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Este estudo investigou os fatores associados à morbidade materna grave entre mulheres atendidas em maternidades públicas do Município de Ribeirão Preto, São Paulo, Brasil. Trata-se de um estudo quantitativo, analítico, transversal. Participaram 1.098 puérperas com parto em uma das quatro maternidades públicas do município. A coleta de dados ocorreu entre 3 de agosto de 2015 e 2 de fevereiro de 2016, a partir de entrevistas face a face, obtenção de informações dos prontuários e dos cartões da gestante. Para a análise de dados, considerou-se como variável dependente a ocorrência de morbidade materna grave, ou seja, quando a mulher era classificada como near miss materno ou condição potencialmente ameaçadora à vida a partir dos critérios de elegibilidade da Organização Mundial de Saúde. Calculou-se a razão do near miss materno, odds ratio (OR), intervalo de 95% de confiança (IC95%) e regressão logística múltipla. A razão do near miss materno foi de 3,6 casos por mil nascidos vivos. As complicações ocorreram principalmente na gravidez (53,8%) e os distúrbios hipertensivos foram os mais frequentes (49,4%). A análise de regressão múltipla mostrou associação entre morbidade materna grave e gestação de risco (OR = 4,5; IC95%: 2,7-7,7) e com trabalho de parto induzido (OR = 2,1; IC95%: 1,2-3,9). A ocorrência de morbidade materna grave, principalmente na gestação, com destaque para as síndromes hipertensivas, aponta para a necessidade de melhor rastreamento e manejo da elevação dos níveis pressóricos no pré-natal. A associação entre morbidade materna grave e gestação de risco também remonta ao pré-natal, para a demanda de uma maior atenção às mulheres classificadas como risco gestacional. A qualidade da assistência é ponto chave para o enfretamento da morbimortalidade materna no país. This study investigated the factors associated with serious maternal morbidity (SMM) in women seen at public maternity hospitals in Ribeirão Preto, São Paulo State, Brazil. This was a cross-section analytical quantitative study. Participation included 1,098 postpartum women who had given birth at one of the four maternity hospitals in the municipality. Data were collected from August 3, 2015, to February 2, 2016, using face-to-face interviews and data obtained from patient records and prenatal cards. The dependent variable for data analysis was the serious maternal morbidity, that is, when the woman was classified as maternal near miss or potentially life-threatening condition based on WHO eligibility criteria. The study calculated the maternal near miss ratio, odds ratio (OR), 95% confidence interval (95%CI), and multiple logistic regression. The maternal near miss ratio was 3.6 cases per 1,000 live births. Complications occurred mainly during pregnancy (53.8%), and hypertensive disorders were the most frequent (49.4%). Multiple regression analysis showed an association between serious maternal morbidity and high-risk pregnancy (OR = 4.5, 95%CI: 2.7-7.7) and induced labor (OR = 2.1, 95%CI: 1.2-3.9). The occurrence of serious maternal morbidity mainly during pregnancy, featuring hypertensive syndromes, points to the need for better screening and management of high blood pressure in the prenatal period. The association between serious maternal morbidity and high-risk pregnancy also calls attention to prenatal care, for the demand for greater care for women classified as having gestational risk. Quality of care is a key point for dealing with maternal morbidity and mortality in Brazil. Este estudio investigó los factores asociados a la morbilidad materna grave entre mujeres atendidas en maternidades públicas del municipio de Ribeirão Preto, São Paulo, Brasil. Se trata de un estudio cuantitativo, analítico, transversal. Participaron 1.098 puérperas con parto en una de las cuatro maternidades públicas del municipio. La recogida de datos se produjo entre el 3 de agosto de 2015 al 2 de febrero de 2016, mediante entrevistas cara a cara, obtención de información de los historiales y cartillas de las gestantes. Para el análisis de datos, se consideró como variable dependiente la ocurrencia de morbilidad materna grave, o sea, cuando la mujer era clasificada como near miss materno o condición potencialmente amenazadora para la vida, a partir de los criterios de elegibilidad de la Organización Mundial de Salud. Se calculó la razón del near miss materno, odds ratio (OR), intervalo de 95% de confianza (IC95%) y regresión logística múltiple. La razón de near miss materno fue de 3,6 casos por 1.000 nacidos vivos. Las complicaciones se produjeron principalmente en el embarazo (53,8%) y las alteraciones hipertensivas fueron las más frecuentes (49,4%). El análisis de regresión múltiple mostró asociación entre morbilidad materna grave y gestación de riesgo (OR = 4,5; IC95%: 2,7-7,7) y con trabajo de parto inducido (OR = 2,1; IC95%: 1,2-3,9). La ocurrencia de morbilidad materna grave, principalmente en la gestación, resaltando los síndromes hipertensivos, apunta la necesidad de un mejor rastreo y gestión de la elevación de los niveles presión arterial en el período prenatal. La asociación entre morbilidad materna grave y gestación de riesgo también se remonta al período prenatal, con el fin de que se preste una mayor atención a las mujeres clasificadas como de riesgo gestacional. La calidad de la asistencia es un punto clave para combatir la morbimortalidad materna en el país.

Resumo: Este estudo objetivou investigar a ocorrência de morbidade materna grave, os critérios diagnósticos mais frequentes e a qualidade da assistência obstétrica nos hospitais públicos de Ribeirão Preto, São Paulo, Brasil. Trata-se de uma pesquisa quantitativa de vigilância das morbidades maternas graves, utilizando os critérios da Organização Mundial da Saúde (OMS) para condições potencialmente ameaçadoras à vida e near miss materno. Os casos foram identificados entre 1º de agosto de 2015 e 2 de fevereiro de 2016. Participaram 259 mulheres com morbidade materna grave (condições potencialmente ameaçadoras à vida/near miss materno) durante o ciclo gravídico-puerperal, internadas para o parto nas quatro instituições públicas com assistência obstétrica no município. Realizou-se análise descritiva a partir das frequências absolutas e relativas dos critérios diagnósticos para condições potencialmente ameaçadoras à vida e near miss materno, além da descrição das mulheres pesquisadas (caracterização sociodemográfica, antecedentes obstétricos, assistência pré-natal e ao parto). Indicadores de qualidade da assistência estabelecidos pela OMS a partir da morbimortalidade também foram calculados. Ocorreram 3.497 partos, 3.502 nascidos vivos em todos os hospitais do município, 2 mortes maternas e 19 near miss materno. A razão do near miss materno foi de 5,4 casos por 1.000 nascidos vivos, e a razão de mortalidade materna foi de 57,1 óbitos por 100 mil nascidos vivos. A taxa de mortalidade entre os casos com desfecho materno grave (somados os casos de near miss materno e morte materna) foi de 9,5%. Observou-se importante frequência de casos de condições potencialmente ameaçadoras à vida e near miss materno no presente estudo. A ocorrência de óbitos por causas hemorrágicas mostra a necessidade de melhoria da qualidade da assistência prestada. Os resultados poderão contribuir para o aprimoramento da política local de assistência obstétrica. Abstract: This study analyzed the occurrence of severe maternal morbidity, the most frequent diagnostic criteria, and the quality of obstetric care in public hospitals in Ribeirão Preto, São Paulo State, Brazil. A quantitative surveillance survey of severe maternal morbidity used World Health Organization (WHO) criteria for potentially life-threatening conditions and maternal near miss. Cases were identified from August 1, 2015, to February 2, 2016. The sample included 259 women with severe maternal morbidity (potentially life-threatening conditions/maternal near miss) during the gestational and postpartum cycle, hospitalized for childbirth in the four public institutions providing obstetric care in the city. The descriptive analysis was based on absolute and relative rates of diagnostic criteria for potentially life-threatening conditions and maternal near miss, besides description of the women in the sample (sociodemographic characteristics, obstetric history, and prenatal and childbirth care). Quality of care indicators set by the WHO based on morbimortality were also calculated. There were 3,497 deliveries, 3,502 live births in all the hospitals in the city, two maternal deaths, and 19 maternal near miss. Maternal near miss ratio was 5.4 cases per 1,000 live births, and the maternal mortality ratio was 57.1 deaths per 100,000 live birth. The mortality rate among cases with severe maternal outcome (maternal near miss plus maternal death) was 9.5%. The study revealed important potentially life-threatening conditions and maternal near miss rates. The occurrence of deaths from hemorrhagic causes highlights the need to improve the quality of obstetric care. The findings can potentially help improve local policy for obstetric care. Resumen: El objetivo de este estudio es investigar la ocurrencia de morbilidad materna grave, así como los criterios para los diagnósticos más frecuentes y la calidad de la asistencia obstétrica en hospitales públicos de Ribeirão Preto, Sao Paulo, Brasil. Se trata de una investigación cuantitativa de vigilancia de la morbilidad materna grave, utilizando criterios de la Organización Mundial de la Salud (OMS) sobre condiciones potencialmente amenazadoras para vida y near miss materno. Los casos se identificaron entre el 1 de agosto de 2015 y 2 de febrero de 2016. Participaron 259 mujeres con morbilidad materna grave (condiciones potencialmente amenazadoras para vida/near miss materno) durante el ciclo embarazo, parto y puerperio, internadas para el parto en cuatro instituciones públicas con asistencia obstétrica en el municipio. Se realizó un análisis descriptivo, a partir de frecuencias absolutas y relativas con criterios diagnósticos para condiciones potencialmente amenazadoras para vida y near miss materno, además de la descripción de las mujeres investigadas (caracterizaciones sociodemográficas, antecedentes obstétricos, asistencia prenatal y al parto). También se calcularon indicadores de calidad de asistencia establecidos por la OMS a partir de la morbimortalidad. Se produjeron 3.497 partos, 3.502 nacidos vivos en todos los hospitales del municipio, 2 muertes maternas y 19 near miss materno. La razón del near miss materno fue de 5,4 casos por 1.000 nacidos vivos y la razón de mortalidad materna fue 57,1 óbitos por 100.000 nacidos vivos. La tasa de mortalidad entre los casos con desenlace materno grave (sumados a los casos de near miss materno y muerte materna) fue de un 9,5%. Se observó una importante frecuencia de casos de condiciones potencialmente amenazadoras para vida y near miss materno en el presente estudio. La ocurrencia de óbitos por causas hemorrágicas expone la necesidad de una mejora de la calidad en la asistencia prestada. Los resultados podrán contribuir a la mejora de la política local de asistencia obstétrica.

Background The partner has an important role when he participates of the prenatal care as showed in the positive results relate to the mother and the child health. For this reason it is an important strategy to bring future fathers closer to health services and to improve their link with paternity. Aim To evaluate whether the implementation of SMS technology, through the PRENACEL program for the partner as a health education program, is a useful supplement to the standard prenatal monitoring. Methods A parallel cluster randomized trial was carried out, with the clusters representing primary care health units. The 20 health units with the largest number of pregnant women in 2013 were selected for the study. There was a balance of the health units according to the size of the affiliated population and the vulnerability situation and these were allocated in intervention and control health units by the randomization. The partners of the pregnant women who started prenatal care prior to the 20th week of gestation were the study population of the intervention group. The participants received periodic short text messages via mobile phone with information about the pregnancy and birth. In the control group units the partners, together with the women, received the standard prenatal care. Results One hundred eighty-six partners were interviewed, 62 from the PRENACEL group, 73 from the intervention group that did not opt ​​for PRENACEL and 51 from the control group. A profile with a mean age of 30 years was found and the majority of respondents (51.3%) declared themselves as brown race/color. The interviewees presented a mean of 9.3 years of study. The majority of the men (95.2%) cohabited with their partner and 63.7% were classified as socioeconomic class C. The adherence to the PRENACEL program was 53.4%. In relation to the individual results, there was a greater participation of the PRENACEL partners in the prenatal consultations, as well as a greater presence of them accompanying the woman at the moment of the childbirth when compared to the other groups. Conclusion The study showed that a health education strategy using communication technology seems to be a useful prenatal care supplement; the intervention had a good acceptability and has a promising role in men’s involvement in prenatal, labour and postpartum care of their partners. Trial registration Clinical trial registry: RBR-54zf73, U1111–1163-7761.

AimTo evaluate prenatal care knowledge of Brazilian community health workers (CHWs).BackgroundRoutine prenatal care is critical for reducing health risks in women and their children. One of the responsibilities of primary healthcare providers is the provision of prenatal care. The CHWs, with their frequent contact with populations, work to improve health outreach efforts and therefore may be key role players in prenatal care.MethodsThis was a cross-sectional study. A questionnaire was developed to ascertain the degree of knowledge regarding prenatal care of CHWs, including: (1) general responsibilities of CHWs; (2) the initial contact with a pregnant woman; (3) examinations and vaccinations recommended for pregnant women; (4) pregnancy complications and signs of labor; and (5) lifestyle considerations for pregnant women. Responses were categorized into levels for knowledge. Demographic data were also collected. Descriptive analyses were conducted. Proportions of subjects with different levels of knowledge were compared according to each demographic variable, separately for each block of knowledge, using the χ2 and Fisher’s exact tests.FindingsIn total, 194 CHWs were interviewed. Overall, the majority of the CHWs presented high levels of knowledge in blocks 1 (43%), 2 (59%) and 5 (83%). However, in block 3 the proportions of subjects with high levels of knowledge regarding examinations and vaccinations were 35 and 40%, respectively. Only 24% of the participants presented a high level of knowledge in block 4. Stratified data analyses suggest that females were statistically more likely to have high levels of knowledge, whereas no statistically significant differences were found for the other demographic variables. Health services are already routinely using the questionnaire.ConclusionThe results suggest that CHWs, especially female CHWs, have an important role in assisting pregnant women in the community. The study indicates the areas of knowledge that require more specific attention from training providers.

ResumoOBJETIVOValidar o instrumento Body Image Relationship Scale (BIRS) em mulheres brasileiras acometidas pelo câncer de mamaMÉTODOSO instrumento foi aplicado por entrevistadoras treinadas em 139 usuárias do Sistema Único de Saúde que foram submetidas aos tratamentos do câncer entre 2006 e 2010. O instrumento foi aferido considerando-se a consistência interna e a confiabilidade. Para efeito de comparação as técnicas de análise fatorial utilizadas no artigo original foram aplicadasRESULTADOSO valor de correlação Spearman-Brown foi 0,8, o que indica alto nível de confiabilidade, e o alfa de Cronbach encontrado foi 0,9, indicando alto nível de consistência interna. A análise fatorial mostrou que quatro questões não tinham poder discriminatório e carga fatorial baixa e outras cinco foram realocadas em outros domínios. Dessa forma, foi aplicada e mostrou variabilidade semelhante ao instrumento originalCONCLUSÃOA versão brasileira do BIRS, renomeada como Escala de Relacionamento e Imagem Corporal (ERIC), apresentou evidências de adequada confiabilidade e consistência interna, o que torna esse instrumento recomendável para aplicação em mulheres brasileiras com câncer de mama, apesar de alguns poucos limites AbstractPURPOSETo validate the instrument Body Image Relationship Scale (BIRS) for Brazilian women with breast cancerMETHODSThe instrument was administered by trained interviewers to 139 women who used the Brazilian Unified Health System (SUS). All of them had been submitted to cancer treatments between 2006 and 2010. The instrument was validated considering internal consistency and reliability. In order to compare the techniques, the same factorial analysis as used in the original paper was carried outRESULTSThe Spearman-Brown correlation value was 0.8, indicating high internal reliability. The Cronbach's alpha found was 0.9, indicating a high level of internal consistency. Factorial analysis showed that four items had low factorial load and no discriminatory power, and another five items were relocated to other factors. When the instrument was applied, it showed variability to that of the original instrumentCONCLUSIONThe Brazilian version of the Body Image Relationship Scale (BIRS), namedEscala de Relacionamento e Imagem Corporal (ERIC), showed evidence of adequate reliability and internal consistency, making this instrument suitable to be recommended for application to Brazilian women with breast cancer, despite some limitations.

Background The aim of this study was to determine whether PRENACEL (a bi-directional, mobile-phone based, short text message service (SMS)) increases the coverage of recommended antenatal care (ANC) practices. Methods A parallel, cluster-randomized trial in which 20 public primary Health Care Units (PHCUs) were randomly allocated to the intervention (10 PHCUs) or control (10 PHCUs) group. The study population included pregnant women aged 18 or above with a gestational age of 20 weeks or less. Pregnant women receiving ANC in intervention PHCUs were invited through leaflets and posters to register in PRENACEL. Women who registered in PRENACEL received a weekly set of short text messages with health education and health promotion content related to pregnancy and childbirth and were also able to clarify ANC queries through SMS. All women received routine ANC. The primary outcome was the proportion of women with high ANC Score, a composite measure of coverage of recommended ANC practices. Chi-square or Fisher’s exact tests and multivariate log-binomial regression were used to analyze the outcomes. Results A total of 1210 eligible women received ANC in the participating PHCUs and took part of this study (770 in the intervention group and 440 in the control group). 20.4% (157/770) of intervention-group women registered in PRENACEL, but only 116 read all messages (73.9% of women who registered in PRENACEL, 116/157). The adjusted intention-to-treat analysis suggested no difference between intervention and control groups in the primary outcome (Adjusted Relative Risk (AdjRR): 1.05 (95% Confidence Interval (CI): 1.00–1.09). Both crude and adjusted per-protocol analysis suggested a positive effect of PRENACEL (Crude RR (95% CI): 1.14 (1.06–1.22), AdjRR (95% CI): 1.12 (1.05–1.21). The multivariate analysis also suggests that the PRENACEL group (women who read all SMS) had higher mean ANC score [48.5 (±4.2) vs 45.2 (±8.7), p

OBJECTIVE: to comprehend the psychosocial and cultural repercussions of breast cancer and its treatment on the sexuality of women.METHOD: this is a qualitative study grounded in the Sexual Scripts Theory with the participation of 23 women who were interviewed and participated in focus groups discussion.RESULTS: each category was related to a level of the sexual scripts. At the cultural scenario level a discourse on sexuality that includes definitions of sexual attractiveness and sexuality was highlighted. The interpersonal scripts level focused on the communication regarding sexuality established with the partner and with healthcare professionals category; and at the subjectivity scripts level the reports of improvement, deterioration and no change in the sexual life after cancer were analyzed.CONCLUSION: the experience of cancer involves cultural, relational, and subjective aspects that affect the sexual life, therefore, healthcare professionals should be aware of them to improve integral healthcare. OBJETIVO: compreender as repercussões psicossociais e culturais do câncer de mama e seus tratamentos na sexualidade de mulheres.MÉTODO: trata-se de estudo qualitativo, embasado na Teoria dos Scripts Sexuais com participação de 23 mulheres entrevistadas e participantes de grupos focais.RESULTADOS: cada categoria foi relacionada a um nível dos scripts sexuais. No nível cenário cultural destacou-se um discurso sobre sexualidade que inclui definições de atratividade sexual e sexualidade. No nível scripts interpessoais focaliza-se a categoria comunicação sobre sexualidade estabelecida com o parceiro e com profissionais de saúde; e no nível scripts da subjetividade analisam-se os relatos de melhora, piora e ausência de alterações na vida sexual após o câncer.CONCLUSÃO: a experiência do câncer envolve aspectos culturais, relacionais e subjetivos que interferem na vida sexual, assim, o profissional de saúde deve estar atento a eles para melhorar a atenção integral em saúde. OBJETIVO: comprender las repercusiones psicosociales y culturales del cáncer de mama y sus tratamientos en la sexualidad de las mujeres.MÉTODO: se trata de un estudio cualitativo basado en la Teoría de los Scripts Sexuales con la participación de 23 mujeres entrevistadas y participantes de grupos focales.RESULTADOS: cada categoría fue relacionada con un nivel de los scripts sexuales. En el nivel escenario cultural se destacó un discurso sobre sexualidad que incluyen definiciones de atracción sexual y sexualidad. En el nivel scripts interpersonales se enfoca la categoría comunicación sobre la sexualidad establecida con el compañero y con profesionales de la salud; y en el nivel scripts de subjetividad se analizan los relatos de mejoría, empeoramiento y sin alteraciones, de la vida sexual después del cáncer.CONCLUSIÓN: la experiencia del cáncer contiene aspectos culturales, relacionales y subjetivos que interfieren en la vida sexual, así el profesional de la salud debe estar atento a ellos para mejorar la atención integral de la salud.

This paper presents findings from a qualitative study of the impact on women's sexual lives after diagnosis and treatment for breast cancer in Ribeirao Preto, São Paulo. The study involved 36 women, 15 of whom were interviewed and the remainder of whom participated in focus and body-image group discussions. Data collection was undertaken between 2008 and 2010. Findings focus on women's experience of breast cancer as a life-threatening condition and document reappraisals of their lives in general, seeking to situate these women's sexual lives within the context of wider ideals about femininity and sexual cultures in Brazil. Women expressed anxiety concerning the effects of treatment for breast cancer, particularly concerns about body image. We draw together implications of the prior findings for the sexual scripts played out in women's sexual relationships and lives. Three main sexual scripts - 'traditional gender roles', 'ageing' and 'egalitarian pleasure-oriented' - are identified and discussed in relation to both the life-changing impact of diagnosis of cancer and wider changes in gender dimensions of Brazilian sexual culture.

Summary Introduction Breast cancer can have repercussions on the sexual experience of women due to body modifications resulting from treatments. Objective To understand how breast cancer and its treatments affect the sexuality of women by its interaction with the psychosocial and cultural aspects that permeate sexual life after treatment. Method This qualitative study was based on the theory of sexual scripts to interpret the material obtained by individual interviews with semi-structured guide, focus groups and thematic group activities. Thirty-six women who were enrolled in a supportive care center for breast cancer participated of this study. Results Three categories were identified: firstly, script of sexuality based on traditional gender roles. Sexuality is seen as restricted to sexual intercourse alone and based on strictly defined female and male social roles. In this script, breast cancer generated fear of abandonment by the partner; secondly, script of sexuality related to ageing. Connections were found between perceptions of the aging process causing changes in the sexual experience independently from changes due to breast cancer; thirdly, script of sexuality based on well-being. Here there is desire on the part of the women concerned for a sexual experience providing sexual pleasure. Some of the women perceived the decline of their sexual life as a consequence of cancer treatment. For others, their sexual life remained satisfactory thanks to partner support. Some women even reported improvement in their sexual life due to strengthening of their relationship. Conclusion Better knowledge of the psychosocial and cultural aspects that affect female sexuality after breast cancer can contribute to improvement of health care.

Resumo OBJETIVO: descrever os casos de violência contra crianças notificados no município de Ribeirão Preto-SP, Brasil. MÉTODOS: estudo descritivo com dados do Sistema de Vigilância de Violências e Acidentes (VIVA) da Secretaria Municipal de Saúde de Ribeirão Preto-SP, Brasil, no período de 2006 a 2008. RESULTADOS: foram registrados 498 casos de violência contra crianças (0-9 anos) no período, com elevação no número de notificações, de 112 em 2006 a 197 em 2008, 79,3% das notificações foram provenientes da área da Saúde, a maioria das crianças era do sexo feminino (56,4%) e apresentava idade entre dois e cinco anos (mais de 60%); prevaleceram agressores do sexo masculino (53,6%), com destaque para a figura paterna (22,7%); agressões físicas foram as mais frequentes (59,2%) e o local de maior ocorrência foi a casa da família (75,5%). CONCLUSÃO: predominaram vítimas do sexo feminino, agredidas por homens, predominantemente pais e outros familiares, na casa da família. Abstract OBJECTIVE: to describe the cases of violence against children reported in Ribeirão Preto-SP, Brazil. METHODS: this was a descriptive study using data provided by the Violence and Accidents Surveillance System (VIVA), of the Municipal Health Department of Ribeirão Preto-SP, Brazil, from 2006 to 2008. RESULTS: a total of 498 cases of violence against children (0-9 years old) were reported in the period, with an increase in the number of notifications, from 112 in 2006 to 197 in 2008; 79.3% of the notifications came from the Health area; and most children were female (56.4%), aged between two and five years old (over 60%); most aggressors were male (53.6%) and the father figure stood out (22.7%); physical aggressions were the most frequent (59.2%) and the most frequent place of the occurrence was the family household (75.5%). CONCLUSION: most victims were female, abused by men, mostly fathers and other family members, at the family household. Resumen OBJETIVO: describir los casos de violencia contra niños notificados en el municipio de Ribeirão Preto-SP, Brasil. MÉTODOS: estudio descriptivo con datos del Sistema de Vigilancia de Violencias y Accidentes (VIVA) de la Secretaria Municipal de Salud de Ribeirão Preto-SP, de 2006 a 2008. RESULTADOS: se registraron 498 casos de violencia infantil (de 0 a 9 años) en dicho periodo, aumentando las notificaciones de 112 en 2006 y 197 en 2008, siendo el 79,3% provenientes del área de salud; la mayoría de los niños era de sexo femenino (56,4%) de edad entre dos y cinco años (más de 60%); prevalecieron agresores de sexo masculino (53,6%), destacándose la figura paterna (22,7%); las agresiones físicas fueran las más practicadas (59,2%) y el lugar de mayor ocurrencia fue la casa de la familia (75.5%). CONCLUSIÓN: predominaron víctimas de sexo femenino agredidas por hombres, en gran parte padres y otros familiares en casa de la familia.

The development of new treatments has improved survival and quality of life among cancer patients. Nurses are expected to answer questions and to provide orientation regarding patients' sexuality since it is an important aspect of life. The main objective of this paper is to understand the representations of sexuality among nurses working with women who survive breast cancer after diagnosis and during treatment assuming that their representations may affect communication with the patient. This is a qualitative study using an in-depth guideline which involved interviews with 28 nurses living and working in the southeast of Brazil. The narratives were submitted to a content analysis and categories of representations were identified and are discussed here. Several representations of sexuality were found in the nurses' discourses. Some of the nurses' representations may be expected to hinder their ability to provide helpful orientation regarding the sexual lives of these patients.

Investigou-se como se desenvolve a comunicação acerca da sexualidade, estabelecida pelas enfermeiras, com as pacientes mastectomizadas. Trata-se de estudo qualitativo, do tipo descritivo-exploratório. Participaram 28 enfermeiras e foram utilizadas entrevistas em profundidade. O material foi submetido à análise de conteúdo temática. Houve variações nos discursos das enfermeiras, articuladas em quatro categorias: a enfermeira não comunica questões de sexualidade; comunica com discurso evasivo e com negação da sexualidade no cuidado; utiliza da comunicação fragmentada, própria do modelo biomédico; e se vale da comunicação acolhedora, integrada, junto a familiares e à equipe de saúde. Evidenciaram-se dificuldades das enfermeiras em contemplarem questões da sexualidade na produção dos cuidados em saúde. Espera-se que este estudo possa suscitar o interesse por novos conhecimentos acerca da interface da sexualidade e dos cuidados na formação em enfermagem, favorecendo a informação e capacitação de outros profissionais da equipe.

PURPOSE: To understand the reproductive and sexual life of women treated for breast cancer. METHODS: A total of 139 women with a diagnosis made at least 6 months ago were interviewed after being randomly selected in a rehabilitation service. The interviews were carried out between 2006 and 2010. The inclusion criteria were: to have used a rehabilitation service between 2006 and 2010, to be a Unified Health System user, to have been a patient at a regional hospital and to be resident in the area of DRS XIII-Ribeirao Preto, state of Sao Paulo. The interviewees were visited at home where a face to face questionnaire regarding sociodemographic features and questions about the disease and reproductive and sexual life was administered. For the last one, the Female Sexual Function Index instrument was used. Data were analyzed statistically by the χ2 test, Fisher exact test, Student's t test, multivariate analysis by logistic regression, factorial analysis and the Cronbach's alpha. RESULTS: Most patients had between 2 to 3 children and 80% used some contraceptive. About half of them had had sexual intercourse in the last month, 45.3% had interrupted sexual intercourse during treatment and 25.9% did not. There were reports of decreasing sexual activity, although half of the interviewees had re-started sexual life during the first six months after treatment. About half presented sexual dissatisfaction. An active sexual life is associated with being younger than 40 years of age and to have a partner. No association was found between active sexual life and diagnosis and types of treatment. CONCLUSION: Sexual activity of women treated for breast cancer is not associated with the treatments, but with age and with the opportunity of having sex.

In this study we combined quantitative (questionnaire survey of 221 health care professionals [HCPs]) and qualitative (interviews with 14 doctors) methods to explore knowledge and attitudes toward health service assistance for women victims of intimate partner violence (IPV). Data were collected in Ribeirão Preto, Brazil, in 2007. We found that most HCPs presented good knowledge of definitions of gender violence, but they had low awareness of its local prevalence, sympathetic attitudes to such women, but highlighted a range of barriers to assisting them. We analyzed these findings in relation to sex, age, profession, and years of experience.

OBJETIVO: Avaliar a satisfação dos usuários com a esterilização cirúrgica realizada pelo Sistema Único de Saúde (SUS) e detectar fatores que possam influenciar a escolha entre laqueadura e vasectomia. MÉTODOS: Foram entrevistados 235 mulheres e 78 homens esterilizados em um período de cinco anos. As variáveis estudadas incluíram as características sociodemográficas, os motivos para esterilizar-se, a facilidade para a obtenção do procedimento, o aconselhamento, a assistência hospitalar e a satisfação com a esterilização. RESULTADOS: A maioria dos entrevistados era casada ou coabitava com um companheiro(a) e tinha em média 3,4 filhos vivos. Frequentaram a escola por 6,7 anos em média e declararam renda familiar per capita média de R$ 212,81 mensais, pertenciam à categoria social C, eram brancos e católicos. Consideraram fácil obter a cirurgia e adequado o tempo de espera, ficaram satisfeitos com o aconselhamento e com a esterilização. No entanto, cerca de um quarto ainda pensava, equivocadamente, ser a esterilização de fácil reversão. Estudando-se os casais, observaram-se diferenças importantes na escolha de vasectomia e laqueadura. CONCLUSÕES: Os resultados apontam para a necessidade de melhoria na informação fornecida aos candidatos ao procedimento que, embora estejam satisfeitos no momento, poderão não estar no futuro. A avaliação realizada na perspectiva do usuário deve levar em consideração não apenas a sua opinião, mas também seus interesses. OBJECTIVES: To evaluate the satisfaction with the surgical sterilization performed by Unified Health System (SUS) and to detect factors that can influence the choice between tubal ligation and vasectomy. METHODS: A total of 235 women and 78 men who were sterilized in a five years time period were interviewed. The studied variables included their socio-demographic features, their reason for sterilization, their opinion on the access to the surgery, the counseling, hospital services and the satisfaction with the procedure. RESULTS: Most were married or lived together, had an average of 3.4 living children and a mean of 6.7 years of schooling. They declared that the average monthly per capita income was R$ 212.81. The most of them belonged to the social status C. They were white and Catholics. The most of them found easy to obtain the surgery and the waiting time was appropriate. They become satisfied with the counseling and 99% were satisfied with sterilization. However, one fourth, incorrectly, found that sterilization was easy to reverse. A study on the couples showed important differences on choosing vasectomy or tubal ligation. CONCLUSIONS: The results show that it is necessary for improvement in the information provided to the candidates to sterilization. Although they are satisfied now, they could not be in the future. The evaluation from the perspective of the health service user should take into account not only their opinion, but also their interests.

RACIONAL: A adesão ao tratamento medicamentoso nas doenças inflamatórias intestinais apresenta grande importância clínica e social. Porém, são escassos os estudos sobre este tema em nosso meio. OBJETIVO: Investigou-se a adesão ao tratamento medicamentoso prescrito, bem como a influência de alguns fatores sobre a adesão, de pacientes com doenças inflamatórias intestinais em acompanhamento em ambulatório de Gastroenterologia de um hospital universitário ligado ao Sistema Único de Saúde (SUS). MÉTODO: Realizou-se estudo transversal, com métodos indiretos, para avaliar a adesão ao tratamento de 26 casos da doença de Crohn, 26 pacientes com retocolite ulcerativa e 4 com colite indeterminada, que faziam uso contínuo de medicamentos, dos quais 89,3% eram fornecidos pelo SUS. Os pacientes foram classificados como tendo alto ou baixo grau de adesão, com base em dois diferentes instrumentos. RESULTADOS: A análise dos medicamentos utilizados revelou baixa adesão em 15,4% de pacientes com doença de Crohn e 13,3% com retocolite ulcerativa. Porém, o teste de Morisky, que avalia hábitos de uso dos medicamentos, mostrou 50% de baixa adesão na doença de Crohn e 63,3% na retocolite ulcerativa. Análise univariada evidenciou na doença de Crohn relação entre baixa adesão e maior duração da doença, estado marital instável, residência próxima ao hospital e envolvimento do cólon. Na retocolite ulcerativa observou-se relação entre baixa adesão e atividade da doença e maior número de medicamentos em uso. Porém, a análise multivariada não evidenciou relação estatisticamente significativa que indicasse influência de qualquer fator sobre a adesão ao tratamento. CONCLUSÕES: Proporções elevadas de pacientes com doenças inflamatórias intestinais apresentam hábitos de uso de medicamentos indicativos de baixa adesão, difíceis de prever a partir de dados demográficos e clínicos, o que aponta para a necessidade de maior atenção dos profissionais de saúde a este importante aspecto do tratamento. BACKGROUND: Compliance to drug therapy is important for a successful treatment. Although many studies have assessed compliance to treatment in patients with chronic diseases, few investigations have been carried out in inflammatory bowel diseases. AIM: To assess compliance to drug therapy in patients with inflammatory bowel diseases - Crohn's disease and ulcerative colitis -, followed at a university hospital, who had prescribed medication supplied by the Brazilian National Health System. METHODS: In a cross sectional study, a structured interview was applied to assess the compliance of 26 Crohn's disease patients, 26 ulcerative colitis patients and 4 cases with undetermined colitis. Patients were characterized as presenting higher or lower degree of compliance, based on the comparison of the information provided by the patient in the interview and data in the medical records. The Morisky test was also used to assess the behavioral pattern of the patient regarding the daily use of the medication. RESULTS: The interview showed that 15.4% of patients with Crohn's disease and 13.3% of those with ulcerative colitis could be regarded as less compliant. However, the Morisky test revealed lower compliance in 50% of patients with Crohn's disease and 63.3% of those with ulcerative colitis. Univariate analysis showed an association between low compliance and long disease duration, married status and colon involvement in Crohn's disease, and between low compliance and increased disease activity and greater number of medications in ulcerative colitis. However, multivariate analysis did not confirm any association between low compliance and any demographic or clinical factor. CONCLUSIONS: A high degree of noncompliance to treatment, linked to habitual behavior and hard to predict from demographic or clinical factor, was detected in inflammatory bowel disease patients, which suggests the need for investment in patient education regarding medication use.

Esta investigação objetivou identificar o conhecimento de adolescentes sobre as DST, formas de transmissão, uso do preservativo e cuidado em saúde. Trata-se de um estudo transversal com entrevistas de 90 adolescentes do Programa Saúde da Família de Ribeirão Preto, São Paulo, Brasil. A coleta de dados realizou-se através de entrevistas domiciliares utilizando um questionário estruturado, e a análise preliminar por meio da freqüência simples das variáveis. A maioria das entrevistadas era solteira, iniciou a vida sexual e apresentava um conhecimento baixo das DST. O preservativo foi identificado como a principal forma de prevenção das DST e apenas 35,2% referiram seu uso sistemático; comparando-se a primeira e última relações sexuais observou-se grande queda no uso (71,1% e 37,1%, respectivamente). As adolescentes não se percebem em risco de adquirir uma DST (65,5%), no entanto, 57,8% tiveram sintomas relacionados a estas doenças e 36,7% nunca tiveram atendimento ginecológico. Os resultados apontam para a necessidade de uma atenção diferenciada, pois além de apresentarem pouco conhecimento sobre as DST, as adolescentes estão em situação vulnerável pela ausência efetiva de métodos, embora não se percebam nesta condição.

NICHD NIH HHS World Health Organization ObjectiveTo generate a global reference for caesarean section (CS) rates at health facilities. DesignCross-sectional study. SettingHealth facilities from 43 countries. Population/SampleThirty eight thousand three hundred and twenty-four women giving birth from 22 countries for model building and 10045875 women giving birth from 43 countries for model testing. MethodsWe hypothesised that mathematical models could determine the relationship between clinical-obstetric characteristics and CS. These models generated probabilities of CS that could be compared with the observed CS rates. We devised a three-step approach to generate the global benchmark of CS rates at health facilities: creation of a multi-country reference population, building mathematical models, and testing these models. Main outcome measuresArea under the ROC curves, diagnostic odds ratio, expected CS rate, observed CS rate. ResultsAccording to the different versions of the model, areas under the ROC curves suggested a good discriminatory capacity of C-Model, with summary estimates ranging from 0.832 to 0.844. The C-Model was able to generate expected CS rates adjusted for the case-mix of the obstetric population. We have also prepared an e-calculator to facilitate use of C-Model (). ConclusionsThis article describes the development of a global reference for CS rates. Based on maternal characteristics, this tool was able to generate an individualised expected CS rate for health facilities or groups of health facilities. With C-Model, obstetric teams, health system managers, health facilities, health insurance companies, and governments can produce a customised reference CS rate for assessing use (and overuse) of CS. Tweetable abstractThe C-Model provides a customized benchmark for caesarean section rates in health facilities and systems. Tweetable abstract The C-Model provides a customized benchmark for caesarean section rates in health facilities and systems. Univ Sao Paulo, Ribeirao Preto Med Sch, Dept Social Med, Av Bandeirantes, BR-3900 Ribeirao Preto, Brazil WHO, World Bank Special Programme Res Dev & Res Traini, UNDP UNFPA UNICEF WHO, Dept Reprod Hlth & Res, CH-1211 Geneva, Switzerland Univ Paris 05, Sorbonne Paris Cite, UMR 216, Inst Dev Res, Paris, France WHO Reg Off Amer, Women & Reprod Hlth CLAP WR, Latin Amer Ctr Perinatol, Montevideo, Uruguay Emory Univ, Rollins Sch Publ Hlth, Dept Epidemiol, Atlanta, GA 30322 USA Paris Descartes Univ, Ctr Epidemiol & Biostat, Obstetr Perinatal & Pediat Epidemiol Res Team, Inserm U1153, Paris, France Natl Inst Publ Hlth, Ctr Populat Hlth Res, Cuernavaca, Morelos, Mexico Univ Technol, Fac Hlth, Sydney, NSW, Australia Natl Ctr Child Hlth & Dev, Dept Hlth Policy, Tokyo, Japan Ctr Rosarino Estudios Perinat, Rosario, Argentina Lindsay Stewart R&D Ctr, Off Res & Clin Audit, Royal Coll Obstetricians & Gynaecologists, London, England London Sch Hyg & Trop Med, Dept Hlth Serv Res & Policy, London WC1, England Shanghai Jiao Tong Univ, Sch Med, Xinhua Hosp, Shanghai Key Lab Childrens Environ Hlth,Minist Ed, Shanghai 200030, Peoples R China Univ Estadual Campinas, Sch Med Sci, Dept Obstet & Gynaecol, Campinas, SP, Brazil Family Hlth Bur, Minist Hlth, Colombo, Sri Lanka Fiocruz MS, ENSP, BR-21045900 Rio De Janeiro, Brazil Natl Inst Hlth & Welf, Helsinki, Finland Univ Tokyo, Grad Sch Med, Dept Paediat, Tokyo, Japan Bayer Krankenhausgesellschaft, Bayer Arbeitsgemeinschaft Qualitatssicherun Stati, Munich, Germany Khon Kaen Univ, Fac Med, Dept Obstet & Gynecol, Khon, Kaen, Thailand Univ Sao Paulo, Ribeirao Preto Med Sch, Dept Obstet & Gynaecol, BR-14049 Ribeirao Preto, Brazil Minist Sante, Direct Sante Famille, Ouagadougou, Burkina Faso Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA Univ Mongolia, Hlth Sci, Sch Publ Hlth, Ulaanbaatar, Mongol Peo Rep GLIDE Tech Cooperat & Res, Ribeirao Preto, SP, Brazil Univ Sao Paulo, Ribeirao Preto Med Sch, Dept Paediat, BR-14049 Ribeirao Preto, SP, Brazil Univ Calif San Francisco, Dept Obstet & Gynaecol & Global Hlth Sci, San Francisco, CA 94143 USA Khon Kaen Univ, Fac Publ Hlth, Dept Biostat & Demog, Khon Kaen, Thailand Univ Fed Sao Paulo, Sch Med Sao Paulo, Dept Obstet, Sao Paulo, Brazil Inter Amer Dev Bank, Social Protect & Hlth Div, Mexico City, DF, Mexico Fortis Mem Res Inst, Gurgaon, Haryana, India Hosp Nacl Itaugua, Itaugua, Paraguay Univ Fed Sao Paulo, Sch Med Sao Paulo, Dept Obstet, Sao Paulo, Brazil NICHD NIH HHS: T32 HD052460 World Health Organization: 001 Web of Science

Forty percent of Brazilian married women from 15 to 49 years of age have undergone surgical sterilization. The 1988 Brazilian Constitution states that all scientifically proven contraceptive methods should be available to all citizens, but it was only in 1997 that specific family planning legislation was approved. This study examines physicians' perceptions and attitudes towards the current provision of female sterilization and its legal implications, as well as women's experience with obtaining and undergoing sterilization. The study design included: (1) an investigation of the hospitals and health professionals and (2) a survey of women sterilized in combination with cesarean delivery in 1998. The survey showed they had a median of 3 living children, 60.0% had been sterilized between 30 and 39 years of age, and 61.0% had paid for the procedure. Many women reported previous method failure and adverse effects with hormonal contraceptives. Women with less schooling and lower socioeconomic status had more children and had begun childbearing and had been sterilized at younger ages than women with more schooling and higher socioeconomic status. Inequalities related to reproduction were strongly associated with teenage pregnancy and inadequate knowledge about contraceptives. Quarenta por cento das mulheres brasileiras casadas de 15 a 49 anos de idade estão esterilizadas. A Constituição Brasileira de 1988 afirma que todos os métodos científicos de contracepção devam estar disponíveis para qualquer cidadão(ã), mas foi somente em 1997 que a regulamentação legal do planejamento familiar foi aprovada. Este estudo examinou as percepções e atitudes dos médicos em relação à oferta atual da esterilização feminina e suas implicações legais, e a experiência das mulheres em obter o procedimento. O desenho do estudo compreende: (1) uma investigação dos hospitais e profissionais de saúde e (2) uma pesquisa com mulheres esterilizadas durante parto cesariano em 1998. Elas tinham em média três filhos vivos, 60,0% foram esterilizadas entre 30 e 39 anos de idade, e 61,0% pagaram pela laqueadura. Muitas relataram falhas de métodos e efeitos adversos com o uso de contraceptivos hormonais. Mulheres de nível educacional e social mais baixo relataram maior paridade, começaram a ter filhos e foram esterilizadas mais jovens do que as mulheres com nível educacional e social mais alto. As desigualdades em torno da reprodução encontram-se fortemente associadas com gravidez na adolescência e baixo nível de conhecimento sobre métodos anticoncepcionais.

The World Health Organization is developing the 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11), planned for publication in 2017. The Working Group on the Classification of Sexual Disorders and Sexual Health was charged with reviewing and making recommendations on disease categories related to sexuality in the chapter on mental and behavioural disorders in the 10th revision (ICD-10), published in 1990. This chapter includes categories for diagnoses based primarily on sexual orientation even though ICD-10 states that sexual orientation alone is not a disorder. This article reviews the scientific evidence and clinical rationale for continuing to include these categories in the ICD. A review of the evidence published since 1990 found little scientific interest in these categories. In addition, the Working Group found no evidence that they are clinically useful: they neither contribute to health service delivery or treatment selection nor provide essential information for public health surveillance. Moreover, use of these categories may create unnecessary harm by delaying accurate diagnosis and treatment. The Working Group recommends that these categories be deleted entirely from ICD-11. Health concerns related to sexual orientation can be better addressed using other ICD categories.L'Organisation mondiale de la Santé est en train de mettre au point la 11e révision de laLa Organización Mundial de la Salud está desarrollando la undécima revisión de laتقوم منظمة الصحة العالمية بوضع المراجعة الحادية عشرة للتصنيف الإحصائي الدولي للأمراض والمشكلات المتعلقة بالصحة (ICD-11)، المخطط نشرها عام 2017. وتم تكليف الفريق العامل المعني بتصنيف الاضطرابات الجنسية وجوانب الصحة الجنسية بمسؤولية مراجعة وإصدار التوصيات بشأن فئات الأمراض ذات الصلة بالميول الجنسية في الفصل المعني بالاضطرابات النفسية والسلوكية في المراجعة العاشرة (ICD-10)، التي تم نشرها عام 1990. ويشمل هذا الفصل فئات التشخيصات المستندة بشكل أساسي على التوجه الجنسي رغم إقرار المراجعة العاشرة للتصنيف الإحصائي الدولي للأمراض والمشكلات المتعلقة بالصحة بأن التوجه الجنسي وحده ليس اضطراباً. وتستعرض هذه المقالة البيّنات العلمية والأساس المنطقي السريري للاستمرار في إدراج هذه الفئات في التصنيف الإحصائي الدولي للأمراض. وتوصلت مراجعة البيّنات التي يتم نشرها منذ عام 1990 إلى وجود قدر ضئيل من الاهتمام العلمي بهذه الفئات. بالإضافة إلى ذلك، لم يجد الفريق العامل أي بيّنات تشير إلى أنها مفيدة سريرياً: لا تسهم في إيتاء الخدمات الصحية أو اختيار العلاج ولا توفر معلومات أساسية لترصد الصحة العمومية. علاوة على ذلك، من الممكن أن يتسبب استخدام هذه الفئات في أضرار غير لازمة عن طريق تأجيل التشخيص الدقيق والعلاج. ويوصي الفريق العامل بحذف هذه الفئات بالكامل من المراجعة الحادية عشرة للتصنيف الإحصائي الدولي للأمراض والمشكلات المتعلقة بالصحة. ويمكن التعامل مع مخاوف الصحة ذات الصلة بالتوجه الجنسي بشكل أفضل باستخدام فئات التصنيف الإحصائي الدولي للأمراض.世界卫生组织正在进行《疾病和有关健康问题的国际统计分类》(ICD-11)的第11次修订,修订版计划于2017年公布。性疾病和性卫生分类工作组负责审查1990年公布的第10次修订(ICD-10)中有关精神和行为障碍章节中与性相关的疾病分类,并提出建议。该章包括主要基于性取向的诊断类别,尽管ICD-10指出性取向本身并不是一种疾病。本文综述了继续在ICD包含这些类别的科学证据和临床理由。针对1990年以来的证据发表一篇综述几乎找不到这些类别有什么科学意义。此外,工作组也没有找到证据表明这些类别在临床上有用:既无益于健康服务交付或治疗选择,对公共卫生监测也没有提供重要信息。此外,使用这些类别可能因为推迟准确的诊断和治疗而产生不必要的伤害。工作组建议在ICD-11中完全删除这些类别。与性取向相关的健康问题可以使用其他ICD类别更好地解决。Всемирная организация здравоохранения разрабатывает 11-ю редакцию

The scope of this paper is to identify the experience, attitudes and impressions of health care professionals (HCPs) in addressing the needs of women patients suffering from intimate partner violence (IPV). In-depth interviews were conducted with 14 doctors and 11 nurses in Ribeirão Preto. Results show that there is an 'apparent invisibility' of IPV, the convenience of a tacit compact of silence about such violence on the part of women and HCPs. We studied the reasons given by HCPs for failing to deal with IPV. We also addressed the health service facility context, and the diversity of the professioinals' responses to violence, with indications of the emergence of a more proactive and positive stance. Qualitative data analysis highlights previous survey findings. A positive response from HCPs shows that there is perhaps some change from a narrow, medically-focused model of health care, to a more broadly defined social model. Objetivos: Identificar a experiência, as atitudes e os sentimentos dos profissionais de saúde (PS) quando abordam as necessidades de mulheres que sofrem violência do parceiro íntimo (VPI). Método: Foram realizadas entrevistas em profundidade com 14 médicos e 11 enfermeiras em Ribeirão Preto. Resultados: Há uma aparente invisibilidade e a conveniência de um acordo tácito de silêncio por parte da mulher e do PS; exploramos as razões dadas por eles para esta inabilidade em atender VPI. Também abordamos o contexto dos serviços de saúde, a diversidade de respostas dos profissionais e a emergência uma postura mais proativa e positiva. Discussão: A análise qualitativa realça os resultados de um inquérito prévio. Uma resposta positiva mostra que talvez haja algumas mudanças de perspectiva de um modelo medicalizado de cuidado à saúde para um modelo mais abrangente ou integral que define saúde como social.

Cross-sectional study compares the perception and attitudes about violence against women of physicians and nurses working in the primary health care clinics in Ribeirão Preto, SP. A total of 170 physicians and 51 nurses were interviewed in the District Health Clinics. Physicians feel more comfortable than nurses to talk about the sex life of patients (P = 0.048) and to investigate the use of drugs (0.001). Compared to the nurses greater number of physicians believed that the aggression to the woman by the husband should be treated as a medical problem (P = 0.000). Both believe that external factors, as alcohol or drug abuse, unemployment, and psychological problems of the husband and not of the victim, can cause violent acts. Most interviewees understand that gender violence exceeds the issues of individuality and privacy and has become a public health problem, by the dimension present in the social relationships.

OBJETIVOS: descrever o conhecimento dos enfermeiros das Unidades Distritais Básicas de Saúde do município de Ribeirão Preto, SP, Brasil, acerca da violência contra a mulher, particularmente aquela cometida pelo parceiro íntimo. MÉTODOS: estudo quantitativo, transversal e descritivo. Participaram 51 enfermeiros, extraídos de um estudo maior com 221 profissionais de saúde. Os dados foram coletados por meio de questionário que investigava o conhecimento em relação à violência cometida contra as mulheres. RESULTADOS: os enfermeiros acertaram de 76% a 90,2% das questões sobre definição de violência de gênero e 78% obtiveram altos escores em questões sobre epidemiologia da violência; no entanto, 70,6% demonstraram desconhecer sua epidemiologia nos serviços de pré-natal. 83,7% dos enfermeiros demonstraram bom conhecimento sobre como abordar as vítimas para obter a revelação da violência ocorrida e 52% demonstraram conhecimento elevado sobre o manejo dos casos. CONCLUSÕES: os enfermeiros conhecem bem a definição de violência, têm conhecimentos sobre o manejo de casos, a necessidade de notificação e encaminhamentos de casos em situação de risco. Entretanto, desconhecem características epidemiológicas importantes da violência contra a mulher, o que pode ser uma barreira para a atuação dos enfermeiros no atendimento a mulheres em situação de risco, principalmente durante a atenção no pré-natal. OBJECTIVES: to outline what nurses from the District Basic Care Units of the municipality of Ribeirão Preto, in the Brazilian State of São Paulo, know about violence against women, especially that perpetrated by an intimate partner. METHODS: a quantitative, cross-sectional, descriptive study was carried out with 51 nurses drawn from a larger study of 221 health workers. The data were collected using a questionnaire that asked about their knowledge regarding violence against women. RESULTS: the nurses correctly answered 76% to 90.2% of the questions on the definition of gender violence and 78% obtained high scores on questions relating to the epidemiology of violence. However, 70.6% showed no knowledge of the epidemiology of violence in prenatal services. 83.7% of the nurses showed good knowledge of how to deal with victims to get them to report the abuse and 52% showed a good knowledge of case management. CONCLUSIONS: nurses are well aware of what violence is and have knowledge about how to manage cases and the need to report abuse and refer women who are at risk. However, they are unaware of important epidemiological features of violence against women, which may pose an obstacle to their ability to attend women at risk, especially during prenatal care.

Os principios norteadores da assistencia a saude sexual e reprodutiva das mulheres sao: liberdade, igualdade e dignidade da pessoa humana, e nenhuma forma de discriminacao ou restricao de acesso deve ser admitida. Esses principios foram reconhecidos pelas Conferencias das Nacoes Unidas, das quais o Brasil e signatario. A autodeterminacao reprodutiva e sexual e parte integrante, inalienavel e indivisivel dos direitos humanos e nenhuma mulher deve ser sujeita a violencia de genero ou a gravidez forcada, sendo estas incompativeis com a dignidade e o valor humano. A Conferencia Mundial sobre Direitos Humanos, realizada em Viena, em 1993, a Conferencia Internacional de Populacao e Desenvolvimento do Cairo, em 1994, e a Conferencia Mundial sobre a Mulher, em Beijing, em 1995, reconhecem esses direitos para garantir a saude sexual e reprodutiva e reconhecem que o aborto inseguro deve ser tratado de forma humana e solidaria. No Brasil, o aborto legal e um direito humano das mulheres que sofreram violencia sexual ou se nao ha outro meio de salvar a vida da mulher, reconhecido pela legislacao brasileira, que nao considera crime ou pune o aborto provocado nessas situacoes (artigo 128 do Codigo Penal). Alem disso, ha jurisprudencia para casos de interrupcao de gravidez quando ha malformacao fetal incompativel com a vida, com o consentimento da mulher. Apesar de esta legislacao existir desde 1940, o acesso ao aborto legal tem sido restrito e enfrenta varios obstaculos. Estudo realizado sobre as internacoes hospitalares no Brasil, de 2002 a 2006, mostra um numero medio anual de 231 mil internacoes de casos relacionados ao abortamento ou suas complicacoes, dos quais menos de 1% sao identificadas como abortos legais. Em pesquisa realizada em 56 hospitais publicos brasileiros, estaduais, municipais e universitarios em 2005, em 19 deles nao foi obtida a informacao sobre este tipo de atendimento, embora o hospital estivesse na lista fornecida pelo Ministerio da Saude para o aborto legal. Segundo Duarte et al., durante muito tempo apenas a interrupcao da gravidez por risco de morte da gestante era praticada nos hospitais, enquanto as mulheres vitimas de violencia sexual recorriam ao aborto clandestino. Evidentemente que a questao do aborto inseguro se coloca, ja que sao estimados cerca de um milhao de abortos clandestinos por ano no pais. Um estudo financiado pelo Ministerio da Saude, em 2002, mostrou que a mortalidade materna