Conhecimento, atitude e prática da mamografia entre usuárias do serviço público de saúde

OBJECTIVE: To evaluate knowledge, attitude and practice related to mammography among women users of local health services, identifying barriers to its performance. METHODS: A total of 663 women were interviewed at 13 local health centers in a city of Southeastern Brazil, in 2001. Interviewees were randomly selected at each center and they were representative from different socioeconomic conditions. The number of interviewees at each center was proportional to monthly mean appointments. For data analysis, answers were described as knowledge, attitude, practice and their respective adequacies and then they were correlated with control variables through the chi-square test. RESULTS: Only 7.4% of the interviewees had adequate knowledge on mammography, while 97.1% of women had an adequate attitude. The same was seen for the practice of mammography that was adequate in 35.7% of the cases. The main barrier to mammography was lack of referral by physicians working at the health center (81.8%). There was an association between adequacy of attitude and five years or more of education and being married. There was also an association between adequacy of mammography practice and being employed and family income up to four minimum wages. CONCLUSIONS: Women users of local health services had no adequate knowledge and practice related to mammography despite having an adequate attitude about this exam.OBJETIVO: Avaliar o conhecimento, a atitude e a prática do exame de mamografia entre as mulheres usuárias do serviço médico municipal, identificando as barreiras para seu acesso à realização do procedimento. MÉTODOS: Foram entrevistadas 663 mulheres de 13 centros de saúde municipais de Campinas, SP, em 2001. As entrevistadas foram incluídas de forma aleatória, representando diferentes estratos sociais. O número de entrevistas em cada centro de saúde foi proporcional ao número médio mensal de mulheres atendidas. As respostas foram descritas quanto ao conhecimento, atitude e prática e suas respectivas adequações. A adequação foi correlacionada com variáveis de controle utilizando o teste qui-quadrado. RESULTADOS: Apenas 7,4% das entrevistadas tinham conhecimento adequado sobre o exame de mamografia, embora a atitude frente a este procedimento tenha sido adequada em 97,1% das mulheres e a prática adequada em 35,7% das entrevistadas. A principal barreira para a realização da mamografia foi a não solicitação por parte dos médicos dos centros de saúde (81,8%). A adequação da atitude esteve relacionada à escolaridade igual ou superior a cinco anos e ser casada. A prática adequada da mamografia associou-se com o trabalho fora de casa e renda familiar igual ou superior a cinco salários mínimos. CONCLUSÕES: O conhecimento e a prática da mamografia entre as usuárias do serviço médico municipal foi inadequada, apesar da atitude adequada em relação ao procedimento

Knowledge, Attitude And Practice Of Mammography Among Women Users Of Public Health Services.

To evaluate knowledge, attitude and practice related to mammography among women users of local health services, identifying barriers to its performance. A total of 663 women were interviewed at 13 local health centers in a city of Southeastern Brazil, in 2001. Interviewees were randomly selected at each center and they were representative from different socioeconomic conditions. The number of interviewees at each center was proportional to monthly mean appointments. For data analysis, answers were described as knowledge, attitude, practice and their respective adequacies and then they were correlated with control variables through the chi-square test. Only 7.4% of the interviewees had adequate knowledge on mammography, while 97.1% of women had an adequate attitude. The same was seen for the practice of mammography that was adequate in 35.7% of the cases. The main barrier to mammography was lack of referral by physicians working at the health center (81.8%). There was an association between adequacy of attitude and five years or more of education and being married. There was also an association between adequacy of mammography practice and being employed and family income up to four minimum wages. Women users of local health services had no adequate knowledge and practice related to mammography despite having an adequate attitude about this exam.42200-

Brazilian doctors' perspective on the second opinion strategy before a C-section

OBJECTIVE: To describe the opinion of doctors who participated in the Latin American Study on Cesarean section in Brazil regarding the second opinion strategy when faced with the decision of performing a C-section. METHODS: Seventy-two doctors from the hospitals where the study took place (where the second opinion was routinely sought) and 70 from the control group answered a pre-tested self-administered structured questionnaire. Descriptive tables were prepared based on the frequency of relevant variables on opinion of physicians regarding: effectiveness of the application of the second opinion strategy; on whether they would recommend implementation of this strategy and reasons for not recommending it in private institutions; feasibility of the strategy implementation and reasons for not considering this implementation feasible in private institutions. RESULTS: Half of the doctors from the intervention hospitals (50%) and about two thirds of those in the control group (65%) evaluated the second opinion as being or having the potential of being effective/very effective in their institutions. The great majority of those interviewed from both intervention and control hospitals considered this strategy feasible in public (87% and 95% respectively) but not in private hospitals (64% and 70% respectively), mainly because in the latter the doctors would not accept interference from a colleague in their decision-making process. CONCLUSION: Although the second opinion strategy was perceived as effective in reducing C-section rates, doctors did not regard it feasible outside the public health system in Brazil.OBJETIVO: Descrever a opinião dos médicos que participaram no Brasil do Estudo Latino-Americano de Cesárea sobre a estratégia da segunda opinião antes de decidir fazer uma cesárea. MÉTODOS: Setenta e dois médicos dos hospitais do grupo de intervenção, onde se implantou a estratégia da segunda opinião, e 70 do grupo controle auto-responderam um questionário estruturado e pré-testado. Prepararam-se tabelas descritivas para apresentar a freqüência das variáveis mais relevantes sobre a opinião dos médicos a respeito: da efetividade da implementação da estratégia da segunda opinião; se recomendariam ou não a sua implementação e as razões para não a recomendarem em instituições privadas; a factibilidade da sua implementação e as razões para não a considerarem factível em instituições privadas. RESULTADOS: Metade dos médicos dos hospitais de intervenção (50%) e cerca de dois terços do grupo controle (65%) consideraram que a estratégia da segunda opinião havia sido ou poderia ser eficaz para reduzir o número de cesáreas na instituição em que eles trabalhavam. A grande maioria dos médicos que responderam o questionário nos hospitais de intervenção e controle considerou que a estratégia seria factível em instituições públicas (87% e 95% respectivamente), mas não nas privadas (64% e 70% respectivamente), principalmente porque nessas últimas os médicos não aceitariam a interferência de um colega sobre a sua decisão de fazer uma cesárea. CONCLUSÃO: Embora a estratégia da segunda opinião tenha sido percebida como capaz de reduzir as taxas de cesariana, os médicos não a consideraram factível fora do sistema público de saúde no Brasil

Perspectiva de médicos brasileiros sobre a estratégia da segunda opinião antes de realizar uma cesárea

OBJECTIVE: To describe the opinion of doctors who participated in the Latin American Study on Cesarean section in Brazil regarding the second opinion strategy when faced with the decision of performing a C-section. METHODS: Seventy-two doctors from the hospitals where the study took place (where the second opinion was routinely sought) and 70 from the control group answered a pre-tested self-administered structured questionnaire. Descriptive tables were prepared based on the frequency of relevant variables on opinion of physicians regarding: effectiveness of the application of the second opinion strategy; on whether they would recommend implementation of this strategy and reasons for not recommending it in private institutions; feasibility of the strategy implementation and reasons for not considering this implementation feasible in private institutions. RESULTS: Half of the doctors from the intervention hospitals (50%) and about two thirds of those in the control group (65%) evaluated the second opinion as being or having the potential of being effective/very effective in their institutions. The great majority of those interviewed from both intervention and control hospitals considered this strategy feasible in public (87% and 95% respectively) but not in private hospitals (64% and 70% respectively), mainly because in the latter the doctors would not accept interference from a colleague in their decision-making process. CONCLUSION: Although the second opinion strategy was perceived as effective in reducing C-section rates, doctors did not regard it feasible outside the public health system in Brazil.OBJETIVO: Descrever a opinião dos médicos que participaram no Brasil do Estudo Latino-Americano de Cesárea sobre a estratégia da segunda opinião antes de decidir fazer uma cesárea. MÉTODOS: Setenta e dois médicos dos hospitais do grupo de intervenção, onde se implantou a estratégia da segunda opinião, e 70 do grupo controle auto-responderam um questionário estruturado e pré-testado. Prepararam-se tabelas descritivas para apresentar a freqüência das variáveis mais relevantes sobre a opinião dos médicos a respeito: da efetividade da implementação da estratégia da segunda opinião; se recomendariam ou não a sua implementação e as razões para não a recomendarem em instituições privadas; a factibilidade da sua implementação e as razões para não a considerarem factível em instituições privadas. RESULTADOS: Metade dos médicos dos hospitais de intervenção (50%) e cerca de dois terços do grupo controle (65%) consideraram que a estratégia da segunda opinião havia sido ou poderia ser eficaz para reduzir o número de cesáreas na instituição em que eles trabalhavam. A grande maioria dos médicos que responderam o questionário nos hospitais de intervenção e controle considerou que a estratégia seria factível em instituições públicas (87% e 95% respectivamente), mas não nas privadas (64% e 70% respectivamente), principalmente porque nessas últimas os médicos não aceitariam a interferência de um colega sobre a sua decisão de fazer uma cesárea. CONCLUSÃO: Embora a estratégia da segunda opinião tenha sido percebida como capaz de reduzir as taxas de cesariana, os médicos não a consideraram factível fora do sistema público de saúde no Brasil.23323

Brazilian Doctors' Perspective On The Second Opinion Strategy Before A C-section.

To describe the opinion of doctors who participated in the Latin American Study on Cesarean section in Brazil regarding the second opinion strategy when faced with the decision of performing a C-section. Seventy-two doctors from the hospitals where the study took place (where the second opinion was routinely sought) and 70 from the control group answered a pre-tested self-administered structured questionnaire. Descriptive tables were prepared based on the frequency of relevant variables on opinion of physicians regarding: effectiveness of the application of the second opinion strategy; on whether they would recommend implementation of this strategy and reasons for not recommending it in private institutions; feasibility of the strategy implementation and reasons for not considering this implementation feasible in private institutions. Half of the doctors from the intervention hospitals (50%) and about two thirds of those in the control group (65%) evaluated the second opinion as being or having the potential of being effective/very effective in their institutions. The great majority of those interviewed from both intervention and control hospitals considered this strategy feasible in public (87% and 95% respectively) but not in private hospitals (64% and 70% respectively), mainly because in the latter the doctors would not accept interference from a colleague in their decision-making process. Although the second opinion strategy was perceived as effective in reducing C-section rates, doctors did not regard it feasible outside the public health system in Brazil.40233-

Ressarcimento das despesas de sujeitos de pesquisa: experiência de pesquisadores

Objective: To assess the experience and opinion of the researchers in the area of Gynecology and Obstetrics about the reimbursement of expenses to the research subjects. Subjects and Methods: A qualitative study was conducted in which semi-structured interviews were done by telephone, with seven researchers-professors from five post-graduate programs in Obstetrics and Gynecology in São Paulo universities. Thematic content analysis from the transcribed interviews was conducted. Results: Five researchers had experience with studies in which the compensation was made to the subjects, usually paid in cash. No researcher reported having any difficult to calculate the amount of compensation because it was determined by the Research Ethics Committee (REC) or by any agency which is given the funds for the research. The research project was approved by an REC which did not make any question about the amount proposed. Participants agreed that in addition to transportation and food, it is convenient to also take into account the time, day job, what exactly would be the subject participation and the complexity of the survey to calculate the amount of compensation. This may not be high because it can "buy the conscience" or produce a "way of commerce"; even in cases it is low; however, if the compensation is so low the participants reported that "it does not worth” to take part of the study. Discussion: The researchers have no official rules regulated, to establish the amount of compensation for each survey. They recognize that it is difficult to establish this value not to constrain people, but at the same time, understand that the compensation can motivate them to participate in the research. They highlights the need to broaden the discussion about it to provide clearer guidelines to researchers.Objetivo: Conhecer a experiência e opinião de pesquisadores da área de ginecologia e Obstetrícia (GO) sobre o ressarcimento de despesas a sujeitos de pesquisa. Sujeitos e métodos: Estudo qualitativo em que se realizaram entrevistas semiestruturadas, por telefone, com sete pesquisadores-docentes de cinco programas de pós-graduação em GO de universidades paulistas. Realizou-se análise temática de conteúdo das entrevistas transcritas. Resultados: Cinco pesquisadores tinham experiência com estudos em que se fez o ressarcimento aos sujeitos, geralmente pago em dinheiro. Nenhum pesquisador referiu ter encontrado dificuldades para calcular o valor do ressarcimento porque isso era determinado pelo Comitê de Ética em Pesquisa (CEP) ou pelas agências de fomento. O projeto da pesquisa havia sido aprovado por um CEP que não questionou o valor do ressarcimento proposto. Os participantes concordaram que, além de transporte e alimentação, também se deveria considerar o tempo, dia de trabalho, em que consistiria a participação da pessoa e a complexidade da pesquisa para calcular o valor do ressarcimento. Este não pode ser alto porque pode “comprar a consciência” ou produzir uma “mercantilização”, mas, se for baixo, “não vale a pena” participar. Conclusão: Os pesquisadores não dispõem de parâmetros oficiais, regulamentados, para estabelecerem o valor do ressarcimento em cada pesquisa. Reconhecem que é difícil estabelecer esse valor para não constrangerem as pessoas, mas, ao mesmo tempo, entendem que o ressarcimento pode motivá-las a participarem das pesquisas. Evidencia-se a necessidade ampliar a discussão a esse respeito para prover diretrizes mais claras aos pesquisadores

Support during childbirth: perception of health care providers and companions chosen by women

OBJECTIVE: To understand health care providers' perception on managing laboring women in the presence of a labor companion of their choice, and the labor companion's perception of this experience. METHODS: A qualitative study was conducted based on a controlled randomized clinical trial. Sampling was intentional and determined through information saturation. Semi-structured interviews were carried out with 11 health care providers and 16 laboring companions in the obstetric unit of a maternity facility at the hospital complex, in Campinas, Southern Brazil, between October 2004 and March 2005. The thematic analysis of discourse was applied using the following methodological figures: central idea, key expressions and discourse of the collective subject. RESULTS: The most remarkable central ideas of health care providers were: no difference was observed in managing laboring women with a labor companion; positive changes were noted in labor management when a labor companion was present; the companion provided emotional support to laboring women who were more pleased, and felt safer and peaceful; many positive aspects were seen in the behavior and involvement of laboring women with a labor companion; the companion caused no problems and encouraged health providers to engage in a more humane and less routine attitude. The main central ideas of labor companions were: positive feelings, emotions, a sense of satisfaction with the experience; being with the laboring woman was a great opportunity to provide her emotional support; and they felt welcome by health care providers. CONCLUSIONS: Health providers considered positive the support provided by a labor companion and had no problems in managing laboring women in the presence of their companions. Labor companions were pleased and happy with this experience. There was no conflicting opinions.OBJETIVO: Descrever a percepção de profissionais da saúde sobre prestar assistência à parturiente na presença do acompanhante por ela escolhido, e a percepção dos acompanhantes sobre essa experiência. MÉTODOS: Realizou-se estudo qualitativo, a partir de ensaio clínico randomizado controlado. A amostra estudada foi intencional e definida por saturação de informação. Foram entrevistados 11 profissionais da saúde e 16 acompanhantes no centro obstétrico de uma maternidade em Campinas, SP, de outubro de 2004 a março de 2005. Empregou-se a técnica de análise temática de discurso, utilizando-se as figuras metodológicas: idéia central, expressões-chave e o discurso do sujeito coletivo. RESULTADOS: Entre as idéias centrais dos profissionais destacaram-se: não houve diferença em prestar assistência com acompanhante durante o trabalho de parto e parto; com o acompanhante ocorreram mudanças positivas na assistência; o acompanhante dá apoio emocional à parturiente, que fica mais satisfeita, segura e tranqüila; existem muitos aspectos positivos no comportamento e participação das parturientes com acompanhante; o acompanhante não causou problema e fez o profissional ter atitude mais humana e menos rotineira. As principais idéias centrais dos acompanhantes foram: sentimentos positivos, emoção, satisfação com a experiência; poder ajudar ao dar apoio emocional; sentir-se bem recebido pelos profissionais. CONCLUSÕES: Os profissionais da saúde consideraram importante o apoio do acompanhante não tendo sido observado problema em prestar assistência na sua presença. Os acompanhantes se sentiram satisfeitos e recompensados com a experiência. Não foram detectados conflitos de opinião entre os envolvidos

[evidence On Support During Labor And Delivery: A Literature Review].

The effects of support for women during labor and delivery provided by health professionals, lay women, and doulas on the maternal and neonatal outcomes have been evaluated through randomized clinical trials, meta-analyses, and systematic reviews. This article presents a review of these studies, focusing on the principal characteristics, support provider, simultaneous presence of the woman's spouse and/or family members during labor and delivery and the outcomes. The analysis included studies published from 1980 to 2004 which explicitly approached these aspects. In general, the results of such support were favorable, highlighting a reduction in the cesarean rate, analgesia/ medication for pain relief, duration of labor, and utilization of oxytocin and an increase in maternal satisfaction with the experience. The benefits were greater when the support provider was not a health professional. The available studies did not evaluate the specific companion chosen by the woman as a support provider, which constitutes a gap in the knowledge that should be filled by future research.211316-2

Support during childbirth: perception of health care providers and companions chosen by women

OBJECTIVE: To understand health care providers' perception on managing laboring women in the presence of a labor companion of their choice, and the labor companion's perception of this experience. METHODS: A qualitative study was conducted based on a controlled randomized clinical trial. Sampling was intentional and determined through information saturation. Semi-structured interviews were carried out with 11 health care providers and 16 laboring companions in the obstetric unit of a maternity facility at the hospital complex, in Campinas, Southern Brazil, between October 2004 and March 2005. The thematic analysis of discourse was applied using the following methodological figures: central idea, key expressions and discourse of the collective subject. RESULTS: The most remarkable central ideas of health care providers were: no difference was observed in managing laboring women with a labor companion; positive changes were noted in labor management when a labor companion was present; the companion provided emotional support to laboring women who were more pleased, and felt safer and peaceful; many positive aspects were seen in the behavior and involvement of laboring women with a labor companion; the companion caused no problems and encouraged health providers to engage in a more humane and less routine attitude. The main central ideas of labor companions were: positive feelings, emotions, a sense of satisfaction with the experience; being with the laboring woman was a great opportunity to provide her emotional support; and they felt welcome by health care providers. CONCLUSIONS: Health providers considered positive the support provided by a labor companion and had no problems in managing laboring women in the presence of their companions. Labor companions were pleased and happy with this experience. There was no conflicting opinions.OBJETIVO: Descrever a percepção de profissionais da saúde sobre prestar assistência à parturiente na presença do acompanhante por ela escolhido, e a percepção dos acompanhantes sobre essa experiência. MÉTODOS: Realizou-se estudo qualitativo, a partir de ensaio clínico randomizado controlado. A amostra estudada foi intencional e definida por saturação de informação. Foram entrevistados 11 profissionais da saúde e 16 acompanhantes no centro obstétrico de uma maternidade em Campinas, SP, de outubro de 2004 a março de 2005. Empregou-se a técnica de análise temática de discurso, utilizando-se as figuras metodológicas: idéia central, expressões-chave e o discurso do sujeito coletivo. RESULTADOS: Entre as idéias centrais dos profissionais destacaram-se: não houve diferença em prestar assistência com acompanhante durante o trabalho de parto e parto; com o acompanhante ocorreram mudanças positivas na assistência; o acompanhante dá apoio emocional à parturiente, que fica mais satisfeita, segura e tranqüila; existem muitos aspectos positivos no comportamento e participação das parturientes com acompanhante; o acompanhante não causou problema e fez o profissional ter atitude mais humana e menos rotineira. As principais idéias centrais dos acompanhantes foram: sentimentos positivos, emoção, satisfação com a experiência; poder ajudar ao dar apoio emocional; sentir-se bem recebido pelos profissionais. CONCLUSÕES: Os profissionais da saúde consideraram importante o apoio do acompanhante não tendo sido observado problema em prestar assistência na sua presença. Os acompanhantes se sentiram satisfeitos e recompensados com a experiência. Não foram detectados conflitos de opinião entre os envolvidos.445

Stress of men and women seeking treatment for infertility

PURPOSE: To evaluate the level of stress in men and women seeking treatment for infertility and to identify the associated variables. METHODS: A cross-sectional study with 101 men and 101 women consulting for the first time at the Human Reproduction Unit. Participants completed the Brazilian version of the Fertility Problem Inventory (FPI) based on four domains: social relationships, life without children; marital relationship/sexual and maternity/paternity and a structured questionnaire with socioeconomic and reproductive variables. Bivariate analysis was performed using the Chi-square and Fisher exact tests, considering p<0.05. Afterwards the multivariate correspondence analysis was done with variables with p<0.20. RESULTS: Overall, the participants presented a high level of stress in all domains, except in the life without children domain. Multivariate analysis of correspondence showed that variables associated with a high level of stress in the social relationships domains were: to be a woman, to have the infertility problem, and to consider the quality of the marital relationship to be regular. In the life without children domain the variables that approached the high stress were: to be woman, age between 18 and 24 years, and to have the infertility problem. To be a man, to consider adoption, parents/in-laws and other people knowing about the difficulty to become pregnant, and to consider the quality of the marital relationship to be excellent were the variables associated with high level of stress in marital/sexual relationship domain. For maternity/paternity domain the variables associated were to be women, consider marital relationship quality regular, age between 25 and 35 years, be evangelical or protestant were the variables associated with a high level of stress. CONCLUSION:Men and women seeking treatment for infertility present a high level of stress and it can be suggested that psychosocial support is important and should be different for men and women.OBJETIVO: Avaliar o nível de estresse de homens e mulheres que buscavam tratamento para infertilidade e identificar variáveis associadas. MÉTODOS: Estudo transversal com 101 homens e 101 mulheres que se consultavam pela primeira vez em um Ambulatório de Reprodução Humana. Os participantes responderam à versão brasileira do Inventário de Problema de Fertilidade (IPF) com base nos quatro domínios: relacionamentos sociais, vida sem filhos; relacionamento conjugal/sexual e maternidade/paternidade e também a um questionário com características socioeconômicas e reprodutivas. Realizou-se análise bivariada através dos testes qui-quadrado e exato de Fisher, considerando p<0,05. Posteriormente realizou-se análise multivariada de correspondência, na qual foram incluídas as variáveis com p<0,20. RESULTADOS: De modo geral, os participantes apresentaram alto nível de estresse em todos os domínios, exceto no domínio vida sem filhos. A análise multivariada por correspondência apontou que as variáveis que se aproximaram do estresse alto no domínio relacionamentos sociais foram: ser do sexo feminino, ter o problema da infertilidade, e considerar a qualidade do relacionamento conjugal regular. No domínio vida sem filhos as variáveis que se aproximaram do estresse alto foram: ser do sexo feminino, ter idade entre 18 e 24 anos, e ter o problema da infertilidade. Ser do sexo masculino, considerar a adoção, pais e/ou sogros e outras pessoas saberem da dificuldade para engravidar, e considerar a qualidade do relacionamento conjugal ótimo aproximaram-se do alto nível de estresse no domínio relacionamento conjugal/sexual. Para o domínio maternidade/paternidade evidenciou-se que as variáveis ser do sexo feminino, considerar a qualidade do relacionamento conjugal regular, ter idade entre 25 e 35 anos, e praticar religião evangélica ou protestante aproximaram-se do alto nível de estresse. CONCLUSÃO: Homens e mulheres que buscam tratamento para infertilidade apresentam alto nível elevado de estresse, sugerindo que o apoio psicossocial é importante e deve ser diferenciado para homens e mulheres.25526