Violência institucional no âmbito da saúde reprodutiva : a percepção de mulheres usuárias do SUS, na cidade de Natal/RN

Institutional violence ranges from the most widespread lack of access to the poor quality of services provided. It includes abuses committed by virtue of the unequal power between patients and professionals within institutions. The aim of this study was to analyze the perception of women with regard to this type of violence, in the services offered at a reproductive health facility belonging to the National Health System (SUS) in Natal, Brazil. Interdisciplinary perspective is important, in that it provides interaction and complementarity between various disciplines, favoring, in an integrated way, a thematic approach in research activities, teaching and extension, involving professionals, students and researchers in medicine, social services, psychology, nursing, anthropology and physical therapy. A quantitative/qualitative approach was used, involving a sample of 401 women, as part of a transversal observational study. In the qualitative stage, which consisted of participatory observation and semi-structured interviews, we used an intentional sample of 10 individuals. The data were analyzed using logistic regression techniques, correspondence analysis and categorical thematic content analysis, showing that the 2 questions that investigated directly the perception of institutional violence obtained affirmative response frequencies of 28.2% and 31.8%, respectively. In regard to data collected in a field diary related to participatory observation, the main complaints referred to the health providerpatient relation, translated into dissatisfaction with the interpersonal relationship and with the resolution of the specific demand that required care. From content analysis, we classified 4 categories: Access; Information; Health professionalpatient relation; and Respect/dignity. We identified 6 subcategories: Impossibility of choice; Repressed demand; Communication difficulty; Asymmetric interpersonal relations; Privacy/confidentiality; Disrespect. We concluded, therefore, that the data presented show that in the reproductive health care programs, there are indicators of institutional violence. However, it is difficult to approach this phenomenon, mainly because of the power relations involved in the patient-health care provider interaction, resulting from unawareness that determinate situations violate sexual and reproductive rights. This can be explained by sociostructural questions that reveal marked inequalities, ratified by issues related to violation of the rights of National Health System (SUS) patients

Avaliação do conhecimento e de habilidades clínicas em saúde sexual e reprodutiva na graduação de medicina

No Brasil, a despeito das conquistas obtidas a partir da implantação do Sistema Único de Saúde e dos avanços legais e institucionais na atenção a diversos problemas relacionados ao gênero, a incorporação de temas relacionados aos direitos humanos, sexuais e reprodutivos no contexto da formação profissional em saúde permanece deficiente. Este trabalho teve como objetivos avaliar a inserção da temática saúde sexual e reprodutiva no currículo do curso de graduação em Medicina, por meio do emprego de avaliações de conteúdo cognitivo, procedimental e atitudinal. Trata-se de estudo de intervenção educacional envolvendo alunos do internato do curso de Medicina da UFRN. Foram utilizados os seguintes métodos avaliativos: prova escrita, exame clínico objetivo estruturado (OSCE) e Mini-CEX. Como variáveis explicativas foram consideradas o sexo, idade e participação prévia no componente curricular optativo Saúde Reprodutiva . A avaliação do processo constou da aplicação de questionários de satisfação e entrevistas acerca dos métodos avaliativos utilizados. Considerando os três métodos avaliativos empregados, 183 estudantes participaram do estudo, com média de idade de 24,5 ± 2,2 anos, sendo 52,5% do sexo masculino e 47,5% do sexo feminino. No contexto geral, observamos concordância entre os desempenhos dos estudantes nas avaliações de conteúdo cognitivo, procedimental e atitudinal. A participação dos estudantes no componente curricular eletivo Saúde Reprodutiva mostrou-se associada com melhor desempenho em algumas dimensões da avaliação cognitiva e na avaliação com o Mini-CEX, em relação às competências de anamnese, profissionalismo e qualidades humanísticas, relação médico paciente e desempenho global. A análise da fidedignidade entre os avaliadores na avaliação com o método OSCE mostrou-se adequada (alfa de Cronbach superior a 70%) em relação ao desempenho global e aos aspectos técnicos das competências avaliadas, observando-se baixa confiabilidade na avaliação da comunicação médico-paciente. O presente trabalho constitui-se numa experiência educacional inovadora e pioneira no âmbito da educação médica brasileira no que tange à inserção da temática de saúde sexual e reprodutiva na graduação, sugerindo-se um impacto positivo da iniciativa na formação do médico generalista na UFRN. A avaliação de conhecimentos, habilidades e atitudes em saúde sexual e reprodutiva na graduação de Medicina mostrou-se factível, com alta concordância entre os diferentes métodos empregados. Os métodos OSCE e Mini-CEX podem ser aplicados ao contexto da saúde sexual e reprodutiva, possibilitando a avaliação de competências clínicas relevantes para a formação do médico generalista e que habitualmente não são contempladas nas avaliações rotineiramente realizadas na graduação

Avaliação da incontinência urinária de esforço em mulheres na pós-menopausa com e sem queixa de perda urinária através da aplicação do pad-test de 1 hora

Stress urinary incontinence (SUI) is defined as "involuntary loss of urine" due to several processes that alter the ability of the bladder to hold urine properly, regarded as a social and hygienic problem that adversely affects quality of life. In postmenopausal women, IU is associated with atrophy and weakness of the pelvic floor muscles. The objective this study was investigate, using the onehour pad test, stress urinary leakage (SUI), evaluate and compare their results in postmenopausal and premenopausal women. The survey was characterized as a cross-sectional study. The study consisted of 60 postmenopausal women were divided into GIU - consisting of 34 volunteers complaining of involuntary loss of urine during stress - and GSIU - consisting of 26 volunteers without complaints of loss of urine during stress, and 15 women, during the premenopausal (GPM), and ovulatory with normal menstrual cycle. All volunteers were evaluated clinically, subjected to one-hour pad test, after the biochemical evaluation of blood and sex hormones. Statistical analysis was performed by descriptive analysis, ANOVA, Turkey´s post-test and Pearson correlation. The results showed that 100% of postmenopausal patients had involuntary loss of urine during one hour pad test (GIU: 4.0 g; GSIU: 4.5 g). GPM remained continent after an hour pad test (GPM: 0.4 g). In addition, Pearson showed a strong correlation between urine loss with time since menopause (r = 0.8, p <0.01) and body mass index - BMI (r = 0.7; p = 0.01). These data suggest that the one-hour pad test is a useful test to assess and quantify urinary leakage, including those volunteers who had no previous complaint of SUI

Conhecimentos, atitudes e práticas sobre contracepção para adolescentes

Conhecer o fenômeno da gravidez no contexto da adolescência, considerando a importância da contracepção como valioso recurso deprevenção, é uma abordagem que carece de atenção e norteia esta pesquisa, cujoobjetivo é avaliar a vivência sexual dos adolescentes e uso de métodos contraceptivos a partir do que eles conhecem sobre esses métodos e de suas atitudes frente à contracepção. Trata-se de um estudo exploratório, conduzido com estudantesdo 7º ao 9º ano de escolaridade. Os instrumentos de coleta de dados foram construídos e validados com análise das melhores condições para obtenção derespostas coerentes. As variáveis consideradas para análise foram: comunicação, atitudes, conhecimentos sobre contracepção, sexo, idade e comportamento sexual. As análises foram realizadas através dos cálculos de frequência, testes de qui-quadrado, t de student e regressão logística (considerou-se p<0,05). Os instrumentos foram validados com alfa de Cronbach de 0,70. Houve dificuldades para aobtenção de dados confiáveis nos auto-relatos dos sujeitos, verificando-se a necessidade de investigar a coerência das repostas mesmo utilizando instrumentos já validados. Dos 570 participantes, 68,8% tinha até 14 anos. Apresentaram pouco conhecimento e atitudes desfavoráveis ou ambivalentes à contracepção. Apenas 65% conversaram sobre o tema e 21,4% declararam iniciação sexual. Entre esses, a maioria (60,8%) tinha até 15 anos e 49,3% nunca usaram qualquer método contraceptivo. Não houve diferença significativa no uso da prevenção entre os que conversaram ou não sobre contracepção (p= 0,201). Os resultados apontam adolescentes expostos não só à gravidez, como à DST e alerta para a necessidade deintervenções que viabilizem uma orientação sexual capaz de promover competências para práticas sexuais mais seguras. Além disso, este estudo alerta para a dificuldade em obter dados confiáveis em pesquisas com adolescentes e evidencia a importância em se verificar a coerência das respostas mesmo utilizando instrumentos validados

Análise das mutações C282Y e H63D no gene da proteína HFE em pacientes com hiperferritinemia

Hereditary Hemochromatosis (HH) is a genetic disease caused by high iron absorption and deposition in several organs. This accumulation results in clinical disturbances such as cirrhosis, arthritis, cardiopathies, diabetes, sexual disorders and skin darkening. The H63D and C282Y mutations are well defined in the hemochromatosis etiology. The aim of this paper was that of identifying the H63D and C282Y genetical mutations in the hemochromatosis gene and the frequency assessment of these mutations in the HFE protein gene in patients with hyperferritin which are sent to the DNA Center laboratory in Natal, state of Rio Grande do Norte. This paper also evaluates the HH H63D and C282Y gene mutations genotype correlation with the serum ferritin concentration, glucose, alanine aminotransferasis, aspartato aminotransferasis, gama glutamil transferasis and with the clinical complications and also the interrelation with life habits including alcoholism and iron overload. The biochemical dosages and molecule analyses are done respectively by the enzymatic method and PCR with enzymatic restriction. Out of the 183 patients investigated, 51,4% showed no mutation and 48,6% showed some type of mutation: 5,0% were C282Y heterozygous mutation; 1,1%, C282Y homozygous mutation; 31%, H63D heterozygous mutation; 8,7%, H63D homozygous mutation; and 3,3%, heterozygous for the mutation in both genes. As to gender, we observed a greater percentage of cases with molecular alteration in men in relation to women in the two evaluated mutations. The individuals with negative results showed clinical and lab signs which indicate hemochromatosis that other genes could be involved in the iron metabolism. Due to the high prevalence of hemochromatosis and taking into account that hemochromatosis is considered a public health matter, its gravity being preventable and the loss treatment toxicity, the early genetic diagnosis is indicated, especially in patients with high ferritin, and this way it avoids serious clinical manifestations and increases patients' life expectation. Our findings show the importance of doing such genetic studies in individuals suspected of hereditary hemochromatosis due to the high incidence of such a hereditary disease in our region

Projeto Prevenir: uma pesquisa acerca das mudanças no perfil das infecções por DST/AIDS, com a perspectiva de detectar pontos vulneráveis da prevenção

Rio Grande do Norte is among the Brazilian States where the tourism and sexual violence increasingly grow in the country, occupying 4th place in 2004. Associated to this fact, it comes the problematic one of the contamination of the women by Sexually Transmitted Disease (STD). Studies in Brazil have presented a considerable increase of the STDs, caused through lack of suitable protection in the sexual relationships. Due to the biological and psychosocial vulnerability, besides failures or inconsistencies in the condom use associated to the raised taxes of sexual activity with different partners, the STDs constitute the main risk of health. Many difficulties are found by the confrontation of this problem. In this context, this project had as aim to evaluate the vulnerability of this population of sexually active women in Natal-RN Ponta Negra neighbourhood to the infections by STDs, such as, Candida sp., Vaginoses Bacterial, Trichomonas Vaginalis and Chlamydia sp., arisen with the explosion of the sex market, showing a current statistical panorama. It was possible to detect vulnerable points in prevention through patient anamnesis, where the study it showed: high number of partners (8,3% with more than five), low age of first relationship and not the use of condoms (31,8% sometimes use and 45,8% had not used in the first relationship). Already consolidated by the preventive cytopathologic examination, these data were strengthened by high incidence of causing agents of STDs (58,6%). In this way, it is clear that the sexuality must to be thought on the context of the deep economic and socio-cultural transformations in which pass societies, and mainly the ones concerning to the sexuality exercise and to the sex market. With the profile change of the infections, new demands are placed in relation to the risk factors. Therefore, it can be concluded that the prevention vulnerable points detected as more important had been the deficiency in self-perception and wareness of the risk existence among the studied women

Prostitutas entendidas: o que entender?

In this research, we propose a discussion from that observed in our field of work that women are prostitutes and who self-define understood. We check these women have sex with men by means of work and with women from the relationship of affection. We analyzed the practice of sexual activity as another possible expression of sexuality. There are many studies that deal with issues around the theme of prostitution and homosexuality in regard to various aspects and disciplines. Our proposal for study with these women is a topic that is on the agenda, as today, the theme of prostitution and homosexuality is well discussed within the Humanities in general. These new studies indicate about sexuality in a privileged place discussing values associated with the intimacy of the modern person, but also suggest that permeate discussions elements underlying the identity of women who have sex with women and men, the latter being, sexual activity mediated through the employment relationship by the financial interest, because according to our informants, prostitution is a job. From the reports of our participants / informants your answers fit the various brands that define the social field of possibilities of the sexual practices of individuals, raising questions about the origin and social class, family history, stage of life they are set of gender relations in the universe in which they live. All these elements provide the beacons to the process of shaping of subjectivity, understood as the social and biographical circumstances that define the direction I face this new constitution of the subject, it is defined by many theorists of the humanities, such as post-modern or modernity, and the insurgency that we have with the liberation movements that gays and lesbians were in question and make the politicization of sexuality

Um dia da caça outro dia do caçador: as (re) configurações de gênero em contexto turístico na praia de Pipa/RN

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

De repente do riso fez-se o pranto: representações e expressões do amor e do sofrimento amoroso

Romantic love constitutes a central value in the social imaginary of modern societies and with reflexes in today s society. This is because the romantic expectation of realization of love appears, in the majority of cases, as a guarantee of completeness and happiness of individuals. However, the ideal of romantic love imposes a series of demands and character roles that are not easy, in modern age, to be brought about into practice by the ones in love. And, it is in this sense that possible conflicts appear between the romantic proposition and the practical reality of contemporary love. Consequently, the possibility of suffering from love emerges because of these propositions. Initiating from these presumptions, this paper aims to study the contemporary forms of representation and expression of love and of the suffering because of love, through the course of love in the life of some men and women, residents of Natal/RN, that live and/or have lived emotional-sexual relationships, observing the relationship that can be established between suffering from love and the ideal romantic love

Padrões cromossômicos e mapeamento de genes ribossomais 18S e 5S em peixes pelágicos Atlânticos

Cytogenetic studies in fish have been contributed significantly to a better understanding of the marine biodiversity, presenting information related to characterization, evolution and conservation of species e fisheries stocks. Among the marine species which cytogenetic data are less well known pelagic forms are detached, that despite the economic importance and conservation efforts have been suffering great pressure from the artisanal and industrial fisheries. The present work characterized cytogenetically six species of large pelagic fish in the Atlantic, belonging to the Order Perciformes, among them, four species of Scombridae, Thunnus albacares, T. obesus, Scomberomorus brasiliensis and Acanthocybium solandri and two Coryphaenidae, Coryphaena equiselis and C. hippurus using Classical cytogenetic methods as conventional staining, C-banding and Ag-NORs and molecular through staining fluorochromes AT and GC-specific and mapping of ribosomal multigene families, 18S and 5S. The identification of phylogenetic patterns and cytotaxonomic markers between the species and the presence of sex chromosomes in at least one species of Coryphaenidae, are particularly useful in the formulating of phylogenetic hypotheses, as well as comparisons between groups and populations

Ingestão alimentar e nutricional de callithrix jacchus: relaçao com hierarquia social e disponibilidade de alimento

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Violência contra a mulher : estudo de caso em uma instituição de ensino

The study research case with a quantitative approach and prospective data, carried out between December 2010 and February 2011 with the aim of identifying the profile of women in the study, to characterize the acts of violence in the type, frequency, location occurrence and aggressor, analyze the steps taken after the occurrence of acts of violence and the main consequences on the victims. The population consisted of 285 workers in a tertiary institution in Rio Grande do Norte. The results showed that 99 (34.74%) have between 51 to 60 years of age, 78 (27.37%) of 41 to 50 and 62 (21.75%) between 20 and 30 years, are considered color white, 162 (56.84%) have completed higher education, 171 (60.00%) and of these 97 (56.73%) reported having some post-graduate degrees, are married, 141 (49.47%) and have from zero to one child, 148 (51.93%) reside in the south of the city of Natal, 146 (51.23%) have a monthly income of three to five minimum wages, 171 (60.00%) and are mostly in the Technical Administrative Sciences 152 (53.33%), 77 (27.02%) reported having experienced violence, 60 (62.50%) episodes of verbal aggression, 26 (27.08%) of bullying , 05 (5.21%) of physical abuse and 05 (5.21%) sexual harassment; 05 (100.00%) assaults were made by the spouse or partner of the victims and co-workers is another profession were responsible for 18 (30.00%) verbal aggression, 15 (57.69%) bullying and 03 (60.00%) sexual harassment, 02 (40.00%) of victims of physical aggression and 18 (30.00 %) of verbal abused only once, 10 (38.46%) of bullying and 02 (40.00%) of sexual harassment experienced four or more times 05 (100.00%) assaults occurred at domestic and work stood out with 36 (60.00%), verbal abuse, 22 (84.62%), moral harassment and 04 (80.00%) sexual harassment, 35 (36.46%) told colleagues work and 31 (32.29%) for family and friends in 75 (78.13%) cases there was no intervention, 07 (7.29) were unable to respond if something had been done and 14 (14.58% ) have been reported intervention of these, 09 (64.29%) were taken by the heads of the victims, 26 (32.10%) did not notify the fact on the ground that no action would be taken, 62 (80.52%) felt stress , 5 (1.76%) of women turned away from work after the episode of violence, accounting for 198 days of absenteeism. It is concluded that there is a high rate of violence against women, even when they have a good socioeconomic status, and in this sense is important to establish bases of new proposals for improving control of cases of health professionals, especially nurses, to approach patients with a more investigative, and that by identifying a case of violence, be instructed about the paths to be followed for notification while providing psychological support to victims.

O retrato de Eros em Florbela Espanca: um estudo sobre a escrita erótica em Charneca em Flor

Portuguese Poet Florbela Espanca (1984 1930) lived and produced her literary work during a period in which, on the one hand, the ideals of an innovative and irreverent movement were being fomented led by Fernando Pessoa, Almada Negreiros and Mário de Sá-Carneiro , on the other hand, Portugal was still dominated by a conservative and authoritarian thought, anchored in a bourgeois-christian ideology. Inserted in an unfavorable social context to the expression of the female sexual impulse, poet Florbela then appears with an innovative speech as threatening the sexual organization of the Portuguese society. This way, considering the relations between the poetic text and the historical-social context, the aim of this work is to present a reading upon the Eroticism in The Flowering Heath (2005) as a way to contravene the borders given to the sexual phenomenon. For this reason, we will mainly resort to the concepts developed on the approach of Georges Bataille The Eroticism (2004) and also by Octavio Paz The Double Flame: Love and Eroticism (2001)

Os focos de resistência face ao poder disciplinar: afetos e sociabilidades nos discursos de uma apenada

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Prazer com razão: análise e crítica da ética sexual Kantiana

This work aims to present the foundations of Kantian ethics concerning to moral judgments about sexual practices. It shows that the sexual act, for the philosopher, inevitably degrades individuals who are taking part of it, given its objectifying nature, manifested in the usage of individuals as mere means to obtain pleasure. To solve this quandary of nature since humanity is an end in itself, by the virtue of being bearer of rationality and cannot, therefore, be treated as mere means Kant claims that marriage is morally the appropriate locus for the exercise of sexuality, given the reciprocity forged there, preventing degradation. In marriage, the bond established between the impulse of nature to the conservation of the species achieved through the sexual intercourse opened to procreation and the duty of man in regarding himself as an animal being preserving the species without degrading the person is accomplished in a fully moral way. This text clarifies that the justification for the assumption of this solution is fixed at two developments of the categorical imperative: the formulas of the law of nature and humanity. Despite the fact the first brings significant contributions to human relations through the concept of reciprocity, the second establishes a normative role for the teleological argument of sexuality, becoming an obstacle in kantian's practical philosophy. To overcome that obstacle, we outline a critics which relies on the studies of Michel Foucault about sex and the power techniques related to them, producer of a scientia sexualis in the Western, demonstrating that the moral of the philosopher from Königsberg is also present in this project somehow. Finally, in a foucaultian's reading of kantian Aufklärung, we recognize that, to propose new ethical possibilities of the experience of sexuality, it is necessary to think and create new relational spaces in which the subject takes autonomously the government of self.