ou inverte planos de trabalho e estudo, e afeta menos a sociabilidade das jovens, pois estas contam com maior estrutura econômica e familiar para seguir curtindo a vida.This manuscript demonstrates how important is the concept of enjoying life for the subjects studied. It was part of a qualitative study carried out in Pelotas during 2001-2002, including 23 adolescent mothers aged 18-19 years, and 10 of their mothers. The aim of the study was to understand the context of adolescent pregnancy among youngsters belonging to poor or medium socioeconomic level families, who are part of a birth cohort study/1982. During the field work, the concept of enjoying life was highlighted in the narratives. This concept helped qualifying, classifying, and justifying youth's behavior. The analyses show that the youngsters should live in an enjoyable way of living, acting positively or negatively according to the context and to the social values. Pregnancy is seen as a consequence of this behavior, after transposing socio-cultural limits in adolescence. Therefore, enjoying life highlights how do they feel, and explains why some behaviors are more criticized in this period of life course

[female Sterilization, Aids, And Medical Culture In São Paulo And Porto Alegre, Brazil].

This paper explores the factors associated with reproductive choices by HIV-positive pregnant women in two settings in Brazil, and particularly how health care providers and the local medical culture can affect these choices. Requesting and submitting to postpartum sterilization provide the focus of the analysis. The data come from a study conducted in prenatal care services in two cities, São Paulo and Porto Alegre. We employed two data collection strategies: collection of information from 427 patient records for HIV-positive women who had received prenatal care, and in-depth interviews with 60 women. While most women in both cities requested tubal ligation after delivery, a much higher proportion of women in Sao Paulo were actually sterilized, as compared to a tiny proportion of women in Porto Alegre. The local medical culture regarding sterilization and organization of prenatal care emerged as important factors for understanding the differences between the two cities.19 Suppl 2S365-7

When stigma becomes institutionalized: the discomforts of a care at the mental health service for drug users

Através do estudo de caso de um paciente atendido por profissionais de saúde de um serviço especializado em saúde mental para usuários de drogas, analisa-se antes e depois da reestruturação desse serviço ao receber recursos do financiamento de políticas públicas do Plano de Enfrentamento ao Crack, Álcool e Outras Drogas. O perfil de paciente esperado destoa do perfil de paciente atendido gerando dificuldades para os profissionais e a própria instituição no atendimento desse paciente e criando entraves no encaminhamento pela rede de atenção disponível. Assim, evidencia as classificações morais que permeiam o cotidiano dos serviços de saúde, bem como suas implicações sobre a vida dos usuários, destaca-se o preconceito e estigma (PARKER; AGGLETON, 2001) sofrido por quem passa por essa rede. Essa situação gera consequências nas práticas de cuidados com a saúde/doença nos fazendo refletir sobre os desafios relacionados ao estigma vivido no âmbito da saúde a fim de rebater diretamente as questões fundamentais sobre garantia dos direitos humanos dos mais vulneráveis (MONTEIRO; VILELLA, 2013). Dessa forma, é possível apontar para os limites do processo de discriminação institucionalizada que devem ser tencionados no atendimento de uma saúde com qualidade – e pública – para a maior parte da população (MONTEIRO; VILELLA; KNAUTH, 2012).Through the case study of a patient assisted by health professionals of a specialized service in mental health for drug users, it is analyzed before and after the maintenance of this service when receiving resources from the funding of policies of the Plan to Combat Crack, Alcohol, and Other Drugs. The profile of the expected patient differs from the profile of the patient treated, generating difficulties for the professionals and the institution itself in the care of this patient and creating obstacles in the referral through the available care network. Thus, evidence such as classification morals that permeate the daily life of health services, as well as their souls about the lives of users, prejudice, and stigma stand out (PARKER; AGGLETON,2001) I suffered for those who pass through this network. This situation has consequences for health/disease care practices making us reflect on the challenges related to the stigma experienced in the field of health to directly refute the fundamental questions about guaranteeing the human rights of the most independent (MONTEIRO; VILELLA, 2013). In this way, it is possible to point to the limits of the institutionalized treatment process that should be intended in the care quality – and public – healthcare for most of the population (MONTEIRO; VILELLA; KNAUTH, 2012)

Eventos marcadores associados à adesão ao tratamento para HIV/aids em um estudo de coorte

OBJETIVO: Analisar como eventos clínicos e sociais podem impactar na adesão ao tratamento antirretroviral para o HIV. MÉTODOS: Trata-se de um estudo de coorte histórica com 528 pacientes que realizaram o tratamento para o HIV em um serviço de assistência especializada em Alvorada, RS. Foram analisadas 3429 consultas executadas entre os anos de 2004 e 2017. Para cada consulta, foram coletados dados de características do tratamento e do quadro clínico dos pacientes. A adesão, aferida pelo autorrelato dos pacientes, foi o desfecho do estudo. O modelo de regressão logística via equações de estimação generalizadas foi utilizado para estimação das associações. RESULTADOS: 67,8% dos pacientes analisados possuem até 8 anos de estudos e 24,8% têm histórico de uso de crack e/ou cocaína. Entre os homens, estar assintomático [razão de chances (RC) = 1,43; IC95% 1,05–1,93], possuir mais de 8 anos de estudo (RC = 2,32; IC95% 1,27–4,23) e nunca ter usado crack (RC = 2,35; IC95% 1,20–4,57) estiveram associados à adesão. Para as mulheres, possuir mais de 24 anos (RC = 1,82; IC95% 1,09–3,02), nunca ter usado cocaína (RC = 2,54; IC95% 1,32–4,88) e estar em gestação (RC = 3,28; IC95% 1,83–5,89) aumentaram as chances de adesão. CONCLUSÕES: Além de características sociodemográficas definidas, eventos pontuais que podem ocorrer na trajetória de pacientes em tratamentos longos, como início de uma nova gestação e não apresentar sintomas, podem impactar nas chances de adesão dos pacientes ao tratamento.OBJECTIVE: To analyze how clinical and social events may impact adherence to antiretroviral treatment for HIV. METHODS: This is a historical cohort study with 528 patients who underwent treatment for HIV in a specialized care service in Alvorada, RS. A total of 3429 queries executed between the years 2004 and 2017 were analyzed. For each visit, data on treatment characteristics and the patients' clinical picture were collected. Adherence, as measured by patients' self-report, was the endpoint of the study. The logistic regression model via generalized estimating equations was used for estimating the associations. RESULTS: 67.8% of the patients analyzed have up to 8 years of education and 24.8% have a history of crack and/or cocaine use. Among men, being asymptomatic [odds ratio (OR) = 1.43; 95%CI 1.05-1.93], having more than 8 years of education (OR= 2.32; 95%CI 1.27-4.23), and never having used crack (RC = 2.35; 95%CI 1.20-4.57) were associated with adherence. For women, being older than 24 years (CR = 1.82; 95%CI 1.09-3.02), never having used cocaine (CR = 2.54; 95%CI 1.32-4.88) and being pregnant (RC = 3.28; 95%CI 1.83-5.89) increased the odds of adherence. CONCLUSIONS: In addition to defined sociodemographic characteristics, one-off events that may occur in the trajectory of patients on long treatment, such as starting a new pregnancy and not having symptoms, can impact patients' chances of treatment adherence

Sobre antropologia e saúde, engajamento político e ética em pesquisa: uma conversa com Daniela Knauth

Em tempos de pandemia, a aproximação entre antropologia e saúde é imprescindível, seja pelas inquietações epistemológicas, conceituais e metodológicas proporcionadas por essa aproximação, seja pelo aporte para a saúde da abordagem e conhecimentos antropológicos. É sobre a vivência dessa aproximação que Daniela Knauth versa nesta conversa, tendo como fio condutor sua trajetória de pesquisadora e as contribuições de antropólogos de diferentes instituições brasileiras. Trata-se da história recente da antropologia da saúde envolvendo temas, implicações e ética em pesquisa convergindo para a consolidação da saúde como campo de investigação antropológica no Brasil.In times of pandemic, the approximation between anthropology and health is more essential than ever, due to epistemological, conceptual, and methodological concerns both area share, and because of the contribution anthropology can give to health issues. In this conversation, Daniela Knauth discusses this relation based on her own trajectory as an anthropologist in the health field and presents the contributions of other anthropologists from different Brazilian institutions. Therefore, the interview is part of a recent history of medical anthropology, involving themes, implications, and ethics towards the consolidation of health as a field of anthropological research in Brazil

Hepatitis B prevalence among men who have sex with men in Brazil

Hepatitis B virus (HBV) is a global public health problem and requires specific prevention actions, particularly focusing on the key populations, such as men who have sex with men (MSM). We aimed at assessing the prevalence of HBV infection, among MSM, in a multicity study in Brazil. In 2016, we conducted a survey using a respondent-driven sampling methodology in 12 Brazilian cities. Rapid tests (RT) were performed on 3178 samples from those MSM. Positive results were tested for HBV DNA and sequenced. If negative for HBV DNA, samples were tested for serological markers. The prevalence rate of HBV exposure and clearance was 10.1% (95% CI: 8.1–12.6), and 1.1% (95%; CI: 0.6–2.1) were confirmed to be HBsAg-positive. Of those samples tested for anti-HBs (n = 1033), only 74.4% presented a serological profile analogous to that elicited by hepatitis B vaccination. Among HBsAg-positive samples (n = 29), 72.4% were HBV DNA-positive, and from these, 18 were sequenced. HBV genotypes A, F, and G were found in 55.5%, 38.9%, and 5.6%, respectively. This study indicates high prevalence rates of MSM HBV exposure and a low positivity index for the serological marker of HBV vaccine immunity. These findings may contribute to the discussion of strategies to prevent hepatitis B and reinforce the importance of promoting HBV vaccination in this key population

Automedicação em crianças de 0–12 anos no Brasil : um estudo de base populacional

Objetive: Studies have shown that the practice of self-medicating children occurs worldwide and is independent of the country’s economic level, medication policies, or access to health services. This study aimed to estimate and characterize the prevalence of self-medication in the Brazilian population of children aged up to 12 years. Methods: We analyzed the data of 7528 children aged up to 12 years whose primary caregivers responded to the National Survey on Access, Use and Promotion of Rational Use of Medicines in Brazil (PNAUM), a cross-sectional population-based study conducted in 245 Brazilian municipalities. The prevalence of selfmedication was defined as the use of at least one medication without a doctor’s or dentist’s indication 15 days before the interview. Results: The prevalence of self-medication was 22.2% and was more frequent in older children belonging to poorer families and without health insurance. The acute conditions for which there was a higher frequency of self-medication were pain, fever, and cold/allergic rhinitis. Analgesics/antipyretics stood out among the most used medications for self-medication. Conclusions: The prevalence of self-medication to treat acute conditions was high in Brazilian children sampled in PNAUM, emphasizing the management of common symptoms such as pain, fever, and cold/allergic rhinitis in this age group. These findings reinforce the need for educational actions aimed at parents and caregivers.Objetivo: Estudos têm mostrado que a prática de automedicar crianças ocorre mundialmente e independe do nível econômico do país, das políticas de medicamentos ou do acesso aos serviços de saúde. O objetivo deste estudo foi estimar e caracterizar a prevalência de uso de medicamentos por automedicação na população brasileira de crianças de zero a 12 anos de idade. Métodos: Foram analisadas informações de 7.528 crianças de zero a 12 anos cujo cuidador principal respondeu à Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM), estudo transversal de base populacional realizado em 245 municípios brasileiros. A prevalência de automedicação foi definida como o uso de pelo menos um medicamento sem indicação de médico ou dentista nos 15 dias anteriores à entrevista. Resultados: A prevalência de automedicação foi de 22,2% e foi mais frequente nas crianças mais velhas e pertencentes a famílias mais pobres e sem plano de saúde. As condições agudas para as quais houve maior frequência de automedicação foram dor, febre, resfriado e rinite alérgica. Analgésicos/antipiréticos destacaram-se entre os medicamentos mais utilizados por automedicação. Conclusões: A prevalência de automedicação no manejo de condições agudas foi elevada nas crianças brasileiras amostradas na PNAUM, com destaque para o manejo de sintomas comuns nessa faixa etária, como dor, febre, resfriado e rinite alérgica. Esses achados reforçam a necessidade de ações educativas voltadas aos pais e cuidadores

The standpoint of professionals on the presence and demands of men on the healthcare services: perspectives for the analysis of the implementation of the Comprehensive Healthcare Policy for Men

In 2009, the Brazilian Comprehensive Healthcare Policy for Men (PNAISH) was launched in Brazil, seeking to reduce morbidity and mortality in this population group. This article strives to analyze the conceptions that health professionals have about the specific demands and behaviors of the male population served by the healthcare services. The data analyzed are part of a larger research project, the objective of which was to evaluate the initial actions of the implementation of PNAISH. Ethnographic observations in 11 health services and semi-structured interviews were conducted with 21 health professionals. From the perspective of health professionals, the presence of men in the healthcare services is still limited. According to them, it is comprised of two types of clients: workers and the elderly. The male behavior characteristics - haste, objectivity, fear and resistance - and the difficulty faced by health services in receiving this population are the main factors that drive men away from health services. Although the concept of gender is central to PNAISH, it is only triggered by healthcare professionals in order to justify the social standards expected in terms of men's behavior. The attribution of men's behavior to cultural factors ultimately obscures the relations of power that underlie gender relations