Acesso aos serviços de saúde, condições de saúde e exposição aos fatores de risco: percepção dos pescadores ribeirinhos do Rio Machado de Ji-Paraná, RO

This paper presents a study about the perceptions of riparian fishermen in the city of Ji-Paraná, Northern Brazil, in relation to their access to the health services of the local public network. In addition, it aims to identify this population's perceptions concerning health conditions and their exposure to risk factors. It is a qualitative, analytical-descriptive research. For data collection, semi-structured interviews and free observation were conducted in home visits in the period of September, October and November 2009, with 23 fishermen (15 men and 8 women). The interviewed population notices they are exposed to several risks and health problems, mainly in the flood period. In their work, there are risks of accidents, drowning and others hazards, due to lack or insufficiency in relation to the use of Individual Protection Equipments - IPE. The majority of the interviewees (19) reported health problems, like back pain, pain in the legs, muscular pain, cramps, sight problems, headaches, flu and skin diseases. The riparian fishermen who participated in the research identify many difficulties in their access to the public health services and deficiencies in basic sanitation. Besides, the researched area is not covered by the Family Health Strategy. Thus, it is necessary to formulate policies that enable the improvement in infrastructure, the reduction in health care inequalities and the expansion of the Family Health Strategy.Este artigo apresenta um estudo sobre as percepções dos pescadores ribeirinhos de Ji-Paraná/RO quanto ao acesso aos serviços de saúde da rede pública local. Objetiva também identificar as percepções das condições de saúde e a exposição aos fatores de risco dessa população. Trata-se de uma pesquisa qualitativa e analítico-descritiva. Para a coleta de dados, utilizaram-se entrevistas semiestruturadas e observação livre, realizadas em visitas domiciliares no período de setembro a novembro de 2009, com 23 pescadores, sendo 15 homens e 8 mulheres. A população pesquisada percebe estar exposta a diversos riscos e problemas de saúde, com maior frequência no período das enchentes. No trabalho, há risco de acidentes, afogamentos e outros perigos devido à inexistência ou precariedade quanto ao uso de Equipamentos de Proteção Individual - EPI. A maioria (19) dos entrevistados relatou problemas de saúde, como dores na coluna, nas pernas, musculares, cãibras, problemas de visão, dor de cabeça, gripe e doenças de pele. Os pescadores ribeirinhos participantes da pesquisa identificam muitas dificuldades no acesso aos serviços de saúde da rede pública e a deficiência no saneamento básico. Além disso, a área pesquisada não é de abrangência da estratégia Saúde da Família. Assim, faz-se necessária a formulação de políticas que viabilizem a melhoria da infraestrutura, a redução das desigualdades no atendimento à saúde e a ampliação da estratégia Saúde da Família

Sexual behaviour among initial academic students

Objective: Describe the sexual practices of beginner students of a Federal University of Minas Gerais, Brazil. Method: Exploratory and cross-sectional study which included 786 academics enrolled in courses of the health area. Results: 623 (79,3%) were female and the average age was 19.2 ± 3.1 years. 693 (88.2%) adolescents had started sexual life, of which 332 (47,9%) has sexual relations with regular partner and 135 (19.5%) reported regular use of condom. Conclusion: It shows the need of health education actions targeted to the teen population in the University context, especially those of health area, with a view to prevention and to the adoption of healthy habits, highlighting not only biological aspects, but also psychosocial and behavioral

A study of some obstetric factors associated with low birth-weight

Estudou-se um contingente de 19.446 eventos obstétricos consecutivos, dos quais foi possível obter dados analisáveis em 18.804. O baixo peso ao nascer ocorreu em 15,93% dos recém-natos. Foi possível encontrar associações estatisticamente significativas com os elementos estudados, ou seja, com: idade materna, assistência pré-natal, número de gestações prévias, hábito de fumar e idade gestacional ao parto. Propõe-se medidas para atenuar o problema, quais sejam: programas educacionais sobre reprodução humana para adolescentes, programas destinados a divulgar a nocividade do hábito de fumar, extensão da assistência pré-natal, programas médicos do bloqueio do parto prematuro, tudo associado a outras, de caráter sócio-econômico.An analysis was made of 18,804 of 19,446 consecutive births of the number analysed 15.93% presented low birth-rate. Significant statistical association was found in relation to maternal age, pre-natal care, previous pregnancies, smoking and gestational age at birth. Measures with a view to the attenuation of the problem are proposed, among them being: educational programs for teenagers on human reproduction, programs designed to create awareness of the harm done by smoking, amplification of antenatal assistance, medical programs for the limitation of premature labor, all of these and others, in association with programs of socio-economic support

Domestic violence as a risk factor in the screening of for post-partum depression

PURPOSE: to assess the prevalence of the risk of post-partum depression in women in the post-natal ward of a hospital in São Paulo city, in the southeastern region of Brazil, and analyze the associated factors, including domestic violence (DV). METHODS: this was a descriptive, cross-sectional study. The participants were 133 women with at least 20 weeks of gestation age, who delivered their babies from August to September 2005 in a tertiary maternity in the city of São Paulo (Brazil). They were interviewed using the Portuguese version of the Abuse Assessment Screen for the diagnosis of violence and filled out a self-evaluation questionnaire for post-partum depression (Edinburgh Postnatal Depression Scale). Variables were presented as absolute and relative frequencies. The chi2 or Fisher exact tests were used to analyze possible associations between the variables of interest and post-partum depression. The value of 5% was considered significant. RESULTS: risk for post-partum depression was detected in 24 women (18%). A total of 38.3% of the participants interviewed had a history of abuse. There was an association between DV after they were 15 years old and risk of depression (p=0.036). The prevalence of abuse in the group of women at risk for post-partum depression was 58.3% and this was significantly higher than the 33.9% observed in the control group. CONCLUSIONS: the probability of presenting depression was high among the post-partum women attended at a tertiary maternity in the southeast of Brazil. The DV after they were 15 years old was significantly associated with risk of post-partum depression.OBJETIVO: apurar a freqüência de risco para depressão pós-parto (DP) em puérperas de hospital de São Paulo, região Sudeste do Brasil, e determinar fatores associados - entre eles a violência doméstica (VD). MÉTODOS: estudo descritivo, tipo corte transversal. Participaram 133 mulheres, que tiveram partos com idade gestacional de 20 semanas ou mais, no período de agosto a setembro de 2005, em maternidade terciária em São Paulo (Brasil). Foram entrevistadas empregando-se a versão em português do Abuse Assessment Screen para o diagnóstico de violência e responderam questionário de auto-avaliação do risco de DP (Edinburgh Postnatal Depression Scale). As variáveis foram representadas por freqüências absoluta e relativa. A associação entre as variáveis de interesse e DP foi avaliada pelo teste do chi2 ou exato de Fisher. Adotou-se o nível de significância de 5%. RESULTADOS: o risco de DP foi identificado em 24 puérperas (18%). Das mulheres entrevistadas, 38,3% referiram história de abusos. Observou-se associação entre a ocorrência de VD após os 15 anos de idade e o risco de depressão (p=0,03). A ocorrência de abusos no grupo de mulheres com probabilidade de apresentar DP foi de 58,3%, proporção significativamente maior do que a observada no grupo controle com 33,9%. CONCLUSÕES: a probabilidade de apresentar depressão foi alta entre as puérperas assistidas em maternidade terciária da região Sudeste do Brasil. A VD sofrida após os 15 anos de idade esteve estatisticamente associada ao risco de DP.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de ObstetríciaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de EnfermagemUniversidade de Santo AmaroUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaHospital do Servidor Público Estadual 'Francisco Morato de Oliveira'Universidade Metropolitana de Santos Departamento de ObstetríciaUNIFESP, EPM, Depto. de ObstetríciaUNIFESP, EPM, Depto. de EnfermagemUNIFESP, EPMSciEL

Interventional radiology to treat severe obstetric hemorrhages

ABSTRACTThe author discusses the recent role of interventional radiology to prevent postpartum hemorrhagic complications that represent an important cause of maternal morbidity and mortality all over the world. Hence, hemorrhage control is mandatory. Traditional management and recent minimally invasive radiological procedures by means of inserting occluding balloons into appropriate vessels are analyzed. It is advisable that maternity hospitals have protocols for the management of obstetric hemorrhage by means of interventional radiology, either in their own departments or in association with other large healthcare units that may have proper equipment and trained staff. However, the evidence related to its efficacy is limited to series of cases analyzed in tertiary centers. This is a promising technique that may be applied to severe obstetric hemorrhages and may bring beneficial results in the majority of cases

A clinical and ultrasound study on the use of postplacental intrauterine device

Objective: To evaluate the relation of postplacental intrauterinedevice insertion immediately after vaginal delivery and cesareansection and its effects on the following: continuation, expulsionrate and eventual removals. To verify if ultrasound is an adequatemethod to follow-up postplacental IUD insertions. To assess if theimmediate insertion of postplacental IUD leads to an increasedrisk of uterine infections and perforations, or greater likelihood ofpregnancy during the observation period. Methods: A group of 50patients who had an intrauterine device introduced within tenminutes after delivery of the placenta were studied. Twenty-fivewomen had vaginal delivery and 25 had cesarean sections. Theintrauterine device used in this study was the Multiload CU 375,standard model, manufactured by Organon Ltd., in Ireland. Theintrauterine device was inserted in those who had vaginal deliveryeither manually and under anesthesia, or with an inserter, whichdid not require anesthesia. In patients who had cesarean sections,the insertion was manual. Clinical and ultrasound follow up wasperformed four times: 48 hours postpartum, and at 6, 12 and 24weeks. The distance from the top of the intrauterine device to theuterine fundus was measured by ultrasound. Results: This studyshowed a significant difference in postplacental intrauterinedevices inserted after vaginal deliveries and cesarean sections.The expulsion/removal rate was 32% among the subjects who hadan intrauterine device inserted after vaginal delivery. There wereno expulsions or removals in those submitted to cesarean sections.In the control ultrasound of intrauterine devices inserted aftervaginal delivery, at 6 weeks, the distance of 10 mm from the top ofthe device to the fundus was an average standard measurementto determine continuation (distance < 10 mm, the IUD wouldremain in the uterus) and expulsion/removal (distance > 10 mm,the IUD would be expelled or be removed). There were no cases ofuterine infections or perforations, and no pregnancies during thecourse of this study. Conclusions: Postplacental intrauterine deviceinsertion showed to be an useful and safe contraceptive method.The ultrasound demonstrated to be a useful and reliable method tocontrol postplacental intrauterine device insertions