Estado emocional e satisfação com o suporte social após uma interrupção voluntária da gravidez

Dissertação de Mestrado apresentada no Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica

Is the legal protection for the foetus adequate in clinical trials?

In 2009 and 2010, the major drug regulatory bodies, the European Medicines Agency and the Food and Drug Administration in the USA, issued requests for the generation of information relating to the absorption, distribution, metabolism, excretion, efficacy and safety of investigational drugs in pregnant women prior to approval. In the wake of thalidomide, research involving pregnant women other than for obstetric or gynaecologic purposes became rare, and studies of investigational drugs practically unknown. Consequently, none of the legislation applicable in the UK and few of the guidelines introduced in the last 40 years properly addresses the conduct of clinical trials of investigational drugs in this population. This thesis questions whether the legal protection for the foetus is adequate in clinical trials. The answer appears to be a qualified “no”. Arguments persist regarding the moral standing of the foetus, particularly regarding abortion. That will not be the intent of such trials, and a moral case is made for the conduct of clinical trials in this population by analogy with the neonate, and the pregnant woman’s autonomy. Legally, we already recognise the foetus has ‘interests’ which crystallise upon live birth, and that compensation is recoverable for harm inflicted in utero manifesting as congenital injury. The essence of research is quite different from medical practice, and the extent to which this is understood by trial participants is unclear. The approvals processes contain a number of inadequacies which have the potential to expose the foetus to harm and affect the consent of the pregnant woman. The recovery of compensation in the event of children born injured following clinical trials during pregnancy in many ways may be more complex than other personal injury cases.. The conclusions of this thesis are that the existence of a foetus does merit recognition by the law in this setting and that morally such studies are justifiable. However, the present legislation and approval processes potentially expose the foetus to avoidable risk and may not be appropriate to enable the recovery of compensation, thereby creating potential to deter future trial participants. A proposal is made regarding an approach to simplify the process for recovery of compensation, and thereby strengthen the approval and consent processes.

Miedos relacionados con el proceso de embarazo y parto en adolescentes entre 12 y 19 años del Subcentro de Salud Ricaurte, Cuenca 2015

ANTECEDENTES: El embarazo en adolescentes es un problema de salud pública que va en aumento e implica riesgos, consecuencias y miedos que se enfrentan en el periodo de gestación, los cuales se exponen por cambios físicos y falta de información en las adolescentes. OBJETIVO: Identificar los miedos relacionados con el proceso de embarazo y parto en adolescentes entre 12 y 19 años del Subcentro de Salud Ricaurte. Cuenca, 2015. MATERIAL Y MÉTODOS: Comprende un estudio cuantitativo descriptivo, constituido por 122 adolescentes embarazadas seleccionadas en el Subcentro de Salud a través de la aplicación de encuestas y entrevistas, previo consentimiento de las adolescentes involucradas y de sus padres. Los datos fueron procesados y analizados a través de los programas SPSS, Microsoft Excel, los resultados se presentan en gráficos y tablas simples con sus respectivos análisis. RESULTADOS: El 10% de adolescentes embarazas que asisten al subcentro de salud de Ricaurte a ser atendidas están entre los 12 a 14 años, el 40 % entre los 15 y 17 años, y el 50% se encuentran con edad superior a los 18 años, el 74,08% tienen miedo a sufrir un aborto. CONCLUSIONES: La adolescencia es un conjunto de cambios fisiológicos, sociales y emocionales; dependiendo de la edad de la adolescente y del tiempo que ha transcurrido entre su desarrollo y el embarazo puede haber más o menos complicaciones. A través de las encuestas pudimos determinar que las adolescentes presentan miedos durante el embarazo y el parto.

Objeção da consciência e aborto previsto em lei : vivências em um serviço público de saúde

Tese (doutorado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Departamento de Enfermagem, Programa de Pós-Graduação em Enfermagem, 2015.

A cross sectional study of leptospirosis and fetal death in Yucatan, Mexico

Introduction: Leptospirosis is a zoonotic disease affecting mainly to low income human population. Acute leptospiral infection during pregnancy has been associated with spontaneous abortion and fetal death during the first trimester and the abortion may occur as consequence of systemic failure. Objective: To estimate the frequency of Leptospira interrogans infection in women with spontaneous abortion in the state of Yucatan, Mexico. Methods: A cross sectional study on women with spontaneous abortion was conducted. Serum samples were tested for Leptospirosis by the microaglutination test, to estimate the frequency of the infecting serovar. The indirect ELISA IgM was used to detect recent infection by L. interrogans. DNA was extracted from paraffin-embedded tissue of placenta for PCR detection of L. interrogans. Results: Overall frequency of infection with L. interrogans in the 81 women with abortion was 13.6%. Five of the 12 serovars evaluated were found and included. Two of the 11 women with abortion and positive to microaglutination test were also positive to the ELISA IgM test. None samples were positive for PCR Leptospira diagnosis. Conclusion: two women could be associated with spontaneous abortion due to leptospirosis, because they showed antibodies against L. interrogans in the microaglutination test and ELISA IgM assays. Differences between regions were found with respect to the prevalences of lesptospirosis.

Protocol for ACCESS : a qualitative study exploring barriers and facilitators to accessing the emergency contraceptive pill from community pharmacies in Australia

INTRODUCTION: The rate of unplanned pregnancy in Australia remains high, which has contributed to Australia having one of the highest abortion rates of developed countries with an estimated 1 in 5 women having an abortion. The emergency contraceptive pill (ECP) offers a safe way of preventing unintended pregnancy after unprotected sex has occurred. While the ECP has been available over-the-counter in Australian pharmacies for over a decade, its use has not significantly increased. This paper presents a protocol for a qualitative study that aims to identify the barriers and facilitators to accessing the ECP from community pharmacies in Australia.

METHODS AND ANALYSIS: Data will be collected through one-on-one interviews that are semistructured and in-depth. Partnerships have been established with 2 pharmacy groups and 2 women's health organisations to aid with the recruitment of women and pharmacists for data collection purposes. Interview questions explore domains from the Theoretical Domains Framework in order to assess the factors aiding and/or hindering access to ECP from community pharmacies. Data collected will be analysed using deductive content analysis. The expected benefits of this study are that it will help develop evidence-based workforce interventions to strengthen the capacity and performance of community pharmacists as key ECP providers.

ETHICS AND DISSEMINATION: The findings will be disseminated to the research team and study partners, who will brainstorm ideas for interventions that would address barriers and facilitators to access identified from the interviews. Dissemination will also occur through presentations and peer-reviewed publications and the study participants will receive an executive summary of the findings. The study has been evaluated and approved by the Monash Human Research Ethics Committee.

The Amplifier - v. 16, no. 3

In this issue...Library, Registration, Ugly Man Contest, Don Heater, Miners Bank, Copper Bowl, Abortion Legalization, AWS Convention, Student Council, Copper Lounge

Effect of Preventive Chlamydia abortus Vaccination in Offspring Development in Sheep Challenged Experimentally

Ovine enzootic abortion, caused by Chlamydia abortus, leads to important economic losses worldwide. In addition to reproductive failures, infection may impact lamb growth during the first weeks after birth, yet this effect has not been well characterized. Vaccination can help to control the disease but variable efficacy values have been described, possibly related with factors associated with the host, the vaccine, the parameter used for efficacy determination and the challenge conditions. In this context, we evaluated the efficacy of an inactivated standard commercial vaccine and a 1/2 diluted dose in pregnant sheep challenged with C. abortus by examining multiple indicators ofvaccine effect (including incidence of reproductive failures, bacterial excretion, and evolution of weight gain of viable lambs during the first month of life). Three groups of ewes [control non-vaccinated, C (n = 18); vaccinated with standard dose, SV (n = 16) and vaccinated with 1/2 dose, DV (n = 17)], were challenged approximately 90 days post-mating and tested using direct PCR (tissue samples and vaginal swabs) and ELISA (serum) until 31 days post-reproductive outcome. There were not significant differences in the proportions of reproductive failures or bacterial shedding after birth/abortion regardless the vaccination protocol. However, a beneficial effect of vaccination on offspring growth was detected in both vaccinated groups compared with the controls, with a mean increase in weight measured at 30 days of life of 1.5 and 2.5 Kg (p = 0.056) and an increase in the geometric mean of the daily gain of 8.4 and 9.7% in lambs born from DV and SV ewes compared to controls, respectively. Our results demonstrate the effect of an inactivated vaccine in the development of the offspring of C. abortus-infected ewes at a standard and a diluted dose, an interesting finding given the difficulty in achieving sufficient antigen concentration in the production of EAE-commercial vaccines.

Factores asociados a embarazo no deseado en mujeres en edad reproductiva en Colombia 2010

Objetivo: Identificar factores sociodemográficos y de fecundidad, asociados a ocurrencia de embarazo no deseado en mujeres colombianas en edad reproductiva en el año 2010. Métodos: Se realizó estudio retrospectivo de corte transversal, basado en los datos de la ENDS Colombia-2010, del total de mujeres en edad fértil (13-49 años) que al momento de la encuesta se encontraban en embarazo. La variable de interés fue embarazo no deseado, se describió la población a estudio y se evaluó la posible asociación con variables sociodemográficas y de fecundidad, a través de análisis bivariado y multivariado. Se realizaron los mismos análisis por grupo de edad (adolescentes vs adultas). Resultados: La prevalencia de embarazo no deseado en las mujeres colombianas en el 2010 fue de 61,4 %. De acuerdo al modelo de regresión logística, no estar en unión a una pareja (OR: 4,01 IC95%: 3,066-5,269), tener hijos (OR: 2,040 IC95%: 1,581 – 2,631), estar en el quintil de menor riqueza (OR: 2,137 IC95%: 1,328-3,440), y ser adolescente (OR: 1,599 IC95%: 1,183-2,162), son factores que aumentan la probabilidad de tener un embarazo no deseado. Se encontraron diferencias en los factores asociados al realizar segmentación por edad. Conclusiones: La prevalencia de embarazo no deseado permanece alta en Colombia respecto a años anteriores y a otros países. Los resultados pueden ser de utilidad para el desarrollo de políticas en salud sexual y reproductiva teniendo en cuenta los factores asociados identificados priorizando a la población adolescente y de menor estatus socioeconómico, para la prevención de embarazo no deseado en Colombia.

Salud sexual y reproductiva: aspectos de análisis para el departamento de Casanare

La sexualidad y la reproducción están íntimamente ligadas a la calidad de vida, tanto en el ámbito de lo individual como de lo social, por tanto la salud sexual y reproductiva representa un componente esencial para la evaluación de desarrollo de un país, y un tema prioritario en la agenda política mundial y nacional como lo evidencian los objetivos del milenio y de desarrollo sostenible; aunque el país ha dado enormes avances en el tema, aun se presentan grandes retos para el logro y goce efectivo de los derechos sexuales y reproductivos en la población. El objetivo del presente estudio es describir y analizar algunos indicadores de salud sexual y reproductiva en el departamento de Casanare, en el periodo 2008- 2015. Como metodología se usó un diseño descriptivo trasversal, los datos fueron tomados de Sivigila departamental, Estadísticas DANE y del Instituto Nacional de Salud. Se usó SPSS versión 18 y Excel para el análisis de los datos. Como resultados se encontraron altas tasas de prevalencia e incidencia para VIH, sífilis gestacional, y fecundidad en adolescentes en el departamento de Casanare que sobrepasan los indicadores nacionales y presentan tendencia creciente

La progresividad del artículo 1° de la Declaración Americana de los Derechos y Deberes: el aporte del desarrollo de los derechos reproductivos en América Latina

 Resumen  El desarrollo progresivo del derecho a la vida, la libertad y la seguridad personal se han visto enriquecidos con la lucha y posterior positivación de los derechos reproductivos, en tanto estos han generado una ampliación de los criterios sobre los cuales se basa la obligación del Estado respecto de los derechos humanos en general, y en particular de aquellos consagrados en el primer artículo de la Declaración Americana de Derechos y Deberes. Los países de América Latina, en el marco de dicha obligación, han adoptado posturas diversas frente a los derechos reproductivos, específicamente en lo que refiere a la despenalización del aborto consolidando tres grandes tendencias regionales que muestran aciertos y desaciertos. El presente artículo que surge como reflexión personal propuesta como aporte académico en el marco de los debates jurídicos llevados a cabo durante el I Congreso Latinoamericano Jurídico sobre Derechos Reproductivos, tiene como objetivo realizar una mirada a dichas tendencias con el fin de dar un panorama general de la situación de América Latina y su deuda frente a los derechos reproductivos y de esta manera pensar propuestas más holísticas para alcanzar la realización de dichos derechos, y consecuentemente seguir promoviendo progresivamente el desarrollo del derecho a la vida, la libertad y la seguridad personal.Palabras clave: derechos reproductivos, vida, libertad personal, progresividad.AbstractThe progressive development of the right to life, liberty and personal security has been enriched by the struggle for and subsequent onset of reproductive rights, in as much as they have widened the State’s obligations towards the respect of human rights and in particular those enumerated in the first article of the American Declaration of the Rights and Duties. Latin American countries, within these requirements, have taken diverse stances towards reproductive rights, specifically with regards to the decriminalization of abortion, which can be reduced into three major trends representing successes as well as errors. This article comes as a personal reflection, and proposed as an academic contribution, in the context of legal debates held during the First Latin American Congress on Reproductive Rights Law. It is aimed at taking a look at these trends in order to give an overview on the situation in Latin America and its debt to reproductive rights, and, in this way, to ponder about more holistic proposals to achieve their fulfillment, hence progressively promoting the development of the right to life, to liberty and to personal security. Keywords: Reproductive rights, life, personal liberty, progressiveness.

Salud sexual, SALUD REPRODUCTIVA Y ABORTO: ¿QUÉ DERECHOS?

ResumenEl aborto es un tema debatido desde hace décadas. En España, se ha aprobado recientemente la LO 2/2010, de salud sexual y reproductiva y de la interrupción voluntaria del embarazo, que implica un importante cambio en la regulación del aborto: establece un sistema de aborto a petición de la embarazada en un plazo, manteniendo determinadas indicaciones durante más tiempo. El presente artículo analiza el contenido de la salud sexual y reproductiva, los derechos de la mujer y la protección del no nacido en el Derecho Internacional, así como la jurisprudencia constitucional española y la diferencia sustancial del sistema de plazos respecto al de supuestos, la ética médica al respecto y las exigencias del consentimiento informado. Finalmente, se aborda el problema del consentimiento de los menores a la unión sexual y al aborto.AbstractAbortion is an issue that has been discussed for decades. In Spain, the Law on sexual and reproductive health and the voluntary interruption of pregnancy (LO 2/2010) has been recently passed. It implies an important change in abortion legislation: it states an abortion upon request of the pregnant woman during a predetermined period of time, while maintaining certain regulations for a long time. This article analyzes the content of sexual and reproductive health, women’s rights and the protection of the unborn under International Law, as well as the constitutional Spanish jurisprudence; the essential difference of the term-based system in regards to the assumptions system, medical ethics on this matter and the requirements of the informed consent. Lastly, the article deals with the problem of the minors’ consent to sexual union and abortion.