Orientador: Luis Guillermo Bahamondes / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-19T05:05:19Z (GMT). No. of bitstreams: 1 Viola_AlexandredeSouza_D.pdf: 11179010 bytes, checksum: b640fe59edc62c7e4656a85dd2252e89 (MD5) Previous issue date: 2011 / Resumo: Objetivos: Avaliar a densidade mineral óssea (DMO) em usuárias por pelo menos um ano e ex-usuárias na pós-menopausa do contraceptivo injetável com acetato de medroxiprogesterona de depósito (AMP-D). Sujeitos e métodos: Foram realizados dois estudos, ambos de corte transversal com usuárias atuais em idade reprodutiva de AMP-D e outro com mulheres na pós-menopausa que usaram AMP-D até a menopausa. Cada usuária foi comparada com uma mulher nunca usuária de AMP-D, da mesma idade (± 1) e mesmo índice de massa corporal (kg/m2) (± 1). Nelas, foram medidas a DMO nas porções distal e ultradistal do rádio do antebraço não dominante pela técnica de DXA (double X-ray absoptiometry). No primeiro estudo foram incorporadas 232 mulheres usuárias do AMP-D e igual número que usavam dispositivo intrauterino (DIU) TCu380A como grupo de controle. As mulheres foram divididas em 5 grupos (1-5) de acordo com o tempo de uso do AMPD: 1-3; 4-6; 7-9; 10-12 e 13-15 anos, respectivamente. No segundo estudo foram incorporadas 79 mulheres com até 5 anos desde a menopausa, sendo 24 ex-usuárias de AMP-D até a menopausa e 55 ex-usuárias de DIU TCu380A também até a menopausa e que tinham avaliado previamente a DMO aos 1-2 e 3 anos após a menopausa. Resultados: No primeiro estudo, a média da idade (± EPM) das usuárias de AMP-D e DIU foi 38,3±0,5 e 38,1±0,57 anos e a média do IMC (índice de massa corporal) (kg/m2) (± EPM) foi de 26,4±0,3 e 26,3±0,3 (kg/m2) para cada grupo, respectivamente. As usuárias de ambos os grupos com pouco tempo de uso dos métodos eram mais jovens que aquelas que os usavam por longo período de tempo, e ambos os grupos apresentavam menor IMC nos primeiros 5 anos de uso. Paridade, cor, prática de atividade física manualmente foram significativamente maiores no grupo das usuárias de DIU (p<0,053, p<0,040 e p<0,012), e o ato de lavar roupas, nas usuárias de AMP-D (p<0,025). Os outros dados sociodemográficos, antropométricos e obstétricos não apresentaram diferenças significantes. As médias da DMO nas regiões distal e ultradistal do rádio foram similares entre as usuárias de AMP-D e DIU, exceto nas usuárias de AMP-D com mais de 13 anos de uso, e que apresentaram DMO significativamente menor (p<0,041 e 0,042, respectivamente). Houve relação direta nos dois grupos entre a DMO e o IMC (kg/m2) e relação inversa entre DMO e idade, nas regiões distal e ultradistal do rádio. No segundo estudo, o tempo de uso de ambos contraceptivos foi de 9,4 ± 3,8 e 14,7 ± 6,2 anos para o AMP-D e DIU, respectivamente. A DMO na região distal nos anos 1; 2-3 e 5-6 após a menopausa foi de 0,426 e 0,445; 0,421 e 0,434 e 0,437 e 0,427 nas usuárias de AMP-D e DIU, respectivamente. Na região ultradistal os valores foram: 0,350 e 0,380; 0,360 e 0,367 e 0,388 e 0,373, respectivamente, todos sem significância estatística. Conclusão: Não foi detectado efeito deletério na DMO do antebraço nas usuárias de AMP-D, com exceção daquelas que o usaram por mais de 13 anos, ou ex-usuárias de AMP-D que estavam na pós-menopausa, quando comparadas às usuárias de DIU. Também foi observada uma relação direta entre DMO e IMC (kg/m2) e indireta entre DMO e idade / Abstract: Objectives: Assess bone mineral density (BMD) in users for at least a year and ex-users in injectable contraceptive postmenopausal with medroxyprogesterone acetate depot (DMPA). Subjects and methods: Two studies have been conducted, both transversal cutting with current users of reproductive age of DMPA and another with postmenopausal women who have used DMPA until menopause. Each user was compared with a woman never using DMPA, the same age (± 1) and the same body mass index (2kg/m) (± 1). In them, were measures the DMO in distal portion and ultra-distal of non-dominant forearm radio technique by DXA (double X-ray absoptiometry). In the first study were incorporated into 232 women users of DMPA and an equal number who used intrauterine device (IUD) TCu380A as control group. Women were divided into 5 groups (1-5) in accordance with the usage time of DMPA: 1 -3; 4-6; 7-9; 10-12 and 13-15 years, respectively. In the second study were incorporated into 79 women with up to 5 years since menopause, being 24 ex-users of DMPA until menopause and 55 ex-users IUD TCu380A also until menopause and who had previously evaluated the DMO to 1-2 and 3 years after menopause. Results: in the first study, the average age (± EPM) of users of DMPA and IUD was 38.1 and 38.3 ± 0.5 ± 0.57 years and average BMI (body mass index) (kg/m2) (± EPM) was 0.3 ± ± 26.3 and 26.4 0.3 (kg/m2) for each group, respectively The users of both groups with little time using the methods were younger than those who used over a long period of time, and both groups had lower BMI in the first 5 years of use. Parity, color, physical activity practice manually were significantly higher in the Group of IUD users (p <0.053, p< 0.040 and p<0.012), and the Act of washing clothes, in the users of DMPA (p < 0.025). The other demographic and anthropometric data partners did not show significant differences obstetric. The average of the DMO in the distal region of the ultra-distal and radio were similar between the users of DMPA and IUD users, except for DMPA with more than 13 years of use with DMO had significantly lower (p < 0.041 and 0.042, respectively). There was no direct relation in two groups between the DMO and the BMI (kg/m2) and inverse relationship between DMO and age, in the region and distal radio ultra-distal. In second study, the time using both contraceptives was 9.4 ± 3.8 and 14.7 ± 6.2 years for DMPA and IUD, respectively. The DMO in distal region in the years 1; 2-3 and 5-6 after menopause was 0.426 and 0.445; 0.434 and 0.421 and 0.437 and requirements in 0.427 DMPA and IUD, respectively. In the ultra-distal region the figures were: 0.350 and 0.380; 0.360 and 0.367 and 0.388 0.373, respectively, and all without statistical significance. Conclusion: No deleterious effects on the DMO requirements in forearm DMPA, with the exception of those who have used for over 13 years, or DMPA ex-users were in post-menopausal women, compared the IUD users. Also we see a direct relationship between the DMO and BMI (kg/m2) and indirectly between DMO and age / Doutorado / Fisiopatologia Ginecológica / Doutor em Ciências da Saúde

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Research question: What is the difference in prevalence of LARCs between women living in urban and rural areas of Latin America and the Caribbean (LAC)? Background, significance, and rationale: While LARCs have been shown to be effective, approved for long duration of use, and cost-effective there is an unmet need for this type contraception in rural areas. The LAC region has a need for improved family planning services, evidenced by the high percentage of maternal deaths due to unsafe abortions. Methods: Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) conducted between 2010 and 2015 in LAC countries were reviewed and analyzed to determine difference in prevalence of LARC use between women living in urban versus rural areas. Additionally, a systematic literature review was performed resulting in selection of 11 primary research articles evaluated for LARC prevalence and sociodemographic factors associated with LARC use.

A Marxist feminist standpoint positions patriarchy and capitalism as mutually beneficial, thus interestingly situating the new market of male contraceptives (MCs). This project takes an in-depth look at the opinions of 15 young men regarding the use of MCs by examining how Western, heterosexual masculinity informs their attitudes and discusses how a new economic market of MCs may affect current social ideologies about of the sexual division of labor. Because notions of masculinity are essential in perpetuating such ideologies, understanding masculinity as it relates to a new market for MCs is imperative. During a series of focus groups men described this relationship in terms of responsibility, control, sexual pleasure, cost, gendered ideologies, and side effects. As a result of this research, I argue that the emerging market for MCs may simultaneously strengthen power dynamics and restructure labor practices within the sexual division of labor.

Class of 2005 Abstract / Objectives: Describe the prevalence of alcohol and tobacco use in college women who use emergency contraception (EC) or oral contraceptives. Methods: This study was a descriptive, retrospective study that utilized patient charts to obtain clinical data including emergency contraception utilization, hormonal contraception utilization, alcohol and tobacco use. The primary dependent variables were smoking status and alcohol use. The overall prevalence of alcohol and tobacco use was calculated by counting the total number and percentage for each substance. Determining if descriptive variables vary according to type of contraception, groups were compared using a t-test for independent groups and a Chi square, respectively. The a priori alpha level is 0.05. Results: The most important finding in this study is students that obtained EC reported drinking alcohol at a significantly higher level than students who used hormonal contraception. 49% of students who used EC reported drinking 5 or more drinks a week. The data for the alcohol use was the only data that was found to be statistically significant (p<0.05). In this study 22% of students who requested EC had unprotected sex. A positive result seen in this study was that only 2% of the EC students requested EC more than once in the spring semester. Freshman composed 54% of the students that used EC during this study. Other data that was of interest was that 33% of students that used EC were currently using oral contraception but only 25% claimed that oral contraception incompliance was the reason for EC utilization. Implications: Prevalence of alcohol use is significantly higher in students who use EC than students who used hormonal contraception. This leads to the conclusion that students that use alcohol are more likely to engage in unprotected sex and therefore request EC. This study also has shown that nurses and physicians need to get more accurate information from students regarding tobacco and alcohol use.

PROJECT ONE Introduction HPV is detected in about 99.7% of cervical cancers. However, the HPV type distribution in South African women is unknown. Objectives To determine HPV-type distribution among women with cervical dysplasia in relation to oral contraceptive usage. Methods Prospective cross-sectional study of four groups of patients according to oral contraceptive usage: non-users, users of less than five years duration, users of between five years and ten years and users of more than ten years duration. Swabs of the cervix were analysed for HPV DNA using polymerase chain reaction method. Results A total of 124 women were recruited for the study. There were 75 HIV-infected patients (seroprevalence 61%). Of the 102(82%) HPV-positive patients, 79 patients had high-risk HPV DNA (78%). In terms of the four oral contraceptive groups, high-risk HPV DNA was detected in 70% (n=21), 79% (n=22), 90% (n=21) and 71% (n=15) of patients, respectively. The odds of having HPV DNA was six times higher for the combination of contraceptive users of less than 5 years duration/non-users (OR 5.9, 95% CI: 1.87 - 18.77). There was no change when adjustment was made for age (OR 6.1, 95% CI: 1.9 - 19.4). HPV DNA types 16 and or 18 was present in a total of 21 patients (49%) (non-contraceptive users and users < 5years duration) versus 15 patients (42%) who used oral contraceptives of more than 5 years duration (p=0.524). HPV type 16 was the commonest HPV type detected (20.2%) and HPV type 58 was the next commonest high-risk HPV type (16.1%). HPV types 58 and 33 was detected in a much greater percentage of our population and HPV 16 in a much smaller percentage of our population compared with a non-South African population. Conclusion The findings of this study demonstrate an interesting distribution of HPV types in a South African population. PROJECT TWO Introduction Various risk factors have been implicated in the causation of cervical cancer including human papillomavirus (HPV), the early genes (E6 and E7) of which encode the main transforming proteins. Studies have suggested that steroid hormones may enhance the expression of these genes leading to loss of p53 gene-mediated cell apoptosis. Methods A total of 120 cervical tissue samples were obtained from patients with proven cervical cancer. Patients who used depo-medroxyprogesterone acetate steroid contraception were recruited as part of the study arm. Only HPV DNA type 16 samples were used for the study. Controls included three cell lines (CaSki, SiHa,&C33A) and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) was used as an internal housekeeping gene. Of 120 patients, there were 111 patients with HPV type 16 identified. Of this number, RNA was present in 63 samples. There were 30 women (30/63) who used steroid contraception. In relation to patients who used contraception, HPV 16 E6 gene expression was present in 79% (n = 23) and 88% (n = 30) of steroid users compared to nonusers, respectively. In total there were 25 patients (40%) with expression of the HPV 16 E6*I gene and 30 patients with expression of the E6*II gene. There were 57% of steroid users (n = 17) who had expression of the E6*I/E6*II gene, compared to 52% (n = 17) of nonusers (P = 0.800). Conclusion From a molecular level, this study reflects almost similar distribution of the HPV 16 E6/E6*1 and E6*11 and does not confirm the role of injectable progesterones in cervical carcinogenesis. Further studies with larger patient numbers are needed. / Thesis (PhD)--University of Pretoria, 2011. / Obstetrics and Gynaecology / unrestricted

The 2010 elections in Myanmar installed the country’s first civilian-elected government in more than 50 years, and subsequent growth and change have been rapid. However, reproductive health indicators are generally poor and reflect significant regional and geographic disparities. Rural populations are increasingly migrating to urban centers, like Yangon, in search of better economic opportunities and in response to persistent conflict. Many are settling in peri-urban Yangon, a dynamic series of townships characterized by poor infrastructure, slums, and a highly mobile population. However, very little is known about the reproductive health needs of this population. This study was designed to identify the reproductive health needs of women in peri-urban Yangon, and to understand better current practices, available services, and potential avenues for improvement. My research focused on delivery care, contraception, abortion, and post-abortion care. Using a multi-methods approach, and standard qualitative analytic techniques, I identified significant unmet reproductive health needs in peri-urban Yangon. The findings suggest that reproductive health services are often available but inaccessible. Findings demonstrate considerable misinformation, common and unsafe practices surrounding abortion and delivery, and a dearth of comprehensive sexual and reproductive health services for adolescent and unmarried populations.

The peri-coital contraceptive pill is a potential method for pregnancy prevention that could be taken in a period before or after unprotected sexual intercourse. However, uptake of a new contraceptive method relies on accessible terminology and frameworks with which to discuss it. I conducted seven focus group discussions across Canada to understand how women talk about different reproductive health technologies, explore the ways these discourses influence language and frameworks women use to talk about peri-coital contraceptives, and identify perceptions of and concerns about this potential method. Women thought the peri-coital contraceptive pill would be a valuable addition to current contraception. They disliked the name ”peri-coital”; although some participants created more resonant names related to unique aspects of this method, many found it challenging to clearly discuss the method with existing language for contraception. Concerted effort to develop terminology that is clearer may help facilitate the eventual introduction of this new contraceptive method in Canada and beyond.

Introduction In 2015, compared to the national rates, Tennessee had the 9th highest teen birth rate, 15th highest rate of reported cases of chlamydia, and 14th highest rate of reported cases of gonorrhea. Sex education that includes instruction on contraception along with abstinence has been found to delay sexual initiation, decrease number of sexual partners, and increase condom or contraceptive use. These behavioral choices by young people can help reduce teen pregnancies and Sexually Transmitted Infections (STIs). Introduction of contraception topics in earlier grades can equip young people with necessary tools to prevent unwanted pregnancies and STIs before they become sexually active. We explored the grades in which sex education providers taught topics such as birth control, condoms, and abstinence and the lowest grade at which they prefer to teach these topics. We then compared providers’ responses with responses from ETSU college students who had their sex education in TN. Methods To obtain information from sex education providers in TN public schools, we sent a recruitment email or letter with a weblink to a web-based survey from April to June 2017, to 3,249 potential providers. Of all potential providers, 509 completed the survey, yielding a response rate of 15.7%. Of those who completed the survey, final analysis included 137 providers who taught sex education in the 2015-2016 school year to any of grades 5 through 12 students. To get information from recipients of sex education in TN schools, a convenience sample of ETSU college students were asked to complete a survey using the ETSU SONA system in Fall 2017 semester. Of 385 students who completed the survey, final analysis included 216 (56.1%) students who were between ages 18-24 and attended the grade in which they had most of their sex education in TN. Provider and student surveys had similar items on grades in which sex education topics were taught and the lowest grade in which they would want these topics to be covered. Survey responses were analyzed using descriptive tests. Results Most providers (83.9%) taught abstinence by grade 12, and 37.2% had taught it by middle school (i.e. at or before 8th grade). Similarly, many students mentioned that abstinence was taught by 12th grade (92.1%) and by 8th grade (62.5%). Whereas, fewer providers taught topics, such as, birth control (65.0%), how to use condoms (22.6%), how to use and where to get birth control (31.4%), and much fewer providers taught these topics by middle school (17.5%, 8.0%, 8.8%, respectively). Most students expressed that these topics be taught by 12th grade (97.7%, 97.2%, 96.3%, respectively), and over two-thirds preferred that these topics be taught by middle school (71.8%, 67.6%, 63.9%, respectively). Also, about half of providers expressed that these topics be taught by middle school (68.6%, 46.7%, 51.8%, respectively). Conclusion This study finds that students want contraception topics to be taught in earlier grades, and that providers also prefer to teach these topics earlier. Future research should focus on factors that can enable providers to teach these topics in earlier grades.

Magister Curationis - MCur / Adolescents account for 20% of the world’s population, and the majority of them are inhabitants of developing countries. Increasing sexual activity amongst adolescents is a public health concern because it can lead to teenage pregnancy which in turn leads to an increase in relative poverty, unemployment, poorer educational achievements (for the adolescent) and poor health of unborn children. Contraceptive use gives females the ability to make informed decisions about their fertility as well as greatly reduce female morbidity and mortality. Despite freely available contraception and accessible reproductive health policies and facilities, a majority of adolescents still report unintended, unplanned pregnancies. The aim of the present study was to describe knowledge, attitudes and practices associated with contraceptives, and the facilitators and barriers that influence contraceptive use amongst adolescent girls in selected public secondary schools in a low-socio-economic community in Cape Town, South Africa. The researcher adopted a quantitative cross-sectional descriptive design – more specifically, a knowledge, attitudes and practices (KAP) survey. The study used a multistage sampling method. The sample size was calculated to be N = 371 (5% confidence interval and a confidence level of 95%).The data collection instrument was a survey in the form of a selfadministered questionnaire with 4 sections that had been adapted for the South African context, from a previously validated instrument. The questionnaire was then pretested and finalised. All data was captured in Microsoft Excel and analysed using SPSS 25.0. The study found that 97% of respondents had knowledge of contraceptives. The 3 most commonly known contraceptives were injection (81.1%), the pill (65.0%) and condoms (61.7%). Their main source of accessing contraceptives was a clinic (86.8%) and the biggest source of contraceptive knowledge was identified as school (82.7%). Their attitudes comprised positive and negative aspects. The respondents did not believe that it was difficult

Women living in rural areas experience barriers in accessing contraceptives, including those related to geographic distance, cost, and the lack of health care providers. Further, conscientious objection to provision of sexual and reproductive health services has a more significant impact in these settings given limited alternatives. The overarching dynamics likely have an even greater impact on adolescents, as young people are less able to navigate complex systems or secure the necessary resources to overcome financial and travel barriers. This multi-method qualitative study investigated the contraceptive experiences of adolescents living in rural Ontario through the use of an online survey, in-depth interviews with adolescents, and key informant interviews. We found that the available sexual health information is difficult to navigate and inconsistent in quality. The services offered in rural areas are limited. The need for more readily accessible information and contraceptive services in rural Ontario is considerable.