RESUMO

BACKGROUND: Social reintegration relies on the support given to prisoners not only during their reentry into society but also throughout their imprisonment. Our goal was to analyze the expectations reported by cisgender and transgender women returning to society and of the justice and social welfare professionals from the Brazilian prison system. METHODS: A qualitative analysis using saturation sampling was conducted. The participants were selected through a non-probabilistic sampling technique. Data was collected through semi-structured interviews with professionals involved in the management of the prison system and female former inmates. Interviews were transcribed and analyzed using an open and focused coding process. Textual data was stored, organized, and coded using Atlas software according to emerging themes. RESULTS: The study involved 15 professionals and 13 female former inmates, five of them identified as transgender women. Among the professionals, the age range went from 38 to 65 years old; they reported a work history in their respective fields, from 10 to 35 years, with an equal distribution across genders. As for the female former inmates, their ages ranged from 24 to 42 years old, and the most reported crime was drug trafficking. Their incarceration time varied from 1 to 8 years. Female inmates were vulnerable to abuse and violence, including physical, sexual, and emotional violence. Women in situations of prior vulnerability faced additional challenges during their sentences. Transgender women were even more neglected and discriminated against by the system. Despite the professionals being aware and concerned about vulnerabilities and the need to improve the reintegration process, in general, they were not sensitive to the gender perspective. There were no specific policies able to support social integration for this public. CONCLUSIONS: Data showed multifaceted challenges faced by female former inmates within the Brazilian prison system, highlighting the insufficient policies for both cisgender and transgender women. Additionally, the results revealed a lack of sensitivity among professionals regarding gender issues and their particularities in the prison system and social reintegration. These findings emphasize the need for a more comprehensive and intersectional approach that addresses the diverse socio-economic backgrounds of these individuals.

RESUMO

BACKGROUND: Sexually transmitted infections (STI) can have severe consequences. In Brazil, case management is recommended by the Clinical Protocol and Therapeutical Guidelines for Comprehensive Care for People with STIs (PCDT-IST). This study assessed the quality of PCDT-IST (2021) and reviewed the main recommendations for the management of STI that cause urethral discharge compared with the World Health Organization (WHO) STI Guidelines. METHODS: The PCDT-IST (2021) quality was independently assessed by 4 appraisers using the Appraisal of Guidelines Research and Evaluation instrument, version II (AGREE II). The PCDT-IST (2021) and the WHO Guidelines for the Management of Symptomatic STI (2021) were compared considering 14 different assessment domains. RESULTS: The PCDT-IST (2021) scores in the AGREE II domains were: Rigor of Development (58%), Applicability (35%), Editorial Independence (38%), Scope and Purpose (78%), Stakeholder Involvement (74%), and Clarity and Presentation (82%). The overall score was 67%, and all appraisers recommended the Brazilian guideline. Regarding the PCDT-IST (2021) and the WHO STI Guidelines (2021) comparation, 10 domains would be relevant for further reviewing the Brazilian recommendations: Diagnostic tests; Etiological approach; Treatment for recurrent urethral discharge; Treatment for urethritis without etiological agent identification; Treatment for gonococcal urethritis; Treatment for chlamydial urethritis; Retreatment for gonococcal infections; Treatment for Mycoplasma genitalium urethritis; Treatment for Trichomonas vaginalis urethritis; 10. Flowcharts. CONCLUSIONS: The PCDT-IST (2021) has a reasonable degree of quality. However, the domains of Applicability, Rigor of Development, and Editorial Independence must be better ensured. The guidelines comparison will help to select key topics that should be addressed with priority in the following national STI guidelines updates.

Assuntos

RESUMO

OBJETIVE: To estimate the prevalence of psychological, physical, and sexual violence perpetrated against women by their intimate partner (IP) in Quilombola communities located in Espírito Santo State, Brazil. METHODS: The data is from a population-based cross-sectional study of Quilombola women conducted from 2017 to 2018. In-person interviews collected information on women's sociodemographic characteristics, behaviors, and their experience of violence perpetrated by their IP. The analysis used chi-square test and hierarchical logistic regression. RESULTS: 219 women (94.8% of the invited ones) agreed to participate in the study. 59.0% (95%CI: 5.25-65.5) reported psychological violence; 41% (95%CI: 34.5-47.5) physical violence; and 8.2% (95%CI: 4.6-11.8) sexual violence. Psychological violence was associated with having three or more sexual partners in life, when compared to those who had up to two partners (p = 0,009), and previous violence involving other people outside of family increased the chance of suffering psychological violence by an IP more than nine times (p ≤ 0.001). Regarding physical violence, the association with use of barrier contraception (p = 0.031) and having a partner with other sexual partners (p = 0.024) were protective factors for IP violence. Having 3 or more sexual partners in the last 12 months (p = 0.006), partner using illicit drugs (p = 0,006), and alcoholism in the family (p = 0,001), increased the chance of suffer physical violence by the partner. Sexual violence perpetrated by the IP was associated with miscarriage (p = 0.016), partner using drugs (p = 0.020), and gynecological symptoms (p = 0.045). CONCLUSIONS: These results showed the high frequency of intimate partner violence in Quilombola women and highlight the importance of reducing social and race inequities for interrupting the culture of violence against women.

Assuntos

RESUMO

Introducción: La atención primaria de salud en Brasil se considera una prioridad. En el año 2013 se creó el Programa Mais Médicos, de formación en servicio y de ampliación de la cantidad de médicos en el país. La cooperación cubana, gestionada por la Organización Panamericana de la Salud fue quien envió la mayor cantidad de profesionales. Objetivo: Analizar las representaciones sociales de los consejeros de salud sobre el Programa Mais Médicos, en municipios en los que prestaron atención a su población médicos provenientes de Cuba. Métodos: Estudio de caso descriptivo de corte transversal abordado con metodología cualitativa. La muestra fue intencional. Se trabajó con 58 entrevistas semiestructuradas y el análisis fue realizado mediante el software gratuito Iramuteq con la técnica de análisis lexical. Resultados: Se pudo distinguir cuatro grupos de representaciones, sobre el funcionamiento de los consejos municipales de salud, sobre las representaciones del Programa Mais Médicos, sobre las redes de atención y sobre los médicos brasileños y cubanos. El estudio aporta evidencias de la aplicación de un nuevo modelo de atención para los consejeros que objetivaron y anclaron en el concepto de nacionalidad. El modelo cubano incorpora características de humanismo, atributos que no estaban contenidos en las representaciones sobre los médicos locales. Conclusiones: Las representaciones sociales sobre el Programa Mais Médicos aluden a una acción que mejora la calidad de los servicios, no obstante, la literatura sobre atención básica aún deja ver algunos problemas de acceso y tránsito por la red del sistema único de salud(AU)

Introduction: Primary health care in Brazil is considered a priority. In 2013, Mais Médicos Program was created, providing in-service training and expanding the number of doctors in the country. Cuban cooperation, managed by the Pan American Health Organization, sent the largest number of professionals. Objective: Analyze the social representations of health counselors on Mais Médicos Program, in municipalities in which doctors from Cuba cared to their population. Methods: Descriptive cross-sectional case study approached with qualitative methodology. The sample was intentional. It was conducted a work with 58 semi-structured interviews and the analysis was carried out using the free software Iramuteq with the lexical analysis technique. Results: Four groups of representations could be distinguished: on the functioning of the municipal health councils, on the representations of Mais Médicos Program, on the care networks and on Brazilian and Cuban doctors. The study brings evidence of the application of a new model of care for counselors who objectified and anchored in the concept of nationality. The Cuban model incorporates characteristics of humanism, attributes that were not contained in the representations about local doctors. Conclusions: The social representations on Mais Médicos Program allude to an action that improves the quality of services, however, the literature on basic care still shows some problems of access and transit through the network of the health system(AU)

Assuntos

RESUMO

ABSTRACT OBJETIVE To estimate the prevalence of psychological, physical, and sexual violence perpetrated against women by their intimate partner (IP) in Quilombola communities located in Espírito Santo State, Brazil. METHODS The data is from a population-based cross-sectional study of Quilombola women conducted from 2017 to 2018. In-person interviews collected information on women's sociodemographic characteristics, behaviors, and their experience of violence perpetrated by their IP. The analysis used chi-square test and hierarchical logistic regression. RESULTS 219 women (94.8% of the invited ones) agreed to participate in the study. 59.0% (95%CI: 5.25-65.5) reported psychological violence; 41% (95%CI: 34.5-47.5) physical violence; and 8.2% (95%CI: 4.6-11.8) sexual violence. Psychological violence was associated with having three or more sexual partners in life, when compared to those who had up to two partners (p = 0,009), and previous violence involving other people outside of family increased the chance of suffering psychological violence by an IP more than nine times (p ≤ 0.001). Regarding physical violence, the association with use of barrier contraception (p = 0.031) and having a partner with other sexual partners (p = 0.024) were protective factors for IP violence. Having 3 or more sexual partners in the last 12 months (p = 0.006), partner using illicit drugs (p = 0,006), and alcoholism in the family (p = 0,001), increased the chance of suffer physical violence by the partner. Sexual violence perpetrated by the IP was associated with miscarriage (p = 0.016), partner using drugs (p = 0.020), and gynecological symptoms (p = 0.045). CONCLUSIONS These results showed the high frequency of intimate partner violence in Quilombola women and highlight the importance of reducing social and race inequities for interrupting the culture of violence against women.

Assuntos

RESUMO

BACKGROUND: Brazil has considerably reduced the number of cases of malaria in recent years and aims to eradicate the disease completely, however, vivax malaria continues to be a major challenge for the health system. In this context, the key to building a successful elimination programme may lie in the knowledge and the perceptions of the health agents, the patients affected by the disease and the personnel responsible for malaria diagnosis, treatment and control at the local level. METHODS: A qualitative study was undertaken in Manaus, capital of the state of Amazonas, Western Brazilian Amazon, using a sample of 33 patients who were being treated for malaria and 22 health agents who were working in malaria diagnosis, treatment and control at the local level. A semi-structured interview with a further thematic analysis was performed. RESULTS: There are still many myths regarding malaria transmission and treatment that may hinder the sensitization of the population of this region in relation to the use of current control tools and elimination strategies, such as mass drug administration (MDA). Most health professionals reported that the abandonment of treatment for malaria by the patient is related to poor social conditions, the high incidence of alcoholism and the low level of schooling of the affected population. One negative perception, observed in both groups with regard to the use of insecticide-treated nets, is that they may cause skin irritations and allergies. Most patients and health professionals have described malaria as an impossible disease to eliminate because it is intrinsically associated with forest landscapes, and according to them, elimination would only be possible if there were a vaccine against malaria. CONCLUSION: In the Amazon, cultural perceptions about the etiology of this disease can influence the behaviour and practices that social groups adopt in relation to the different forms of living in a malaria-endemic context. Negative perceptions about malaria elimination can act as a barrier when trying to reach proper coverage for control strategies such as mosquito nets and MDA.

Assuntos

RESUMO

[RESUMEN]. Objetivo. Mostrar las narrativas de miembros brasileños de los equipos de salud de la familia acerca del humanismo percibido en la práctica de los cooperantes cubanos del programa Mais Médicos. Métodos. Estudio de caso descriptivo de corte transversal. Se aplicó una entrevista semiestructurada a miembros brasileños de los equipos de salud de la familia que trabajaran desde el inicio del programa con médicos cubanos en municipios seleccionados inscritos en el programa Mais Médicos, con 20% o más de su población en extrema pobreza, y menos de cinco médicos o una tasa de 0,5 médicos por 1 000 habitantes antes del programa. Se procesaron los datos mediante la técnica de análisis de contenido. Resultados. Se entrevistaron 30 licenciados y 28 técnicos en enfermería, 1 técnico administrativo y 19 agentes sanitarios. Los entrevistados valoraron positivamente el trabajo de los médicos cooperantes cubanos y resaltaron su responsabilidad, ética y humanismo, así como la elevada calidad de las consultas médicas y sus buenas relaciones con los pares de la atención básica. Conclusiones. Se constataron diferencias en los patrones de atención de los médicos cooperantes cubanos del programa Mais Médicos con respecto a los médicos que ejercieron en las comunidades estudiadas antes de la implantación de ese programa. Entre los rasgos diferenciales de los médicos cubanos resaltados más frecuentemente figuran el compromiso con la población —tanto en la consulta médica como en la solución de sus problemas—, la empatía, el respeto y, en general, el humanismo con el que tratan a los pacientes.

[ABSTRACT]. Objective. To present the narratives of Brazilian members of family health teams with regard to the humanism perceived in the practice of Cuban physician cooperating in the Mais Médicos program. Methods. Cross-sectional descriptive case study. A semi-structured interview was applied to Brazilian members of family health teams who had worked from the beginning of the program with Cuban physicians in selected municipalities included in the Mais Médicos program (20% or more of the population in extreme poverty and less than five physicians or a rate of 0.5 physicians per 1, 000 population prior to the program). The data were processed using the content analysis technique. Results. Interviews were held with 30 senior nurses, 28 nursing assistants, one administrative technician, and 19 health agents. The interviewees offered a positive assessment of the work of the Cuban cooperating physicians, emphasizing their responsibility, ethics, and humanism, as well as the high quality of their medical consultations and their good relations with their peers in basic health care teams. Conclusions. There were confirmed differences between the patterns of care of the Cuban cooperating physicians in the Mais Médicos program and the physicians who were working before in the studied communities prior to implementation of that program. The differential features of the Cuban physicians most frequently mentioned include their commitment to the population (both in medical consultations and in solving people’s problems), their empathy, their respect, and in general, the human values with which they treat patients.

[RESUMO]. Objetivo. Apresentar as narrativas dos integrantes brasileiros das equipes de saúde da família sobre o humanismo percebido na prática dos colaboradores cubanos do Programa Mais Médicos. Métodos. Trata-se de um estudo de caso descritivo transversal. Foi realizada uma entrevista semiestruturada com os integrantes brasileiros das equipes de saúde da família que trabalhavam desde o início do programa com médicos cubanos em municípios selecionados cadastrados no Programa Mais Médicos. Estas localidades têm 20% ou mais da população vivendo em situação de extrema pobreza, contando com menos de cinco médicos (taxa de 0,5 médico por 1.000 habitantes) antes do programa. Os dados foram analisados com o uso da técnica de análise de conteúdo. Resultados. Foram entrevistados 30 enfermeiros diplomados, 28 técnicos em enfermagem, 1 técnico administrativo e 19 agentes comunitários de saúde. Os participantes avaliaram de forma positiva o trabalho dos médicos colaboradores cubanos destacando características como responsabilidade, postura ética e humanismo bem como a alta qualidade das consultas médicas e o bom relacionamento com os pares da atenção básica. Conclusões. Foram constatadas diferenças no padrão de atenção dos médicos colaboradores cubanos do Programa Mais Médicos em relação aos médicos brasileiros que atuavam nas comunidades estudadas antes da implantação do programa. Entre as características distintivas dos médicos cubanos destacadas estão o compromisso com os pacientes, tanto na consulta médica quanto na solução de problemas, a empatia, o respeito e o humanismo em geral com que eles tratam os pacientes.

Assuntos

RESUMO

Objetivo. Mostrar las narrativas de miembros brasileños de los equipos de salud de la familia acerca del humanismo percibido en la práctica de los cooperantes cubanos del programa Mais Médicos. Métodos. Estudio de caso descriptivo de corte transversal. Se aplicó una entrevista semiestructurada a miembros brasileños de los equipos de salud de la familia que trabajaran desde el inicio del programa con médicos cubanos en municipios seleccionados inscritos en el programa Mais Médicos, con 20% o más de su población en extrema pobreza, y menos de cinco médicos o una tasa de 0,5 médicos por 1 000 habitantes antes del programa. Se procesaron los datos mediante la técnica de análisis de contenido. Resultados. Se entrevistaron 30 licenciados y 28 técnicos en enfermería, 1 técnico administrativo y 19 agentes sanitarios. Los entrevistados valoraron positivamente el trabajo de los médicos cooperantes cubanos y resaltaron su responsabilidad, ética y humanismo, así como la elevada calidad de las consultas médicas y sus buenas relaciones con los pares de la atención básica. Conclusiones. Se constataron diferencias en los patrones de atención de los médicos cooperantes cubanos del programa Mais Médicos con respecto a los médicos que ejercieron en las comunidades estudiadas antes de la implantación de ese programa. Entre los rasgos diferenciales de los médicos cubanos resaltados más frecuentemente figuran el compromiso con la población ­tanto en la consulta médica como en la solución de sus problemas, la empatía, el respeto y, en general, el humanismo con el que tratan a los pacientes.(AU)

Objective. To present the narratives of Brazilian members of family health teams with regard to the humanism perceived in the practice of Cuban physician cooperating in the Mais Médicos program. Methods. Cross-sectional descriptive case study. A semi-structured interview was applied to Brazilian members of family health teams who had worked from the beginning of the program with Cuban physicians in selected municipalities included in the Mais Médicos program (20% or more of the population in extreme poverty and less than five physicians or a rate of 0.5 physicians per 1, 000 population prior to the program). The data were processed using the content analysis technique. Results. Interviews were held with 30 senior nurses, 28 nursing assistants, one administrative technician, and 19 health agents. The interviewees offered a positive assessment of the work of the Cuban cooperating physicians, emphasizing theirresponsibility, ethics, and humanism, as well as the high quality of their medical consultations and their good relations with their peers in basic health care teams. Conclusions. There were confirmed differences between the patterns of care of the Cuban cooperating physicians in the Mais Médicos program and the physicians who were working before in the studied communities prior to implementation of that program. The differential features of the Cuban physicians most frequently mentioned include their commitment to the population (both in medical consultations and in solving people's problems), their empathy, their respect, and in general, the human values with which they treat patients.(AU)

Objetivo. Apresentar as narrativas dos integrantes brasileiros das equipes de saúde da família sobre o humanismo percebido na prática dos colaboradores cubanos do Programa Mais Médicos. Métodos. Trata-se de um estudo de caso descritivo transversal. Foi realizada uma entrevista semiestruturada com os integrantes brasileiros das equipes de saúde da família que trabalhavam desde o início do programa com médicos cubanos em municípios selecionados cadastrados no Programa Mais Médicos. Estas localidades têm 20% ou mais da população vivendo em situação de extrema pobreza, contando com menos de cinco médicos (taxa de 0,5 médico por 1.000 habitantes) antes do programa. Os dados foram analisados com o uso da técnica de análise de conteúdo. Resultados. Foram entrevistados 30 enfermeiros diplomados, 28 técnicos em enfermagem, 1 técnico administrativo e 19 agentes comunitários de saúde. Os participantes avaliaram de forma positiva o trabalho dos médicos colaboradores cubanos destacando características como responsabilidade, postura ética e humanismo bem como a alta qualidade das consultas médicas e o bom relacionamento com os pares da atenção básica. Conclusões. Foram constatadas diferenças no padrão de atenção dos médicos colaboradores cubanos do Programa Mais Médicos em relação aos médicos brasileiros que atuavam nas comunidades estudadas antes da implantação do programa. Entre as características distintivas dos médicos cubanos destacadas estão o compromisso com os pacientes, tanto na consulta médica quanto na solução de problemas, a empatia, o respeito e o humanismo em geral com que eles tratam os pacientes.(AU)

Assuntos

RESUMO

Objetivo. Caracterizar áreas de cooperación interinstitucional y agendas con-vergentes de salud de la Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS), del Consejo de Salud de la Unión de Naciones Suramericanas (UNASUR) y de la Organización del Tratado de Cooperación Amazónica (OTCA) en América del Sur a partir de los determinantes sociales de la salud. Métodos. Estudio cualitativo basado en fuentes documentales oficiales de las tres organizaciones. El abordaje metodológico desarrolló un análisis comparativo sobre las agendas de salud de esos organismos y la Declaración de Río (2011). La sistematización de la información se realizó por medio de una matriz analítica que identifica convergencias en las respectivas agendas. Resultados. La formulación de las agendas de salud de estos organismos recibe influencias de diversas fuerzas internacionales tales como la política externa de los Estados Miembros, estrategias y modelos de cooperación internacional y lineamientos político-estratégicos de las instituciones. Estas agendas revelan esfuerzos por fortalecer bloques, mecanismos de cooperación y acciones programáticas articuladas. Conclusiones. Las agendas de la OPS/OMS, del Consejo de Salud de la UNASUR y de la OTCA apuntan posibilidades de convergencias en diversas áreas programáticas, con énfasis en los determinantes sociales de la salud. A partir de los acuerdos globales de la Declaración de Río como un marco analítico que establece recomendaciones en cinco esferas decisorias, es posible desarrollar acciones de cooperación estructurante en los países de la región, mediadas en conjunto por estos organismos.

Objective. Characterize areas of interinstitutional cooperation and converging health agendas of the Pan American Health Organization/World Health Organization (PAHO/WHO), the Health Council of the Union of South American Nations (UNASUR), and the Amazon Cooperation Treaty Organization (ACTO) in South America based on social determinants of health. Methods. A qualitative study based on official documentary sources from the three organizations, using a comparative analysis of the health agendas of these agencies and the Rio Political Declaration on Social Determinants of Health (2011). Information was systematized using an analytical matrix that identifies convergences in the respective agendas. Results. Development of the health agendas of these agencies is influenced by various international forces such as Member States’ foreign policy, international cooperation strategies and models, and the institutions’ political and strategic guidelines. These agendas reveal efforts to strengthen blocs, cooperation mechanisms, and coordinated programmatic actions. Conclusions. The agendas of PAHO/WHO, the UNASUR Health Council, and ACTO point towards opportunities for convergence in various programmatic areas, emphasizing social determinants of health. Based on the overall agreements of the Rio Declaration as an analytical framework with recommendations in five decisionmaking spheres, structural cooperation actions can be carried out in the region’s countries, jointly mediated by these agencies.

Assuntos

RESUMO

OBJECTIVE: Characterize areas of interinstitutional cooperation and converging health agendas of the Pan American Health Organization/World Health Organization (PAHO/WHO), the Health Council of the Union of South American Nations (UNASUR), and the Amazon Cooperation Treaty Organization (ACTO) in South America based on social determinants of health. METHODS: A qualitative study based on official documentary sources from the three organizations, using a comparative analysis of the health agendas of these agencies and the Rio Political Declaration on Social Determinants of Health (2011). Information was systematized using an analytical matrix that identifies convergences in the respective agendas. RESULTS: Development of the health agendas of these agencies is influenced by various international forces such as Member States' foreign policy, international cooperation strategies and models, and the institutions' political and strategic guidelines. These agendas reveal efforts to strengthen blocs, cooperation mechanisms, and coordinated programmatic actions. CONCLUSIONS: The agendas of PAHO/WHO, the UNASUR Health Council, and ACTO point towards opportunities for convergence in various programmatic areas, emphasizing social determinants of health. Based on the overall agreements of the Rio Declaration as an analytical framework with recommendations in five decision-making spheres, structural cooperation actions can be carried out in the region's countries, jointly mediated by these agencies.

Assuntos