Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 6 uppsatser.

Thesis (Ph.D.) - University of Glasgow, 2008. / PhD thesis submitted to the Medical Research Council, Social and Public Health Sciences Unit. Includes bibliographical references. Print version also available.

Th.--Méd.--Paris 13--Bobigny, 1978. N°: 52.

Th. 3e cycle--Pharm.--Paris 5, 1980. N°: 10.

The availability of accessible, effective, and timely emergency contraception (EC) technologies is an important issue in women’s reproductive health. In Canada, three methods of EC are currently available: the levonorgestrel pill (LNg-EC), the Copper-T intrauterine device (IUD), and ulipristal acetate (UPA). This study explores the EC knowledge, attitudes, and practices of Ontario pharmacists through a mixed-methods study. The mixed-methods study includes a bilingual mailed survey with a representative sample of retail pharmacists and in-depth interviews with a subset of respondents. Results of the survey indicate that there is considerable interest among pharmacists to expand access to EC in Ontario; however, the results indicate that LNg-EC continues to be a behind-the- counter product and knowledge of other EC modalities is modest. Pharmacists view themselves as playing a critical role in patient education and counseling, as well as raising awareness about EC in the community. Developing and implementing continuing education efforts targeting pharmacists appears warranted. This research could ultimately play a role in expanding access to IUDs and UPA, as well as raising awareness of these modalities within the pharmacy community. La disponibilité à des technologies de contraception d’urgence (CU) accessible, efficace et dans un délai raisonnable est une problématique d’importance pour la santé reproductive des femmes. Au Canada, trois méthodes de CU sont actuellement disponibles : le comprimé de levonorgestrel (CU-LNg), le dispositif intra-utérin de cuivre (DIU) et l’acétate ulipristal (UPA). Cette étude multi-méthodes qui est composée d’une sondage bilingue posté à un échantillon représentatif de pharmaciens travaillant en milieu communautaire et d’entrevues réalisées avec un sous-ensemble de participants a pour but d’explorer les connaissances, les attitudes et la prestation de services des pharmaciens en Ontario par rapport à la contraception d’urgence. Les résultats des sondages démontrent qu’il y a un intérêt considérable de la part des pharmaciens quant à l’amélioration de l’accessibilité à la CU en Ontario. Toutefois, nos résultats démontrent que la CU-LNg continue d’être un produit situé en Annexe II et que les connaissances des pharmaciens quant aux autres méthodes de contraception d’urgence sont limitées. Les pharmaciens croient qu’ils sont un élément clé pour l’éducation de leurs patients et pour prodiguer des conseils sur la CU dans la communauté. Le développement et l’implantation de formation continue spécifiques aux pharmacies sont nécessaires. Cette recherche pourrait favoriser l’accessibilité au DUI et à l’UPA en plus d’améliorer les connaissances de ces technologies au sein de la communauté pharmaceutique.

Hormonal contraception is widely used by women within the U.S. and is considered to be empowering and beneficial for women’s progress in society. Hormonal birth control is framed as having benefits beyond fertility control, often in ways that medicalize and problematize women’s natural reproductive cycle. This study takes a critical look at the framing of hormonal contraception in both women’s and men’s magazines from an ecofeminist perspective. Articles were gathered from Women’s Health, Cosmopolitan, Men’s Health and Maxim and were analyzed through Entman’s four functions of a frame. Special attention was paid to the differences between men’s and women’s magazines. The results show that hormonal contraception is being normalized through medicalizing women’s natural cycle and through naturalizing medical and scientific authority in making health decisions. Men’s magazines discuss contraception far less than women’s magazines, and both continue to place contraceptive responsibility on women.

Introdução: A contracepção de emergência, embora disponível há mais de 30 anos, ainda nos dias atuais encontra resistências de natureza religiosa, cultural e social em diferentes regiões do mundo. Estados como o Pará, segundo maior da Amazônia brasileira e da Região Norte do Brasil, com características continentais, têm, certamente na geografia, na diversidade populacional e no ecossistema, fatores que contribuem sobremaneira para a ocorrência de gestações precoces e indesejadas, assim como a prática de abortamento. Pouco se sabe sobre o nível de conhecimento sobre a contracepção de emergência pelas mulheres e sua utilização pela população brasileira. Objetivo: Avaliar o nível de conhecimento sobre contracepção de emergência entre mulheres atendidas nos Ambulatórios de Ginecologia do Hospital da Fundação Santa Casa de Misericórdia do Estado do Pará. Métodos: Foi realizado estudo transversal com 316 mulheres sexualmente ativas, com idade entre 18 e 50 anos, que frequentaram o Ambulatório de Ginecologia entre junho e julho de 2012. As pacientes responderam a um questionário contendo 29 perguntas, incluindo: idade em anos, nível educacional, conhecimento e uso prévio do método de contracepção de emergência. Resultados: A idade média das participantes foi de 31,84 ± 8,00 anos, 46,84% delas concluíram o ensino médio e apenas 8,55% possuíam o ensino superior. A maioria obtivera informações sobre contracepção de emergência por meio de amigos (48,61%, n = 152) e apenas 7,30% através de seus médicos. Embora 83,54% das participantes relatassem estar familiarizadas com o método, apenas 0,63% disseram que o contraceptivo de emergência poderia ser usado até 5 dias após a relação sexual desprotegida e 76,58% nunca tinham utilizado o método. Conclusão: As mulheres incluídas neste estudo demostraram ter elevado conhecimento e prevalência de uso da contracepção de emergência, apesar de pouco conhecimento sobre o tempo máximo para sua utilização e, devem receber mais informações sobre o contraceptivo de emergência. / Introduction: emergency contraception although available as a safe and effective method for more than 30 years, even today, meets resistance as religious, cultural and social development in different regions of the world, limiting their use and compromising your knowledge on the part of the population. States such as Pará, the second largest Brazilian Amazon State, and of the northern region of Brazil, with continental characteristics, has certainly, in geography, population diversity, ecosystem, factors that contribute greatly favoring the occurrence of premature and unwanted pregnancies, as well as the practice of abortion. Little is known about the level of knowledge about emergency contraception by women and their use in Brazil. Objective: To assess the level of knowledge about emergency contraception among women attending at gynecology clinics in the Hospital Santa Casa de Misericordia of State of Pará. Methods: cross-sectional study was conducted with 316 sexually active women aged 18-50 years attending the gynecology outpatient clinic, between June and July 2012. The patients answered a questionnaire containing 29 questions, including: age in years, education level, knowledge and previous use of emergency contraception method. Results: The mean age of participants was 31.84 ± 8,00 years. 46.84% of them completed high school, and only 8.55% have higher education. Most women obtained information on emergency contraception through friends (48.61%, n = 152) and only 7.30% of its physicians. 83.54% participants reported being familiar with the method, only 0.63% said that emergency contraception could be used up to 5 days after unprotected intercourse, 57.59% did not know, and 76,58% (n = 242) had never used the method. Conclusion: The women in our study seem to have high level of knowledge and prevalence of use of emergency contraception, although little known about the time limit for its use and should receive more information about the emergency contraceptive.

Introdução: A contracepção de emergência, embora disponível há mais de 30 anos, ainda nos dias atuais encontra resistências de natureza religiosa, cultural e social em diferentes regiões do mundo. Estados como o Pará, segundo maior da Amazônia brasileira e da Região Norte do Brasil, com características continentais, têm, certamente na geografia, na diversidade populacional e no ecossistema, fatores que contribuem sobremaneira para a ocorrência de gestações precoces e indesejadas, assim como a prática de abortamento. Pouco se sabe sobre o nível de conhecimento sobre a contracepção de emergência pelas mulheres e sua utilização pela população brasileira. Objetivo: Avaliar o nível de conhecimento sobre contracepção de emergência entre mulheres atendidas nos Ambulatórios de Ginecologia do Hospital da Fundação Santa Casa de Misericórdia do Estado do Pará. Métodos: Foi realizado estudo transversal com 316 mulheres sexualmente ativas, com idade entre 18 e 50 anos, que frequentaram o Ambulatório de Ginecologia entre junho e julho de 2012. As pacientes responderam a um questionário contendo 29 perguntas, incluindo: idade em anos, nível educacional, conhecimento e uso prévio do método de contracepção de emergência. Resultados: A idade média das participantes foi de 31,84 ± 8,00 anos, 46,84% delas concluíram o ensino médio e apenas 8,55% possuíam o ensino superior. A maioria obtivera informações sobre contracepção de emergência por meio de amigos (48,61%, n = 152) e apenas 7,30% através de seus médicos. Embora 83,54% das participantes relatassem estar familiarizadas com o método, apenas 0,63% disseram que o contraceptivo de emergência poderia ser usado até 5 dias após a relação sexual desprotegida e 76,58% nunca tinham utilizado o método. Conclusão: As mulheres incluídas neste estudo demostraram ter elevado conhecimento e prevalência de uso da contracepção de emergência, apesar de pouco conhecimento sobre o tempo máximo para sua utilização e, devem receber mais informações sobre o contraceptivo de emergência. / Introduction: emergency contraception although available as a safe and effective method for more than 30 years, even today, meets resistance as religious, cultural and social development in different regions of the world, limiting their use and compromising your knowledge on the part of the population. States such as Pará, the second largest Brazilian Amazon State, and of the northern region of Brazil, with continental characteristics, has certainly, in geography, population diversity, ecosystem, factors that contribute greatly favoring the occurrence of premature and unwanted pregnancies, as well as the practice of abortion. Little is known about the level of knowledge about emergency contraception by women and their use in Brazil. Objective: To assess the level of knowledge about emergency contraception among women attending at gynecology clinics in the Hospital Santa Casa de Misericordia of State of Pará. Methods: cross-sectional study was conducted with 316 sexually active women aged 18-50 years attending the gynecology outpatient clinic, between June and July 2012. The patients answered a questionnaire containing 29 questions, including: age in years, education level, knowledge and previous use of emergency contraception method. Results: The mean age of participants was 31.84 ± 8,00 years. 46.84% of them completed high school, and only 8.55% have higher education. Most women obtained information on emergency contraception through friends (48.61%, n = 152) and only 7.30% of its physicians. 83.54% participants reported being familiar with the method, only 0.63% said that emergency contraception could be used up to 5 days after unprotected intercourse, 57.59% did not know, and 76,58% (n = 242) had never used the method. Conclusion: The women in our study seem to have high level of knowledge and prevalence of use of emergency contraception, although little known about the time limit for its use and should receive more information about the emergency contraceptive.

Introdução: A contracepção de emergência, embora disponível há mais de 30 anos, ainda nos dias atuais encontra resistências de natureza religiosa, cultural e social em diferentes regiões do mundo. Estados como o Pará, segundo maior da Amazônia brasileira e da Região Norte do Brasil, com características continentais, têm, certamente na geografia, na diversidade populacional e no ecossistema, fatores que contribuem sobremaneira para a ocorrência de gestações precoces e indesejadas, assim como a prática de abortamento. Pouco se sabe sobre o nível de conhecimento sobre a contracepção de emergência pelas mulheres e sua utilização pela população brasileira. Objetivo: Avaliar o nível de conhecimento sobre contracepção de emergência entre mulheres atendidas nos Ambulatórios de Ginecologia do Hospital da Fundação Santa Casa de Misericórdia do Estado do Pará. Métodos: Foi realizado estudo transversal com 316 mulheres sexualmente ativas, com idade entre 18 e 50 anos, que frequentaram o Ambulatório de Ginecologia entre junho e julho de 2012. As pacientes responderam a um questionário contendo 29 perguntas, incluindo: idade em anos, nível educacional, conhecimento e uso prévio do método de contracepção de emergência. Resultados: A idade média das participantes foi de 31,84 ± 8,00 anos, 46,84% delas concluíram o ensino médio e apenas 8,55% possuíam o ensino superior. A maioria obtivera informações sobre contracepção de emergência por meio de amigos (48,61%, n = 152) e apenas 7,30% através de seus médicos. Embora 83,54% das participantes relatassem estar familiarizadas com o método, apenas 0,63% disseram que o contraceptivo de emergência poderia ser usado até 5 dias após a relação sexual desprotegida e 76,58% nunca tinham utilizado o método. Conclusão: As mulheres incluídas neste estudo demostraram ter elevado conhecimento e prevalência de uso da contracepção de emergência, apesar de pouco conhecimento sobre o tempo máximo para sua utilização e, devem receber mais informações sobre o contraceptivo de emergência. / Introduction: emergency contraception although available as a safe and effective method for more than 30 years, even today, meets resistance as religious, cultural and social development in different regions of the world, limiting their use and compromising your knowledge on the part of the population. States such as Pará, the second largest Brazilian Amazon State, and of the northern region of Brazil, with continental characteristics, has certainly, in geography, population diversity, ecosystem, factors that contribute greatly favoring the occurrence of premature and unwanted pregnancies, as well as the practice of abortion. Little is known about the level of knowledge about emergency contraception by women and their use in Brazil. Objective: To assess the level of knowledge about emergency contraception among women attending at gynecology clinics in the Hospital Santa Casa de Misericordia of State of Pará. Methods: cross-sectional study was conducted with 316 sexually active women aged 18-50 years attending the gynecology outpatient clinic, between June and July 2012. The patients answered a questionnaire containing 29 questions, including: age in years, education level, knowledge and previous use of emergency contraception method. Results: The mean age of participants was 31.84 ± 8,00 years. 46.84% of them completed high school, and only 8.55% have higher education. Most women obtained information on emergency contraception through friends (48.61%, n = 152) and only 7.30% of its physicians. 83.54% participants reported being familiar with the method, only 0.63% said that emergency contraception could be used up to 5 days after unprotected intercourse, 57.59% did not know, and 76,58% (n = 242) had never used the method. Conclusion: The women in our study seem to have high level of knowledge and prevalence of use of emergency contraception, although little known about the time limit for its use and should receive more information about the emergency contraceptive.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Tratou-se de estudo com abordagem quantitativa, transversal, do tipo levantamento, que teve como objetivo geral investigar sobre a prÃtica do aborto provocado e sua relaÃÃo com a gravidez nÃo planejada, comparativamente com o aborto espontÃneo e como objetivos especÃficos analisar aspectos demogrÃficos, socioeconÃmicos e reprodutivos comparativamente ao aborto provocado e espontÃneo; verificar o conhecimento e a prÃtica anticoncepcional prÃvia a gestaÃÃo interrompida por aborto provocado e por aborto espontÃneo e conhecer os meios utilizados na prÃtica do aborto provocado e os motivos determinantes. Foi realizado no Hospital Distrital Gonzaga Mota da Barra do Cearà e no Hospital Geral Dr. Cesar Cals (HGCC), de junho a dezembro de 2011. A populaÃÃo correspondeu Ãs mulheres em abortamento com idade maior ou igual a 18 anos atendidas nos respectivos hospitais no perÃodo da coleta de dados. A entrevista seguiu um formulÃrio estruturado, que foi prÃ-testado. Finalizou-se o estudo com 70 participantes, sendo 33 (47,1%) mulheres que tiveram aborto provocado e 37 (52,9%) aborto espontÃneo. Os dados receberam tratamento estatÃstico descritivo e as comparaÃÃes das mÃdias dessas variÃveis e o tipo de aborto foram realizados por meio do teste t de Student para dados independentes e com variÃncia desiguais (analisadas pelo teste de Levene). Compararam-se, somente para aborto provocado, as porcentagens das variÃveis dicotÃmicas por meio do teste z para proporÃÃes. As anÃlises de associaÃÃes entre tipo de abortamento e as variÃveis nominais foram realizadas por meio do &#61539;2 e de razÃo de verossimilhanÃa. Calcularam-se as razÃes de chances (RC) com seus respectivos IC95% entre tipo de abortamento e essas variÃveis. Consideraram-se como estatisticamente significantes as analises com p<0,05. Dentre as variÃveis demogrÃficas e socioeconÃmicas, somente a mÃdia do nÃmero de pessoas na famÃlia apresentou associaÃÃo com o tipo de aborto (p= 0,042). Com relaÃÃo Ãs variÃveis reprodutivas e condiÃÃo de uniÃo, houve associaÃÃo entre planejamento da gravidez e tipo de aborto (p<0,001) (RC=2,4; IC95%: 1,7-3,3). Isto evidencia que a gravidez nÃo planejada foi um fator de risco para o aborto provocado. A mÃdia do tempo de uniÃo das que tiveram aborto espontÃneo foi maior do que aquelas de aborto provocado (p= 0,041). ParticipaÃÃo masculina na decisÃo pelo aborto mostrou-se como fator de risco para o aborto provocado (p=0,002). Nenhuma variÃvel relacionada à informaÃÃo e acesso ao MAC em uso prÃvio ao aborto foi significativa para o tipo de aborto. Houve associaÃÃo entre uso de AOC e tipo de aborto, sendo o uso de AOC fator protetor ao aborto provocado (p=0,040). Pensamento mÃgico de acreditar que a gravidez nÃo ocorreria consigo foi significante com o tipo de aborto (p=0,003). ChÃs e misoprostol foram os meios mais referidos pelas mulheres para provocar o aborto, sendo os motivos para provocÃ-lo a baixa condiÃÃo financeira, seguida do relacionamento instÃvel e do despreparo para cuidar da crianÃa. Concluiu-se que promover aÃÃes efetivas de planejamento familiar, com prioridade para as populaÃÃes mais carentes e com estratÃgias que garantam a participaÃÃo masculina representam meios para reduzir o aborto provocado. / This is a research study with quantitative and transversal approach aiming to investigate the induction of abortion and its relationship with an unplanned pregnancy, in comparison with natural abortion. It also aimed to analyse the demographic, socioeconomic and reproductive aspects of both methods of abortion; verify the knowledge and use of contraceptive methods prior to the interrupted pregnancy through induced and natural abortion and know which methods are used for induced abortion and it motifs. The study took place at the District Hospital Gonzaga Mota in Barra do Cearà and General Hospital Dr. Cesar Cals (HGCC), from June until December of 2011. The population consisted of women in abortion and over 18 years of age who were being assisted at the hospitals during data collection. The interview followed a structured questionnaire that was previously tested. The study consisted in the end with 70 participants, being 33 (47,1%) women who induced abortion and 37 (52,9%) with natural abortion. The data were analysed with descriptive statistics and the comparison of the means of these variables and the type of abortion were done with the Student t test for independent data and with unequal variance (analysed with Leveneâs test). It was compared only for induced abortion, the percentage of dichotomous variables with the z test for proportions. The association analysis between the type of abortion and the nominal variables were conducted with &#61539;2 and likelihood ratio. It was calculated the chance ratios (CR) with its respective IC95% between the type of abortion and these variables. It was considered as statistically significant, analysis with p<0,05. Amongst the demographic and socioeconomic variables, only the average number of people in the family presented association with the type of abortion (p= 0,042). Regarding reproductive variables and marital status, there was an association between planning of a pregnancy and abortion (p<0,001) (RC=2,4; IC95%: 1,7-3,3). This shows that an unplanned pregnancy was a risk factor for induced abortion. The average time of union with their partner was higher in women with natural abortion than in those with induced abortion (p= 0,041). It was shown that the male participation in the decision of an abortion is a risk factor for induced abortion (p= 0,002). Variables regarding information and access to contraceptive methods prior to the abortion were not significant to the type of abortion. There was an association between the use of AOC and type of abortion, being the use of AOC a protective factor to induced abortion (p= 0,040). The belief that a pregnancy would not occur with themselves was significant with the type of abortion (p= 0,003). Herbal teas and misoprostol were the most frequent methods mentioned by the women to induce an abortion, being their low economical situation, followed by an unstable relationship and unpreparedness to take care of a child the main reasons to render towards these methods. It was concluded that promoting effective methods of family planning, prioritizing poorer populations, with strategies that assures male participation represent means to reduce induced abortions.