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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
11

Barreiras organizacionais para disponibilização do dispositivo intrauterino nos serviços de Atenção Básica à Saúde (macrorregião Sul de Minas Gerais) / Organizational barriers to providing the intrauterine device in Primary Health Attention services (macro-region in the southern of Minas Gerais)

Vanderlea Aparecida Silva Gonzaga 29 November 2016 (has links)
Embora o dispositivo intrauterino (DIU) seja pouco usado no Brasil, ele é o método contraceptivo reversível mais usado no mundo. Trata-se de um método seguro, altamente eficaz e com resultados positivos na saúde das populações. Por meio da prevenção de gestações não planejadas, atua na redução da morbidade e mortalidade materna, mortalidade infantil e abortos inseguros. Pesquisas recentes, contudo, mostram que o acesso ao DIU nos serviços de Atenção Básica à Saúde nem sempre é facilitado, sendo permeado por barreiras organizacionais que contribuem para sua subutilização. Tais barreiras podem restringir o pleno exercício dos direitos sexuais e reprodutivos das mulheres brasileiras. Objetivo: Identificar barreiras organizacionais para disponibilização do DIU nos serviços de Atenção Básica à Saúde e elaborar, como produto desta dissertação, uma síntese destas barreiras, destinada aos gestores de saúde, com suas implicações e recomendações. Método: Estudo quantitativo, descritivo. A coleta de dados foi realizada por meio do preenchimento de um instrumento estruturado, online, pelos 79 profissionais responsáveis pela área técnica de Saúde da Mulher. O cenário do estudo foi a macrorregião Sul de Minas Gerais. A análise dos dados foi realizada por meio do software Stata, versão 14.0, e descrita por meio de número absoluto e proporções. Resultados: A maioria dos municípios possui protocolo de atenção à saúde da mulher (55,7%). Destes, 77,3% elaboraram seu próprio protocolo, mas 29,6% não treinaram a equipe de saúde para usá-lo. Dentre todos os municípios participantes, 15,2% não disponibilizam DIU, sendo que alguns também não referenciam a mulher para outros serviços (8,3%). Dentre aqueles que disponibilizam o DIU, a grande maioria não possui protocolo específico (68,7%); uma parcela não adota a gravidez como condição impossibilitante da inserção do DIU (10,5%) e, por outro lado, adotam condições menos relevantes como infecção vaginal (80,6%). Como critério para acesso ao DIU, 86,5% referiram prescrição médica, 71,6% realização de exames, 44,6% idade acima de 18 anos e 24,4% participação em grupos. Como exames necessários, foi citado o Papanicolaou (94,7%), teste de gravidez (63,2%) e exame de sangue (29,8%). Quanto ao local de disponibilização, 83,7% não o disponibilizam nas Unidades Básicas de Saúde. Como profissional que insere o DIU, 97,0% referiram médico e nenhum citou o enfermeiro. Quanto aos grupos de planejamento reprodutivo, 43,0% dos municípios não os realizam. Por fim, 86,1% dos trabalhadores reportaram não haver dificuldades para obtenção do DIU. Conclusão: Foram identificadas barreiras organizacionais que dizem respeito ao uso de protocolos, também barreiras relacionadas à disponibilização e inserção do DIU, e barreiras relativas aos grupos de planejamento reprodutivo. / Introduction: Although the intrauterine device (IUD) is little used in Brazil, it is the most used reversible contraceptive method in the world. It is about a safe method, highly effective and with positive results in the health of populations. By means of preventing unplanned pregnancies, it works to reduce maternal morbidity and mortality, infant mortality and unsafe abortions. Recent research, however, show that access to IUD in Primary Health Attention services is not always facilitated, being permeated by organizational barriers that contribute to their underutilization. Such barriers may restrict the full exercise of sexual and reproductive rights of Brazilian women. Objective: To identify organizational barriers for providing IUD in the Primary Health Attention services and elaborate, as a product of this dissertation, a summary of these barriers, which is intended for health managers, with their implications and recommendations. Method: Qualitative, descriptive study. Data collection was performed by completing, online, a structured instrument, by 79 professionals responsible for the technical field of Womens Health. The study setting was the macro-region in the southern of Minas Gerais. Data analysis was performed using Stata software, version 14.0, and described by absolute number and proportions. Results: Most municipalities have attention protocol to womens health (55.7%). Of these, 77.3% developed its own protocol, but 29.6% did not train health staff to use it. Among all participating municipalities, 15.2% do not offer IUD, and some did not refer women to other services (8.3%). Among those, which provide the IUD, the vast majority do not have specific protocol (68.7%); a portion does not adopt pregnancy as an impeditive condition of insertion of the IUD (10.5%) and, on the other hand, adopt less relevant conditions such as vaginal infection (80.6%). As a criterion for accessing the IUD, 86.5% reported prescription, 71.6% exams, 44.6% aged over 18 years old and 24.4% participation in groups. As required exams, it was quoted the Pap smear (94.7%), pregnancy test (63,2%) and blood tests (29,8%). As a place of availability, 83.7% do not provide in the Basic Health Units. As a professional to insert the IUD, 97.0% reported the doctor and none cited the nurse. Municipalities do not realize reproductive planning group at 43.0%. Finally, 86.1% of workers reported not having difficulties in obtaining the IUD. Conclusion: Organizational barriers were identified concerning the use of protocols, also barriers related to the availability and IUD insertion, and barriers related to the reproductive planning groups.
12

O efeito do sistema intra-uterino de levonorgestrel (SIU-LNG) no fluxo das artérias uterinas, volume uterino e espessura endometrial em pacientes com endometriose pélvica: estudo comparativo com o análogo de GNRH (GnRHa) / The effect of System Intrauterine levonorgestrel (LNG-IUS) in the uterine artery flow, volume uterinoe Endometrial thickness in patients with endometriosis Pelvic: comparative study with the GnRH analogue (GnRHa)

Manetta, Luiz Alberto 13 December 2007 (has links)
Objetivos: O objetivo deste estudo foi comparar os índices de Pulsatilidade (IP) e Resistência (IR) das artérias uterinas, o volume uterino e a espessura endometrial após o uso do Sistema Intra-uterino de Levonorgestrel (SIU-LNG) ou do agonista do GnRHa (GnRHa) em pacientes portadoras de endometriose pélvica. Pacientes e métodos: Setenta e nove mulheres voluntárias, com idade entre 18 e 40 anos, foram incluídas neste ensaio clínico comparativo, prospectivo, randomizado e controlado. Dezoito foram eliminadas do estudo baseadas nos critérios de exclusão, As 61 pacientes remanescentes foram divididas em dois grupos: 31 pacientes fizeram parte do grupo SIU-LNG (uma foi excluída antes da inserção por apresentar-se grávida) e 30 fizeram parte do grupo GnRHa. Foram submetidasa exame ultra-sonográfico transvaginal bidimensional no dia em que iniciaram o tratamento (inserção do SIU-LNG ou administração de uma ampola de 3,75 mg de GnRHa por via intra-muscular) e seis meses após, avaliando a espessura endometrial, o volume uterino e os IR e IP das artérias uterinas. Resultados: Ambos tratamentos promoveram redução da espessura endometrial (6.08±3.00mm para 2.70±0.98mm e 6.96±3.82mm para 3.23±2.32mm - média ±SD, grupo SIU-LNG e grupo GnRHa, respectivamente). O volume uterino teve redução no grupo usuário do GnRHa (86.67±28.38cm3 para 55.27±25.52cm3) sem alteração significativa nas usuárias do SIU-LNG (75.77±20.88cm3 para 75.97±26.62cm3). Em relação à ascularização uterina, notamos incremento dos IP das artérias uterinas em ambos os grupos (grupo SIU-LNG: artéria uterina direita de 2.38±0.72 para 2.76±0.99 (média ±SD) e artéria uterina esquerda 2.46±0.70 para 2.87±0.96, e grupo GnRHa: artéria uterina direita 2.04±0.59 para 3.12±0.98 eartéria uterina esquerda 2.24±0.59 para 3.15±0.89). Em relação ao IR das artérias uterinas, observamos incremento no grupo GnRHa em ambas artérias e somente na artéria uterina esquerda no grupo SIU-LNG (grupoSIU-LNG - artéria uterina direita de 0.85±0.08 para 0.88±0.07 e artéria uterina esquerda de 0.86±0.07 para 0.89±0.06, e grupo GnRHa: artéria uterina direita de 0.81±0.07 para 0.93±0.09 e artéria uterina esquerda 0.84±0.06 para 0.93±0.09). No entanto, ao compararmos as diferenças, a elevação foi significativamente maior nas usuárias do GnRHa. Conclusões: Ambos GnRHa e SIU-LNG promoveram redução na espessura endometrial e aumento no IP das artérias uterinas. Houve redução do volume uterino nas usuárias do grupo GnRHa, não se alterando no grupo SIU-LNG. Em relação ao IR, houve incremento em ambas as artérias nas usuárias de GnRHa e somente na artéria uterina esquerda nas usuárias do SIU-LNG. / Objectives:The objective of the present study was to compare the uterine arteries pulsatility index (PI) and resistence index (IR), uterine volume and endometrial thickness changes promoted by the use of the levonorgestrel intrauterine device (LNG-IUD) and the gonadotropin-releasing hormone analogue (GnRHa)in patients with endometriosis. Methods: Seventy nine women aged 18 to 40 years were included in this randomized controlled trial. Eighteen was excluded based on the exclusion criteria. The patients were randomly allocated in two groups: 31 women who used the LNG-IUD (since one became pregnant before insertion and wasexcluded) and 30 who used monthly GnRHa injections. They were submitted to a transvaginal two dimensional ultrasound scan on the day the treatment started and 6 months later, for the evaluation of uterine arteries PI, uterine arteries RI, uterine volume and endometrial thickness. Results: The use of LNG-IUD promoted an ndometrial thickness decrease (6.08±3.00mm to 2.7±0.98mm; mean±SD) as does the use of GnRHa (6.96±3.82mm to 3.23±2.32mm). The uterine volume decreased in the GnRHa group (86.67±28.38cm3to 55.27±25.52cm3), but not in the LNG-IUD group (75.77±20.88cm3 to 75.97±26.62cm3). Uterine arteries PI increased in both groups : Uterine arteries PI: LNG-IUD right uterine arterie 2.38 ± 0.72 to 2.76 ± 0.99 and left uterine arterie 2.46 ± 0.70 to 2.87 ± 0.96, and GnRHa right uterine arterie 2.04 ± 0.59 to 3.12 ± 0.98 and left uterine arterie 2.24±0.59 to 3.15 ± 0.89. Uterine arteries RI increased in both arteries in GnRHa and only in the left uterine arterie in the LNG-IUD :Uterine arteries RI : LNG-IUD right uterine arterie 0.85 ± 0..08 to 0.88 ± 0.07 and left uterine arterie 0.86 ± 0.07 to 0.89 ± 0.06, and GnRHa right uterine arterie 0.81 ± 0.07 to 0.93 ± 0.09 and left uterine arterie 0.84 ± 0.06 to 0.93 ± 0.09 . However, the increase was significant higher in the GnRHa group. Conclusions: Both GnRHa and LNG-IUD promoted an endometrial thickness decrease and an increase in the uterine arteries PI. The uterine volume decreased in women who used GnRHa, but not in those who used LNG-IUD.
13

The Clinical Appearance of Pelvic Inflammatory Disease in Relation to Use of Intrauterine Device in Latvia : A Study with Special Emphasis on Factors Influencing the Clinical Course of PID in IUD Users

Viberga, Ilze January 2006 (has links)
<p>The objectives of this case-control study, investigating 51 in-patient women with acute pelvic inflammatory disease (PID) and 50 healthy women attending for routine gynecological check-up, were to investigate the background and reproductive history of women, who are considered at low risk of sexually transmitted infection presenting with PID, to examine whether intrauterine device (IUD) use <i>per se</i> and long use affects the microbiology and clinical course of the disease, to identify risk factors for PID and to examine whether IUD use is an independent risk factor for PID.</p><p>The most striking difference regarding the background and reproductive history between women with PID and healthy women over age 25 were related to socio-demographic factors and not to common risk factors for PID.</p><p>There was little difference between healthy women and women with current PID with regard to single microbes. The finding of combinations of several anaerobic or aerobic/anaerobic microbes appeared to be associated with PID, particularly in women over 35. The pathogenesis of non-sexually transmitted PID appears to be associated with a synergistic effect between several pathogens, possibly facilitated by the presence of an IUD.</p><p>IUD use <i>per se</i> was associated with an increased risk of PID in women 35 and older. There was an association between IUD use and complicated PID in women over 35, which was possibly influenced by long-term IUD use. Age over 35 and IUD use, independently of each other, were associated with an increased risk of failed conservative treatment, necessitating surgery in patients with PID.</p><p>An observational study showed that Latvian obstetrician-gynecologists participate actively in contraceptive counseling and are very experienced with regard to IUD use. Physicians’ attitudes and perceptions towards IUD are generally positive and their clinical considerations are in good agreement with that of doctors in other countries. Antibiotics are widely used around IUD insertion by doctors, possibly driven by a liberal attitude towards IUD use in women with a potential risk of STI. The study could identify some possible gaps in the theoretical knowledge about the IUD and other methods.</p>
14

The Clinical Appearance of Pelvic Inflammatory Disease in Relation to Use of Intrauterine Device in Latvia : A Study with Special Emphasis on Factors Influencing the Clinical Course of PID in IUD Users

Viberga, Ilze January 2006 (has links)
The objectives of this case-control study, investigating 51 in-patient women with acute pelvic inflammatory disease (PID) and 50 healthy women attending for routine gynecological check-up, were to investigate the background and reproductive history of women, who are considered at low risk of sexually transmitted infection presenting with PID, to examine whether intrauterine device (IUD) use per se and long use affects the microbiology and clinical course of the disease, to identify risk factors for PID and to examine whether IUD use is an independent risk factor for PID. The most striking difference regarding the background and reproductive history between women with PID and healthy women over age 25 were related to socio-demographic factors and not to common risk factors for PID. There was little difference between healthy women and women with current PID with regard to single microbes. The finding of combinations of several anaerobic or aerobic/anaerobic microbes appeared to be associated with PID, particularly in women over 35. The pathogenesis of non-sexually transmitted PID appears to be associated with a synergistic effect between several pathogens, possibly facilitated by the presence of an IUD. IUD use per se was associated with an increased risk of PID in women 35 and older. There was an association between IUD use and complicated PID in women over 35, which was possibly influenced by long-term IUD use. Age over 35 and IUD use, independently of each other, were associated with an increased risk of failed conservative treatment, necessitating surgery in patients with PID. An observational study showed that Latvian obstetrician-gynecologists participate actively in contraceptive counseling and are very experienced with regard to IUD use. Physicians’ attitudes and perceptions towards IUD are generally positive and their clinical considerations are in good agreement with that of doctors in other countries. Antibiotics are widely used around IUD insertion by doctors, possibly driven by a liberal attitude towards IUD use in women with a potential risk of STI. The study could identify some possible gaps in the theoretical knowledge about the IUD and other methods.
15

O efeito do sistema intra-uterino de levonorgestrel (SIU-LNG) no fluxo das artérias uterinas, volume uterino e espessura endometrial em pacientes com endometriose pélvica: estudo comparativo com o análogo de GNRH (GnRHa) / The effect of System Intrauterine levonorgestrel (LNG-IUS) in the uterine artery flow, volume uterinoe Endometrial thickness in patients with endometriosis Pelvic: comparative study with the GnRH analogue (GnRHa)

Luiz Alberto Manetta 13 December 2007 (has links)
Objetivos: O objetivo deste estudo foi comparar os índices de Pulsatilidade (IP) e Resistência (IR) das artérias uterinas, o volume uterino e a espessura endometrial após o uso do Sistema Intra-uterino de Levonorgestrel (SIU-LNG) ou do agonista do GnRHa (GnRHa) em pacientes portadoras de endometriose pélvica. Pacientes e métodos: Setenta e nove mulheres voluntárias, com idade entre 18 e 40 anos, foram incluídas neste ensaio clínico comparativo, prospectivo, randomizado e controlado. Dezoito foram eliminadas do estudo baseadas nos critérios de exclusão, As 61 pacientes remanescentes foram divididas em dois grupos: 31 pacientes fizeram parte do grupo SIU-LNG (uma foi excluída antes da inserção por apresentar-se grávida) e 30 fizeram parte do grupo GnRHa. Foram submetidasa exame ultra-sonográfico transvaginal bidimensional no dia em que iniciaram o tratamento (inserção do SIU-LNG ou administração de uma ampola de 3,75 mg de GnRHa por via intra-muscular) e seis meses após, avaliando a espessura endometrial, o volume uterino e os IR e IP das artérias uterinas. Resultados: Ambos tratamentos promoveram redução da espessura endometrial (6.08±3.00mm para 2.70±0.98mm e 6.96±3.82mm para 3.23±2.32mm - média ±SD, grupo SIU-LNG e grupo GnRHa, respectivamente). O volume uterino teve redução no grupo usuário do GnRHa (86.67±28.38cm3 para 55.27±25.52cm3) sem alteração significativa nas usuárias do SIU-LNG (75.77±20.88cm3 para 75.97±26.62cm3). Em relação à ascularização uterina, notamos incremento dos IP das artérias uterinas em ambos os grupos (grupo SIU-LNG: artéria uterina direita de 2.38±0.72 para 2.76±0.99 (média ±SD) e artéria uterina esquerda 2.46±0.70 para 2.87±0.96, e grupo GnRHa: artéria uterina direita 2.04±0.59 para 3.12±0.98 eartéria uterina esquerda 2.24±0.59 para 3.15±0.89). Em relação ao IR das artérias uterinas, observamos incremento no grupo GnRHa em ambas artérias e somente na artéria uterina esquerda no grupo SIU-LNG (grupoSIU-LNG - artéria uterina direita de 0.85±0.08 para 0.88±0.07 e artéria uterina esquerda de 0.86±0.07 para 0.89±0.06, e grupo GnRHa: artéria uterina direita de 0.81±0.07 para 0.93±0.09 e artéria uterina esquerda 0.84±0.06 para 0.93±0.09). No entanto, ao compararmos as diferenças, a elevação foi significativamente maior nas usuárias do GnRHa. Conclusões: Ambos GnRHa e SIU-LNG promoveram redução na espessura endometrial e aumento no IP das artérias uterinas. Houve redução do volume uterino nas usuárias do grupo GnRHa, não se alterando no grupo SIU-LNG. Em relação ao IR, houve incremento em ambas as artérias nas usuárias de GnRHa e somente na artéria uterina esquerda nas usuárias do SIU-LNG. / Objectives:The objective of the present study was to compare the uterine arteries pulsatility index (PI) and resistence index (IR), uterine volume and endometrial thickness changes promoted by the use of the levonorgestrel intrauterine device (LNG-IUD) and the gonadotropin-releasing hormone analogue (GnRHa)in patients with endometriosis. Methods: Seventy nine women aged 18 to 40 years were included in this randomized controlled trial. Eighteen was excluded based on the exclusion criteria. The patients were randomly allocated in two groups: 31 women who used the LNG-IUD (since one became pregnant before insertion and wasexcluded) and 30 who used monthly GnRHa injections. They were submitted to a transvaginal two dimensional ultrasound scan on the day the treatment started and 6 months later, for the evaluation of uterine arteries PI, uterine arteries RI, uterine volume and endometrial thickness. Results: The use of LNG-IUD promoted an ndometrial thickness decrease (6.08±3.00mm to 2.7±0.98mm; mean±SD) as does the use of GnRHa (6.96±3.82mm to 3.23±2.32mm). The uterine volume decreased in the GnRHa group (86.67±28.38cm3to 55.27±25.52cm3), but not in the LNG-IUD group (75.77±20.88cm3 to 75.97±26.62cm3). Uterine arteries PI increased in both groups : Uterine arteries PI: LNG-IUD right uterine arterie 2.38 ± 0.72 to 2.76 ± 0.99 and left uterine arterie 2.46 ± 0.70 to 2.87 ± 0.96, and GnRHa right uterine arterie 2.04 ± 0.59 to 3.12 ± 0.98 and left uterine arterie 2.24±0.59 to 3.15 ± 0.89. Uterine arteries RI increased in both arteries in GnRHa and only in the left uterine arterie in the LNG-IUD :Uterine arteries RI : LNG-IUD right uterine arterie 0.85 ± 0..08 to 0.88 ± 0.07 and left uterine arterie 0.86 ± 0.07 to 0.89 ± 0.06, and GnRHa right uterine arterie 0.81 ± 0.07 to 0.93 ± 0.09 and left uterine arterie 0.84 ± 0.06 to 0.93 ± 0.09 . However, the increase was significant higher in the GnRHa group. Conclusions: Both GnRHa and LNG-IUD promoted an endometrial thickness decrease and an increase in the uterine arteries PI. The uterine volume decreased in women who used GnRHa, but not in those who used LNG-IUD.

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