Repercussões clínicas e psíquicas da laqueadura tubária videolaparoscópica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Clinical and psychological repercussions of videolaparoscopic tubal ligation: observational, single cohort, retrospective study

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Percepção de adolescentes em relação a doenças sexualmente transmissíveis e métodos contraceptivos

Introduction: sexually transmitted diseases (DST) can represent an important impact on teenager’s health due its consequences. Objective: to identify the perception and knowledge of teenagers about DST, its transmission forms and contraception. Methods: it was made a cross-sectional study type investigation, with 136 teenager students from a Technical Education Public Institution in a middle-sized city. It was used a tested instrument, self answered, with opened and closed questions about theme and sociodemographic data. The same data were stored and analyzed by Program Epi Info version 3.5.1. Results: 97,1% affirmed to know male condoms, 89,0% oral contraceptives, 87,5% female condoms, 74,3% postcoital contraceptives, 47,8% natural family planning methods, 41,9% hormonal injection, 33,1% intrauterine devices, 31,6% coitus interruptus and 1,5% other contraceptive methods. According with them, the information was gave principally on high school (46,1%), by friends or partners (20,3%), doctor (10,9%), television (10,2%). In relation to DST, 98,5% affirmed that diseases can be transmitted during coitus. The aids (91,2%) and herpes (72,8%) were the most cited diseases. Just 31,6% of teenagers affirmed that run the risk to acquire some DST, and 88,4% of them, due no use of condoms, 30,2% due their partner make relation with other people, 18% due have many sexual partners and 9,3% due other causes. Conclusion: even teenagers knowing many contraceptive methods and sexually transmitted diseases, the teenagers have not prevented theirselves yet. It’s necessary that the high school reinforce the use of contraceptive methods, because the school is an important source of educative information on health area.

Comportamiento de mujeres y sus parejas referentes a la planificación familiar

Objective. To describe women behavior regarding birth control and analyze if such behavior has any cultural influence. Methodology. Qualitative study in which patients were women who were waiting for their family health program consult in three health units of the city Ilah Comprida in Sao Paulo, Brazil. Data were collected during October and November of 2007, the interview was used as source of information, subsequently they were subjected to the content analysis technique. Results. Women are responsible for birth control; they consider there are difficulties with birth control especially due to inefficient information about methods of contraception and family influence over this adopted behavior. Conclusion. Birth control is influenced by cultural models, moral, social and religious values related with the exercise of sexuality.

Repeat pregnancies among adolescents in a tertiary hospital in Brazil

Objective: to investigate factors associated with repeat pregnancies among adolescents in a tertiary hospital in the city of Sao Paulo, Brazil. Background: Teenage mothers present a high risk of repeat pregnancies during adolescence. Most of these pregnancies are unplanned. Methods: A cross-sectional study conducted in a tertiary hospital in Sao Paulo, Brazil. The study population included 745 first-time pregnancies and 170 two or more times pregnant teenagers hospitalised for childbirth. Logistic regression models were used to identify independent factors associated with repeat pregnancy in this population. Results: Older age at first pregnancy was associated with a decreased risk of repeat pregnancies (odds ratio and 95% confidence interval 0.78 (0.68-0.89)). Prenatal examinations (0.13 (0.05-0.32)), higher education (0.83 (0.76-0.91)) and higher monthly income (0.79 (0.67-0.95)) were also protective against repeat pregnancies. Those who used contraceptives (2.76 (1.80-4.21)) and lived with their partners (2.44 (1.53-3.88)) had an increased risk of becoming pregnant more than once. Conclusion: Preventive programmes aiming to avoid repeat pregnancies in adolescents should not be restricted to the transmission of information. Behavioural changes in family planning must include access not only to adequate information but also to adequate healthcare, contraceptive methods, education and training.

Fertility in Curitiba, Brazil: levels, trends and differentials

Objectives: To identify levels, tendency and recent differentials in fertility in Curitiba, Brazil. Methods: It is a quantitative and temporal series study, in which the birth rates, general and total fertility indicators, for the period of 1995-2007, were calculated and analyzed in Curitiba, Brazil, as well as the proportion of women with high fertility in 2005-2007, compared to the state of Parana. In order to evaluate inner regional differences in the city of Curitiba the same rates were calculated for each one of the administrative districts in the capital. Results: It was noticed a tendency of decline in fertility rates in Curitiba. The total fertility rate in 2007 was 1.49 children per woman and 1.66 in Parana state. The proportion of women with high fertility in the interior of Parana was 1.8 times higher than in the capital. The analysis of fertility rates by districts in Curitiba pointed out important differences: only 10 out of 75 districts had total fertility rates higher than 2.1 children per woman, and 9 districts concentrated 59.6% of women with high fertility. Conclusions: Curitiba showed a quick and sharp reduction in fertility rates. However, the inner regional differences in the city suggests the need to devise actions of reproductive health and social measures, directed to specific groups of population.

Riabilitazione protesica ed implanto-protesica di pazienti in età evolutiva affetti da Displasia Ectodermica

Introduction. Ectodermal Dysplasias are a heterogeneous group of inherited disorders characterized by dysplasia of tissues of ectodermal origin (hair, nails, teeth, skins and glands). Clinically, it may be divided into two broad categories: the X-linked hypoidrotic form and the hidrotic form. Hypohidrotic Ectodermal Dysplasia (H.E.D) is characterized by the triad oligo-anodontia, hypotricosis, hypo-anhydrosis (Christ-Siemens-Tourane syndrome). The incidence of HED is about 1/100,000. Mutation in the actodysplasin-A (EDA) and ectodysplasin-A receptor (EDAR) genes are responsible for X-linked and autosomal HED. The clinical features include sparse, fine hair, missing or conical-shaped teeth, decreased sweat and mucous glands, hypoplastic skin, and heat intolerance with exercise or increased ambient temperature. Complete or partial anodontia and malformation of teeth are the most frequent dental findings. Incisors and canines are often conical-shaped while primarily second molars, if present, are mostly affected by taurodontism. Treatment is supportive and includes protection from heat exposure, early prosthetic rehabilitation, skin, hair ear, nose and nail care, and genetic counseling for family planning. The diagnosis of HED in the neonatal and early infancy period may be difficult since sparse hair and absent teeth are normal finding at this age. In childhood the diagnosis is more easily made on the basis of history and clinical examination. Dental abnormalities are the most common complaint. Prosthetic rehabilitation has been recommended as an essential part of the management of HED because is important from functional, esthetic, and psychological standpoint. A team approach that includes input from a pediatric dentist, an orthodontist, a prosthodontist, and an oral and maxillofacial surgeon is necessary for a successful outcome. Conventional prosthodontic rehabilitation in young patient is often difficult because of the anatomical abnormalities of existing teeth and alveolar ridges. The conical shaped teeth and “knife-edge” alveolar ridges result in poor retention and instability of dentures. Moreover, denture must permit jaws expansion and a correct pattern of growth. Materials and Methods. Complete removable dentures were provided to allow for normal physiological development and a corrected masticatory function. Initial maxillary and mandibular impressions were made with smallest stock trays and irreversible hydrocolloid and then final impressions ware made with light-bodied polysulfide rubber base impression material. A base of autopolymerizing resin was constructed and a wax rim was added to the base. The patient’s vertical dimension of occlusion was established by assessing phonetic and esthetic criteria. Preliminary occlusal relations were recorded, and the mandibular cast was mounted on the articulator. Acrylic resin teeth specific for children dentures were selected and mounted. The dentures were tried in and, after proper adjustments, were inserted. The patients were monitored clinically every month to fit prostheses. Cephalometric radiographs were taken every 6 month with the prostheses in place in order to evaluate correct pattern of growth. Cephalometric measurements were realized and used to evaluate the effect of rehabilitation on craniofacial growth. Cephalometric measurements of sound patients were compared with ED patients. After two month expander screws (three-way screw in the upper denture and two-way the lower one)were inserted in each denture in order to permit the expansion of the denture and the jaws growth. Where conical teeth were present, composite crown were realized and luted to improve the esthetic and phonesis. In order to improve retention the placement of endosseous implants was carried out. TC 3D Accuitomo was performed and a resin model of mandibular bone of the patient was realized. At the age of 11 years two implants were inserted into anterior mandible in a child with anodontia. Despite a remarkable multi-dimensional atrophy of the mandibular alveolar process, the insertion of two tapered screw implants (SAMO Smiler, diameter 3.8, length 10 mm). After a submerged healing period of two-three month, the implants were exposed. Implants were connected with an expansion guide that permits mandibular growth and prosthetic retention. The amount of mandibular growth was also evaluate dusing the expansion guide. Results. Early oral rehabilitation improve oral function, phonesis and esthetic, reducing social impairment. Treated patients showed normal cephalometric measurement. Early rehabilitation is able to prevent the prognatissm of the mandibula . The number of teeth was significantly related to several changes in craniofacial morphology. Discussion. In the present study the 5,3% of ED patients showed hypodontia, the l’89,4% di oligodontia, and the 5,3% di anodontia. The cephalometric analysis supports that ED patients showed midface hypoplasia. ED groups showed an increased pogonion to nasion measurement than sound patients, indicative of class III tendency. The present study demonstrated that number of teeth was significantly correlated with deviation of cephalometric measurements from normality. Oligoanodontia is responsible for changing of cephalometric measuraments also on sagittal plane with a class III tendency. Maxillary jaw showed a retrused position related to the presence of hypodontia.

Combinazioni androgeno-progestiniche per la contraccezione maschile

La contraccezione è un diritto fondamentale dell’uomo per il suo ruolo sulla salute, sulla qualità della vita e sul benessere della persona. La pianificazione familiare è uno dei principali strumenti che dà la possibilita’ a uomini e donne di condividere le proprie responsabilità sulla scelta contraccettiva e di decidere nella stessa misura della propria vita riproduttiva. Sin dall’introduzione della contraccezione femminile, la responsabilita’ della pianificazione familiare è ricaduta unicamente sulla donna. Attualmente infatti vi sono pochissimi metodi contraccettivi a disposizione degli uomini anche se vi e’ un rinnovato interesse da parte di questi ultimi nel sostenere le proprie partner nella scelta contraccettiva. Questo lavoro riassume i principali studi effettuati negli ultimi 10 allo scopo di sviluppare un contraccettivo che sia sicuro, efficace, reversibile e accettabile per l’uomo.

Commentary on "A Tale of Two States"

While both California and Texas have experienced declines in teen birth rates over the past three decades, declines in California have been larger, particularly among Hispanic teens. Differences in state policies may have shaped this disparity, as suggested by Tortolero and her colleagues in their article “A Tale of Two States: What We Learn from California and Texas”. Fundamental differences exist between Texas and California in their approaches to sex education, access to family planning services for teens, and public-private partnerships. However, methodological challenges are present when drawing state comparisons, including the limitations of available public health data and the difficulty of disaggregating state characteristics from state policies. Based on their comparison of state data and policies, Tortolero and her colleagues issue sensible recommendations for reducing the teen birth rate in Texas. History suggests that state policies are most effective when political commitment is linked to scientifically effective approaches. Based on our understanding of the scientific literature, the most effective strategies for reducing rates of teen childbearing in Texas would be providing comprehensive school sexuality education and improving teen access to contraceptive services.

The door of the tomb is open: Participatory action research to assess the impact of strengthened community capacity on maternal health care in rural Mali

This participatory action-research project addressed the hypothesis that strengthened community and women's capacity for self-development will lead to action to address maternal health problems and the prevention of maternal morbidity and mortality in Mali. Research objectives were: (1) to undertake a comparative cross-sectional study of the association of community capacity with improved maternal health in rural areas of Sanando, Mali, where capacity building interventions have taken place in some villages but not in others. (2) to describe women's maternal health status, access to and use of maternal health services given their residence in program or comparison communities.^ The participatory action research project was an integrated qualitative and quantitative study using participatory rural appraisal exercises, semi-structured group interviews and a cross-sectional survey.^ Factors related to community capacity for self-development were identified: community harmony; an understanding of the benefits of self-development; dynamic leadership; and a structure to implement collective activities.^ A distinct difference between the program and comparison villages was the commitment to train and support traditional birth attendants (TBAs). The TBAs in the program villages work in the context of the wider, integrated self-development program and, 10 years after their initial training, the TBAs continue to practice.^ Many women experience labor and childbirth alone or are attended by an untrained relative in both program and comparison villages. Nevertheless a significant change is apparent, with more women in program villages than in comparison villages being assisted by the TBAs. The delivery practices of the TBAs reveal the positive impact of their training in the "three cleans" (clean hands of the assistant, clean delivery surface and clean cord-cutting). The findings of this study indicate a significant level of unmet need for child spacing methods in all villages.^ The training and support of TBAs in the program villages yielded significant improvements in their delivery practices, and resulting outcomes for women and infants. However, potential exists for further community action. Capacities for self-development have not yet been directed toward an action plan encompassing other Safe Motherhood interventions, including access to family planning services and emergency obstetric care services. ^

Developing a point-of-care electronic medical record system for TB/HIV co-infected patients: experiences from Lighthouse Trust, Lilongwe, Malawi.

BACKGROUND Implementation of user-friendly, real-time, electronic medical records for patient management may lead to improved adherence to clinical guidelines and improved quality of patient care. We detail the systematic, iterative process that implementation partners, Lighthouse clinic and Baobab Health Trust, employed to develop and implement a point-of-care electronic medical records system in an integrated, public clinic in Malawi that serves HIV-infected and tuberculosis (TB) patients. METHODS Baobab Health Trust, the system developers, conducted a series of technical and clinical meetings with Lighthouse and Ministry of Health to determine specifications. Multiple pre-testing sessions assessed patient flow, question clarity, information sequencing, and verified compliance to national guidelines. Final components of the TB/HIV electronic medical records system include: patient demographics; anthropometric measurements; laboratory samples and results; HIV testing; WHO clinical staging; TB diagnosis; family planning; clinical review; and drug dispensing. RESULTS Our experience suggests that an electronic medical records system can improve patient management, enhance integration of TB/HIV services, and improve provider decision-making. However, despite sufficient funding and motivation, several challenges delayed system launch including: expansion of system components to include of HIV testing and counseling services; changes in the national antiretroviral treatment guidelines that required system revision; and low confidence to use the system among new healthcare workers. To ensure a more robust and agile system that met all stakeholder and user needs, our electronic medical records launch was delayed more than a year. Open communication with stakeholders, careful consideration of ongoing provider input, and a well-functioning, backup, paper-based TB registry helped ensure successful implementation and sustainability of the system. Additional, on-site, technical support provided reassurance and swift problem-solving during the extended launch period. CONCLUSION Even when system users are closely involved in the design and development of an electronic medical record system, it is critical to allow sufficient time for software development, solicitation of detailed feedback from both users and stakeholders, and iterative system revisions to successfully transition from paper to point-of-care electronic medical records. For those in low-resource settings, electronic medical records for integrated care is a possible and positive innovation.

Contraceptive use in women by body mass index categories

The prevalence of obesity has increased sharply in the United States since the mid 1970's. Obese women who become pregnant are at increased risk of pregnancy complications for both mother and fetus. This study assessed whether women in higher body mass index (BMI) categories engage in the preventive behaviors of contraception more frequently than normal weight women. It also evaluated the type of contraception used by both obese and normal weight women. The study used cross-sectional data from 7 states participating in the Family Planning Module of the 2006 Behavioral Risk Factor Surveillance System (BRFSS). The Behavioral Risk Factor Surveillance System survey is an annual random digit dialed telephone survey of the non-institutionalized civilian population aged 18 years and older. The Family Planning Module was administered by Arizona, Kentucky, Minnesota, Missouri, Montana, Oregon, and Wisconsin. Of the 4,757 women who participated in the Family Planning Module, 2,244 (53.2%) were normal weight, 1,202 (25.6%) were overweight, and 1,072 (21.2%) were obese. The majority of these women 4,115 (86.2%) reported using some type of contraception to prevent pregnancy. Six hundred forty two women (13.8%) stated they did not use any type of contraception to prevent pregnancy. Within body mass index categories, 14% of normal weight women, 13% of overweight women, and 13.4% of obese women did not use any type of contraception. Neither the bivariate analysis nor the logistic regressions found body mass index categories to be statistically associated with contraceptive use. The relationship between body mass index categories and contraceptive method was found to be statistically significant. The predictive probability graph found that women at all levels of BMI have a lower probability of using barrier contraception methods as compared to procedural and hormonal methods. Hormonal contraception methods have the highest probability of use for women with a BMI of 15 to 25. In contrast, the probability of using procedural contraception methods is relatively flat and less than hormonal methods for BMI between 15 and 25. However, the probability of using procedural contraception increases dramatically with a BMI greater than 25. At a BMI greater than 42, women have a greater than 50% probability of using procedural contraception. Although a relationship between body mass index and contraception use was not found, contraception method was found to be associated with body mass index. The reasons why normal weight women prefer hormonal contraception while overweight/obese women are more likely to use procedural methods needs to be explored. By understanding the relationship between obesity and contraception, we can hopefully decrease unintended pregnancies and overall improve pregnancy related health outcomes. To determine if relationships between contraception use/type and body mass index exist, further research needs to be conducted on a national level. ^

Evaluation of web-based resources for pregnant and parenting teens

Current teen pregnancy and repeat pregnancy rates reveal that there is a pressing need for comprehensive care for pregnant and parenting teens to address their unique needs. The Internet has become a source of various types of information and as a result, several efforts have begun to assess the quality of health information provided on websites. The objective of this study was to assess the functionality and quality of websites containing health information and resources for pregnant and parenting teens. The three most widely used search engines currently: Google, MSN, and Yahoo were searched using three general search terms “teen pregnancy”, “pregnant teen”, and “teen parent”. The first 5 pages of each search were reviewed and categorized to yield 12 websites which met inclusion criteria for content evaluation. The 12 websites were rated using a pre-existing instrument encompassing two domains: functionality and content analysis. Within the functionality domain, this sample highlighted the need to improve accessibility and credibility for the target population. The content analysis revealed that among the topics which are recommended for pregnant and parenting teens, the topics most commonly covered were mental health and primary and preventive health care. The majority of websites neglected sexual health topics including STI’s and family planning. This study provides the first glimpse into health information and resources for pregnant and parenting teens on the Internet. Researchers, health care providers, social workers, health educators, and website sponsors can use these results to maintain and recommend websites which offer easily accessible, accurate, and practical information for pregnant and parenting teens.^

A descriptive study of comprehensive and categorical services for pregnant and parenting adolescents in West Dallas

This study evaluates the effectiveness of the Children and Youth Projects' Adolescent Family Life Program, a comprehensive program serving pregnant and parenting adolescents in the economically disadvantaged area of West Dallas. The underlying question asked is what are the relative contributions of the comprehensive, school-linked Adolescent Family Life (AFL) Program compared with the Maternal Health and Family Planning Program (MHFPP), a categorical provider of family planning and reproductive services, towards meeting the immediate and intermediate term needs of adolescent mothers. Also addressed are the protective effects of participation in the Dallas Independent School District Health Special Program, a segregated school for pregnant adolescents.^ A cohort of 339 West Dallas adolescent mothers who delivered babies during a two-year period, 1986 through 1987, are monitored by linking records from Parkland Hospital, the primary provider to hospital services to indigent women in Dallas, the Dallas Independent School District, and the prenatal care providers, the AFL and MHFP Programs. Information is collected on each teen describing her demographic, fertility, service utilization and educational characteristics.^ The study tests the hypothesis that adolescents receiving services from the comprehensive AFL program will be less likely to have a repeat birth and to discontinue school during the 24 month study period, compared with categorical provider clients. Although the study finds that there are no statistically significant differences in repeat deliveries, using survival analysis, or in school continuation between programs, important findings are revealed about the ethnic differences. Black and Hispanic fertility and educational behaviors are compared, and their implications for program design and evaluation discussed. ^

Aborto inducido y embarazo no planeado en Guatemala

Aunque la legislación guatemalteca permite el aborto inducido solamente para salvar la vida de la mujer, con frecuencia muchas mujeres obtienen abortos, en condiciones de riesgo, y en respuesta a un embarazo no planeado. Estudios recientes indican que el aborto inseguro es un factor clave que contribuye a la morbilidad y mortalidad materna en el país; sin embargo, no existen datos a nivel nacional sobre la incidencia del aborto.