Violência de gênero e saúde reprodutiva: subsídios para o psicólogo hospitalar

The present work presents a reflection concerning the relevance of articulated subject between violence and gender related questions with the activity of hospital psychologist, considering it a basic matter for the understanding of suffering process and for the proposal of efficient, critical and consequent therapeutic and prophylactic performance.El presente trabajo propone una ponderación acerca de la relevancia de la articulación entre violencia y cuestiones de género con la actividad del psicólogo en el ámbito hospitalario, considerándola fundamental para la comprensión del proceso salud- enfermedad y para las futuras propuestas terapéuticas y profilácticas eficaces, críticas y consecuentes.Le présent travail présente une réflexion concernant l'importance de l’articulation entre la violence et les questions de genre avec l'activité du psychologue hospitalier, en la considérant comme fondamentale pour la compréhension du processus de souffrance et pour la proposition de performances thérapeutiques et prophylactiques efficaces, critiques et conséquentes. O presente trabalho propõe uma reflexão acerca da relevância da articulação entre violência e questões de gênero com a atividade do psicólogo hospitalar, considerando-a fundamental para a compreensão do processo de adoecimento e para a proposição de atuações terapêuticas e profiláticas eficazes, críticas e conseqüentes.

The relationship between indicators of socioeconomic status and cesarean section in public hospitals

OBJECTIVE To assess the relationship between indicators of socioeconomic status and cesarean section in public hospitals that adopt standardized protocols of obstetrical care. METHODS This was a prospective cohort study conducted between May 2005 and January 2006 with 831 pregnant women recruited from 10 public primary care clinics in São Paulo, Brazil. Demographic and clinical characteristics were collected during pregnancy. The three main exposures were schooling, monthly family income per capita, and residential crowding. The main outcome was cesarean section at three public hospitals located in the area. Crude and adjusted risk ratios (RR), with 95% confidence intervals were calculated using Poisson regression with robust variance. We examined the effects of each exposure variable on cesarean section accounting for potential confounders by using four different models: crude, adjusted by mother’s characteristics, by obstetrical complications, and by the other two indicators of socioeconomic status. RESULTS Among the 757 deliveries performed in the public hospitals, 215 (28.4%) were by cesarean section. In the bivariate analysis, cesarean section was associated with higher family income per capita, higher education, lower residential crowding, pregnancy planning, white skin color, having a partner, and advanced maternal age. In the multivariate analysis, after adjustment for covariates, none of the socioeconomic status variables remained associated with cesarean section. CONCLUSIONS In this group, the chance of women undergoing cesarean section was not associated with indicators of socioeconomic status only, but was defined in accordance with major obstetric and clinical conditions

Monoparentalidade Programada e Reprodução Assistida: da “produção independente” à utilização de sêmen pós mortem

A utilização das técnicas de Reprodução Assistida vem possibilitando nas últimas décadas a realização da vontade de exercer a parentalidade em diferentes contextos e situações. Aqui são elaboradas reflexões associadas à monoparentalidade buscada, não acidental, considerando contingências específicas

Representação da relação mãe-bebê através do procedimento desenho-estória em gestantes adolescentes e tardias

O vínculo que a mãe estabelece com seu bebê começa a ser construído durante o processo gestacional e é influenciado por aspectos pessoais e culturais. O objetivo deste trabalho foi investigar a representação de gestantes primíparas adolescentes e tardias em relação a seu feto, por meio de entrevistas semidirigidas e do procedimento Desenho-Estória de Trinca (1997).Participaram deste estudo qualitativo 14 mulheres com idades entre 15 e 44 anos. Observamos indícios de dificuldades nessa representação que podem estar associadas à ambivalência materna, bem como pensar essa criança como bebê, sujeito autônomo. Os resultados apontam para a importância de se disponibilizar um espaço de acolhimento e escuta durante a gestação para que tais aspectos possam ser mais facilmente elaborados

The relationship between socioeconomic indicators during pregnancy and gynecological appointment at any time after childbirth

Abstract\ud \ud Background\ud The rates of receipt of postnatal care vary widely between high and low-middle income countries. This study aimed to examine the association between indicators of socioeconomic status during pregnancy and gynecological appointment at any time after childbirth (GA).\ud \ud \ud Methods\ud a prospective cohort study with pregnant women recruited from 10 primary care clinics of the public sector in the city of São Paulo, Brazil. Socioeconomic characteristics and obstetric information were obtained through a questionnaire administered during pregnancy and in the postpartum period. Adjusted risk ratios (RR) with 95 % confidence intervals (CI) were calculated using Poisson regression.\ud \ud \ud Results\ud Eight hundred and thirty one pregnant women were included in the study during the antenatal period and 701 were re-assessed during the postnatal period. Among them, 283 (59.6) attended a gynecological consultation. After adjusting for covariates, higher socioeconomic status during pregnancy was associated with greater risk of having a GA (RR:1.23, CI 95 %:1.05:1.45 for family per capita monthly income; RR:1.19, CI 95 % 1.01:1.40 for asset score).\ud \ud \ud Conclusion\ud In this sample, the attendance for GA was above average and women with higher socio-economic status were more likely to have receipt of such care. Special efforts should be made to improve the attendance and frequency of gynecological consultations after childbirth among poorer women.FAPESPCNP

Use of a Mobile Phone App to Treat Depression Comorbid With Hypertension or Diabetes: A Pilot Study in Brazil and Peru

Background Depression is underdiagnosed and undertreated in primary health care. When associated with chronic physical disorders, it worsens outcomes. There is a clear gap in the treatment of depression in low- and middle-income countries (LMICs), where specialists and funds are scarce. Interventions supported by mobile health (mHealth) technologies may help to reduce this gap. Mobile phones are widely used in LMICs, offering potentially feasible and affordable alternatives for the management of depression among individuals with chronic disorders. Objective This study aimed to explore the potential effectiveness of an mHealth intervention to help people with depressive symptoms and comorbid hypertension or diabetes and explore the feasibility of conducting large randomized controlled trials (RCTs). Methods Emotional Control (CONEMO) is a low-intensity psychoeducational 6-week intervention delivered via mobile phones and assisted by a nurse for reducing depressive symptoms among individuals with diabetes or hypertension. CONEMO was tested in 3 pilot studies, 1 in São Paulo, Brazil, and 2 in Lima, Peru. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) at enrollment and at 6-week follow-up. Results The 3 pilot studies included a total of 66 people. Most participants were females aged between 41 and 60 years. There was a reduction in depressive symptoms as measured by PHQ-9 in all pilot studies. In total, 58% (38/66) of the participants reached treatment success rate (PHQ-9 <10), with 62% (13/21) from São Paulo, 62% (13/21) from the first Lima pilot, and 50% (12/24) from the second Lima pilot study. The intervention, the app, and the support offered by the nurse and nurse assistants were well received by participants in both settings. Conclusions The intervention was feasible in both settings. Clinical data suggested that CONEMO may help in decreasing participants' depressive symptoms. The findings also indicated that it was possible to conduct RCTs in these settings

A Mobile Health Intervention for Patients With Depressive Symptoms: Protocol for an Economic Evaluation Alongside Two Randomized Trials in Brazil and Peru

BACKGROUND: Mobile health interventions provide significant strategies for improving access to health services, offering a potential solution to reduce the mental health treatment gap. Economic evaluation of this intervention is needed to help inform local mental health policy and program development. OBJECTIVE: This paper presents the protocol for an economic evaluation conducted alongside 2 randomized controlled trials (RCTs) to evaluate the cost-effectiveness of a psychological intervention delivered through a technological platform (CONEMO) to treat depressive symptoms in people with diabetes, hypertension, or both. METHODS: The economic evaluation uses a within-trial analysis to evaluate the incremental costs and health outcomes of CONEMO plus enhanced usual care in comparison with enhanced usual care from public health care system and societal perspectives. Participants are patients of the public health care services for hypertension, diabetes, or both conditions in São Paulo, Brazil (n=880) and Lima, Peru (n=432). Clinical effectiveness will be measured by reduction in depressive symptoms and gains in health-related quality of life. We will conduct cost-effectiveness and cost-utility analyses, providing estimates of the cost per at least 50% reduction in 9-item Patient Health Questionnaire scores, and cost per quality-adjusted life year gained. The measurement of clinical effectiveness and resource use will take place over baseline, 3-month follow-up, and 6-month follow-up in the intervention and control groups. We will use a mixed costing methodology (ie, a combination of top-down and bottom-up approaches) considering 4 cost categories: intervention (CONEMO related) costs, health care costs, patient and family costs, and productivity costs. We will collect unit costs from the RCTs and national administrative databases. The multinational economic evaluations will be fully split analyses with a multicountry costing approach. We will calculate incremental cost-effectiveness ratios and present 95% CIs from nonparametric bootstrapping (1000 replicates). We will perform deterministic and probabilistic sensitivity analyses. Finally, we will present cost-effectiveness acceptability curves to compare a range of possible cost-effectiveness thresholds. RESULTS: The economic evaluation project had its project charter in June 2018 and is expected to be completed in September 2021. The final results will be available in the second half of 2021. CONCLUSIONS: We expect to assess whether CONEMO plus enhanced usual care is a cost-effective strategy to improve depressive symptoms in this population compared with enhanced usual care. This study will contribute to the evidence base for health managers and policy makers in allocating additional resources for mental health initiatives. It also will provide a basis for further research on how this emerging technology and enhanced usual care can improve mental health and well-being in low- and middle-income countries. TRIAL REGISTRATION: ClinicalTrials.gov NCT12345678 (Brazil) and NCT03026426 (Peru); https://clinicaltrials.gov/ct2/show/NCT02846662 and https://clinicaltrials.gov/ct2/show/NCT03026426. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/26164

Performance of elderly on the three words-three shapes test: A Brazilian study

Abstract The three words-three shapes test is a brief bedside technique for assessment of learning and memory using verbal and non-verbal material. To the best of our knowledge, performance of Brazilian elderly on this test has not yet been reported. Objective: To evaluate the performance of normal Brazilian elderly on the three words-three shapes test. Method: A total of 50 adult patients, 25 males and 25 females, with age ranging from 55 to 81 years (66.0±7.10 years), 1 to 8 years of schooling, different economic conditions and living in the São José do Rio Preto municipality, State of São Paulo, were evaluated. Results: There was no statistically significant difference between performance of males and females. Performance on incidental recall was significantly lower than in delayed recall. The performance in the learning phase improved following at least two further presentations of the stimuli. Approximately 50% of the participants did not remember the six stimuli and had to proceed to the recognition stage. The performance in the recognition stage was significantly better than during spontaneous recall. Patients with low educational level (less years of schooling) had poorer performance on the recall of shapes and on the total score of the test. Conclusions: The three words-three shapes test is rapid, efficient and straightforward to apply in the elderly, but low educational level was associated with poorer performance on this test. Normal elderly individuals had greater difficulty in the encoding process and in searching for stored information

The relationship between indicators of socioeconomic status and cesarean section in public hospitals

ABSTRACT OBJECTIVE To assess the relationship between indicators of socioeconomic status and cesarean section in public hospitals that adopt standardized protocols of obstetrical care. METHODS This was a prospective cohort study conducted between May 2005 and January 2006 with 831 pregnant women recruited from 10 public primary care clinics in São Paulo, Brazil. Demographic and clinical characteristics were collected during pregnancy. The three main exposures were schooling, monthly family income per capita, and residential crowding. The main outcome was cesarean section at three public hospitals located in the area. Crude and adjusted risk ratios (RR), with 95% confidence intervals were calculated using Poisson regression with robust variance. We examined the effects of each exposure variable on cesarean section accounting for potential confounders by using four different models: crude, adjusted by mother&#8217;s characteristics, by obstetrical complications, and by the other two indicators of socioeconomic status. RESULTS Among the 757 deliveries performed in the public hospitals, 215 (28.4%) were by cesarean section. In the bivariate analysis, cesarean section was associated with higher family income per capita, higher education, lower residential crowding, pregnancy planning, white skin color, having a partner, and advanced maternal age. In the multivariate analysis, after adjustment for covariates, none of the socioeconomic status variables remained associated with cesarean section. CONCLUSIONS In this group, the chance of women undergoing cesarean section was not associated with indicators of socioeconomic status only, but was defined in accordance with major obstetric and clinical conditions