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

Risco de doença cardiovascular em mulheres com história de distúrbio hipertensivo da gravidez

OBJECTIVE: Preeclampsia is a disease that can lead to a high maternal and infant morbidity. Worldwide, the incidence of this disease is highly variable and there is no data on this disorder in the Brazilian population. This study aimed at determining incidence and risk factors in the hypertensive disorders during pregnancy in a neighborhood of Natal, in addition to observing the evolution of these disorders one year and five years after delivery. METHODS: Prospective cohort study to assess the outcome of pregnancies of 242 women who became pregnant between 2004-2007 in the neighborhood of Bom Pastor in the city of Natal, state of RN, Brazil. Five years after delivery, there was an active search of thirty-nine (39) women who became pregnant and had a hypertensive disorder during pregnancy and/or pré-eclâmpsia, out of the total of 242 participants in the initial study. We administered a structured questionnaire to obtain basic information about the current clinical situation of patients and occurrences of subsequent pregnancy and presence of hypertensive disorders during pregnancy. We also searched for information on the use of hypotensive drugs and contraceptives. The following characteristics were checked and recorded: a) current weight, b) blood pressure c) body mass index - BMI, and we collected biological samples (blood and urine) for measurement of biochemical parameters and evaluation of microalbuminúria. Finally, we monitored the ambulatory blood pressure (ABP), which uses the method of automatic measurement of heart rate, systolic and diastolic blood pressure and an average of the two for the period of 24 hours. RESULTS: Out of 218 women who completed the study, the incidence of hypertensive disorders was of 16.9% (37 out of 218), while the incidence of preeclampsia was 13.8% (30 of 218). Women with preeclampsia had a BMI (body mass index) averaged of 25.3 (± 4.8) while this ratio in normotensive women was of 23.5 (± 3.7), p = 0.02. The risk of preeclampsia rises with age (OR 1084 p = 0.0034) and with a family history of hypertension (OR 2.6 p = 0.01). The follow-up one year after delivery revealed that 50% of women with hypertensive disorders in pregnancy remained hypertensive. High BMI was also observed after 5 years of delivery. CONCLUSIONS: an elevated BMI, age above 35 years and excessive weight gain during pregnancy were associated with hypertension in the long term in patients with prior preeclampsia. History of preeclampsia increases the risk of chronic hypertension

Exercício aeróbico, resistência de artéria carótidae autonomia funcional em mulheres idosas

The aim of this study was to analyze the effects of an aerobic exercise program on the internal right carotid resistive index (IRCRI) and the functional autonomy levels of elderly women. The sample was composed of 25 elderly sedentary women, aged between 60 and 75 years, allocated into two groups: an experimental group consisting of 14 women submitted to aerobic treatment and a control group (n=11). Carotid artery resistance assessment was conducted using Doppler ultrasound and functional autonomy by the following tests: 10m walk (10mW), rising from a sitting position (RSP), rising from a chair and moving about the house (RCMH), rising from the ventral decubitus position (RVDP) and putting on and removing a t-shirt (PRTS). Aerobic training consisted of walking 30 minutes a day, 3 times a week, for 3 months. To control the intensity of the walk, the index of perceived exertion was used, with standardized Borg scale values corresponding to 13-15 points, characterized as slightly tiring exercise with training heart rate (TRH) between 50% and 80% of heart rate reserve (HRR). Repeated measures ANOVA was used for statistical analysis. Compared to the control, the experimental group obtained a statistically significant decrease in right internal carotid resistance (p = 0.021) and a significant increase in the following tests: 10mW (p=0.000), RSP (p=0.035) and RCMH (p=0.016). These results suggest that engaging in aerobic exercises was effective in decreasing IRCRI and improving functional autonomy inelderly women

Exercício aeróbico, resistência de artéria carótida e autonomia funcional em mulheres idosas

Este estudo teve como objetivo analisar os efeitos de um programa de exercício físico aeróbico sobre o índice de resistência da artéria carótida interna direita (IRCID) e os níveis de autonomia funcional de mulheres idosas. A amostra foi constituída por 25 idosas sedentárias, com idade entre 60 e 75 anos, divididas em dois grupos: grupo experimental com 14 idosas submetidas ao treinamento aeróbico e grupo controle (n=11). A avaliação da resistência da artéria carótida foi realizada pelo método de ultrasom Doppler e a autonomia funcional pelos testes: caminhar 10m (C10m), levantar da posição sentada (LPS), levantar-se da cadeira e locomover-se pela casa (LCLC), levantar-se da posição decúbito ventral (LPDV) e vestir e tirar a camisa (VTC). O treinamento aeróbico foi realizado na forma de caminhada, 30 minutos por dia, 3 vezes por semana, durante 3 meses. Para o controle da intensidade da caminhada foi utilizado o índice de esforço percebido, com valores padronizados pela escala de Borg onde a intensidade deveria corresponder a uma faixa entre os valores 13 a 15 pontos, correspondente a uma situação orgânica derivada de um exercício compreendido como ligeiramente cansativo e a frequência cardíaca de treino (FCT) entre 50% a 80% da frequência cardíaca de reserva. Para analise estatística foi utilizado a ANOVA de medidas repetidas. O grupo experimental quando comparados com o grupo controle obteve uma diminuição estatisticamente significativa na resistência da artéria carótida interna direita (p=0,021), e um aumento significativo nos testes: C10m (p=0,000), LPS (p=0,035) e no LCLC (p=0,016). Estes resultados sugerem que a prática de exercícios físicos aeróbicos foi eficaz em diminuir o IRCID e melhorar os níveis de autonomia funcional em mulheres idosa

Doença cardiovascular em mulheres com histórico de pré-eclâmpsia e seguimento no sistema único de saúde

The aim of the present study was to analyze cardiovascular risk of women with a history of preeclampsia, as well as its follow-upin the National Health System.This is a cross-sectional quantitative research conducted at the Januário Cicco Maternity School. The study population was composed of 573 women selected from a databank belonging to the Women s Health Research Group of the Gynecology Department at Universidade Federal do Rio Grande do Norte, with a history of preeclampsia, and normotensives who gave birth at this institution five years before. The final sample consisted of 147 women, 64 in the group with a history of PE and 83 normotensives. Data were collected on a questionnaire containing the following: sociodemographic aspects, anthropometric measures, life habits, personal and family history of pregnancy-induced hypertension, family history of cardiovascular diseases and frequency of measuring current blood pressure levels. In relation to the association between cardiovascular risk and altered blood pressure (≥130x85 mmHg), the likelihood of exhibiting the latter condition was significantly higher in women with a history of preeclampsia (CI 95% 4.12-38.92), the overweight and obese (CI 95% 1.70-20.75), and in those with a family historyof CVD and personal history of PIH (CI 95% 0.78-47.07 and CI 95% 3.20-25.39) respectively. Likewise, the probability of having altered blood pressure was higher in women with fasting glycemia ≥100mg/dL (CI 95% 2.09-24.73), as well as in those with triglycerides ≥150mg/dl (CI 95% 1.72-9.66). After fitting the logistic model, diagnosis previous preeclampsia and altered triglycerides remained as explanatory variables.The women with a history of preeclampsia five years before exhibited altered blood pressure levels, clinical and laboratory manifestations suggestive of elevated risk for cardiovascular disease, as well as family and personal history of hypertension. There is no differential treatment or adequate outpatient follow-up for this population in basic health care units

Experienciando a ausência do companheiro nas consultas de pré-natal

This research aimed to understand pregnant general meaning about consort absence in prenatal care. It s an exploratory and descriptive qualitative approach, developed at Centro de Saúde de Jardim Lola, São Gonçalo do Amarante / RN. Participated in investigation 20 pregnant enrolled in prenatal program, their aged over 18 years, guidance of mental faculties and who survive together her partner. Data were collected from March to May 2009, through semi-structured interview. The analysis was processed according to grounded theory and symbolic interactionism as theoretical and methodological references. To support discussions were used literature findings involving political aspects of women humanization in health care and gender relations within family. Following footsteps of points it were adopted derived following sub categories: ¨Realizing involvement of consort during prenatal¨, ¨Expressing feelings during prenatal¨ and ¨Manifesting attitudes during prenatal period¨. These, when they had their properties and dimensions analyzed, resulted in the main category ¨ Experiencing absence of compeer in clinical prenatal¨. The construction of this theory leads to conclusion that women understand absence of her partner, attributing this to even work at the moment prenatal care or does not like to attend health institutions. However, this does not mean that his presence is dismissed, because desire to be with him in prenatal care was mentioned by most interviewees. So, partner absent at time, leads women to experience desires, feelings, attitudes, perceptions and expectations about studied phenomenon. This reality, induce that absence of them partner in prenatal care predisposes women to strengthening of discomforts arising from pregnancy and therefore goes against wellbeing of pregnant, and ensure the possibility of marital discord. This requires professional nursing measures to get in inclusion of partner in daily pre-natal care in humanization perspective.

Representações sociais do comportamento agressivo do homem sob a ótica da mulher em situação de violência

We aim to understand the social representations of man's aggressive behavior from the perspective of women in situations of domestic violence. This is a descriptive, exploratory and representational study, whose methodological approach falls into the qualitative category. We chose as a scenario for research, by the Reference Center for Citizen Women (CRMC), Natal / RN. The criteria for selection of participants were women who lived/live in situations of domestic violence, with affective or relationship bonding with the assailant, in psychological and emotional positions appropriated to the reality; that are being protected or assisted by the service listed above; whose aggressor is male. We adopted as data collection instruments: questionnaire, Drawing-Story (DE) and a field diary. For analysis of textual data, we decided to use the ALCESTE software conjugated to editing analyze and initial reading. Were investigated 20 women victims of domestic violence, whose author of the attacks was the husband/partner. We identified, from the respondents, that 70% (n = 14) of men with aggressive behavior also had a family history of violence and fragile family relationships. About the physical and emotional condition of the assailant at the time of violence, 50% (n = 10) of these men, regardless the use of alcohol, had often quarrelsome and/or nervous behavior, impatient and unpredictable humor facing a setback, worry or annoyance. Regarding the nature of violence, we observed that women were victims of all types of violence, however, the psychological prevailed in 100% of cases. The corpus "Men" has three classes, whose focuses are, respectively: resignation, denounce and violence/aggression, being possible categorizing them as well: Category 1: The imprisonment of women; Category 2: Violence and its meanings; Category 3: Breaking the violent cycle. We show that the social representations of man s aggressive behavior, from the women in situations of violence, are anchored in the social roles of men in family and society, becoming a dominant model of masculinity. It is aimed, on one hand, from the reproduction of what is already known and/or experienced by male aggressors in the family, as repetitions of behavior. And on the other, present themselves as a state of illness, addiction or psychopathy

Trajetória de vida de mulheres mastectomizadas integrantes de um grupo de auto ajuda a luz da História Oral

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Assistência de enfermagem às urgências e emergências psiquiátricas no serviço de atendimento móvel de urgência em Mossoró-RN

This study aims to identify the concepts of professional nursing team on assistance in urgency and psychiatric emergencies in SAMU in Mossoró/RN, identifying the difficulties in implementing an emergency assistance to the user in psychiatric distress in this service and point strategies in pursuit of consolidation and expansion of comprehensive health care to the public. It is a descriptive research with qualitative and exploratory approach. The subjects were employees of the nursing staff of SAMU of that mentioned municipality. Semi-structured interviews are applied as tool for data collection. It was counted on the consent of the institution where the study was developed and approval by the Ethics Committee in Research of UFRN with CAAE No 17326513.0.0000.5537, besides signing the Informed Free Consent Term by the participants. Data analysis was done by means of thematic analysis proposed by Bardin. Thus , as a result of the research produced the following categories: mechanistic practice; dehumanization of care; need for qualification, barriers to assistance in urgency and psychiatric emergency and strategies in pursuit of comprehensive care, which proceeded in preparing two articles entitled "Nursing care to the emergency room and psychiatric emergencies in the mobile emergency care service" and "Barriers for emergency service and psychiatric emergencies in the mobile emergency care service". In the studied reality it was identified that nursing care offered to users in situations of urgency and psychiatric emergency is made based primarily on the use of chemical and physical restraints, as well as transportation to the general hospital, constantly using the police force support, which meets the guidelines of the Psychiatric Reform and thereby undermining the provision of an effective and humane care. This scenario is worsened by the lack of an organized network of services in mental health, where after the service the user is taken to a general hospital, considering that there is no ready or appropriate psychiatric emergency service as a Center of Psychosocial Care - CAPs III to reference it, thereby precluding the realization of a resolute and comprehensive care. Thus, it is concluded that nursing care is based on biologicist and medicine-centered model advocated by classical psychiatry, and that despite all the advances in psychiatric reform, still guides the mental health care, so the lack of service network organized in hierarchical and mental health, where the user in urgency and emergency service can be watched in full and the guidelines of the psychiatric reform can be realized in practice

Quando as mulheres se tornam mães: a história reprodutiva feminina numa visão evolucionista

In this thesis we tested evolutionary hypotheses, with empirically collected data, in a sample composed of pregnant Brazilian women. We consider that during pregnancy and soon after the baby's birth fundamental reproductive decisions take place, given the complete feminine involvement with the reproduction phenomenon. The results are presented in four empirical articles related to the history of female reproduction. The topics approached were mate selection, the life-history theory, the strategies of parental investment and postpartum depression. Data collection was accomplished through interviews with pregnant women and after the baby s birth, with a sample composed of women from two income classes (low income and middle class), in Natal, Brazil. With respect to mate selection, the results suggest that a real situation of reproductive mate selection shows significant differences when compared to the results obtained in studies involving potential mate selection (Article I). Considering the life-history theory, we have partially confirmed the hypothesis of the father`s absence influencing the development of the young female syndrome (Article II). In regard to parental investment strategies and the decrease of fatherhood uncertainty, we identified a larger attribution of the baby's resemblance after birth with the father, confirming our hypothesis (Article III). The results related to postpartum depression occurrence partially support the hypothesis that it is an evolutionary adaptation (Article IV). This thesis is part of a consolidation movement of Evolutionary Psychology in Brazil and it presents results on female reproductive history hitherto unpublished.

Comportamento de parâmetros fisiológicos de homens e mulheres em condições de estresse laboral submetidos à técnica Watsu

The physiological variations of parameters in situations of laboral stress can function like indicator in the sprouting of disorder. Those conditions have led researchers to investigate alternatives that can favor the quality of life in persons under stress laboral. The present research had as objectives investigate the physiological behavior of parameters (blood pressure, heart hat and respiratory hat) of men and women in condition of stress laboral submitted to the technique Watsu. It was used a experimental methodology with a group formed by men and women in reproductive age, that work as salesclerk in a supermarket net in Natal/RN. The seven individuals selected were submitted to the three phases of the study (dependent groups), that consisted of the phase 1 of obtaining from the measure basal (control 1), in the phase 2 of immersion in the water (control 2), and phase 3 from the application the technique Watsu (experimental phase). It was verified that during the phase basal (condition 1) the physiological parameters (BPS, BPD, HH and RH) of both sexes evaluated showed the medium values of the women (average±detour-standard: BSP = 104.1±7.92; BPD = 70.83 ±7.92; HH = 77.58 ±3.87; RH = 19.83 ±2.58) similar those presented by the men (BPS = 118.75 ±7.55; BPD = 75.00 ±9.91; HH = 71.75 ±14.95; RH = 16.62 ±3.99). The evaluation of those parameters before and after immersion of the volunteers in the water (condition 2) showed a significant reduction (W = 3.0: p≤0.05) barely for the values of BPS presented by the sex females after immersion. In the men group, all of the physiological parameters analyzed did not vary significantly. Regarding the profile of those variables before and after application of the watsu (condition 3), was verified a significant increase (W= 0,0: p≤0.05) for the BPS one and SABP in the women. The Men did not show significant variation for all of the physiological parameters. Faced with the results presented, we are able to conclude that the systolic and diastolic blood pressures were the physiological parameters that are on influence from the Technique Watsu, only for the kind females

Dependência química em mulheres :um estudo sobre o consumo de medicamentos ansiolíticos no serviço público de saúde de Natal/RN

This work was concerned to investigate the meaning attributed to anxiolytic drugs by women, in public health service. It proposes a joint analysis through a link between three dimensions: the woman, the drug, and public health service itself, in an hegemonic medical assistance model. It is observed that the relation between these elements has a great influence over the use and construction of a particular meaning, by the user. The medication is analysed as a consumption merchandise and as an health symbol. In this way, it reflects a biologized vision, which believes the drug as a solution for all health problems. It tries to analyse the generalized medical prescription for anxiolythics and it s consequences. It focalizes also the production and utilization of public health services by patients, mainly women. The question related to the use of anxiolytics and the meaning construted by women is analysed focusing the way that relations of masculine/feminine gender are organized in our society. At this point of view, it tries to understand the dimension that these questions have in subjectivity production, and how it acts in the health/disease process. Finally, this work tries to understand, in a broad sense, the use of anxiolytics looking at the problem not only as a biological question, but also as a cultural matter. The research was done over seventeen women, all of them anxiolytic users. It was used, as research instrument, semi-structured interview associated with methodological analysis of user s speeches

As relações de gênero no trabalho: uma análise da inserção das mulheres e homens na rede de fast food

The purpose of this study was investigate the sexual division of the work in a chain of fast food, in Natal, RN. These aspects were analyzed with the ways of organization of the work, being made a case study. The main objective of this survey was to analyze the influence of gender relations in the insertion of men and women in the job market and to analyze the question of feminine submission in the professional world. These questions were analyzed considering the current period of the worldwide capitalism, from the characteristics of productive process and the growth of the service sectors. The research was made with a group of workers on the production sectors; attendance, management and human resources at restfood store, where six clerks were interviewed. Through our research, it is possible to perceive the permanence of the sexual division at the job in the interior of the productive processes at Restfood, that puts the woman in a subordinate position in relation to the man. This result can be confirmed if we considerate that the women, on this chain of food, occupy in first place the function of waitress and on this, trere s no functional progression, while her workmates (the men) for occupying other functions can progress inside the company. It was also evidenced that in a context of globalization of the capital, deregulation and disrespect of labor laws, the capital acts without any respect to workers. That was what we observed at the interviewer speech; the scarcity of the conditions of work and the constant disrespect of the labor laws. This way, we could evidence that the scarcity of work conditions hit men and women, but it has a crueler face with the women, and this one reproduces itself, day by day in the process of social reproduction, through family life, insertion in the world of the work, information and received social education. So, the capital explores all of them, but the gender relations create to the capital, the possibility of a different degree of exploration, becoming this way, the women main victims herself

(In)visibilidade da violência doméstica no atendimento do Sistema Público de Saúde: nos bairros das Quintas e de Felipe Camarão

It analyses the approach given by health professionals (social workers, nurses and doctors) against woman violence at the Medical Unities of Felipe Camarão and Quintas of the City of Natal and searches to identify if the domestic violence is (in)visible at the Public Health Assistance System attendance. and It refers to the grandiosity of this violence and its consequences to the women health, recognizing it as a public health problem. To the comprehension of the relationship between violent acts against women and their health serious damages, exposes the battle history of the feminist movements and the brazilian women, demonstrating the visibility acquired by theses conquests of the questions related to the women and how the gender study becomes the central category to (re) think the social relations involving women and men, specially, the violent relationships between them. It analyses, mainly, those practiced by the husbands, partners, boyfriends or lovers. It refers, at the end, about the public politics of violence combat adopted at police stations at health centers, showing the difficulties to establish the legislation that exists to combat the violence suffered by the women that look for assistance at the health unities. It intends, with this way, to give more visibility to the domestic questions at the marital relations and ask attention from the public power and health professionals between them, the social worker to the (in) visibility of this problems at the attendances practiced

As Mulheres e as Muralhas do Patriarcado e do Capitalismo: Terceirização e Precarização do Trabalho no Sistema do Capital

Our dissertation deals with the material living conditions of women workers and the relations of the wage who undergo in the hospital scope, taking as the locus of empirical research the Hospital Dr. João Machado, located in Natal / RN. Its purpose is to analyze the main implications of precarious work contracts in the economic and social dimensions from life of workers, explaining the main conditionings. The majority presence of women in wage relations not only in the hospital service, as well as in the service sector in general has motivated us to appreciation of the form of participation of women in health services and, in particular, at the hospital space. From the critical dialectical method, through processes of successive approximations to the reality, we analyze the patriarchal system of social relations and their repercussions for the Social and Sexual Division of Labor in the context of contemporary capitalist society, explaining the determinants of inequality, founded in social relations of sex, to the predominance of women in the hospital service and unveiling these participation trends in the labor market. The analyzes are based on bibliographic research - theoretical and methodological basis of research - combined with reflections that emerged from the field. The systematized and analyzed information reveal the uniqueness of the current social and economic situation of workers women with ties outsourced, paradoxically expresses on the expansion of the insertion in universe of labor, in overexploitation, in the precariousness of work and living conditions and persistent inequality in and in the social relations and in relations between the sexes