ABSTRACT
BACKGROUND: Congenital syphilis (CS) is a major cause of mortality in several countries, especially in Latin America and the Caribbean. This study aimed to analyze fetal and infant mortality of CS reported to the Health Information System in a State in Northeastern Brazil. METHODS AND RESULTS: This was a cross-sectional study that analyzed the deaths of CS from 2010 to 2014 through the linkage of the Mortality Information System (SIM) and the Notifiable Diseases Information System (Sinan). The Statistical Package for the Social Sciences (SPSS) version 23.0 was used to calculate the rates of Fetal, Perinatal, Neonatal (early and late), and Postneonatal Mortality. Simple linear regression was performed. Fisher's exact test or Pearson's chi-square test were used for comparison of proportions and Student's t-test was used for comparison of means. Of the 414 cases reported to the SIM as deaths possibly caused by CS, 44 (10.6%) presented CS as the underlying cause. From 2010 to 2014 the Infant Mortality Rate of CS was 16.3 per 100,000 live births (y = 0.65x + 14.33, R2 = 0.2338, p = 0.003). There was an 89.4% underreporting of deaths. Perinatal deaths and fetal deaths of CS accounted for 87.7% and 73.9% of total deaths, respectively. CONCLUSIONS: The results of the study revealed a significant Fetal and Infant Mortality rate of CS and demonstrated the importance of using the linkage method in studies that involve the analysis of secondary data obtained from mortality and disease reporting systems. The underreporting of CS as a cause of fetal and infant mortality leads to unawareness of the reality of deaths from this disease, hindering the development of public policies aimed at its prevention.
Subject(s)
Health Information Systems , Syphilis, Congenital/mortality , Adolescent , Adult , Brazil , Cross-Sectional Studies , Female , Humans , Infant , Infant Mortality , Infant, Newborn , Pregnancy , Prenatal Care , Young AdultABSTRACT
RESUMO Objetivo Avaliar o acesso de gestantes às tecnologias para prevenção e controle da sífilis congênita (SC). Método Estudo de casos múltiplos que analisou a atenção pré-natal de gestantes com sífilis, identificando os aspectos que dificultam o acesso das mesmas às tecnologias leves, leves-dura e dura em saúde que podem contribuir para a prevenção da SC. A pesquisa de campo foi realizada no período de abril a setembro de 2011 em quatro unidades primárias de saúde e ocorreu por meio da observação não participante e entrevistas com coordenadores das unidades, médicos, enfermeiros, profissionais do Serviço de Atendimento Medico Estatístico, agentes de saúde e gestantes. Foram consideradas tecnologias leves e leves-dura: o acolhimento, a visita domiciliar e o aconselhamento e duras a coleta do material biológico para realização do diagnostico sorológico de sífilis e o tratamento da gestante e do parceiro sexual. A análise consistiu em extrair sentido e contextualizar as falas, interpretando-as sob a perspectiva do acesso. Resultados Os profissionais têm dificuldade em lidar com as questões subjetivas relacionadas às infecções sexualmente transmissíveis. Ademais, as unidades apresentam problemas organizacionais, de continuidade do atendimento e de estrutura física que comprometem o acesso das gestantes às tecnologias para prevenção e controle da SC. Discussão As gestantes com sífilis não têm acesso às diferentes tecnologias para prevenção e controle da SC, situação que inviabiliza o diagnóstico precoce da sífilis e possivelmente contribuem para os péssimos indicadores de sífilis no município de Fortaleza.(AU)
ABSTRACT Objective To evaluate access to technologies for prevention and control of Congenital Syphilis (CS) by pregnant women. Methodology Multi-case study that analyzed prenatal care to pregnant women with syphilis, which aimed at identifying the aspects that hinder their access to soft, soft-hard and hard health technologies that may contribute to the prevention of SC. The field research was done from April to September 2011 at four Health Units of two Regional Executive Divisions in Fortaleza City. Data was collected through observation and interviews with the health professionals and coordinators of the different units, the Statistic Medical Attendance Service professionals, health agents and pregnant women. Soft technologies include active search for pregnant women and home visits; light-hard technologies correspond to counseling, and hard technologies to the gathering of biological material for the serological diagnosis of syphilis and the treatment of pregnant woman and their sexual partners. The analysis consisted in contextualizing and interpreting the meanings of the answers obtained considering access as the main focus. Results Professionals have difficulty dealing with the subjective issues that involve sexually transmitted infections, and the units have problems in organizational aspects, continuity of care delivery and physical structure, which compromise the access of pregnant women to the technologies for prevention and control of CS. Discussion Pregnant women with syphilis do not have access to different technologies for prevention and control of CS, a situation that makes early diagnosis of syphilis unfeasible and possibly contributes to poor syphilis indicators in Fortaleza.(AU)
RESUMEN Objetivo Evaluar el acceso de las gestantes a las tecnologías para prevención y control de la Sífilis Congénita (SC). Metodología Estudio de casos múltiples que analizó la atención prenatal de gestantes con sífilis, identificando los aspectos que dificultan el acceso de las mismas a las tecnologías leves, leves-duras y duras en salud, que pueden contribuir para la prevención de la SC. La investigación de campo fue realizada de abril a septiembre de 2011 en cuatro unidades primarias de salud mediante observación directa y entrevistas con los coordinadores de las unidades, médicos, enfermeros, profesionales del Servicio de Atendimiento Médico Estadístico, agentes de salud y gestantes. Fueron consideradas tecnologías leves y leves-duras: la acogida, la visita domiciliaria y el asesoramiento y duras la recolección del material biológico para realización del diagnóstico serológico de sífilis y el tratamiento de la gestante y del compañero sexual. El análisis consistió en extraer el sentido y contextualizar las declaraciones interpretándolas desde la perspectiva del acceso. Resultados Los profesionales tienen dificultad para lidiar con las cuestiones subjetivas relacionadas a las infecciones sexualmente transmisibles y las unidades presentan problemas organizacionales, de continuidad del atendimiento y de estructura física que dificultan el acceso de las gestantes a las tecnologías para prevención y control de la SC. Discussión Las gestantes con sífilis no tienen acceso a las diferentes tecnologías para prevención y control de la SC, situación que inviabiliza el diagnóstico precoz de sífilis y posiblemente contribuye para los pésimos indicadores de sífilis en el municipio de Fortaleza.(AU)
Subject(s)
Prenatal Care/organization & administration , Syphilis, Congenital/prevention & control , Health Services Accessibility/organization & administration , Brazil/epidemiology , Counseling , Statistical Databases , User Embracement , House CallsABSTRACT
OBJECTIVE: To evaluate access to technologies for prevention and control of Congenital Syphilis (CS) by pregnant women. METHODOLOGY: Multi-case study that analyzed prenatal care to pregnant women with syphilis, which aimed at identifying the aspects that hinder their access to soft, soft-hard and hard health technologies that may contribute to the prevention of SC. The field research was done from April to September 2011 at four Health Units of two Regional Executive Divisions in Fortaleza City. Data was collected through observation and interviews with the health professionals and coordinators of the different units, the Statistic Medical Attendance Service professionals, health agents and pregnant women. Soft technologies include active search for pregnant women and home visits; light-hard technologies correspond to counseling, and hard technologies to the gathering of biological material for the serological diagnosis of syphilis and the treatment of pregnant woman and their sexual partners. The analysis consisted in contextualizing and interpreting the meanings of the answers obtained considering access as the main focus. RESULTS: Professionals have difficulty dealing with the subjective issues that involve sexually transmitted infections, and the units have problems in organizational aspects, continuity of care delivery and physical structure, which compromise the access of pregnant women to the technologies for prevention and control of CS. DISCUSSION: Pregnant women with syphilis do not have access to different technologies for prevention and control of CS, a situation that makes early diagnosis of syphilis unfeasible and possibly contributes to poor syphilis indicators in Fortaleza.
ABSTRACT
A violência contra as mulheres pode assumir várias formas, desde assédio sexual, discriminação e desrespeito até formas mais graves tais como violência física e sexual. Objetivo: Descrever a frequência de violência doméstica e sexual relatadas por mulheres atendidas em um clínica de doenças sexualmente transmissíveis (DST) em Vitória, Brasil. Métodos: As mulheres que buscaram atendimento clínico na clínica de DST/AIDS, durante o período de estudo, foram convidadas a participar e responderam a uma entrevista após assinar um termo de consentimento informado. O questionário utilizado incluiu dados sobre as características sócio-demográficas e clínicas, os comportamentos de risco para DST e a história de violências domésticas e sexuais. Resultados: Um total de 276 (96,8%) mulheres concordaram em participar do estudo, das quais 109 (39,5%) eram HIV-positivas e 167 (60,5%) eram HIV-negativas. História de violência doméstica foi relatada por 52,6% das mulheres, principalmente relacionada ao abuso de álcool (41,6%), uso de drogas ilícitas (27,2%), e problemas psiquiátricos (25,3%). Violência sexual prévia foi relatada por 28,6% das mulheres, e 31,6% desses casos ocorreu quando as participantes tinham menos de 14 anos de idade. Um total de 69,2% das mulheres tinham entre 18 e 34 anos; 11,2% relataram o uso frequente de álcool; 21% o uso de drogas ilícitas e 2,2% relataram o uso de drogas injetáveis. Em relação ao uso de preservativos, as mulheres HIV-positivas tinham menos receio de pedir ao parceiro para usar preservativos em comparação com mulheres HIV-negativas (31,2 versus 41,9%, p=0,022). Conclusão: História de violência doméstica e sexual foi frequentemente relatada neste estudo. Os efeitos da violência sobre a saúde física e mental das mulheres são amplamente conhecidos como um grave problema de saúde pública. Para além dessa importância, a violência é um problema invisível em nossa sociedade e precisamos aprender como abordá-lo na prática clínica.
Violence against women can take several forms; ranging from sexual harassment, discrimination, and discounting to even more serious forms such as those physical and sexual in nature. Objective: To describe the frequency of domestic and sexual violence reported by women attending a sexually transmitted infections (STI) clinic in Vitória, Brazil. Methods: Women attending the STI/AIDS clinic during the period of study were invited to participate and were interviewed after signing a written consent form. The assessment questionnaire included information on socio-demographic characteristics such as risk behaviors for STI and clinical, domestic, and sexual violence reports. Results: A total of 276 (96.8%) women agreed to participate, of which 109 (39.5%) were HIV-positive and 167 (60.5%) were HIV-negative. History of domestic violence was reported by 52.6% of women, mainly related to alcohol abuse (41.6%), use of illicit drugs (27.2%), and psychiatric problems (25.3%). Previous sexual violence was reported by 28.6%, and 31.6% of these cases occurred when the participants were younger than 14 years old. A total of 69.2% of women were between 18 and 34 years old; 11.2% reported frequent use of alcohol; 21% use of illicit drugs and 2.2% reported injectable drugs. Regarding the use of condoms, HIV-positive women were less afraid to ask the partner to use condoms compared with HIV-negative women (31.2% versus 41.9%, p=0.022). Conclusion: History of domestic and sexual violence was frequently reported in this study. The effects of violence to women's physical and mental health are widely known as a serious public health problem. In addition to its importance, violence is an invisible problem in our society and we need to learn how to approach it during clinical consultation.
Subject(s)
Humans , Female , Acquired Immunodeficiency Syndrome , Sexually Transmitted Diseases , Violence Against Women , Mental Health , Public Health , Unsafe SexABSTRACT
A partir de la elaboración de las teorías, la enfermería se define como profesión y como ciencia. Las teorías necesitan ser testadas y evaluadas, para que sean mejoradas o rechazadas. El objetivo es hacer un análisis de contexto del concepto de "ambiente" de la teoría humanística de Paterson y Zderad, usando el modelo de análisis de Meleis. Este concepto está presente y fundamenta la teoría y se concibe de forma subjetiva y trascendente. Representa la comunión, la relación Intra subjetiva, que puede ocurrir entre la enfermera y el paciente individualmente, como también en la comunidad. Es el diálogo vivo, o sea, estar en común, en conjunto, comprometido. El espacio físico no se muestra relevante, al considerar que el acto de hacer de la enfermera no se limita sólo a los actos del cuidado físico, sino a un venir a ser, que puede surgir tanto en un ambiente privado o colectivo
Starting from the elaboration of theories, Nursing is defined as a profession and a science. Theories need to be tested and evaluated in order to be either improved or rejected. One aims at analyzing the context of the "environment" concept in the Paterson and Zederad's Humanistic Theory using the Meleis analysis model. This concept is present and bases the theory and is conceived in a subjective, transcendent way. It represents communion, inter-subjective relation, which can occur between the nurse and the client individually, as well as in the community. It is a living dialogue, that is, being in common, in group, involved. The physical space is not relevant, considering that the nurse's act is not restricted to the physical care act, but to a becoming, which can take place in either a private or collective environment
