O impacto do beber feminino

O estudo objetivou analisar os discursos e condutas de mulheres cadastradas na Unidade Saúde da Família diante do consumo abusivo de álcool. Esse consumo gera julgamento moral, preconceito e estigma, além de acarretar danos em sua vida social, mental e biológica. Pesquisa qualitativa, descritivo-exploratória, realizada com nove mulheres, usou entrevista semiestruturada, que é uma das estratégias de escolha mais comum para trabalhar as representações sociais. Constatou-se que as mulheres fazem uso abusivo de álcool por prazer e para aliviar sofrimento e declararam não ter danos relacionados a esse consumo. Mesmo diante de alguns prejuízos, apagões, quedas, sexo desprotegido, infertilidade e síndrome pré-menstrual, não relacionaram esses danos ao consumo e afirmaram que não tiveram nenhuma orientação profissional sobre o tema. Para elas, o álcool não é considerado uma droga, sendo assim, os resultados sugerem um alerta no provável impacto psicossocial em torno do uso abusivo de álcool na vida dessas mulheres

O impacto do beber feminino

O estudo objetivou analisar os discursos e condutas de mulheres cadastradas na Unidade Saúde da Família diante do consumo abusivo de álcool. Esse consumo gera julgamento moral, preconceito e estigma, além de acarretar danos em sua vida social, mental e biológica. Pesquisa qualitativa, descritivo-exploratória, realizada com nove mulheres, usou entrevista semiestruturada, que é uma das estratégias de escolha mais comum para trabalhar as representações sociais. Constatou-se que as mulheres fazem uso abusivo de álcool por prazer e para aliviar sofrimento e declararam não ter danos relacionados a esse consumo. Mesmo diante de alguns prejuízos, apagões, quedas, sexo desprotegido, infertilidade e síndrome pré-menstrual, não relacionaram esses danos ao consumo e afirmaram que não tiveram nenhuma orientação profissional sobre o tema. Para elas, o álcool não é considerado uma droga, sendo assim, os resultados sugerem um alerta no provável impacto psicossocial em torno do uso abusivo de álcool na vida dessas mulheres

DIAGNÓSTICO PARTICIPATIVO DO SETOR SAÚDE NO MUNICÍPIO DE GOIANA (PE)

This article presents a diagnosis of the health care network in Goiana in the state of Pernambuco. The main reason for choosing this area is the rapid process of socio-spatial transformations resulting from various industrial enterprises that are setting up in its territory. The research approach was qualitative and quantitative, using techniques of social participation in the debates of issues and construction of results. We found that the health sector in the city has a quite deficient structure. This is a worrying fact since there is a trend of population growth in the short term. Also improvement proposals and creation of local public policies have been suggested. We conclude that the diagnostic process based on participation is a valuable tool for planning and local management of the health sector, because it provides the empowerment of local people about their problems and the strategies to face them.Este artigo objetiva apresentar um diagnóstico sobre a rede de atenção à saúde no município de Goiana no Estado de Pernambuco. A principal razão da escolha desta área é o rápido processo de transformações socioespaciais decorrentes de vários empreendimentos industriais que estão se instalando no seu território. A abordagem de investigação foi quantitativa e qualitativa, utilizando-se de técnicas de participação social nos debates da problemática e construção dos resultados. Verificamos que o setor saúde no município possui uma estrutura bastante deficitária. Este é um fato preocupante, pois existe uma tendência de aumento populacional no curto prazo. Também foram sugeridas propostas de aperfeiçoamento e criação de políticas públicas locais. Concluímos que o processo de diagnóstico pautado na participação é um valioso instrumento para o planejamento e a gestão local do setor saúde, porque propicia o emponderamento da população local sobre os seus problemas e as estratégias para o enfrentamento dos mesmos

The promise and pitfalls of social science research in an emergency: lessons from studying the Zika epidemic in Brazil, 2015-2016.

Social science generates evidence necessary to control epidemics. It can help to craft appropriate public health responses, develop solutions to the epidemic impacts and improve understanding of why the epidemic occurred. Yet, there are practical constraints in undertaking this international research in a way that produces quality, ethical and appropriate data, and that values all voices and experiences, especially those of local researchers and research participants. In this paper, we reflected on the experience of undertaking social science research during the 2015/2016 Zika epidemic in Brazil. This experience was considered from the perspective of this paper's authors: three Brazilian academics, two UK academics and two mothers of children affected by congenital Zika syndrome. This group came together through the conduct of the Social and Economic Impact of Zika study, a mixed-methods social science study. The key findings highlight practical issues in the achievement of three goals: the conduct of high-quality social science in emergencies and efforts towards the decolonisation of global health in terms of levelling the power between Brazilian and UK researchers and optimising the role of patients within research. From our perspective, the information collected through social science was valuable, providing detailed insight into the programmatic needs of mothers and their affected children (eg, economic and social support and mental health services). Social science was considered a low priority within the Zika epidemic despite its potential importance. There were logistical challenges in conducting social science research, foremost of which are the difficulties in developing a trusting and balanced power relationship between the UK and Brazilian researchers in a short time frame. When these issues were overcome, each partner brought unique qualities, making the research stronger. The mothers of affected children expressed dissatisfaction with research, as they were involved in many studies which were not coordinated, and from which they did not see a benefit. In conclusion, the importance of social science in epidemics must continue to be promoted by funders. Funders can also set in place mechanisms to help equalise the power dynamics between foreign and local researchers, researchers and participants, both to promote justice and to create best quality data

Emergency and permanence of the Zika virus epidemic: an agenda connecting research and policy.

Submitted by Ana Beatriz Oliveira ([email protected]) on 2019-04-15T14:03:31Z No. of bitstreams: 1 Emergency and permanence of the Zika virus.pdf: 127208 bytes, checksum: 9f42e85e68cad6f3bb6b3fdea62abb95 (MD5)Approved for entry into archive by Ana Beatriz Oliveira ([email protected]) on 2019-04-16T13:34:46Z (GMT) No. of bitstreams: 1 Emergency and permanence of the Zika virus.pdf: 127208 bytes, checksum: 9f42e85e68cad6f3bb6b3fdea62abb95 (MD5)Made available in DSpace on 2019-04-16T13:34:46Z (GMT). No. of bitstreams: 1 Emergency and permanence of the Zika virus.pdf: 127208 bytes, checksum: 9f42e85e68cad6f3bb6b3fdea62abb95 (MD5) Previous issue date: 2018Horizonte 2020, o Programa-Quadro de Pesquisa e Inovação da União Européia, sob o acordo de subvenção da Rede Latino-Americana de Prontidão para Zika (ZikaPLAN) n. 734584 do Departamento para o Desenvolvimento Internacional do Reino Unido (DFID) e Wellcome Trust (206016 / Z / 16 / A). Conselho Nacional de Pesquisa (CNPq) e Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ); financiamento da produtividade em pesquisa para os alunos MCN Moreira e MEL Moreira.Fundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira. Rio de Janeiro, RJ, Brasil.Universidade Federal de Pernambuco. Recife, PE, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz​. Instituto Aggeu Magalhães. Recife, PE, Brasil.London School of Hygiene & Tropical Medicine. London, U.K

Avaliação da assistência hospitalar materna e neonatal: índice de completude da qualidade

OBJECTIVE Develop an index to evaluate the maternal and neonatal hospital care of the Brazilian Unified Health System. METHODS This descriptive cross-sectional study of national scope was based on the structure-process-outcome framework proposed by Donabedian and on comprehensive health care. Data from the Hospital Information System and the National Registry of Health Establishments were used. The maternal and neonatal network of Brazilian Unified Health System consisted of 3,400 hospitals that performed at least 12 deliveries in 2009 or whose number of deliveries represented 10.0% or more of the total admissions in 2009. Relevance and reliability were defined as criteria for the selection of variables. Simple and composite indicators and the index of completeness were constructed and evaluated, and the distribution of maternal and neonatal hospital care was assessed in different regions of the country. RESULTS A total of 40 variables were selected, from which 27 single indicators, five composite indicators, and the index of completeness of care were built. Composite indicators were constructed by grouping simple indicators and included the following variables: hospital size, level of complexity, delivery care practice, recommended hospital practice, and epidemiological practice. The index of completeness of care grouped the five variables and classified them in ascending order, thereby yielding five levels of completeness of maternal and neonatal hospital care: very low, low, intermediate, high, and very high. The hospital network was predominantly of small size and low complexity, with inadequate child delivery care and poor development of recommended and epidemiological practices. The index showed that more than 80.0% hospitals had a low index of completeness of care and that most qualified heath care services were concentrated in the more developed regions of the country. CONCLUSIONS The index of completeness proved to be of great value for monitoring the maternal and neonatal hospital care of Brazilian Unified Health System and indicated that the quality of health care was unsatisfactory. However, its application does not replace specific evaluations.OBJETIVO Desenvolver índice para avaliar a assistência hospitalar materna e neonatal do Sistema Único de Saúde. MÉTODOS Estudo descritivo de corte transversal, com abrangência nacional, com base na tríade estrutura-processo-resultado proposta por Donabedian e na integralidade da assistência. Utilizaram-se dados do Sistema de Informações Hospitalares e do Cadastro Nacional de Estabelecimentos de Saúde. Conformaram a rede materna e neonatal do SUS, 3.400 hospitais que realizaram pelo menos 12 partos/2009, ou cujo número de partos realizados representassem 10,0% ou mais no total de internações/2009. Relevância e confiabilidade foram definidas como critérios para seleção das variáveis a serem utilizadas. Foi realizada a construção e valoração dos indicadores simples, compostos e do índice de completude, e distribuição da rede hospitalar materna e neonatal nas regiões do País. RESULTADOS Selecionaram-se 40 variáveis a partir das quais foram construídos 27 indicadores simples, cinco indicadores compostos e o índice de completude. Os indicadores compostos foram construídos a partir da agregação dos indicadores simples, conformando as dimensões: porte hospitalar, complexidade, prática assistencial ao parto, práticas hospitalares recomendáveis e práticas epidemiológicas. O índice de completude agregou as cinco dimensões, fracionado em ordem crescente, originando cinco níveis de completude da assistência hospitalar materna e neonatal: baixíssima, baixa, intermediária, alta e altíssima. A rede hospitalar foi predominantemente de pequeno porte, baixa complexidade, com desempenho inadequado das práticas assistenciais ao parto e com baixo desenvolvimento das práticas recomendáveis e epidemiológicas. O índice mostrou que mais de 80,0% dos hospitais apresentam baixa completude e que os serviços mais qualificados concentraram-se nas regiões mais desenvolvidas do País. CONCLUSÕES O índice de completude mostrou ser de grande valor para o monitoramento da assistência hospitalar materna e neonatal do Sistema Único de Saúde e apontou que a qualidade dessa assistência foi insatisfatória. No entanto, seu emprego não substitui avaliações específicas

The association of depression, anxiety, and stress with caring for a child with Congenital Zika Syndrome in Brazil; Results of a cross-sectional study.

BACKGROUND: Zika virus (ZIKV) infection in pregnancy can cause microcephaly and a wide spectrum of severe adverse outcomes, collectively called "Congenital Zika Syndrome" (CZS). Parenting a child with disabilities can have adverse mental health impacts, but these associations have not been fully explored in the context of CZS in Brazil. METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional study was undertaken in Recife and Rio de Janeiro, including 163 caregivers of a child with CZS (cases) and 324 caregivers with an unaffected child (comparison subjects), identified from existing studies. The primary caregiver, almost always the mother, was interviewed using a structured questionnaire to collect information on: depression, anxiety, and stress (Depression, Anxiety, and Stress Scale-DASS-21), social support (Medical Outcomes Study Social Support Scale-MOS-SSS), and socio-demographic data. Data was collected May 2017-January 2018. Ethical standards were adhered to throughout the research. A high proportion of mothers reported experiencing severe or extremely severe levels of depression (18%), anxiety (27%) and stress (36%). Mothers of children with CZS were more likely to experience symptoms of depression, anxiety andstress, compared to mothers of comparison children. These associations were more apparent among mothers living in Rio de Janeiro. These differences were reduced after adjustment for socio-economic status and social support. Among mothers of children with CZS, low social support was linked to higher levels of depression, anxiety and stress, but there was no association with socio-economic status. CONCLUSIONS/SIGNIFICANCE: Depression, anxiety and stress were very common among mothers of young children in Brazil, regardless of whether they were parenting a child with disabilities. Mothers of children with CZS may be particularly vulnerable to poor mental health, and this association may be buffered through better social support

Estimating the cost of congenital Zika syndrome to families and healthcare providers in Rio de Janeiro and Pernambuco, Brazil: results of a case-control study

This study aimed to estimate the direct costs of CZS from the health provider and family perspectives, and the indirect costs for families, in two Brazilian states: Rio de Janeiro and Pernambuco. Methods: A case-control study was undertaken between May 2017-January 2018 recruiting 174 cases with severe CZS, 41 with mild/moderate CZS and 269 children with no CZS, across the two sites, from existing studies. The primary caregiver was interviewed using a structured questionnaire to collect information on healthcare use and costs incurred during the previous 12 months. In Rio de Janeiro, health care utilization data was also extracted from electronic medical records. We estimated direct and indirect costs incurred as a result of CZS from the perspective of the health system and families. Results: Children with CZS accessed more healthcare facilities and reported longer travel and waiting times than children unaffected by CZS. Total costs from the health provider perspective of outpatient visits, were highest for children with severe CZS (U$1,411) followed by children with mild/moderate CZS (U$264) and children without CZS (U$107). This pattern was apparent for direct costs incurred by families, while median indirect costs were low. Families of children with CZS reported high levels of catastrophic expenditures; Expenses incurred by families to meet their child’s needs as a proportion of household income was 30% (IQR=14%-67%, p<0.01) for children with severe CZS, 11% (IQR=4%-33%, p<0.01) for mild/moderate CZS, and 1% (IQR=0%-8%) for controls. Costs incurred by families were generally higher in Rio de Janeiro than Pernambuco. Conclusions: Families of children affected by CZS in Brazil may need additional public health resources and social benefits to protect them from incurring catastrophic expenses while meeting the needs of their children

Hope and trust in times of Zika: the views of caregivers and healthcare workers at the forefront of the epidemic in Brazil.

This article investigates how hope and trust played out for two groups at the forefront of the Zika epidemic: caregivers of children with congenital Zika syndrome and healthcare workers. We conducted 76 in-depth interviews with members of both groups to examine hope and trust in clinical settings, as well as trust in public institutions, in the health system and in the government of Brazil. During and after the Zika epidemic, hope and trust were important to manage uncertainty and risk, given the lack of scientific evidence about the neurological consequences of Zika virus infection. The capacity of healthcare workers and caregivers to trust and to co-create hope seems to have allowed relationships to develop that cushioned social impacts, reinforced adherence to therapeutics and enabled information flow. Hope facilitated parents to trust healthcare workers and interventions. Hope and trust appeared to be central in the establishment of support networks for caregivers. At the same time, mistrust in the government and state institutions may have allowed rumours and alternative explanations about Zika to spread. It may also have strengthened activism in mother's associations, which seemed to have both positive and negative implications for healthcare service delivery. The findings also point to distrust in international health actors and global health agenda, which can impact community engagement in future outbreak responses in Brazil and other countries in Latin America