Desistência do abortamento de gestação decorrente de violência sexual: o papel do agressor sexual

Introduction: Unwanted pregnancy is a serious consequence for women who experience sexual violence. Although deciding on abortion is frequent in these cases, there is not much information on women who give up abortion in this circumstance. Objective: To analyse the associated factors in abortion withdrawal of sexual violence pregnancy. Methods: A cross-sectional epidemiological study with a convenience sample of adolescents and women with pregnancy due to sexual violence and requesting legal abortion between August 1994 and December 2012, at Hospital Pérola Byington, São Paulo, Brazil. Pregnant women who gave up abortion after receiving the procedure approval were included and, in another group, pregnant women who completed the abortion. The variables were selected from a digitized database and analyzed using SPSS 15.0 software. The outcome was abortion withdrawal. The study variables were age; low education level; gestational age; color/black ethnicity; not being united; declare religion; serious threat from the aggressor; known offender; and residence of the aggressor. Odds ratios with 95% confidence intervals were calculated. The analysis used Wald's chi-square test (?2W) and logistic regression with variable of interest defined as the known aggressor. The research was approved by the Research Ethics Committee of the Federal University of São Paulo, Opinion No. 6767. Results: The study included 941 women, 849 (90.2%) who had an abortion and 92 (9.8%) who gave up after being approved. Age ranged from 10-46 years, mean 23.2 ± 7.9 years, gestational age 4-22 weeks, average 11.9 ± 4.5 weeks. Among those who gave up abortion, 12.0% were <14 years old; 50.0% had gestational age ? 13 weeks; 50.0% had low education; 14.2% were black; 90.2% single; 85.9% declared to have religion; 50.0% were threatened; 12.0% of the cases occurred at the perpetrator's residence and 53.3% of the victims were raped by known perpetrators. In logistic regression, the only significant variable was the known perpetrator, increasing the victim's chance of giving up abortion twice. Conclusion: The known sex offender has influenced the woman or adolescent's decision to give up legal abortion.Introdução: A gravidez forçada é uma grave consequência para mulheres que sofrem violência sexual. Embora decidir pelo aborto seja frequente nestes casos, há escassa informação sobre as mulheres que desistem de realizar ao aborto nessa circunstância. Objetivo: Analisar os fatores associados na desistência do abortamento de gestação decorrente de violência sexual. Método: A cross-sectional epidemiological study com amostra de conveniência de adolescentes e mulheres com gravidez decorrente de violência sexual e solicitação de aborto legal entre agosto de 1994 e dezembro de 2012, no Hospital Pérola Byington, São Paulo, Brasil. Foram incluídas gestantes que desistiram de realizar o aborto após receberem aprovação do procedimento e, em outro grupo, as gestantes que concluíram o aborto. As variáveis foram selecionadas de banco de dados digitalizado e analisadas em software SPSS 15.0. O desfecho foi desistência do aborto. As variáveis de estudo foram a idade, baixa escolaridade; idade gestacional; cor/etnia negra; não estar unida; declarar religião; grave ameaça do agressor; agressor conhecido; e residência do agressor. Foram calculadas as razões de chances (Odds Ratio) com intervalo de confiança de 95%. A análise utilizou teste de qui-quadrado de Wald (?2W) e regressão logística com variável de interesse definida como o agressor conhecido. A pesquisa recebeu aprovação do Comitê de Ética e Pesquisa da Universidade Federal de São Paulo, Parecer nº 6767. Resultados: O estudo contou com 941 mulheres, sendo 849 (90,2%) que realizaram o aborto e 92 (9,8%) que desistiram após receberem aprovação. A idade variou de 10-46 anos, média 23,2±7,9 anos, com idade gestacional de 4-22 semanas, média 11,9±4,5 semanas. Entre as que desistiram do aborto, 12,0% tinham idade < 14 anos; 50,0% apresentaram idade gestacional ? 13 semanas; 50,0% tinham baixa escolaridade; 14,2% eram negras; 90,2% solteiras; 85,9% declararam ter religião; 50,0% sofreram ameaça; 12,0% dos casos ocorreram na residência do agressor e 53,3% das vítimas foram violentadas por agressores conhecidos. Na regressão logística, a única variável significante foi o agressor conhecido, aumentando em duas vezes a chance da vítima de desistir do aborto. Conclusão: O agressor sexual conhecido exerceu influência na decisão da mulher ou adolescente de desistir do aborto legal

A disseminação da COVID-19: um papel expectante e preventivo na saúde global

Coronaviruses (CoV) make up a large family of viruses, known since the mid-1960s, which received this name due to the spikes on its surface, which resemble a crown (from the Latin corona). CoV infections can cause everything from a common cold to severe respiratory syndromes, such as severe acute respiratory syndrome (SARS-CoV) and Middle Eastern respiratory syndrome (MERS-CoV). COVID-19 is a new variant of the coronavirus, and its isolation occurred in China on January 7th, 2020. COVID-19 has stood out with a high impact on public health due to the high number of cases with infection in a short period of time. However, it is possible to observe that 17% of patients confirmed with COVID-19 have severe infections and about 2.5% of these patients die. Current studies have shown that the number of mild and asymptomatic cases may be even greater. Thus, the challenges for controlling unreported cases of patients with mild symptoms that are spreading the virus and interfering with the magnitude and real data of the cases stand out. The transmission of the coronavirus occurs between humans, and it can occur from person to person through the air, through coughing or sneezing, by touching or shaking hands or by contact with contaminated objects or surfaces, followed by contact with the mouth, nose or eyes. Given the fluctuation in the incidence and the lethality rate, it is essential to stand out the precepts of health promotion in search of reorienting hygiene practices, considering that there is validity in health care models, still with a curative approach and the current situation experienced by the world population requires a preventive stance.Os coronavírus (CoV) compõem uma grande família de vírus, conhecidos desde meados da década de 1960, que receberam esse nome devido às espículas na sua superfície, que lembram uma coroa (do latim corona). As infecções pelo CoV podem causar desde um resfriado comum até síndromes respiratórias graves, como a síndrome respiratória aguda grave (SARS-CoV) e a síndrome respiratória do Oriente Médio (MERS-CoV). O COVID-19 é nova variante do coronavírus, sendo que o seu isolamento ocorreu na China em 07/01/2020. O COVID-19 tem se destacado com alto impacto na saúde pública devido ao elevado número de casos com a infecção em um curto período de tempo. Entretanto, é possível observar que apenas 17% dos pacientes confirmados com COVID-19 apresentam infecções graves e cerca de 2,5% destes pacientes morrerem. No entanto, os estudos atuais tem evidenciado que o número de casos leves e assintomáticos podem ser ainda maiores. Dessa forma, destacam-se os desafios para o controle dos casos não notificados de pacientes com sintomas leves que estão espalhando o vírus e interferindo na magnitude e nos dados reais dos casos. A transmissão do coronavírus acontece entre humanos, podendo ocorrer de pessoa a pessoa pelo ar, por meio de tosse ou espirro, pelo toque ou aperto de mão ou pelo contato com objetos ou superfícies contaminadas, seguido pelo contato com a boca, nariz ou olhos. Dada a oscilação da incidência e da taxa de letalidade reforça-se a importância dos preceitos da promoção da saúde em busca da reorientação de práticas de higiene, considerando que há vigência nos modelos assistenciais em saúde, sendo hegemônico o curativismo e a atual situação vivenciada pela população mundial exige postura preventiva

The right to scientific information: one of the main elements of the unified health system

 Citizen care in the health field is a fundamental right provided by the federal constitution of Brazil. The Unified Health System (SUS) is one of the best and most important systems in the world and serves around 220 million people. The System is comprehensive and characterized by three pillars of support: universality, completeness and equity. The right to scientific information is one of the main elements of the SUS and the Journal of Human Growth and Development has contributed over its 27 years of existence providing a democratic scenario and a place to debate ideas in the field of public health and the irrefutable defence of SUS in Brazil. In this way, JHGD maintains its tradition of publishing articles devoted to the field of public health and contributing to the dissemination of knowledge and to the progress of science. The Journal intends to serve as a space for exchange knowledge among professionals in universities and help them to deal with the problems of human growth and development, improving the publication scenario of scientific articles refereed by peers, highlighting its commitment to communicate the knowledge obtained through ethic research with bilingual and free publications.The Citizen care in the health field is a fundamental right provided by the federal constitution of Brazil. The Unified Health System (SUS) is one of the best and most important systems in the world and serves around 220 million people. The System is comprehensive and characterized by three pillars of support: universality, completeness and equity. The right to scientific information is one of the main elements of the SUS and the Journal of Human Growth and Development has contributed over its 27 years of existence providing a democratic scenario and a place to debate ideas in the field of public health and the irrefutable defence of SUS in Brazil. In this way, JHGD maintains its tradition of publishing articles devoted to the field of public health and contributing to the dissemination of knowledge and to the progress of science. The Journal intends to serve as a space for exchange knowledge among professionals in universities and help them to deal with the problems of human growth and development, improving the publication scenario of scientific articles refereed by peers, highlighting its commitment to communicate the knowledge obtained through ethic research with bilingual and free publication

A Cloud-Based Collaboration Platform for Model-Based Design of Cyber-Physical Systems

Businesses, particularly small and medium-sized enterprises, aiming to start up in Model-Based Design (MBD) face difficult choices from a wide range of methods, notations and tools before making the significant investments in planning, procurement and training necessary to deploy new approaches successfully. In the development of Cyber-Physical Systems (CPSs) this is exacerbated by the diversity of formalisms covering computation, physical and human processes. In this paper, we propose the use of a cloud-enabled and open collaboration platform that allows businesses to offer models, tools and other assets, and permits others to access these on a pay-per-use basis as a means of lowering barriers to the adoption of MBD technology, and to promote experimentation in a sandbox environment

FACTORS ASSOCIATED WITH INFANT MORTALITY IN THE METROPOLITAN REGION OF CARIRI, CEARÁ, BRAZIL

Introduction: The identification of factors related to children’s deaths is very important in planning public health actions for restructure and improve the mother and child assistance, aimed in reducing child mortality. Objective: Analyze the factors associated with infant mortality in the metropolitan area of Cariri, Ceará, Brazil. Method: This is a cross-sectional study. All deaths occurring in children under one year old of the metropolitan region of Cariri, Ceará, Brazil, contained in the mortality information system and in live births’s information system, from January 2009 to December 2013. Newborn variables (sex, race/color, weight, age); maternal variables (maternal age and education and type of gestation); assistance variables (labor type) were extracted from the SUS (Sistema Único de Saúde/Unified Health System) Informatics Department and presented in chart and tables in absolute and percentage frequency form. Results: In the five-year period, 816 infant deaths in 48321 births were registered associated to the following factors: 453 (55.5%) male, 471 (57.7%) drab and 514 (63%) low weight in birth, 458 (56.1%) with 20 to 34 years of age, 353 (43.2%) 8 years or more of schooling, 657 (80.5%) only pregnancy and 414 (50.7%) vaginal birth. Conclusion: Infant mortality variables in the metropolitan region of Cariri, Ceará, Brazil were associated mostly with deaths occurring in drab boys with birth weight below the normal, whose mothers were young, with good education and who had just one gestation, born of vaginal birth

Zika virus and measures of legal interventions in public health

The zika virus is an emerging and important world health problem. In public health its harmful effects have stimulated various legal interests. The Federal Government of Brazil recently adopted several social and health surveillance measures, extending the instruments of possibilities to combating the virus transmitter in Brazil. Law No. 13.306/2016 brought incisive determinations about action awareness policies and educational campaigns, and at the same time authorizes the highest authorities of the Unified Health System (SUS) within federal, state, county and municipal governments to establish and implement the necessary measures to control the diseases caused by the virus, i.e. dengue, chikungunya and zika. The published legislation has created a motivating environment for researchers to develop projects aimed at the mosquito that transmits the dengue virus, the chikungunya virus and the zika virus. Therefore, studies on A. aegypti have led to greater scientifi c knowledge about its habitat, reproduction and development and a description of means to combat it, as a precondition for the ful filment of the social purposes of Law No. 13.301, of June 27, 2016, mainly if researches about more efficient management models and management of public finances, contributing to unveiling impacts on public health and growth and human development

INFLAMMATORY BREAST NEOPLASMS: A SYSTEMATIC REVIEW

Overview: Inflammatory Breast Cancer (IBC) is a rare and very aggressive type of cancer that tends to develop at a younger age, compared with other subtypes of breast cancer. Because a distinct lump may not be noticeable, correct diagnosis takes longer and, therefore, successful treatment may hinder a patient’s prognostics. This study aims to conduct a systematic review of research articles on IBC. Methods: This is a systematic review of studies in the PubMed database to April 2013, which fit the eligibility criterion of “Inflammatory Breast Neoplasms” (MeSH Terms), filtered by Languages (English OR Portuguese OR Spanish). Findings: Of the 119studies identified, 25 complied with the eligibility criterion for the disease, diagnostics, treatment and prognostics. Final Considerations :Despite methodological differences, findings evidence that although IBC presents particular features (lower survival rate and worse prognostics than most types of breast cancer), very few studies examine its epidemiology and specific risk factors in depth and use any other therapeutic approaches than those commonly used for other breast cancer subtypes. Therefore, further investigation of the disease’s aggressiveness is still necessary

Influence of forensic examination on the accountability of sexual violence authors in teenagers

OBJETIVO: avaliar a influência do exame médico-legal na responsabilização criminal de acusados de violência sexual contra adolescentes do sexo feminino. MÉTODO: foram analisados retrospectivamente 137 processos judiciais de estupro contra adolescentes matriculadas no Centro de Referência da Criança e do Adolescente entre janeiro de 1995 e dezembro de 2004. Os laudos do Instituto Médico Legal foram classificados como negativos ou positivos para a materialidade do crime sexual e confrontados com a sentença judicial, condenatória ou não para o acusado. Os dados foram informatizados em Programa EpiInfo e submetidos ao teste de Qui-quadrado para Tabelas de contingência, fixando-se em p &lt; 0,05 o nível de rejeição da hipótese de nulidade. RESULTADOS: em 30 casos (21,9%) o laudo foi concordante com a queixa de estupro. Em 107 casos (78,1%) o exame médico-legal não encontrou evidência material do crime sexual. Entre os exames positivos, 25 acusados (83,3%) foram condenados, enquanto nas perícias negativas ocorreram 68 condenações (63,5%). CONCLUSÕES: o exame médico-legal positivo se associou com maior probabilidade de condenação do acusado da violência sexual. A ausência de elementos comprobatórios materiais não impediu a responsabilização de parte expressiva dos acusados, indicando que outros meios de convencimento são admitidos pela justiça.OBJECTIVE: to evaluate the influence of forensic examination on the accountability of sexual violence criminal charges in adolescent girls. METHOD: retrospective study, it was analyzed 137 lawsuits rape in teenagers enrolled in the Reference Center for Children and Adolescents between January 1995 and December 2004. The awards of the Forensic Institute were classified as negative or positive for the materiality of sexual crimes and confronted with the judicial sentence, condemnatory or not. Data was computerized in EpiInfo Program and subjected to chi-square test for contingency tables, considering p < 0.05 the level of rejection of the hypothesis of nullity. RESULTS: in 30 cases (21.9%) the award was consistent with the complaint of rape. In 107 cases (78.1%) the forensic examination found no physical evidence of sexual crime. Among the positive cases, 25 accused (83.3 %) were condemned, while in the negative skills it was observed 68 condemnations (63.5 %). CONCLUSIONS: the positive forensic examination was associated with the most part of probability of condemnation of the accused of the sexual violence. The absence of corroborative material elements did not obstruct the accountability of expressive part of the accused subjects, indicating that other means of persuasion are accepted by the courts

Colecting the collector: the shortest way to humanization of assistance

INTRODUÇÃO: o acolhimento tem se constituído num potente disparador de mudanças. Este trabalho reflete a satisfação experimentada, resultante da atuação num ambiente altamente sinérgico e produtivo. OBJETIVO: implantação e implementação da assistência materno-neonatal a partir do acolhimento ao cliente interno. MÉTODO: realizou-se observação direta do cotidiano em setores distintos do Hospital Maternidade Interlagos (HMI) -SES/SP e seu Ambulatório. Foram realizadas entrevistas semi-estruturadas com dois profissionais da equipe multidisciplinar, as quais subsidiaram oficinas de humanização no ambiente hospitalar. Os profissionais foram divididos em áreas de exercício profissional, da administrativa à assistencial. RESULTADOS: ocorreu implantação do Comitê de Acolhimento e Humanização da Assistência Materno-Neonatal no Hospital Maternidade Interlagos, com participação dos líderes de acolhimento na gerência institucional, provendo melhor desempenho individual e coletivo no exercício laboral na Unidade Hospitalar.INTRODUCTION: the shelter consists in a powerful cause of changes. This work reflects the experimented satisfaction, outcome of the performance in a synergic and highly productive environment. OBJECTIVE: to implant the maternal-neonatal assistance from the shelter to the internal customer. METHOD: direct daily observation of in distinct sectors of the Hospital the Maternity Interlagos (HMI) - SES/SP and its out patient sector was performed. Two members of the multidisciplinary team nade semistructured interviews that supported humanization in the hospital environment. The professionals were divided by areas of professional exercise, from the administrative to the assistencial work. RESULTS: implantation of a Collection and Humanization Committee of the Maternal Assistance occurred in the Hospital Interlagos Maternity, with participation of the leaders of shelter in the institutional management, this providing better individual and collective performance in the activities in the Hospital

Saphenofemoral arteriovenous fistula as hemodialysis access

<p>Abstract</p> <p>Background</p> <p>An upper limb arteriovenous (AV) fistula is the access of choice for haemodialysis (HD). There have been few reports of saphenofemoral AV fistulas (SFAVF) over the last 10-20 years because of previous suggestions of poor patencies and needling difficulties. Here, we describe our clinical experience with SFAVF.</p> <p>Methods</p> <p>SFAVFs were evaluated using the following variables: immediate results, early and late complications, intraoperative and postoperative complications (up to day 30), efficiency of the fistula after the onset of needling and complications associated to its use.</p> <p>Results</p> <p>Fifty-six SFAVF fistulas were created in 48 patients. Eight patients had two fistulas: 8 patent (16%), 10 transplanted (20%), 12 deaths (24%), 1 low flow (2%) and 20 thrombosis (39%) (first two months of preparation). One patient had severe hypotension during surgery, which caused thrombosis of the fistula, which was successfully thrombectomised, four thrombosed fistulae were successfully thrombectomised and revised on the first postoperative day. After 59 months of follow-up, primary patency was 44%.</p> <p>Conclusion</p> <p>SFAVF is an adequate alternative for patients without the possibility for other access in the upper limbs, allowing efficient dialysis with good long-term patency with a low complication rate.</p