The same occurred with human rights activist Linda Brasil in Aracaju, the capital of Sergipe state, both representing the left-wing Socialism and Freedom Party. The total percentage of women candidates and elected mayors broke records, though still remains far below the percentage of women that make up the total population. Brazil is a majority female country, comprising Out of every ten elected mayors in the first round of voting, three are black or multiracial — a slight increase from four years ago.
According to census data, In the municipality, quilombolas live in small and isolated rural communities, often without running water or basic sanitation. The indices of adequate use of prenatal care are based on the number of visits recommended for a low-risk pregnancy, but they do not establish any recommendation of a standard number of visits for women at high risk and do not contemplate the intervals between visits.
Another limitation is the use of self-reported data. In addition, it was not possible to assess the efficacy or quality of the visits since the indices are quantitative, this being a limitation observed in most studies [ 7 , 8 , 52 , 53 ]. However, even with these limitations, the indices for the evaluation of adequate use of available prenatal care provide useful information.
Prenatal care coverage was practically universal and there was a reduction in the rate of its inadequate utilization. Both predisposing and enabling factors, as well as factors related to health needs were associated with inadequate utilization of prenatal care. However, social and racial disparities still persist in the use of this care, even after the improvement of income and schooling observed during this period.
Being poor, black or mulatto and having a low educational level are important barriers against receiving adequate prenatal care.
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The present data support the importance of the Family Health Program as a model of organization of health care, since women covered by this program had lower rates of inadequate utilization of prenatal care. Cad Saude Publ. Google Scholar. Brazil Rev Panam Salud Publ. Braz J Med Biol Res. Contrasts in health status, Volume 1.
Am J Public Health. Rev Saude Publica. Andersen RM: Revisiting the behavioral model and access to medical care: does it matter?. J Health Soc Behav. Rosenstock IM: Why people use health services. Milbank Mem Fund Q. Dutton D: Financial, organizational and Professional factors affecting health care utilization. Soc Sci Med. Why are some people health and others not? The determinants of health of populations.
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J Adv Nurs. BMC Pregnancy Childbirth. Rev Bras Ginecol Obstet. Barros FC, Victora C, Barros A: The challenge of reducing neonatal mortality in middle-income countries: findings from three Brazilian birth cohorts in , and Rev Bras Enferm.
Br J Obstet Gynaecol. Rev Bras Epidemiol. Rev Enferm. Rev Bras Med Fam Com. Cochrane Database Syst Rev. Public Health Rep. Health Policy Plan. J Epidemiol Community Health. Download references. The authors declare no interests, stocks, competing interests, or shares in organizations that may profit or lose through publication of this paper. All authors read and approved the final manuscript. Reprints and Permissions. Bernardes, A. BMC Pregnancy Childbirth 14, Download citation. Received : 21 August Accepted : 05 August Published : 10 August Skip to main content.
Search all BMC articles Search. Download PDF. Abstract Background Over the last decades there has been a reduction of social inequalities in Brazil, as well as a strong expansion of health services, including prenatal care. Results Only 2. Conclusions Despite strong expansion of health services and expressive improvements in adequate prenatal care use and social indicators, inequalities in prenatal care use still persist.
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Background Appropriate care during pregnancy and childbirth is essential to reduce the magnitude of mother-child morbidity and mortality. Table 1 Characteristics of prenatal care use based on the minimum calendar of the ministry of health Full size table.
Table 2 Socioeconomic, demographic, reproductive, behavioral, and morbidity characteristics of women having given birth Full size table. Table 3 Non-adjusted analysis of the factors associated with inadequate prenatal care utilization Full size table.
Table 4 Adjusted analysis by means of hierarchized modeling of the factors associated with inadequate prenatal care use Full size table. Universal prenatal care coverage Several studies have shown improved care during pregnancy and delivery throughout Brazil [ 1 , 29 ]. Factors predisposing to the use of prenatal care services The rates of inadequate prenatal care use decreased with increasing maternal schooling.
Factors facilitating the use of prenatal care — enabling resources Income inequalities, although still strongly present in Brazil, have shown a decreasing trend [ 1 ]. Strengths One of the advantages of the present study was the use of an index that seems to be more appropriate for the Brazilian reality, as recommended by the Ministry of Health.
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Limitations At least one limitation of the study concerned the methods used to determine the time when prenatal care was started and the number of prenatal care visits in order to assess the adequacy of prenatal care use. Conclusions Prenatal care coverage was practically universal and there was a reduction in the rate of its inadequate utilization.
Pain was a symptom referred to by the patients and it was related to the surgical incision, the nausea and the long period spent in bed: pain in the chest, that pain was too strong patient 8. The only thing that bothered me was the vomiting. It was a back pain which felt like a bone being pulled away from inside patient 2. The relationship with the health care professionals: impersonality, professional presence representing safety and comfort, orientation and information representing safety and clarification.
The guy who does the anesthesia talked to me, there were two guys. I do not remember their names patient 2. The non-identification of the health care professionals by their names was a common factor amongst some of the patients interviewed. Although the members of the health team were not identified by their names, their presence gave the patients safety and comfort: they do not leave you for a minute patient 1.
There is one nurse for each person, that nurse is always alert patient 2. The physiotherapist has been helping me a lot patient 3. The nurses and the doctors are our friends, therefore I felt safe patient 5. The orientation and information provided the knowledge of what was going to happen according to the plan: I remembered everything that was planned by the cardiac team patient 4. On the other hand, even though being informed and advised about the postoperative period, other patients presented contradictory statements: I think it is tense for us not knowing what is going to happen patient 1.
The biggest difficulty is the unknown patient 3.
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These conflicting statements are possibly justified by the exposure to high levels of stress. Surgical experience: overcoming fear. It was noted that some patients showed the feeling of 'accomplished stage', as if they felt that the worst was over. The fear was a feeling more connected to the pre-operative period, when they referred to the tension related to the time prior to the surgery. The results coincide with national and international literature, which considers the ICU stay the most difficult period for the patient because they find themselves in a new situation, surrounded by equipment and exposed to noise, factors that caused stress and emotional change.
During the first hours of the cardiac surgery's postoperative period, strict hydric control is kept in order to minimize the risks of complications resulting from the excess of liquid into the extracellular space. On the other hand, patients feel violated with the limitation of liquid ingestion, which can drive them desperate as they do not understand or accept this control. Other studies have identified thirst as a stress factor for patients in ICU. A study undertaken in Spain using a qualitative approach has identified thirst as an anxiety-causing factor for patients in the first 24 hours after having cardiac surgery.
In the present study, the endotracheal cannula appeared to be an unpleasant and very stressful experience. The results are in line with the literature. Research undertaken in Brazil and in other countries with patients who were subject to intubation in an ICU showed that the presence of an endotracheal tube is one of the most stressful factors for the patients. According to some authors, one explanation for the stress the endotracheal tube caused in patients would be its inhalation, as the tube needs to be inhaled regularly in order to keep the airways cleared during the intubation period.
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A research developed with patients undergoing cardiac surgery related the pain symptom to various factors, such as the surgical-anesthetic procedure, the psychological state of the patient and the ICU environment In another study, the pain referred to by the patients was analyzed as a subjective symptom, impossible to be predicted beforehand and which can be associated to the undertaken procedures and physical discomfort.
The cardiac surgery and the stay at ICU are unique events that emotionally weaken the patient. In this sense, knowing that health care professionals who are always present and transmit safety and comfort are taking care of them makes them feel protected. An explanation that meets the results of the present study may be that, during their ICU stay, patients can recede to a childish standard of behavior and to a dependency state because they have to trust strangers to perform simple tasks such as hygiene, feeding or change of position in bed.
In a study undertaken at a teaching hospital in Rio de Janeiro with patients who stayed at ICUs, the patients showed satisfaction with the ICU nurses' care delivery and the stress factors that affected them were of physical and environmental origin. The patients, in their statements, considered the surgery as a stage to be accomplished, as it was the only option for the health state they were in. The fear was present in the pre-operative period and the patients referred to this feeling as expected for someone who is undergoing a surgical intervention like the cardiac surgery.
This fear can be considered as a potentially stressful factor. Thirst, the endotracheal tube and the pain were frequently mentioned and the authors considered them potentially stressful factors. It is believed that strategic measures could reduce the stress the oral hydric control and endotracheal tube, tube removal and pain cause.
Through the identified stress factors, nurses can intervene by using intervention technics in order to relieve patients' pain and to promote an environment in which it is possible to rest, with less luminosity, noise and the least possible interruption. Through the statements two large groups of stress factors could be identified: intrapersonal and extrapersonal. The intrapersonal ones were: thirst, pain, sleep deprivation, reduced mobility, the tube and no notion of time.
Background
The most significant extrapersonal stress factors were related to the environment: different noises and luminosity. It should be emphasized that, when the patients expressed these factors, they were accompanied by expressions and vocal intonations that revealed that these were highly stressful factors. Therefore, based on the patients' statements, the results of the present study allowed the understanding of stressful situations, which can be predicted in the nursing care planning in this sector, aiming to reduce the impact of these stress factors.
Based on the above, this study provides support for the improvement of nursing practice at the study unit, with a view to promoting care that takes into account the needs of cardiac surgery patients, and also reduces the impact of potentially stressful factors detected and their negative effects on patients' homeostasis and recovery.