Duration of temporary catheter use for hemodialysis: an observational, prospective evaluation of renal units in Brazil

<p>Abstract</p> <p>Background</p> <p>For chronic hemodialysis, the ideal permanent vascular access is the arteriovenous fistula (AVF). Temporary catheters should be reserved for acute dialysis needs. The AVF is associated with lower infection rates, better clinical results, and a higher quality of life and survival when compared to temporary catheters. In Brazil, the proportion of patients with temporary catheters for more than 3 months from the beginning of therapy is used as an evaluation of the quality of renal units. The aim of this study is to evaluate factors associated with the time between the beginning of hemodialysis with temporary catheters and the placement of the first arteriovenous fistula in Brazil.</p> <p>Methods</p> <p>This is an observational, prospective non-concurrent study using national administrative registries of all patients financed by the public health system who began renal replacement therapy (RRT) between 2000 and 2004 in Brazil. Incident patients were eligible who had hemodialysis for the first time. Patients were excluded who: had hemodialysis reportedly started after the date of death (inconsistent database); were younger than 18 years old; had HIV; had no record of the first dialysis unit; and were dialyzed in units with less than twenty patients. To evaluate individual and renal unit factors associated with the event of interest, the frailty model was used (N = 55,589).</p> <p>Results</p> <p>Among the 23,824 patients (42.9%) who underwent fistula placement in the period of the study, 18.2% maintained the temporary catheter for more than three months until the fistula creation. The analysis identified five statistically significant factors associated with longer time until first fistula: higher age (Hazard-risk - HR 0.99, 95% CI 0.99-1.00); having hypertension and cardiovascular diseases (HR 0.94, 95% CI 0.9-0.98) as the cause of chronic renal disease; residing in capitals cities (HR 0.92, 95% CI 0.9-0.95) and certain regions in Brazil - South (HR 0.83, 95% CI 0.8-0.87), Midwest (HR 0.88, 95% CI 0.83-0.94), Northeast (HR 0.91, 95% CI 0.88-0.94), or North (HR 0.88, 95% CI 0.83-0.94) and the type of renal unit (public or private).</p> <p>Conclusion</p> <p>Monitoring the provision of arteriovenous fistulas in renal units could improve the care given to patients with end stage renal disease.</p

Evaluación del uso del preservativo femenino promovido desde un programa de educación para la salud: un enfoque cualitativo

El trabajo aquí recogido se aborda desde un estudio de caso, a través del enfoque cualitativo, mediante la técnica del grupo de discusión con la participación de 9 grupos, conformados por un total de 83 estudiantes universitarios del noroeste de España, con edades entre 19 y 42 años. Los objetivos principales de este trabajo son conocer la satisfacción de los y las participantes con el uso del preservativo femenino, así como las ventajas y obstáculos encontrados en su utilización que ha sido promovida a través de un programa de promoción de la salud. Como resultados y conclusiones destacar que las mujeres enfatizan en mayor medida que los varones la satisfacción y ventajas obtenidas con la utilización del método. Como puntos fuertes sobre el uso del preservativo femenino los y las participantes destacan la alta resistencia a la rotura y entre las debilidades apuntan los problemas ligados a su colocación y estética. El estudio sobre el uso del preservativo femenino revela la necesidad de continuar desarrollando intervenciones de formación encaminadas a la promoción de este método, sin excluir el empleo de otros, así como de reforzar la incorporación de estrategias educativas que permitan avanzar en la eliminación de estereotipos de género.This study is concerned with the promotion of the female condom. It is a qualitative study that was carried out by means of discussion groups, with the participation of nine groups. The study's sample was formed by 83 university students aged 19-42 years, from Galicia (Spain). The main objective of this study is to know the degree of satisfaction of the participants, and the advantages/drawbacks of using the female condom, which was promoted by a health programme. With regard to the conclusions of the study, it should be pointed out that the female participants focused more on the advantages of using the female condom, whereas the male participants primaly emphasised its drawbacks. The main point mentioned in favour of the female condom was its resistance to breakage, and its insertion and appearance were the most common complaints. The evaluation of the use of the female condom reveals the need to continue developing health programmes aimed at its promotion, without ruling out the utilization of other methods, and also to reinforce the incorporation of educational strategies which foster the elimination of gender stereotypes

Intenções reprodutivas de mulheres que vivenciam regime de alta fecundidade em um grande centro urbano

This quantitative and population-based study aimed to identify reproductive intentions of women with five or more children living in Curitiba, Paraná. 441 women were interviewed in their homes between the years 2006 to 2008. Frequencies were calculated, as well as Student's t test and Spearman coefficient for some variables. To analyse the open questions it was used content analysis and worked out tables with categories , their frequencies and percentages. The study revealed that for 51% of women the ideal number of children would have been two children; 10% had the number of children they wanted. In 113 cases (40.4%) the husbands would rather have a larger number of children than women. Difficulties were identified in the definition and achievement of desired fertility, besides failures in reproductive health care and social and gender inequalities. Health managers should monitor the differentials in fertility rates in order to pursue social justice and ensure human rights, as well as sexual and reproductive rights in Brazil.Neste estudo quantitativo e de base populacional objetivou-se identificar as intenções reprodutivas de mulheres com cinco ou mais filhos, residentes em Curitiba, Paraná. Foram entrevistadas 441 mulheres em seus domicílios entre os anos de 2006 a 2008. Calcularam-se frequências, e o teste t de Student e o coeficiente de Spearman para algumas variáveis. Para análise das perguntas abertas utilizou-se a análise de conteúdo e se elaboraram tabelas com as categorias e as respectivas frequências. O estudo revelou que para 51% das mulheres o número ideal de filhos seria dois; 10% tiveram o número de filhos que desejavam. Em 113 casos (40,4%) o marido preferia ter um número maior de filhos do que as mulheres. Identificaram-se dificuldades na definição e na conquista da fecundidade desejada, falhas na assistência à saúde reprodutiva e desigualdades sociais e de gênero. O monitoramento pelos gestores de saúde dos diferenciais de fecundidade é necessário para o alcance da justiça social e a garantia dos direitos humanos, sexuais e reprodutivos, no Brasil.Universidade Tuiuti do Paraná Programa de Mestrado e Doutorado em Distúrbios da ComunicaçãoUniversidade de São PauloUNIFESP Departamento de Medicina PreventivaUniversidade Federal de Minas Gerais Escola de Enfermagem Departamento Materno Infantil e Saúde PúblicaUniversidade de São Paulo Faculdade de Saúde Pública Departamento de Saúde Materno-infantilUNIFESP, Depto. de Medicina PreventivaSciEL

Brazilian adolescents' knowledge and beliefs about abortion methods: A school-based internet inquiry

Background: Internet surveys that draw from traditionally generated samples provide the unique conditions to engage adolescents in exploration of sensitive health topics.Methods: We examined awareness of unwanted pregnancy, abortion behaviour, methods, and attitudes toward specific legal indications for abortion via a school-based internet survey among 378 adolescents aged 12-21 years in three Rio de Janeiro public schools.Results: Forty-five percent knew peers who had undergone an abortion. Most students (66.0%) did not disclose abortion method knowledge. However, girls (aOR 4.2, 95% CI 2.4-7.2), those who had experienced their sexual debut (aOR1.76, 95% CI 1.1-3.0), and those attending a prestigious magnet school (aOR 2.7 95% CI 1.4-6.3) were more likely to report methods. Most abortion methods (79.3%) reported were ineffective, obsolete, and/or unsafe. Herbs (e.g. marijuana tea), over-the-counter medications, surgical procedures, foreign objects and blunt trauma were reported. Most techniques (85.2%) were perceived to be dangerous, including methods recommended by the World Health Organization. A majority (61.4%) supported Brazil's existing law permitting abortion in the case of rape. There was no association between gender, age, sexual debut, parental education or socioeconomic status and attitudes toward legal abortion. However, students at the magnet school supported twice as many legal indications (2.7, SE.27) suggesting a likely role of peers and/or educators in shaping abortion views.Conclusions: Abortion knowledge and attitudes are not driven simply by age, religion or class, but rather a complex interplay that includes both social spaces and gender. Prevention of abortion morbidity and mortality among adolescents requires comprehensive sexuality and reproductive health education that includes factual distinctions between safe and unsafe abortion methods

Violência sexual contra mulheres no Brasil: conquistas e desafios do setor saúde na década de 2000

O artigo traz uma revisão sobre as políticas públicas para o enfrentamento da violência sexual contra mulheres desenvolvidas ao longo da década de 2000. Analisa o embate sobre os avanços, retrocessos e desafios do tema à luz das proposições do setor saúde. Foram analisados documentos institucionais e artigos selecionados sobre o assunto, apontando variadas estratégias para intervenções propostas e realizadas pelo Sistema Único de Saúde. O texto apresenta ainda questões emblemáticas que nos fazem refletir sobre os desafios a serem superados pelos gestores de saúde na década atual, tais como a cobertura e continuidade dos serviços de atenção e capacitação permanente dos profissionais, bem como o atendimento para a interrupção da gravidez, prevista em lei.The article brings a revision on the public politics for the confronting of the sexual violence against women developed along the decade of 2000s. It analyzes the collision on the progress, retreats and challenges of the theme to the light of the proposi-tions of the section health. Institutional documents and articles were analyzed selected on the subject, pointing varied strategies for intervention proposed and accomplished by the Brazilian National Health System. The text still presents emblematic ques-tions that send us to think on the challenges to be overcome by the managers of health in the current decade, such as the covering and continuity of the services of attention, the professionals’ permanent training, as well as the service to the legal abortion