O planejamento familiar na perspectiva feminina

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Soroepidemiologia da sífilis em gestantes e seus recém-nascidos

A sífilis é uma doença infecto-contagiosa sistêmica causada pelo Treponema pallidum, parasita exclusivo do homem, cuja transmissão se faz essencialmente pelo contato sexual. A incidência desífilis congênita tem atingido proporções de verdadeira epidemia, apesar do conhecimento de medidas que poderiam controlar esta doença. A investigação caracterizou gestantes com sífilis internadas na FSCMPA no período de janeiro de 2001 até junho de 2003, quanto às características sócio-demográficas, comportamento para promoção da saúde sexual e reprodutiva, dados sorológicos e clínicos relacionados à sífilis no binômio mãe/recém-nascido. O estudo é de natureza analítico-descritivo, de corte transversal, com 245 gestantes, a partir da revisão de prontuários destes pacientes, com sorologia positiva para sífilis e do recém-nascido, testados pelo método de VDRL. A incidência de sífilis em gestantes foi de 1,73% do total de pacientes internadas nos últimos 2 anos e meio. O perfil epidemiológico demonstrou que os principais fatores de risco para aquisição da sífilis na gestação foram: ausência de acompanhamento pré-natal e de tratamento, inclusive do parceiro sexual. De acordo com a soropositividade materna no pós-natal, verificou-se que a possibilidade de um recém-nascido ter sífilis, se VDRL positivo, foi de 98,68%. A icterícia e o baixo peso foram os sinais clinícos de maior ocorrência, a prematuridade também foi sinal clínico observado. Estas análises revelam a necessidade de campanhas educativas mais abrangentes, sobre os fatores de risco para aquisição desta enfermidade e um melhor atendimento às gestantes no pré-natal, com acompanhamento e diagnóstico controle das gestantes.

A saúde de jovens mães: desafios para os sitemas de proteção social

Pós-graduação em Serviço Social - FCHS

Travestis, escolas e processos de subjetivação

In this paper, we analyze transvestites’ reports regarding their experiences at schools. It is a cartography that focuses on negative and positive aspects which call to consideration difficulties from the operators of the education in dealing with this population. Such cartography clarifies the urgent need for opening to a broaden debate to increase the educational actions in the perspective of the protection of the Sexual and Human Rights with strategies of inclusion and defense of citizenship. In spite of the transvestites’ difficulties in enduring and concluding their studies, it is possible to locate some schools in which the transvestites can be welcomed and respected in consideration to their personal choices. Thus, it clarifies the lines that composes their subjectivation processes.

Corpo e sexualidade na gravidez

Estudo etnográfico que teve como objetivo compreender como as gestantes vivenciam os processos fisiológicos do seu corpo durante a gestação e a sua repercussão na sexualidade. A pesquisa envolveu sete mulheres residentes em bairro popular de São Paulo. Na coleta de dados, utilizou-se observação participante e entrevista com questões norteadoras. Os dados foram apresentados na forma de narrativa e posteriormente organizados nas categorias: Percebendo as transformações corporais; Convivendo com as mudanças no corpo; Sentimentos e sensações na vida sexual durante a gestação e imaginando o corpo e a sexualidade após a gestação. As mulheres referiram-se às transformações do corpo como desconfortos e expressaram a preocupação de que fossem definitivas. Expressaram o desejo de que, após o parto, o corpo volte a ser como era e que volte a sentir desejo sexual. O reconhecimento destes fatos constitui-se numa ferramenta primordial na adequação das práticas profissionais.

Aportes ético-políticos a la discusión sobre el Programa de Salud Reproductiva

El trabajo, elaborado en ocasión de la discusión en el seno de la Universidad Nacional de Cuyo sobre el tema de salud reproductiva, intenta realizar un aporte a tal discusión en relación con: 1. La oportunidad y conveniencia de establecer un debate de la comunidad universitaria en torno al proyecto de salud reproductiva que toca diferentes dimensiones de la vida comunitaria. 2. El concepto de vida, vida humana y vida moral. 3. La legitimidad y oportunidad de la intervención de las instituciones sociales (Estado, nacional o provincial, Universidad) en las cuestiones relacionadas con la vida.

Advance provision of emergency contraception for pregnancy prevention (Review)

Background Emergency contraception can prevent pregnancy when taken after unprotected intercourse.Obtaining emergency contraception within the recommended time frame is difficult for many women. Advance provision could circumvent some obstacles to timely use. Objectives To summarize randomized controlled trials evaluating advance provision of emergency contraception to explore effects on pregnancy rates, sexually transmitted infections, and sexual and contraceptive behaviors. Search strategy In November 2009, we searched CENTRAL, EMBASE, POPLINE,MEDLINE via PubMed, and a specialized emergency contraception article database. We also searched reference lists and contacted experts to identify additional published or unpublished trials. Selection criteria We included randomized controlled trials comparing advance provision and standard access (i.e., counseling whichmay ormay not have included information about emergency contraception, or provision of emergency contraception on request at a clinic or pharmacy). Data collection and analysis Two reviewers independently abstracted data and assessed study quality. We entered and analyzed data using RevMan 5.0.23. Main results Eleven randomized controlled trials met our criteria for inclusion, representing 7695 patients in the United States, China, India and Sweden. Advance provision did not decrease pregnancy rates (odds ratio (OR) 0.98, 95% confidence interval (CI) 0.76 to 1.25 in studies for which we included twelve-month follow-up data; OR 0.48, 95% CI 0.18 to 1.29 in a study with seven-month follow-up data; OR 0.92, 95% CI 0.70 to 1.20 in studies for which we included six-month follow-up data; OR 0.49, 95% CI 0.09 to 2.74 in a study with three-month follow-up data), despite reported increased use (single use: OR 2.47, 95% CI 1.80 to 3.40; multiple use: OR 4.13, 95% CI 1.77 to 9.63) and faster use (weighted mean difference (WMD) -12.98 hours, 95% CI -16.66 to -9.31 hours). Advance provision did not lead to increased rates of sexually transmitted infections (OR 1.01, 95% CI 0.75 to 1.37), increased frequency of unprotected intercourse, or changes in contraceptive methods.Women who received emergency contraception in advance were equally likely to use condoms as other women. Authors’ conclusions Advance provision of emergency contraception did not reduce pregnancy rates when compared to conventional provision. Results from primary analyses suggest that advance provision does not negatively impact sexual and reproductive health behaviors and outcomes. Women should have easy access to emergency contraception, because it can decrease the chance of pregnancy.However, the interventions tested thus far have not reduced overall pregnancy rates in the populations studied.

Saving Young Lives: Pathfinder International’s Youth-Friendly Postabortion Care Project

As many as 2.5 million adolescent women seek abortion each year, and nearly 70,000 women die from complications related to unsafe abortion, of which almost half are women under the age of 25. A further 5 million women suffer disability due to unsafe abortion yearly. In most developing countries, abortion is legally restricted or highly inaccessible, which leads young women to seek services from unskilled practitioners often leading to incomplete, septic abortions and massive bleeding, which can result in permanent injury, infertility, and death. Based on our deeply held belief that all people, including adolescents, have a right to sexual and reproductive health services and the importance of addressing adolescent needs within Postabortion Care (PAC) services, Pathfinder used private funds to initiate a Youth-Friendly Postabortion Care (YFPAC) program in eight sub-Saharan African countries. Implemented between June 2007 and May 2008, the YFPAC program offered an opportunity to apply the PAC Consortium’s Technical Guidance on Youth-Friendly PAC, generating promising approaches and lessons learned. The goal of the YFPAC initiative was to increase access to PAC services that are responsive to adolescent needs in sub-Saharan Africa. While outcomes varied according to the country, the overall outcomes included: Increased community support for services and activities that prevent unwanted pregnancy, decreased stigma around abortion, and awareness of the issue of unsafe abortion among adolescent women: 311 peer educators reached almost 17,487 youth and other community members; 171 stakeholders (e.g., religious and traditional leaders, health officials, and local government officials) were sensitized on YFPAC, resulting in a positive shift in communities’ attitudes toward youth in need of PAC services. 125 service providers were trained to deliver YFPAC services and three doctors in Ghana were provided with a technical update on YFPAC. YFPAC services are available in Angola, Ghana, Nigeria, Mozambique, Tanzania, Uganda, Ethiopia, and Kenya. Pathfinder introduced YFPAC services into 25 facilities (in 27 service delivery points), and provided more than 3,800 clients with YFPAC services throughout the eight countries. The number of adolescent PAC clients seen at the project facilities increased— 710 clients were seen in the first quarter, 1,144 were seen in the fourth. The number of adolescent PAC clients who adopt a contraceptive method to prevent future unintended pregnancies has increased. Statistics show an average postabortion contraceptive acceptance of 69%, with the highest acceptance being 83% and the lowest being 44%. Evidence-based approaches, tools, and lessons learned are being disseminated and used for scale-up or replication of YFPAC interventions.

ADOLESCÊNCIA E SEXUALIDADE: UMA ANÁLISE DO DISCURSO DA MÍDIA SEGMENTADA

Esse estudo propõe uma reflexão sobre o tratamento dado ao tema sexualidade nas revistas Atrevida e Capricho, destinadas a adolescentes. Nosso corpus constitui-se de 62 edições, veiculadas nos anos de 1996 e 2006. No contexto social, há uma preocupação crescente com as questões de saúde sexual e reprodutiva, gravidez precoce e aborto inseguro entre os menores de 18 anos. O objetivo do presente trabalho é, portanto, verificar qual é a contribuição dessas revistas adolescentes no que diz respeito à informação e ao esclarecimento sobre sexualidade e indicar se, em virtude do tempo, houve uma variação na forma de tratar o assunto. Também é nosso interesse verificar de que maneira os discursos sobre sexualidade são construídos nestes espaços e, para tanto, utilizamos a análise do discurso como eixo teórico-metodológico. Concluímos que, embora o assunto tenha espaço nas duas revistas, sua cobertura é restrita e não há freqüência ou continuidade nos temas abordados. Nota-se um esforço em esclarecer sobre sexualidade e disseminar comportamentos seguros, porém, a cobertura do temas é feita, em grande parte das vezes, de modo bastante superficial e seguindo padrões de abordagem que não são capazes de abranger o tema em toda a sua complexidade.(AU)

ADOLESCÊNCIA E SEXUALIDADE: UMA ANÁLISE DO DISCURSO DA MÍDIA SEGMENTADA

Esse estudo propõe uma reflexão sobre o tratamento dado ao tema sexualidade nas revistas Atrevida e Capricho, destinadas a adolescentes. Nosso corpus constitui-se de 62 edições, veiculadas nos anos de 1996 e 2006. No contexto social, há uma preocupação crescente com as questões de saúde sexual e reprodutiva, gravidez precoce e aborto inseguro entre os menores de 18 anos. O objetivo do presente trabalho é, portanto, verificar qual é a contribuição dessas revistas adolescentes no que diz respeito à informação e ao esclarecimento sobre sexualidade e indicar se, em virtude do tempo, houve uma variação na forma de tratar o assunto. Também é nosso interesse verificar de que maneira os discursos sobre sexualidade são construídos nestes espaços e, para tanto, utilizamos a análise do discurso como eixo teórico-metodológico. Concluímos que, embora o assunto tenha espaço nas duas revistas, sua cobertura é restrita e não há freqüência ou continuidade nos temas abordados. Nota-se um esforço em esclarecer sobre sexualidade e disseminar comportamentos seguros, porém, a cobertura do temas é feita, em grande parte das vezes, de modo bastante superficial e seguindo padrões de abordagem que não são capazes de abranger o tema em toda a sua complexidade.(AU)

Gravidez e transplante hepático : revisão a propósito de um caso clínico

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

ADOLESCÊNCIA E SEXUALIDADE: UMA ANÁLISE DO DISCURSO DA MÍDIA SEGMENTADA

Esse estudo propõe uma reflexão sobre o tratamento dado ao tema sexualidade nas revistas Atrevida e Capricho, destinadas a adolescentes. Nosso corpus constitui-se de 62 edições, veiculadas nos anos de 1996 e 2006. No contexto social, há uma preocupação crescente com as questões de saúde sexual e reprodutiva, gravidez precoce e aborto inseguro entre os menores de 18 anos. O objetivo do presente trabalho é, portanto, verificar qual é a contribuição dessas revistas adolescentes no que diz respeito à informação e ao esclarecimento sobre sexualidade e indicar se, em virtude do tempo, houve uma variação na forma de tratar o assunto. Também é nosso interesse verificar de que maneira os discursos sobre sexualidade são construídos nestes espaços e, para tanto, utilizamos a análise do discurso como eixo teórico-metodológico. Concluímos que, embora o assunto tenha espaço nas duas revistas, sua cobertura é restrita e não há freqüência ou continuidade nos temas abordados. Nota-se um esforço em esclarecer sobre sexualidade e disseminar comportamentos seguros, porém, a cobertura do temas é feita, em grande parte das vezes, de modo bastante superficial e seguindo padrões de abordagem que não são capazes de abranger o tema em toda a sua complexidade.(AU)

The use of motivational interviews by nurses to promote health behaviors in adolescents: a scoping review protocol

Adolescents - defined as young people between 10 and 19 years of age1 - are, in general, a relatively healthy segment of the population.2 However, the developmental changes that take place during adolescence may affect their subsequent risk for diseases and for a variety of health-related behaviors. In fact, early onset of preventable health problems (e.g. obesity, malnutrition, STDs) and the engagement in health risk behaviors (e.g., sedentary life style, excessive alcohol consumption, unprotected sex) during adolescence, are likely to put them at greater risk for physical and mental health problems at a later stage in life. Moreover, health related problems and health risk behaviors may disrupt adolescents' physical and cognitive development and therefore may affect their ability to think and act in relation to decisions about their health in the future.1 In summary, health-related behaviors in adolescence, apart from their influence on the continuum of "health-disease", they also have the potential to influence future behaviors. In fact, several studies have shown that past behaviors are good predictors of future behaviors .3,4 Thus, promoting healthy practices during adolescence and taking measures to better protect young people from health risks are essential for the prevention of health problems in adulthood.5 According to the World Health Organization, the main problems affecting young people include mental health problems (such as behavioral disorders, eating disorders, suicide, anxiety or depression), the use of substances (illegal substances, alcohol and tobacco), interpersonal violence, nutrition (a proper nutrition consists of healthy eating habits and physical exercise), unintentional injuries (which are a leading cause of death and disability among young people, with road traffic injuries accounting for about 700 deaths per day), sexual and reproductive health (for example, risky sexual behaviors, early pregnancy and childbirth) and HIV (resulting from sexual transmission and drug injection).5,6 On the other hand, the number of children and youth with chronic health conditions has increased dramatically in the past four decades7 as larger numbers of chronically ill children survive beyond the age of 10.8 Despite the lack of data on adolescents' health making it difficult to determine the prevalence of chronic illnesses in this age group9, it is known that one in ten adolescents suffers from a chronic condition worldwide.10 In fact, national population based studies from Western countries show that 20-30% of teenagers have a chronic illness, defined as one that lasts longer than six months.8 The most prevalent chronic illness among adolescents is asthma and the one with the highest incidence is diabetes mellitus, particularly type II.9 Traditionally, healthcare professionals have been mainly investing in health education activities, through the transmission of knowledge with a view to creating habits, customs and behaviors, and promoting healthy lifestyles. However, empowering people does not only consist of giving them the right information11 , i.e. good information is not enough to cause people to make changes.12 The motivation or desire to change unhealthy behaviors and habits depends on many factors, namely intrinsic motivation, control over personal decisions, self-confidence and perception of effectiveness, personal ambivalence, and individualized assistance.12 Many professionals assume that supplying knowledge is sufficient for behavioral changes; however, even very good advice often fails to generate behavioral change. After all, people continue to engage in unhealthy behaviors despite clearly knowing what they should do and how to change. "What is lacking is the motivation to apply that knowledge".13, p.1233 In fact, behavioral change is a complex phenomenon with multiple determinants that also includes motivational variables. It is associated with ambivalent processes expressed in the dilemma between keeping the current status and moving on to new ways of acting. For example, telling adolescents that if they keep on engaging in a certain behavior, they are increasing the risk of developing a long-term condition such as cardiovascular disease, stroke or diabetes is rarely enough to trigger the desired behavioral change; people are more likely to change when they believe that the change is really effective and that they are able to implement it.12 Therefore, it is essential to provide specific training for "healthcare professionals to master motivational techniques, avoid confrontation with the users, and facilitate behavioral changes".14 In this context, motivating patients to make behavioral changes is also an important nursing task where change in lifestyle is a major element of patients' treatment and preventive interventions.15 One of the nurse's goals is to help improve a patient's health or help them to manage existing health conditions. Once nurses are in a position where they have to focus on accomplishing tasks and telling patients what needs to be accomplished16, the role of the nurse is expanding even more into the use of motivational strategies.17 MI is bringing nurses back to therapeutic communication and moving them closer to successful health promotion and disease management, by promoting behavior change and empowering their patients. As the nursing profession evolves, MI is seen as a challenge and the basis of nurse's interactions with individuals, families and communities.16, 17 In the same way, MI may be taken as an essential tool in the provision of nursing care to adolescents, being itself a workspace with possible therapeutic effects regarding problems, clarification of doubts, and development of skills.18 In fact, MI may be particularly applicable in work with adolescents because of their specific developmental stage. Adolescents attempt to establish their own autonomy and identity while struggling with social interactions and moral issues, which leads to ambivalence.19 Consistent with the developmental challenges during adolescence, "MI explicitly honors autonomy, people's right and irrevocable ability to decide about their own behavior"20 while allowing the person to explore possibilities for change of risky or maladaptive behaviours.19 MI can be defined as a directive, client-centred counselling style for eliciting behavior change by helping clients to explore and resolve ambivalence. It is most centrally defined not by technique but by its spirit as a facilitative style of interpersonal relationship.21 It is a set of strategies and techniques widely used in clinical practice based on the transtheoretical model of change. The Stages of Change model describes five stages of readiness—precontemplation, contemplation, preparation, action, and maintenance—and provides a framework for understanding behavior change.22 The MI has been widely tested and applied in different areas, such as modification of addictive behaviors, interventions with offenders in the context of justice, eating disorders, promotion of therapeutic adherence among chronic patients, promotion of learning in school settings or intervention with adolescents at risk.18,23 In general, clinical practice has been adopting the perspective of motivation as something relatively immutable, i.e., the adolescent is either motivated for change/treatment and, in these conditions, the professional's role is to help him/her, or the adolescent is not motivated and then change/treatment is not feasible. Alternatively the theoretical model underlying the MI technique postulates that the individual's adherence to change/treatment depends on his/her motivation, which can change throughout the therapeutic intervention. As several studies found positive results for effects of MI24-26 and its use by health professionals is encouraged23,27 nurses may play an important role in patients' process of change. As nurses have a crucial role in clinical contexts, they can facilitate the process of ending risk behaviors and/or adopting positive health behaviors through some motivational techniques, namely with adolescents. A considerable number of systematic reviews about MI already exist pointing to some benefits of its use in the treatment of a broad range of behavioral problems and diseases.13,28,29 Some of the current reviews focus on examining the effectiveness of MI for adolescents with diverse health risks/problems 30-32. However, to date there are no reviews that present and assess the evidence for the use of nurse-led MI in adolescents. Therefore, we have little knowledge of what works for whom (which adolescent subpopulation) under what circumstances (in which setting, for what problem) in relation to motivational interviewing by nurses. There is a clear need for scoping or mapping the use of MI by nurses with adolescents to identify evidence gaps and to inform opportunities for future development in nursing practice. On the other hand, information regarding nurse-led implemented and evaluated interventions, techniques and/or strategies used, contexts of application and adolescents subpopulation groups is dispersed in the literature33-36 which impedes the formulation of precise questions about the effectiveness of those interventions conducted by nurses and therefore the realization of a systematic review. In other words, it is known that different kind of motivational interventions have been implemented in different contexts by nurses, however does not exist a map about all the motivational techniques and/or strategies used. Furthermore the literature does not clarify which is the role of nurses at cross professional motivational intervention implemented programs and finally the outcomes and evaluation of interventions are unclear. Thus, the practical implication of this mapping will be clarifying all these aspects. Without this clarification is not possible to proceed to the realization of a systematic review about the effectiveness of the use of motivational interviews by nurses to promote health behaviors in adolescents, in a particular context and/or health risk behavior; or regarding the effectiveness of certain technique and/or strategy of MI. Consequently, there are important questions about the nature of the evidence in this area that need to be answered before formulating a precise question of effectiveness. This scoping review aims to respond to these questions. An initial search of the JBI Database of Systematic Reviews & Implementation Reports, Cochrane Database of Systematic Reviews, , Database of promoting health effectiveness reviews (DoPHER), The Campbell Library, Medline and CINAHL, has revealed that currently there is no Scoping Review (published or in progress) on the subject. In this context, this scoping review will examine and map the published and unpublished research around the use of MI by nurses implemented and evaluated to promote health behaviors in adolescents; to establish its current extent, range and nature and identify its feasibility, outcomes and gaps in the evidence defining research priorities in this field. This scoping review will be informed by the JBI methodology37 that suggests a five stage methodological framework for conducting scoping reviews which includes: identifying the research question, searching for relevant studies, selecting studies, charting data, collating, summarizing and reporting the results.

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.

Reproductive and sexual behavior changes in male rats exposed perinatally to picrotoxin

Previous studies in rats suggested that picrotoxin, a GABA(A) receptor antagonist, may cause long-term changes in male reproductive physiology and behavior in rats exposed during prenatal and postnatal periods. The present study has further examined this phenomenon. Wistar rat dams were dosed subcutaneously with 0.75 mg/kg picrotoxin in saline, or vehicle alone, during the perinatal period (day 19 of gestation, immediately after parturition, and once a day during the first 5 days of lactation). Birth weight and sexual maturation of pups were unchanged; however, plasma testosterone levels and sexual behavior was altered in male offspring. Although fertile, these males showed altered mating behavior in terms of a decrease in the mean number of mounts during a 30-min observation period with normal females. Some showed homosexual behavior when castrated and pretreated with exogenous estrogen. These findings suggest that perinatal exposure to picrotoxin alters sexual dimorphism in the developing rat brain, manifesting as altered reproductive performance and sexual behavior of males. (c) 2004 Elsevier B.V. All rights reserved.