Saúde Coletiva

Resumo Este estudo visa relatar as reuniões de um grupo de ajuda mútua organizadas por um Núcleo de Apoio à Saúde da Família (NASF), utilizando a Estratégia Saúde da Família (ESF), no interior da Bahia. O objetivo é entender de que modos a ESF trabalha o cuidado no convívio com pessoas em sofrimento mental, seus cuidadores e os trabalhadores. A escolha por adotar a abordagem praxiográfica como método investigativo foi inspirada nos estudos sobre cuidado de Annemarie Mol. Deste modo, a partir dos registros em um diário de campo, realizados ao longo de um ano, foram produzidas compreensões sobre os efeitos da participação dos usuários e familiares nos grupos, além de suas interações com outros atores não humanos. Ao produzir o reconhecimento minucioso de uma prática, este estudo pôde demonstrar o quanto essa tecnologia se apresenta de forma imprevisível e incerta, pois é mediada e modificada por vários atores, ainda que também os modifique. Essa abordagem tornou possível perceber a fl...

In the past three decades, Brazil has undergone rapid changes in major social determinants of health and in the organisation of health services. In this report, we examine how these changes have aff ected indicators of maternal health, child health, and child nutrition. We use data from vital statistics, population censuses, demographic and health surveys, and published reports. In the past three decades, infant mortality rates have reduced substantially, decreasing by 5·5% a year in the 1980s and 1990s, and by 4·4% a year since 2000 to reach 20 deaths per 1000 livebirths in 2008. Neonatal deaths account for 68% of infant deaths. Stunting prevalence among children younger than 5 years decreased from 37% in 1974-75 to 7% in 2006-07. Regional diff erences in stunting and child mortality also decreased. Access to most maternal-health and child-health interventions increased sharply to almost universal coverage, and regional and socioeconomic inequalities in access to such interventions were notably reduced. The median duration of breastfeeding increased from 2·5 months in the 1970s to 14 months by 2006-07. Offi cial statistics show stable maternal mortality ratios during the past 10 years, but modelled data indicate a yearly decrease of 4%, a

This study aimed to identify the factors associated with induced abortion in the first pregnancy in young women and in the first time young men got their partners pregnant. The methodology was a household survey with face-to-face interviews in a probabilistic sample in three stages with 4,634 subjects, aged 18 to 24 years of age residing in the cities of Salvador, Rio de Janeiro, and Porto Alegre, Brazil. Logistic regression analysis was used with a hierarchical strategy for entering variables into the model. Abortion was the reported outcome of the first pregnancy for 16.7% of the women and 45.9% of the men (in relation to their partners). Key factors associated with abortion included higher schooling and the occasional nature of the relationship with the male or female partner in the respective pregnancy. Inclusion of males in the study provided new elements for understanding the abortion phenomenon, including in the gender issues in discussion of the theme. The authors recommend greater public investment to warrant access to information and means for young people to achieve their reproductive plans in a security and healthy way, respecting their sexual and reproductive rights.

This paper aims to discuss the construction of teenage pregnancy as a social problem. It also seeks to present and analyze the data of the qualitative phase of the research study Teenage Pregnancy: A Multicentric Study of Young People, Sexuality and Reproduction in Brazil (GRAVAD study) undertaken in four Brazilian capitals: Porto Alegre, Rio de Janeiro and Salvador. The data indicate the indissoluble character of the articulation between social class and gender in the understanding of the phenomenon of teenage pregnancy. Among girls from the middle class we observe alterations in their management of their school projects and course, which, until that point, were processed in a linear manner. The same does not occur among girls from lower income groups whose irregularity in school life is independent of motherhood. Among the young men there are no significant changes, since middle class boys not interrupt their school projects or courses, and boys from lower income groups enter the work force precociously, and this is not a direct consequence of teenage fatherhood.

O conhecimento sobre saúde reprodutiva e sexualidade tem avançado muito como resultado de iniciativas voltadas à formação em pesquisa. Saúde. Tendo formado 250 alunos e 97 bolsistas, seus resultados podem ser conferidos em outras publicações e também neste suplemento, com artigos de bolsistas e docentes dedicados à "Avaliação em Saúde Sexual e Reprodutiva".

This study aims to estimate the prevalence of adolescent pregnancy (AP) in three Brazilian cities Salvador, Rio de Janeiro, and Porto Alegre and to examine the profiles of pregnant girls and their partners in relation to pregnancy outcomes. Data for a retrospective assessment of AP were collected using an interview-based household survey applied to a stratified sample of males and females aged 18-24. A total of 4,634 individuals were interviewed (85.2 % of the eligible individuals). 21.4% of males and 29.5% of females aged 20-24 reported AP, but few such pregnancies had taken place before age 15 (0.6% and 1.6%). Pregnancy between adolescent partners was reported by 55.1% of males and 27.9% of females. 79.8% of the latter became pregnant while involved in a stable relationship with an older partner. AP levels varied inversely to schooling and income levels. 72.2% of females and 34.5% of males carried their first AP to completion, and more cases of induced abortion were reported by male partners in pregnancies (41.3%) than by females (15.3%). With the birth of the first child, 25.0% of women interrupted their studies temporarily and 17.3% definitively. However, 42.1% of primiparous mothers were already outside school before pregnancy.

OBJETIVO: O interesse sobre o comportamento contraceptivo de adolescentes vem crescendo, especialmente pela relevância social conferida à gravidez nessa faixa etária. Assim, realizou-se estudo para investigar fatores associados ao uso de métodos anticoncepcionais entre adolescentes escolares. MÉTODOS: Estudo transversal que utilizou um questionário auto-aplicado em 4.774 alunos de ambos os sexos, entre 11 e 19 anos. Calcularam-se as prevalências de uso de contraceptivos na primeira e na última relação sexual e em ambas as situações (uso consistente). A regressão logística foi utilizada para a análise simultânea dos fatores e cálculo de medidas ajustadas. RESULTADOS: Entre 1.664 estudantes com iniciação sexual, os fatores associados positivamente ao uso consistente de contraceptivos pelos rapazes incluíram a iniciação sexual mais tardia, com parceria estável, contar com a família como fonte potencial de contraceptivos e acesso a serviços de saúde; entre as moças, ter iniciado a vida sexual há pouco tempo e ter o pai como fonte de informação sobre sexualidade, contracepção e prevenção DST/Aids. A gravidez foi relatada por 6,4% dos rapazes e 18,1% das moças, sendo sua ausência associada ao uso consistente de contraceptivos por elas (OR=3,83; 2,06-7,15). CONCLUSÕES: Os resultados confirmam a complexidade da determinação do comportamento contraceptivo entre adolescentes e a necessidade de que os programas educativos incorporem as múltiplas dimensões da questão para que tenham efetividade.

OBJETIVO: Avaliar a associação entre demanda psicológica e controle sobre o trabalho e a ocorrência de distúrbios psíquicos menores entre trabalhadoras de enfermagem. MÉTODOS: Estudo de corte transversal, incluindo 502 trabalhadoras de enfermagem de um hospital público de Salvador, Bahia. O Modelo Demanda-Controle, de Karasek, foi utilizado para avaliar as dimensões psicossociais estudadas. Para mensuração de distúrbios psíquicos menores (DPM), utilizou-se o SRQ-20. RESULTADOS: A prevalência de DPM foi 33,3%, variando de 20,0% entre enfermeiras a 36,4% entre auxiliares. Observou-se nítido gradiente tipo dose-resposta de associação positiva entre demanda psicológica e DPM, e associação negativa entre controle sobre o trabalho e DPM. A prevalência de DPM foi mais elevada (RP=2,6; IC95%: 1,81-3,75) no quadrante de trabalho em alta exigência (alta demanda, baixo controle), quando comparado às profissionais em trabalho de baixa exigência (baixa demanda, alto controle), depois de ajustado, num modelo de regressão logística múltipla, por potenciais confundidores. CONCLUSÕES: Os achados reforçam a relevância da adoção de medidas de intervenção na estrutura organizacional, de modo a elevar o controle sobre o trabalho e redimensionar os níveis de demanda psicológica.

A juventude é contemporaneamente considerada como a melhor fase da vida e, ao mesmo tempo, período de grande risco. O primeiro caso diz respeito aos potenciais físicos e psíquicos e o segundo se refere, em especial, aos possíveis danos à saúde. Como palcos desses riscos, duas esferas: a da sociabilidade, na qual se teme a exposição à violência e ao uso de drogas, e a da sexualidade, em que se problematiza a iniciação sexual precoce, a AIDS e a "gravidez na adolescência". Essas concepções, muito difundidas pelo senso comum e pela mídia, apresentam os jovens como incapazes de gerir a vida afetiva e sexual e, com freqüência, como irresponsáveis em seus comportamentos. A imagem dominante é de uma vida sexual desregrada, na qual predominam os relacionamentos efêmeros. Imagem que se nutre de variada gama de preconceitos que a pesquisa científica deve ajudar a desconstruir.

This paper describes the relationship between school trajectory and incidence of teenage pregnancy. A cross-sectional residence-based questionnaire was applied, interviewing 4,634 youth ages 18 to 24 years, selected through a stratified three-stage sample. For the present study, young people ages 20 to 24 years (65.6%) were chosen, with teenage pregnancy rates of 29.5% for females and 21.4% for males (in relation to their partners). Sexual debut was reported by 87% of women and 95.3% of men. The majority of young people reported irregular school trajectory, with 39% enrolled in school at the time of the study. Nearly half of those who had interrupted their studies at least once reported a teenage pregnancy. The main reasons for interrupting their studies were pregnancy and children for women and work for men. School dropout due to teenage pregnancy was mentioned by 40.1% of women for whom the outcome of pregnancy was a child. However, 20.5% had already dropped out of school before becoming pregnant.

In the past three decades, Brazil has undergone rapid changes in major social determinants of health and in the organisation of health services. In this report, we examine how these changes have aff ected indicators of maternal health, child health, and child nutrition. We use data from vital statistics, population censuses, demographic and health surveys, and published reports. In the past three decades, infant mortality rates have reduced substantially, decreasing by 5·5% a year in the 1980s and 1990s, and by 4·4% a year since 2000 to reach 20 deaths per 1000 livebirths in 2008. Neonatal deaths account for 68% of infant deaths. Stunting prevalence among children younger than 5 years decreased from 37% in 1974-75 to 7% in 2006-07. Regional diff erences in stunting and child mortality also decreased. Access to most maternal-health and child-health interventions increased sharply to almost universal coverage, and regional and socioeconomic inequalities in access to such interventions were notably reduced. The median duration of breastfeeding increased from 2·5 months in the 1970s to 14 months by 2006-07. Offi cial statistics show stable maternal mortality ratios during the past 10 years, but modelled data indicate a yearly decrease of 4%, a

This study aimed to identify the factors associated with induced abortion in the first pregnancy in young women and in the first time young men got their partners pregnant. The methodology was a household survey with face-to-face interviews in a probabilistic sample in three stages with 4,634 subjects, aged 18 to 24 years of age residing in the cities of Salvador, Rio de Janeiro, and Porto Alegre, Brazil. Logistic regression analysis was used with a hierarchical strategy for entering variables into the model. Abortion was the reported outcome of the first pregnancy for 16.7% of the women and 45.9% of the men (in relation to their partners). Key factors associated with abortion included higher schooling and the occasional nature of the relationship with the male or female partner in the respective pregnancy. Inclusion of males in the study provided new elements for understanding the abortion phenomenon, including in the gender issues in discussion of the theme. The authors recommend greater public investment to warrant access to information and means for young people to achieve their reproductive plans in a security and healthy way, respecting their sexual and reproductive rights.

O conhecimento sobre saúde reprodutiva e sexualidade tem avançado muito como resultado de iniciativas voltadas à formação em pesquisa. Saúde. Tendo formado 250 alunos e 97 bolsistas, seus resultados podem ser conferidos em outras publicações e também neste suplemento, com artigos de bolsistas e docentes dedicados à "Avaliação em Saúde Sexual e Reprodutiva".

This study aims to estimate the prevalence of adolescent pregnancy (AP) in three Brazilian cities Salvador, Rio de Janeiro, and Porto Alegre and to examine the profiles of pregnant girls and their partners in relation to pregnancy outcomes. Data for a retrospective assessment of AP were collected using an interview-based household survey applied to a stratified sample of males and females aged 18-24. A total of 4,634 individuals were interviewed (85.2 % of the eligible individuals). 21.4% of males and 29.5% of females aged 20-24 reported AP, but few such pregnancies had taken place before age 15 (0.6% and 1.6%). Pregnancy between adolescent partners was reported by 55.1% of males and 27.9% of females. 79.8% of the latter became pregnant while involved in a stable relationship with an older partner. AP levels varied inversely to schooling and income levels. 72.2% of females and 34.5% of males carried their first AP to completion, and more cases of induced abortion were reported by male partners in pregnancies (41.3%) than by females (15.3%). With the birth of the first child, 25.0% of women interrupted their studies temporarily and 17.3% definitively. However, 42.1% of primiparous mothers were already outside school before pregnancy.