Women`s opinions about mode of birth in Brazil: a qualitative study in a public teaching hospital

Objective: to describe women`s feelings about mode of birth. Design: exploratory descriptive design. Semi-structured interviews were conducted using a questionnaire that had been developed previously (categorical data and open-and closed-ended questions). Qualitative analysis of the results was performed through a context analysis technique. Setting: the largest public university hospital in Brazil. Participants: 48 women in their third trimester of pregnancy. Findings: most women expressed a preference for vaginal birth, as they perceived that they would have a faster recovery. Women who expressed a preference for caesarean section did so because of lack of pain during the birth and the need for tubal sterilisation. The majority of women considered it important to have experience with a mode of birth in order to choose a preference. Complications associated with maternal illness were very influential in the decision-making process. Key conclusions: these results provide a useful first step towards the identification of aspects of women`s feelings about modes of birth. Most women expressed a preference for vaginal birth. Further exploration of women`s feelings regarding parturition and the decision-making process is required. (C) 2008 Elsevier Ltd. All rights reserved.

Oral Health in Brazil - Part I: public oral health policies

This paper reviews the historical development of public health policies in Brazil and the insertion of oral health in this context. Since 1988, Brazil established a Unified National Health System ("Sistema Único de Saúde" - SUS), which was conceived to assure access to health actions and services, including oral health. However, a history of lack of access to health services and the health problems faced by the Brazilian population make the process of building and consolidating the SUS extremely challenging. Since 2004, the Oral Health National Policy has proposed a reorientation of the health care model, supported by an adaptation of the working system of Oral Health teams so that they include actions of health promotion, protection and recovery. Human resources should be prepared to act in this system. The qualifying process must take in consideration knowledge evolution, changes in the work process and changes in demographical and epidemiological aspects, according to a perspective of maintaining a balance between technique and social relevance.

Economic impact of treatment for surgical site infections in cases of total knee arthroplasty in a tertiary public hospital in Brazil

The aim of this study was to estimate the additional cost of treatment of a group of nosocomial infections in a tertiary public hospital. A retrospective observational cohort study was conducted by means of analyzing the medical records of 34 patients with infection after total knee arthroplasty, diagnosed in 2006 and 2007, who met the criteria for nosocomial infection according to the Centers for Disease Control and Prevention. To estimate the direct costs of treatment for these patients, the following data were gathered: length of hospital stay, laboratory tests, imaging examinations, and surgical procedures performed. Their costs were estimated from the minimum values according to the Brazilian Medical Association. The estimated cost of the antibiotics used was also obtained. The total length of stay in the ward was 976 days, at a cost of US$ 18,994.63, and, in the intensive care unit, it was 34 days at a cost of US$ 5,031.37. Forty-two debridement procedures were performed, at a cost of US$ 5,798.06, and 1965 tests (laboratory and imaging) were also performed, at a cost of US$ 15,359.25. US$ 20,845.01 was spent on antibiotics and US$ 1,735.16 on vacuum assisted closure therapy, microsurgical flaps, implant removal, spacer use, and surgical revision. The total additional cost of these cases of hospital infection in 2006 and 2007 was of US$ 91,843.75. Based on that, we demonstrate that the high cost of treatment for hospital infections emphasizes the importance of taking measures to prevent and control hospital infection.

Mudanças no Código Florestal e seu impacto na ecologia e diversidade dos mamíferos no Brasil

Os ecossistemas florestais do Brasil abrigam um dos mais altos níveis de diversidade de mamíferos da Terra, e boa parte dessa diversidade se encontra nas áreas legalmente protegidas em áreas de domínio privado. As reservas legais (RLs) e áreas de proteção permanente (APPs) representam estratégias importantes para a proteção e manutenção dessa diversidade. Mudanças propostas no Código Florestal certamente trarão efeitos irreversíveis para a diversidade de mamíferos no Brasil. Os mamíferos apresentam papéis-chave nos ecossistemas, atuando como polinizadores e dispersores de sementes. A extinção local de algumas espécies pode reduzir os serviços ecológicos nas RLs e APPs. Outra consequência grave da redução de áreas de vegetação nativa caso a mudança no Código Florestal seja aprovada será o aumento no risco de transmição de doenças, trazendo sério problemas a saúde pública no Brasil.

A revision of the Neotropical Solenopsidini ant genus Oxyepoecus Santschi, 1926 (Hymenoptera: Formicidae: Myrmicinae): 2. Final. Key for species and revision of the Rastratus species-group

In the first paper of this series (Albuquerque & Brandão, 2004) we revised the Vezenyii species group of the exclusively Neotropical solenopsidine (Myrmicinae) ant genus Oxyepoecus. In this closing paper we update distribution information on the Vezenyii group species and revise the other Oxyepoecus species-group (Rastratus). We describe two species (Oxyepoecus myops n. sp. and O. rosai n. sp.) and redescribe previously known species of the group [O. daguerrei (Santschi, 1933), O. mandibularis (Emery, 1913), O. plaumanni Kempf, 1974, O. rastratus Mayr, 1887, and O. reticulatus Kempf, 1974], adding locality records and comments on the meagre biological data of these species. We also present an identification key to Oxyepoecus species based on workers.

Complex networks: the key to systems biology

Though introduced recently, complex networks research has grown steadily because of its potential to represent, characterize and model a wide range of intricate natural systems and phenomena. Because of the intrinsic complexity and systemic organization of life, complex networks provide a specially promising framework for systems biology investigation. The current article is an up-to-date review of the major developments related to the application of complex networks in biology, with special attention focused on the more recent literature. The main concepts and models of complex networks are presented and illustrated in an accessible fashion. Three main types of networks are covered: transcriptional regulatory networks, protein-protein interaction networks and metabolic networks. The key role of complex networks for systems biology is extensively illustrated by several of the papers reviewed.

Vigilância de eventos adversos pós-vacinação e segurança de programas de imunização

O objetivo da revisão foi analisar aspectos conceituais e operacionais de sistemas de vigilância de eventos adversos pós-vacina. Foram incluídos artigos disponíveis em formato eletrônico, publicados entre 1985 e 2009, selecionados nas bases Medline/PubMed, com as palavras-chave: "adverse events following vaccine", "adverse events following vaccine surveillance", "post-marketing surveillance" e "safety vaccine" e "Phase IV clinical trials", e excluídos aqueles com foco em tipos específicos desses eventos. Foram apontados os principais aspectos que justificam a importância dos eventos adversos pós-vacina em saúde pública, os instrumentos que garantem a segurança das vacinas e as finalidades, atributos, tipos, interpretações de dados, limitações e novos desafios da vigilância de eventos adversos pós-vacina, bem como estratégias para aumentar sua sensibilidade. A revisão é concluída com desafios para os próximos anos, visando à segurança e confiabilidade dos programas de vacinação.

Recommendations for folate intake in women: implications for public health strategies

Folate deficiency has been associated with anemia and other adverse outcomes in pregnancy such as neural tube defects. The current recommendations for prevention of such outcomes are difficult to achieve through diet only, and folic acid supplementation and food fortification are feasible public health strategies. However, it is necessary to determine the usual diet and supplement use among women of reproductive age, including an accurate assessment of other dietary micronutrients. In addition to the beneficial effects observed in randomized clinical trials, health risks to the population have also been widely evaluated and discussed in the scientific community: for a minority to benefit from fortification programs, many are exposed to high folic acid intake levels.

Política de saúde e gestão no processo de (re)construção do SUS em município de grande porte: um estudo de caso de São Paulo, Brasil

O processo de (re)construção do SUS no Município de São Paulo, Brasil, foi analisado, no período de 2001- 2008, por meio de estudo de caso, utilizando-se distintas fontes: documentos; entrevistas com informantes-chave e observação participante. Os conceitos de política de saúde e de gestão em saúde foram utilizados na qualidade de categorias analíticas. Foram selecionadas e analisadas apenas políticas priorizadas pela gestão iniciada em 2001 e que tiveram sustentação até 2008. Discutem-se desafios para a (re)construção do SUS no município relacionados com o contexto político-institucional e com mudanças de estrutura implementadas. As reorganizações da Secretaria Municipal de Saúde de São Paulo propiciaram a constituição e manutenção de dois subsistemas municipais, um hospitalar e outro ambulatorial. Negociações entre os governos municipal, estadual e federal não avançaram para que o município assumisse a gestão de fato de todo sistema de saúde, constatando-se a coexistência de três subsistemas públicos de saúde paralelos: dois municipais e um estadual. A sustentação política do Programa Saúde da Família foi associada ao fato de que esse programa não se constituiu como marca da primeira gestão municipal e, ainda, de ser política prioritária e estimulada pelo governo federal.

Trends in morbid obesity and in bariatric surgeries covered by the Brazilian public health system

Background Obesity is an increasingly serious public health problem on a global level. Morbid obesity, defined as a body mass index greater than 40 kg/m2, is associated with increased mortality and a high burden of obesity-related morbidities. Methods To study the prevalence of morbid obesity in Brazil, three national anthropometric surveys were reanalyzed. Data about bariatric surgeries were obtained from the Ministry of Health Hospital Information System, which is available online. Results A 255% rise in the prevalence of morbid obesity was observed, starting at 0.18% in 1975-1976 and growing to 0.33% in 1989 and 0.64% in 2002-2003. There was a higher rate in the South in the first two surveys, but the prevalence in the Southeast rose steadily, reaching 0.77% in 2002-2003 and overtaking the South. Since 1999, the Brazilian Unified Health System has covered surgical treatment for morbid obesity. From 2000 to 2006, there was a sixfold increase in the number of surgeries, which topped the 2,500 mark in 2006. The geographic distribution of these surgeries is heavily concentrated in the Southeast, the most developed region of Brazil, where there is also the highest prevalence of morbid obesity. This was followed by the Southern region. Conclusions The figures for the rise in morbid obesity in Brazil are startling, especially the increase among men. This is a situation that calls for further study, alongside measures to encourage the adoption of healthy lifestyles. Preventive measures aimed at slowing down or reversing the obesity epidemic are urgently required

Barreiras às intervenções relacionadas à saúde do trabalhador do setor saúde no Brasil

OBJETIVO: Identificar na literatura situações que possam impedir ou prejudicar as ações de prevenção de acidentes e doenças ou de promoção da saúde de trabalhadores do setor saúde. MÉTODO: Foi realizada uma revisão da literatura utilizando a base SciELO para o período de 1967 a 2008, complementada por busca na base PubMed para o período de 1950 a 2008. Os seguintes termos foram utilizados para identificar artigos em português, inglês e espanhol: trabalho, trabalhador, ocupacional, riscos, doenças, ergonomia, capacidade para o trabalho, qualidade de vida, organização, acidentes, condições de trabalho, intervenção e administração. Foram selecionados artigos sobre prevenção de doenças e acidentes e sobre promoção da saúde no trabalho em serviços de saúde latino-americanos. Também foram selecionados artigos sobre intervenções em ambientes de trabalho no setor saúde. RESULTADOS: Foram identificadas as seguintes situações desfavoráveis: programas de intervenção sem boa base teórica e não integrados à gestão do serviço como um todo; falhas em avaliar a eficácia das intervenções; vigilância da saúde restrita a doenças e agravos específicos; falta de compromisso da gestão com as intervenções; falhas na comunicação; falta de participação e controle por parte dos trabalhadores sobre o ambiente de trabalho; e programas e intervenções baseados exclusivamente na mudança comportamental dos trabalhadores. CONCLUSÕES: A literatura mostra que todas as barreiras citadas afetam tanto a melhoria do estado de saúde dos trabalhadores em saúde quanto a sua capacidade para o trabalho

Mothers’ birth care experiences in a Brazilian birth centre

Objective: to explore the reasons why women with previous hospital experience seek care at a birth centre, and their perceptions related to the care received in both settings. Design, setting and participants in-depth interviews focusing on the care experiences of 18 women who received birth care in a birth centre of the Brazilian public health system. Findings: three key themes emerged from the analysis: ‘Confrontation with strong problems in the hospital setting’, ‘Reasons to seek the birth centre’ and ‘Satisfaction related to birth centre care’. The main aspects that the mothers mentioned in the first and third themes were related to the institutional structure and system of care. Key conclusions and implications for practice mothers’ narratives suggested that their previous experience of problems in the hospital setting was the main motive for seeking care at the birth centre. The most important components of birth care were attention, meeting personal care demands and establishment of an adequate interpersonal relationship. More sensitive birthing care in the hospital setting is necessary, and this can be promoted through continuing professional education

Extended-spectrum beta-lactamases among Enterobacteriaceae isolated in a public hospital in Brazil

Extended-spectrum beta-lactamases (ESBL) in enterobacteria are recognized worldwide as a great hospital problem. In this study, 127 ESBL-producing Enterobacteriaceae isolated in one year from inpatients and Outpatients at a public teaching hospital at Sao Paulo, Brazil, were Submitted to analysis by PCR with specific primers for bla(SHV), bla(TEM) and bla(CTX-M) genes. From the 127 isolates, 96 (75.6%) Klebsiella pneumoniae, 12 (9.3%) Escherichia coli, 8 (6.2%) Morganella morganii, 3 (2.3%) Proteus mirabilis, 2 (1.6%) Klebsiella oxytoca, 2 (1.6%) Providencia rettgeri, 2 (1.6%) Providencia stuartti, 1 (0.8%) Enterobacter aerogenes and 1 (0.8%) Enterobacter cloacae were identified as ESBL producers. Bla(SHV), bla(TEM), and bla(CTX-M) were detected in 63%, 17.3% and 33.9% strains, respectively. Pulsed field get eletrophoresis genotyping of K. pneumoniae revealed four main molecular patterns and 29 unrelated profiles. PCR results showed a high variety of ESBL groups among strains, in nine different species. The results Suggest the spread of resistance genes among genetically different strains of ESBL-producing K. pneumoniae in some hospital wards, and also that some strongly related strains were identified in different hospital wards, Suggesting clonal spread in the institutional environment

Significado da intervenção médica e da fé religiosa para o paciente idoso com câncer

Neste estudo, procurou-se identificar o significado da intervenção médica e da fé religiosa para o paciente idoso com câncer. Pesquisa qualitativa e descritiva foi desenvolvida no período de 9/01 a 28/03/2001 no Hospital do Servidor Público Estadual - Francisco Morato de Oliveira/ IAMSPE. A amostra foi não aleatória, constituída de vinte idosos com câncer. A coleta de dados ocorreu mediante a técnica da entrevista semi-estruturada. Para a tabulação e análise dos dados, utilizou-se o método do Discurso do Sujeito Coletivo, com aplicação de três figuras metodológicas: a Idéia Central, as Expressões-chave e o Discurso do Sujeito Coletivo (DSC). As principais idéias centrais presentes nos discursos foram: 1. Nada a reclamar. Eu acho muito bom e penso que eles estão no caminho certo; 2. Não. Por enquanto estou acompanhando tudo o que os médicos falam; 3. Eu já participei, mas atualmente não; 4. Eu não participo de atividade religiosa; 5. Fortalecimento, esperança e equilíbrio. A fé religiosa é tudo!; 6. Continua a mesma, porém, mudou a maneira de ser. O DSC mostra que o procedimento médico adotado forneceu maior esperança ao paciente, elegendo a fé religiosa como instrumento-chave para o enfrentamento da doença