Conflitos vivenciados pelas adolescentes com a descoberta da gravidez Conflictos vivenciados por las adolescentes con el descubrimiento del embarazo Conflicts experienced by female adolescents with the discovery of pregnancy

O estudo investigou os conflitos vivenciados pelas adolescentes com a descoberta da gravidez. A pesquisa descritiva com 12 adolescentes grávidas foi realizada em Jucás-Ceará. Os achados foram analisados após agrupamento em categorias temáticas emergidas das falas das entrevistadas ao responderem à indagação: Como tem vivenciado a gravidez na adolescência? Verificou-se que a gravidez era vista como um problema indesejado e que as adolescentes tinham medo de partilhar sua descoberta com a família ou o companheiro. Foram observadas reações dos pais ou responsáveis e o baixo nível socioeconômico como determinantes da não aceitação da gestação. Concluiu-se que a gravidez na adolescência constitui-se um problema de Saúde Pública, que deve ser visualizado amplamente, percebendo-se a adolescente e seus problemas cotidianos.<br>En el estudio se investigó los conflictos vivenciados por las adolescentes al descubrir su embarazo. Esta investigación descriptiva realizada con 12 adolescentes embarazadas se llevó a cabo en Jucás-Ceará. Los hallazgos fueron analizados después del agrupamiento en categorías temáticas que emergieron de los discursos de las entrevistadas al responder a la pregunta: Cómo has vivenciado el embarazo en la adolescencia? Se verificó que el embarazo era visto como un problema indeseado y que las adolescentes tenían miedo de compartir su descubrimiento con la familia o el compañero. Fueron observadas reacciones de los padres o responsables y el bajo nivel socioeconómico como determinantes de la no aceptación de la gestación. Se concluyó que el embarazo en la adolescencia se constituye en un problema de Salud Pública, que debe ser visualizado ampliamente, percibiéndose a la adolescente y sus problemas cotidianos.<br>This descriptive research with 12 pregnant teenagers was conducted in Jucás, State of Ceará. The findings were analyzed after being grouped in the thematic categories that emerged from the interviews carried out with the young women, who were asked to answer the question: How have you been experiencing pregnancy in adolescence?It was verified that pregnancy was seen as an undesired problem and that the pregnant teenagers were afraid to share their state with their family or partner. It was observed that the reaction from parents or legal guardians and the low socio-economic level were determinant for the non-acceptance of pregnancy. It was concluded that pregnancy in adolescence is an issue that belong to the realm of Public Health, and that it must be seen as part of a wider picture, in which the adolescents and their daily problems need to be considered

O relacionamento entre hospitais e operadoras de planos de saúde no âmbito do Programa de Qualificação da Saúde Suplementar da ANS The relationship between hospitals and health plans organizations in the scope of ANS Health Insurance Qualification Program

No mercado de saúde suplementar brasileiro, o modelo de remuneração fee-for-service ainda predomina nas relações entre os hospitais e as operadoras de planos de saúde. Com o advento do Programa de Qualificação da Saúde Suplementar (PQSS), uma ótica focada na qualidade da assistência prestada ao beneficiário, as operadoras de planos de saúde serão avaliadas conforme indicadores de desempenho assistenciais estabelecidos por esse programa. O presente estudo discute as implicações desse modelo no relacionamento entre operadoras de saúde e hospitais, a partir de consultas realizadas com dezoito gestores de operadoras a respeito do uso na gestão hospitalar de indicadores de desempenho compatíveis com os adotados pelo PQSS. Na percepção dos entrevistados, apenas três hospitais utilizam esses tipos de indicadores, sendo que dois deles são hospitais pertencentes a operadoras de saúde. O alinhamento de interesses entre a operadora e a sua rede credenciada de prestadores, nos moldes propostos pelo PQSS, implicará em modificações do modelo de remuneração entre esses players do mercado, no sentido da inclusão do desempenho e da qualidade da assistência prestada pela rede credenciada ao beneficiário como um dos componentes da valoração remunerativa.<br>In Brazilian health insurance sector, the fee-for-service model still remains the major payment method for health services, and predominates in the relationship between hospitals and private health insurance companies. After the creation of Health Insurance Qualification Program (HIQP), which focuses on the quality of the assistance given to consumers, the health insurance companies will be evaluated by health care performance indicators, established by this program. The present study discusses the impact of this pattern on the relationship between health insurance companies and hospitals, by analyzing data from interviews carried through with 18 health insurance managers, regarding the use - in hospital management - of performance indicators compatible to those adopted by HIQP. According to the managers perception, only three hospitals use this sort of indicators, two of them which are hospitals managed by the health insurance companies. The alignment of interests between health plans organizations and health care providers, at the HIQP proposed template, will imply changes in payment models between these market players, towards the inclusion of performance and quality of assistance given to users by providers, as components of wage determination

Evaluation of genotoxicity using the micronucleus assay and nuclear abnormalities in the tropical sea fish Bathygobius soporator (Valenciennes, 1837) (Teleostei, Gobiidae)

The micronucleus and nuclear abnormalities assays have been used increasingly to evaluate genotoxicity of many compounds in polluted aquatic ecossystems. The aim of this study is to verify the efficiency of the micronucleus assay and nuclear abnormality assay in field and laboratory work, when using erythrocytes of the tropical marine fish Bathygobius soporator as genotoxicity biomarkers. Gill peripheral blood samples were obtained from specimens of Bathygobius soporator. In order to investigate the frequencies of micronuclei and to assess the sensitivity of species, the results were compared with samples taken at the reference site and maintained in the laboratory, and fish treated with cyclophosphamide. The micronucleus assay was efficient in demonstrating field pollution and reproducing results in the labotatory. There were significant higher frequencies of micronuclei in two sites subject to discharge of urban and industrial effluents. The nuclear abnormality assay did not appear to be an efficient tool for genotoxicity evaluation when compared with field samples taken at a reference site in laboratory, with a positive control