De senaste årtiondena har flyktingströmmar från länder som praktiserar kvinnlig könsstympning (FGM) kommit till länder i västvärlden. I mötet med den nya vården riskerar kvinnorna att få fel diagnos, omvårdnad och bemötande. Syftet var att belysa könsstympade kvinnors möte med vården i västvärlden, utifrån följande frågeställningar: hur erfar kvinnorna mötet med vårdpersonalen? Hur erfar vårdpersonalen mötet med kvinnor som genomgått FGM? Studien genomfördes som en litteraturstudie, baserad på 15 artiklar av kvalitativ design. Analysen resulterade i sju teman utifrån de två frågeställningarna. Resultatet visade att kvinnorna upplevde mötet med vårdpersonalen som diskriminerande, ångestfullt och oroande. Brist på stöd ledde till känslor av ensamhet och kvinnorna kände sig annorlunda i den nya kulturen. Vårdpersonalen upplevde mötet med kvinnor som genomgått FGM som stressande och såg kvinnorna som okunniga och outbildade. Språkbarriärer var en försvårande faktor i kommunikationen. En god kommunikation och förståelse är viktigt för att skapa ett tryggt vårdmöte. Sjuksköterskan bör ta hänsyn till såväl kroppsliga som kulturella faktorer. Undervisning om FGM bör inkluderas i samtliga grundutbildningar för sjuksköterskor och övrig vårdpersonal. Vidare forskning bör belysa interventioner om ökad kunskap om FGM, fokusera på de könsstympade kvinnornas möte med olika vårdprofessioner, samt den åldrande gruppen som genomgått FGM och är i behov av vård. / The last decades a large number of refugees from countries where female genital mutilation (FGM) is practiced have come to countries in the West. The risk in the health care meeting is that the woman gets the wrong diagnosis, therapy and treatment. The aim was to highlight genitally mutilated women's encounters with the health care in the Western world, based on the following questions: how do the women experience the meeting with the caregivers? How do the caregivers experience the meeting with women who have undergone FGM? The study was conducted as a literature study, based on 15 articles with qualitative design. The analysis resulted in seven themes based on the two questions. The results showed that women felt the meeting with caregivers as being discriminatory, anguished and upsetting. Lack of support led to feelings of loneliness and the women felt different in the new culture. The nursing staff felt that meetings with the women were stressful and saw the women as unexperienced and uneducated. Language barriers were an aggravating factor in communication. Good communication and understanding is important in order to create a safe care meeting. The nurse should take into account both physical and cultural factors in order to build a good relationship. Education about FGM should be a part of the basic education of nurses and other health care professionals. Further research should shed light on interventions of increased knowledge about FGM, focus on the mutilated woman's encounter with various health care professions, as well as the aging group who have undergone FGM and is in need of care.

Female genital mutilation, or FGM, is a harmful traditional practice that was brought to Europe by immigrants from practising regions in Africa. Despite numerous approaches to the eradication of FGM, the tradition perpetuates within the immigrant communities in several European countries. Drawing on the available literature, film and interviews, this thesis presents a comparison of the French and Dutch strategies to tackling the problem of FGM. The thesis argues that the Dutch preventative approach could benefit from adopting particular features of the French punitive approach. The thesis concludes by proposing that strong legislative measures that apply to the discovery, investigation and prosecution of FGM cases have contributed significantly to the decline of FGM among practising communities in France, and as such, would have similar results if incorporated into the Dutch strategy for the eradication of FGM.

Mate choice among males is relatively understudied, despite recent evidence supporting its ubiquity. Theory predicts male mate choice in response to variation in female quality, and male mating strategies that limit polygyny. However empirical research investigating these connections, particularly under natural conditions, is generally lacking. Using the Western black widow spider, Latrodectus hesperus, I investigated male mate choice, male investment, and the advantage of mating with females that differ in their potential to deliver fitness benefits to males via higher fecundity and/or reduced risk of sperm competition. Males were found to be preferentially attracted to larger, high-diet virgin females over females that were smaller due to a lower diet, or having been previously mated, or both. Through a three-year field study on females I found that males likely benefit from selectivity, as smaller, low-diet females often failed to deposit any egg sacs throughout the breeding season, likely due to their shortened web-site tenure and/or lack of bodily resources. I investigated the costs and benefits to male genital breakage in L. hesperus, a strategy typically assumed to result in male sterility while providing paternity protection. I found that genital mutilation in L. hesperus did not cause sterility and that males were capable of inseminating multiple females, likely because of the comparatively low amount of genital damage and the likelihood of the efficient placement of genital fragments. Evidence from double mating trials supported the efficacy of broken genital fragments as plugs, but first male sperm precedence was often maintained in cases where male genital breakage failed or fragments were positioned incorrectly, which occurred frequently. Together, these laboratory and field experiments contribute to a more complete view of mate choice.

Mate choice among males is relatively understudied, despite recent evidence supporting its ubiquity. Theory predicts male mate choice in response to variation in female quality, and male mating strategies that limit polygyny. However empirical research investigating these connections, particularly under natural conditions, is generally lacking. Using the Western black widow spider, Latrodectus hesperus, I investigated male mate choice, male investment, and the advantage of mating with females that differ in their potential to deliver fitness benefits to males via higher fecundity and/or reduced risk of sperm competition. Males were found to be preferentially attracted to larger, high-diet virgin females over females that were smaller due to a lower diet, or having been previously mated, or both. Through a three-year field study on females I found that males likely benefit from selectivity, as smaller, low-diet females often failed to deposit any egg sacs throughout the breeding season, likely due to their shortened web-site tenure and/or lack of bodily resources. I investigated the costs and benefits to male genital breakage in L. hesperus, a strategy typically assumed to result in male sterility while providing paternity protection. I found that genital mutilation in L. hesperus did not cause sterility and that males were capable of inseminating multiple females, likely because of the comparatively low amount of genital damage and the likelihood of the efficient placement of genital fragments. Evidence from double mating trials supported the efficacy of broken genital fragments as plugs, but first male sperm precedence was often maintained in cases where male genital breakage failed or fragments were positioned incorrectly, which occurred frequently. Together, these laboratory and field experiments contribute to a more complete view of mate choice.

a) INTRODUCCIÓN, HIPÓTESIS DE TRABAJO, OBJETIVOS:La esterilidad afecta a un 15% de las parejas que desean tener descendencia. Distintas estadísticas señalan que las alteraciones de la trompa de Falopio son el factor responsable de dicha esterilidad en el 15-50% de casos.El factor tubárico es de difícil solución: en general. Los resultados de la microcirugía no son lo brillantes que en un principio se esperaba. Por otra parte, a pesar de la simplificación actual de las técnicas de FIV, los resultados obtenidos son pobres.En el momento actual, gracias tanto al desarrollo en las técnicas quirúrgicas como al descubrimiento y generalización del uso de la ciclosporina, estamos asistiendo a un desarrollo espectacular en el campo del trasplante de órganos.Teniendo en cuenta todo ello y las perspectivas de que se desarrollen nuevas posibilidades de inmunosupresión, nosotros nos propusimos demostrar: 1º) que el trasplante de trompa y ovario es técnicamente factible y 2º) que la ciclosporina constituye un logro en este sentido y abre esperanzadoras perspectivas para el trasplante genital.Así pues hemos marcado los siguientes objetivos, necesarios para contrastar la viabilidad del trasplante de órganos genitales:1.- Analizar los embarazos conseguidos tras la realización del trasplante.2.- Analizar la permeabilidad tubárica post-intervención, en los casos en que no haya habido embarazo.3.- Estudiar la función ovárica tras el trasplante de dicho órgano para comprobar su viabilidad.4.- Verificar si el análisis de dicho funcionalismo puede constituir un marcador para el control post-trasplante de la función ovárica.5.- Valorar la eficacia del tratamiento inmunosupresor con ciclosporina, mediante estudio histológico de la trompa de Falopio y del ovario, analizando diversos parámetros en animales inmunosuprimidos, comparando los resultados obtenidos con los observados en animales inmunocompetentes.b) MATERIAL Y MÉTODOS:1.-Animal de experimentación.Hemos utilizado conejas adultas jóvenes de raza neozelandesa, de aproximadamente 2,5-3 kg de peso y que nunca habían estado en contacto con el macho.2.- Protocolo de trabajo.Se establecieron dos grupos de animales, decidiéndose de manera aleatoria si un animal sería utilizado como receptor o como donante. Tras esta decisión, se incluía, también de manera aleatoria, al animal receptor en uno de los dos grupos siguientes:A: Animales trasplantados que recibían tratamiento inmunosupresor.B: Animales trasplantados que no recibían tratamiento inmunosupresor.Además se utilizaron otros dos grupos de animales:C: Animales a los que solo se les extirpó un anejo.D: Animales a los que se les extirparon los dos anejos.Estos dos grupos fueron utilizados como controles.El calendario de trabajo fue el siguiente: a los 2, 7 y 30 días de la intervención se realizaron los controles hormona/es que más adelante se detallan. A partir del día 30 se puso a los animales en contacto con el macho, con una periodicidad de aproximadamente 15 días. Tras el coito, se administraban 100 UI de HCG. Si después de tres contactos con el macho: la coneja no quedaba gestante era sacrificada y sometida a una laparotomía donde se extirpaban los órganos trasplantados. Si el animal moría antes del fin del estudio se le practicaba una autopsia, en el curso de la cual eran extirpados los órganos trasplantados.Se realizaron los siguientes controles.a) Control hormonalLos días 2, 7 y 30 del postoperatorio se determinaron los niveles de Estradiol, Progesterona y FSH de acuerdo con el siguiente esquema:-Determinación basal-Administración de 100 UI de HCG-Determinación a las dos horas-Determinación a las 24 horasEn los animales de los grupos C y D estas determinaciones se realizaron sólo una vez.b) Control histológicoEstudio macroscópico: Coloración, tamaño y peso de ovarios y trompa. Permeabilidad tubárica. Existencia de adherencias.Estudio microscópico: Se valoraba la existencia y aspecto de folículos y cuerpos amarillos ováricos, el estado de las anastomosis y la existencia de infiltración inflamatoria.3.- InmunosupresiónComo fármaco inmunosupresor se ha utilizado la ciclosporina. la primera dosis de 10 mg/kg se administró unas dos horas antes de la intervención. Esta dosis se repitió diariamente durante los primeros 15 días del estudio y posteriormente se redujo a la mitad.4.- Técnica quirúrgicaLas intervenciones se han llevado a cabo con técnicas de microcirugía.La intervención se inicia por el animal que será utilizado como donante, aunque este primer tiempo quirúrgico es similar en ambos casos; el primer paso practicado es la apertura de la hoja posterior del peritoneo parietal en las proximidades del nacimiento de los vasos ováricos, realizándose a continuación una cuidadosa disección de la vena y arteria ováricas, en una extensión de aproximadamente 1,5 a 2 centímetros. Una vez completada se practica la sección del meso tubo-ovárico a partir del ligamento infundíbulo-pélvico hasta los vasos ováricos y desde estos hasta la unión tubo-uterina. La zona elegida para la anastomosis es la porción más proximal de la trompa. Al finalizar este primer tiempo se repiten en el animal receptor los mismos pasos que se acaban de describir para el donante.Tras completar la preparación del campo operatorio en el receptor se trabaja de nuevo sobre el donante y se colocan sendos "clamps" vasculares a nivel de la porción proximal de la trompa y del inicio de los vasos ováricos, seccionando inmediatamente después dichas estructuras, con lo que se libera totalmente el injerto.Después de obtener el injerto se vuelve a trabajar sobre el receptor extirpando el anejo izquierdo de dicho animal, colocando unos "clamps" de doble pinza en vasos y trompa. Se traslada el órgano a trasplantar a este animal y se introducen los extremos de la arteria y trompa en la segunda pinza del "clamp" correspondiente y se inicia la anastomosis vascular. Una vez realizada se procede a realizar la anastomosis tubárica que, técnicamente, es mucho más sencilla.Tras completar el tiempo quirúrgico del trasplante propiamente dicho, se procede a practicar la ligadura de la trompa y la exéresis del ovario contralaterales y se cierra el abdomen.c) RESULTADOSDe los animales utilizados 27 fueron incluidos en el grupo A, mientras que 23 lo fueron en el grupo de animales que no recibieron tratamiento inmunosupresor. Los grupos C y D estaban compuestos por 10 animales cada uno de ellos. Los diferentes grupos fueron comparables entre si, no encontrándose diferencias en el peso de los animales, ni tampoco en el tamaño o peso de los genitales internos. Asimismo, tampoco se encontraron diferencias en parámetros tan importantes para el resultado de la intervención como la duración de la misma o del período en que los animales permanecieron bajo el efecto de las drogas anestésicas ni en el tiempo en que los órganos trasplantados permanecieron en estado de isquemia. Donde sí hubo diferencias fue en los hallazgos del estudio histológico. Así, a nivel macroscópico se encontró que el injerto era fácilmente identificable en casi el 90% de los animales del grupo A, mientras que en casi el 75% de los animales inmunocompetentes fue imposible identificarlo de manera adecuada. También los animales de este último grupo presentaban mayor cantidad de adherencias y de mayor gravedad que las presentadas en los animales del grupo A. El injerto, o la zona correspondiente al mismo, presentaba una coloración normal en el 63% de los animales del grupo A, mientras que tenía aspecto necrótico en más del 50% de los animales no inmunosuprimidos. Las anastomosis vasculares fueron permeables en casi el 90% de los animales del grupo A, mientras que estaban trombosadas en más del 80% de los animales del grupo B; algo similar ocurría con las anastomosis tubáricas, aunque aquí el porcentaje de permeabilidad en los animales del grupo A se reducía al 63% de los casos. Los resultados microscópicos confirman los anteriores y mientras que casi el 75% de los animales del grupo A presentaban una histología tubárica normal o casi normal, el injerto no resultaba identificable, ni siquiera microscópicamente, en el 73% de los animales pertenecientes al grupo B, ocurriendo algo similar en el caso del ovario.Los niveles obtenidos en las determinaciones de los niveles de estradiol y progesterona realizadas en los animales del grupo A son claramente superiores a los niveles de las mismas hormonas observados en el grupo B, sobre todo a partir de las realizadas el séptimo día. Por otra parte, aunque los niveles observados en los animales del grupo A son comparable a los observados en el grupo C, los observados en el grupo B presentan una clara tendencia a hacerse comparables a los observados en el grupo D.Las diferencias encontradas en los parámetros histológicos y hormonales lógicamente se han de traducir en mejores resultados funcionales. Así, mientras seis de los animales del grupo A quedaron gestantes, ninguno de los del grupo B se embarazó. Este número supone un 20% de gestaciones sobre el total de animales de grupo A, pero representa casi un 40% de los animales de dicho grupo que sobrevivieron lo suficiente como para poder ser puestos en contacto con el macho.Los animales del grupo A que quedaron gestantes no mostraron diferencias con respecto a los animales del mismo grupo que no quedaron gestantes ni en el peso, ni en el tamaño de los genitales. Aunque los animales que no quedaron gestantes tenían medias de duración de la intervención y del período de isquemia ligeramente superiores a las encontradas en los animales que se embarazaron, las diferencias no alcanzan la significancia estadística.Tampoco se encontraron diferencias estadísticamente significativas entre los animales gestantes y no gestantes en los parámetros histológicos valorados: identificabilidad del injerto o presencia de adherencias, coloración, permeabilidad vascular o tubárica, ni en el estudio microscópico de la trompa ni en el del ovario.Las diferencias en los niveles de estradiol tampoco fueron significativas, pero los niveles del grupo de gestantes fueron superiores a los encontrados en el de no gestantes. Los niveles de progesterona presentaron una distribución similar, con niveles más elevados en el grupo de gestantes. Con la FSH ocurría lo contrario, siendo los niveles superiores en el grupo de animales que no se embarazaron.d) CONCLUSIONESDel análisis de los resultados obtenidos en este trabajo se pueden obtener las siguientes conclusiones, referidas siempre al animal de experimentación:1.- El trasplante homólogo, vascularizado, de trompa y ovario, utilizando procedimientos microquirúrgicos, es técnicamente factible si se dispone del utillaje adecuado para ello; su realización, además, no entraña un grado de dificultad inaceptablemte alto.2.- Se constata una alta tasa de viabilidad del trasplante, encontrando casi un 40% de gestaciones y más del 60% de casos con permeabilidad tubárica demostrada en el grupo de animales que recibieron tratamiento inmunosupresor.3.- Se comprueba que existe (en el grupo de animales inmunosuprimidos): a) baja tasa de formación de adherencias; b) alta tasa de permeabilidad vascular; c) bajo porcentaje de aparición de alteraciones histológicas.4.- La función ovárica tras el trasplante en los animales que quedaron gestantes (grupo inmunosuprimido) es comparable a la de ovarios normales no trasplantados, hallando valores basales similares a los presentados por animales no trasplantados y una respuesta ovárica comparable a la de estos cuando se estimula la ovulación con Gonadotrofina Coriónica.5.- La determinación seriada de los niveles de hormonas esteroideas producidas por el ovario es un buen marcador del grado de normalidad de la función de dicho órgano y de la posibilidad de gestación.6.- Tanto la trompa como el ovario son rechazados de manera vigorosa cuando no se utiliza un fármaco inmunosupresor, comprobándose en el grupo de animales no inmunosuprimidos la existencia de infiltración inflamatoria, trombosis vascular, necrosis y, posteriormente, práctica desaparición del órgano trasplantado. / Disease affecting the capacity of the Fallopian Tube to allow free passage of spermatozoa and ova accounts for about one quarter to one half of all cases of infertility in women. The results of treatment of these diseases are almost universally bad even when modern assisted reproductive technologies are used.In the future one possibility for selected patients might be homograft transplantation of tubes from healthy women.A rabbit model was developed for microsurgical en bloc vascularized adnexal allograft. Transplantation of tube and ovary from donors to tubo-oophorectomized recipients was technically successful in fifty rabbits. After surgery animals were allocated by random into two groups: in the animals of group A 10 mg/kg/day of cyclosporine for immunosuppression was begun on the day of surgery and were given for fifteen days and then lowered to 5mg/kg/day throughout the experiment; the animals in group 8 not did not receive immunosuppressive therapy. In group A, sixteen animals survived the transplant procedure and six animals became pregnant (37%). No pregnancies were seen in group B. In group A hormonal secretion of ovary was normal and comparable with this found in normal animals. In group B the levels of ovarian steroid hormones were very low and comparable to those seen in oophorectomized rabbits. These results suggest that microsurgical tubal transplantation with an appropriate immunosuppressive regimen warrants further investigation as potential treatment for certain infertility problems in humans.

Chlamydia trachomatis is a human pathogen of the genital tract and ocular epithelium. It is an obligate intracellular parasite with a unique biphasic development cycle. C.trachomatis infection is the most common bacterial sexually transmitted disease in industrialized nations. Its ability to cause chronic disease makes it a serious economic burden and health threat to developed and developing countries. Although treatable, approximately 70% of C.trachomatis infections are asymptomatic, potentially leading to the development of chronic sequelae. Furthermore, chlamydial genital tract infection has been associated with an increased risk of cervical cancer and human immunodeficiency virus infection. Consequently, the development of an efficacious vaccine is the most convenient, potentially reliable and cost effective option to control chlamydial infection and disease complications. Anti-chlamydial protective immunity is essentially mediated by a T helper, type 1 (Th1), response that is dependent upon the presentation of antigen via major histocompatibility (MHC) class II molecules. While antibody secreting cells are not critical components of the primary effector response, they have been shown to be important for clearance of re-infection. Thus an ideal vaccine would be one capable of inducing both a strong Th1 T cell response and a strong mucosal antibody response. Currently there are very few efficacious vaccine candidates that have been identified and characterized. More specifically, there is only a limited number of known T cell antigens processed and presented by the human leukocyte antigen (HLA) class II molecules. This type of antigen is going to be essential to the development of an efficacious chlamydial vaccine. In this study we have identified a number of unique vaccine candidates using a novel in silico approach. In an attempt to overcome HLA polymorphism the whole chlamydial genome was screened for proteins containing epitopes predicted to bind multiple HLA class II molecules (i.e. predicted ‘promiscuous’ T cell epitopes). A wide range of HLA class II molecules were used in this screen to identify vaccine antigens that could potentially offer broad and ethnically balanced population coverage. This analysis identified a number of novel targets and was validated by the identification of a known chlamydial T cell epitope. A selection of these target proteins was cloned, expressed and purified. Recombinant protein was screened against serum samples from patients with both acute and chronic chlamydial infections. Two novel targets, hypothetical protein CT425 and ribonucleotide reductase small chain protein (NrdB) were identified as being immunoreactive. The in vivo protective efficacy of NrdB was analyzed using a mouse model. CD4+ T cells were harvested from NrdB immunized mice and adoptively transferred to naïve mice, which were subsequently infected at the genital site. NrdB immunization was found to confer a CD4+ T cell driven degree of protection similar to that seen with CD4+ T cells primed from a live challenge. The adjuvants and route of immunization used ensured immunological responses were initiated at both the systemic and local sites of infection. Immunization elicited a predominant Th1 response with primed T cells producing high levels of interferon gamma, an essential requirement for the development of an efficacious chlamydial vaccine. Furthermore, high titres of antigen specific IgG and IgA were produced following immunization, with sera derived antibodies demonstrating neutralization properties. NrdB is a highly conserved chlamydial protein with an essential role in the replication of chlamydiae and could play a central role in a multi-subunit vaccine against chlamydial genital tract infections.

The distinctive feature of the Human Immunodeficiency Virus (HIV) epidemic in the 21st century is the burden it places on women. Scientists believe that the best opportunities for successful interventions to prevent sexual HIV transmission lie in the initial stages of infection at the portal of entry, the genital tract (GT), which offers the greatest host advantages and viral vulnerabilities. However, understanding of the correlates of protection/vulnerability and innate immunity at the portal of entry is poor. First and foremost, there is no agreement about which GT sub-compartment is the primary site of HIV/SIV infection. Second, the epithelium, previously studied solely for its function as a barrier, has hardly been investigated for its role in innate immunity in the context of SIV/HIV infection. MIP-3α, a chemokine secreted by epithelial cells, was previously proposed to have a role in amplifying the early Simian Immunodeficiency Virus (SIV) infection events in the GT of female macaques. Specifically, MIP-3α was shown to be secreted by epithelial cells of the endocervix, accumulating subepithelially within the first 24 hours post exposure, following deposition of an intravaginal inoculum of SIV. Similar studies in humans have not been reported. We hence undertook to study MIP-3α for its role in early HIV infection events in the endocervix of humans. In order to achieve this, we first characterised MIP-3α constitutive secretion patterns in different sub-compartments of the GT before proceeding to determine its induced secretion patterns, stimulating with HIV-1 and various Toll-like receptor ligands. For completeness we determined constitutive and induced secretion patterns of multiple soluble proteins (SPs) and antimicrobial peptides (AMPs) in the endocervices of humans and macaques. The GT being an immunohormonal system, we further studied the influence of endogenous hormonal changes on the stability of MIP-3α and that of other innate immune markers. We quantified MIP-3α with a sandwich Elisa, and SPs and AMPs with the Luminex multiplex bead assay. Our results showed that the GT is a rich source of MIP-3α with its levels being among those of the highest SPs in the GT. Constitutive levels were highest in the endocervical sub-compartment of all the sub-compartments studied. Further, the GT is an inflammatory environment, which would explain the high levels of MIP-3α. The primary driver of MIP-3α levels appears to be inflammation rather than hormonal levels. MIP-3α levels are significantly higher in the GT of humans than in macaques. There was no evidence that MIP-3α levels are elevated on exposure to HIV and SIV in humans and macaques, respectively. We therefore concluded that since the endocervix is unlikely to respond to HIV/SIV by secreting MIP-3α in vivo, contrary to the previous reports, MIP-3α is hence not a key player in amplifying early events in infection. And as such, it should not be a prime target for preventive therapy. Further, the human GT having a pre-existing inflammatory profile may explain the high rates of HIV sexual transmission. Lastly, we concluded that the infection mechanisms described in the macaque model (i.e. the 'outside-in' signaling) are likely not required for human infection.

Orientador: Rogério Saad Hossne / Coorientador: Sidney Roberto Nadal / Banca: Fábio Vieira Teixeira / Banca: Maria Aparecida C. Arruda Henry / Resumo: O Papiloma Vírus Humano (HPV), é considerado um problema mundial de saúde pública, sendo a doença sexualmente transmissível mais prevalente. Guarda uma relação direta com o risco e a incidência do câncer do canal anal. Seu diagnóstico, tratamento e seguimento são de extrema importância. Neste sentido o escovado do canal anal tem um papel fundamental no rastreamento e seguimento das lesões HPV induzidas e consequente evolução para o câncer anal. Determinar a ocorrência de lesão HPV induzida em mulheres que participam dos programas de prevenção do câncer de colo uterino nas Unidades Básicas de Saúde (UBS) no município de Botucatu. Trata-se de um estudo transversal observacional que teve 228 mulheres submetidas ao escovado do canal anal a fim de estabelecer a ocorrência de lesão HPV induzida e suas correlações com dados sociais e comportamentais. Os 11 casos que apresentaram alteração de ASCUS e LSIL no escovado do canal anal traziam relação com estado civil, baixa escolaridade, não prática do sexo seguro, e a prática do sexo anal / Abstract: Human Papillomavirus (HPV) has been a world concern in Public Health, and it is the most prevalent sexually transmitted disease. It has a direct association with the risk and incidence of cancer in the anal canal. Its diagnosis, treatment and follow-up are extremely important. Using this approach, the smear of the anal canal has a crucial role in the screening and follow up of HPV-induced lesions and in the resulting development of anal cancer. To determine the occurrence of HPVinduced lesions in women who attended programs of uterine cervix cancer prevention in Basic Health Units (BHU) in Botucatu city. It is a cross sectional observational study, in which 228 women underwent brushing of the anal canal in order to establish the occurrence of HPV-induced lesion and its correlation with social and behavioral data. The 11 cases which had ASCUS and LSIL changes in the smear of the anal canal were associated with marital status, low education level, practice of unsafe intercourse and anal intercourse / Mestre

Orientador: Cristina Maria Garcia de Lima Parada / Coorientador: Márcia Guimarães da Silva / Banca: Maria Antonieta de Barros Leite Carvalhaes / Banca: Marli Terezinha Cassamassimo Duarte / Banca: Sandra Marisa Pelloso / Banca: Flávia Gomes-Sponhoz / Resumo: O objetivo geral deste estudo foi analisar o resultado perinatal de gestantes submetidas a busca ativa de infecção genital inferior. Para alcance deste objetivo foram realizados três subprojetos, apresentados em capítulos. Capítulo I- Infecção do trato genital inferior e repercussões perinatais: revisão integrativa da literatura, teve por objetivo identificar, na produção científica dos últimos 10 anos, evidências sobre as condições dos neonatos ao nascimento, quando a mãe apresentou infecção do trato genital inferior na gravidez. Os resultados foram variados, sendo que os estudos apontaram associação de determinado tipo de infecção a alguns desfechos e não a outros. A associação mais frequentemente buscada foi entre vaginose bacteriana e prematuridade, tendo sido apontada associação em seis estudos e ausência em três. Capítulo II - Resultado perinatal de gestantes submetidas à busca ativa de infecção do trato genital inferior: estudo observacional e analítico, teve por objetivo analisar o resultado perinatal de gestantes de baixo risco submetidas à busca ativa de infecção genital. Observou-se que a chance do índice de Apgar de primeiro minuto ser inferior a sete pontos foi significativamente menor entre as gestantes que passaram pela busca ativa e esse grupo teve recém-nascidos com peso ao nascer em média 350 gramas maior. Capítulo III: Resultado perinatal de mulheres com história de trabalho de parto prematuro e submetidas à busca ativa de infecção do trato genital inferior, objetivou comparar a frequência de prematuridade e de índice de Apgar de primeiro minuto de vida inferior a sete em gestantes submetidas ou não a busca ativa de infecções do trato genital inferior e tratamento etiológico. Estudo controlado, não randomizado, não encontrou relação significativa entre busca ativa e menores taxas de prematuridade e melhores índices de Apgar. Conclui-se que, pela relevância do tema para ... / Abstract: This paper aimed at evaluate perinatal results of pregnant women who were submitted to an active search of inferior genital infection. Three sub-projects were developed in chapters in order to reach this objective. Chapter 1 - Infection of the lower genital tract and perinatal outcomes: a literature review. The purpose was to identify in 10 years scientific production, evidences of neonatal conditions at birth when the mother presented genital tract infection during pregnancy. The results differed. The studies showed an association of certain types of infection in some outcomes and not in others. The most frequently searched association was among bacterial vaginitis and prematurity, present in six cases and absent in three of them. Chapter II - Perinatal outcome of pregnant women submitted to an active search of the lower genital tract infection; observational and analytical study. The purpose was to evaluate the perinatal result of low risk pregnant women submitted to an active search of genital infection. In this case, the chance of first minute Agpar score to be less than 7 points was significantly smaller among pregnant women who underwent an active search. Newborns in this group weighed 350 grams more. Chapter III - Perinatal results of women who experienced premature labor and were submitted to an active search of inferior genital tract infection. The purpose was to compare prematurity frequency and first minute Apgar score, inferior to seven, in pregnant women submitted or not to an active search of the inferior genital tract and etiological treatment. The study was controlled and non randomized. A significative relationship between an active search and lower prematurity indexes and better Agpar scores was found. The study leads to the conclusion that considering the relevance of the subject for public health, the results should be seen as a first approach. Further investigations on special controlled studies with larger ... / Doutor

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Objective: Systematic review and meta-analysis to assess the effects of uterine or paracervical lidocaine application on pain control during IUD insertion. Methods: PubMed and five other electronic research databases were searched through 15 November 2017 for RCTs comparing lidocaine treatment vs. a control (placebo or no-intervention) to prevent pain during IUD insertion. Searched terms included ‘IUD insertion’, ‘lidocaine’ and ‘randomised controlled trial’. RCTs evaluating lidocaine treatment before IUD insertion without restriction of language, age and IUD type. Pain measured by visual pain scales at tenaculum placement, IUD insertion and immediate post-IUD insertion. Results of random effects meta-analyses were reported as mean differences (MDs) of visual pain scale (VPS) scores and their 95% confidence intervals (CIs). Results: Eleven RCTs (n = 1458 women) reporting paracervical lidocaine block or uterine mucosa lidocaine application before IUD insertion. Lidocaine produced lower VPS scores during tenaculum placement (MD −0.99, 95% CI: −1.73 to −0.26), IUD insertion (MD −1.26, 95% CI: −2.23 to −0.29) and immediate post-IUD insertion period (MD −1.25, 95% CI: −2.17 to −0.33). Conclusion: Lidocaine treatment was associated with modest reduction of pain during tenaculum placement and after IUD insertion. / Revisión por pares