Made available in DSpace on 2016-07-27T13:49:26Z (GMT). No. of bitstreams: 1 BERENICE VAZ DE ALMEIDA FERREIRA.pdf: 4646156 bytes, checksum: 85fd22fb5990ff806d629be6d6057b0b (MD5) Previous issue date: 2007-08-29 / This research proposes is to examine the influence of religious beliefs in the Church Assembly of God, for its women members, as the design and contraception. We also see what the speech of the Church Assembly of God, told by their leaders, about contraception; Discovering because women use contraceptives and some methods not yet know others and in part the imaginary symbolic of women of the Assembly of God about maternity and contraception. This matter is of great interest to all of society, but, in particular, to health professionals, those investigating the religion and women members of the Church Assembly of God in order to hear the speech of the leaders of the Church , were conducted interviews with them in their churches, and women belonging to the Assembly of God Church and users of SUS, the interviews were conducted in Ciams New Horizon. At the moment to make a choice, but for women of the Assembly of God, they have not had much influence on the use of contraceptives. Once discovered, with great surprise, that the main reason for rejection of the method Diu is not religious in nature, and, yes, a concern about their health. Found that women of the Assembly of God have preference for oral contraceptives and that the church, through its leaders, does not provide much guidance and neither prohibit its use, leaving in charge of health services, guidance and indication of the use of contraceptives . / Esta pesquisa propõe-se, a analisar a influência das crenças religiosas presentes na Igreja Assembléia de Deus, para as suas mulheres membros, quanto a concepção e anticoncepção. Buscamos também verificar qual o discurso da Igreja Assembléia de Deus, dito pelos seus líderes, a respeito de anticoncepção; Descobrir porque, as mulheres usam alguns métodos anticoncepcionais e não outros e ainda conhecer em parte o imaginário simbólico das mulheres da Assembléia de Deus a respeito de maternidade e anticoncepção. Este assunto é de grande interesse para toda a sociedade, mas, de modo especial, para os profissionais de saúde, os que investigam a religião e as mulheres membros da Igreja Assembléia de Deus, com o fim de conhecer o discurso dos líderes da referida Igreja, foram realizadas entrevistas com eles, nas suas igrejas, e com as mulheres pertencentes à Igreja Assembléia de Deus e usuárias do SUS, as entrevistas foram realizadas no Ciams Novo Horizonte. A fé e a religiosidade não são os únicos valores, levados em consideração no momento de se fazer uma escolha, mas, para as mulheres da Assembléia de Deus, elas não tiveram muita influência quanto ao uso de anticoncepcionais. Assim descobrimos, com grande surpresa, que o motivo principal da rejeição do método anticoncepcional Diu não é de caráter religioso, e, sim, uma preocupação com a saúde. Constatamos que as mulheres da Assembléia de Deus têm preferência pelos anticoncepcionais orais e que a igreja, através de seus líderes, não fornece muita orientação e nem proíbem o seu uso, deixando a cargo dos serviços de saúde, a orientação e indicação do uso de anticoncepcionais.

Esse estudo foi realizado de maneira prospectiva e randomizada com o objetivo de comparar duas técnicas de vasectomia. Foram avaliados 644 pacientes. Na técnica sem bisturi foram utilizadas duas pinças específicas. O tempo médio da técnica sem bisturi foi de 20,95 minutos e da convencional 22,95. Infecção de ferida operatória e epididimites foram menores na técnica sem bisturi. Não houve diferença entre as técnicas nas complicações intra-operatórias e pós-operatórias. Dez pacientes apresentaram espermatozóides vivos no espermograma de controle. A técnica sem bisturi apresenta um menor tempo cirúrgico e um menor índice de infecção que a técnica convencional. O índice de falha foi semelhante em ambas as técnicas / This study was carried out with objective of comparison two techiniques of vasectomy. Six hundred and fourteen four patients were assessed. For the no-scalpel technique, two specific clamps were used. The operating time for the no scalpel technique was less than for the conventional technique. There was a smaller percentage of infection of the operative wound and epididymitis in the no scalpel technique. There was no difference between the techniques with respect to complications during the operation and later complications. The no scalpel technique requires less time in surgery and has a lower infection rate than the conventional technique. The failure rate was similar for both techniques

Sumário: O DIU TCu380A é um método contraceptivo de alta eficácia e taxa de continuidade. O ACOG recomenda que o mesmo seja oferecido como primeira linha de contracepção para adolescentes independente da paridade. A falta de conhecimento e informação apropriada pode ser um fator decisivo para a nãoescolha do método. Objetivos: avaliar o grau de conhecimento sobre o DIU e identificar os principais motivos para sua não-escolha como contraceptivo por adolescentes entre 13 e 19 anos. Materiais e Métodos: Estudo transversal, prospectivo, onde o fator em estudo é o conhecimento sobre DIU e o desfecho é prevalência da opção pelo uso DIU (reposta SIM a pergunta " usaria DIU "). A amostra foi de 38 pacientes que consultam nos ambulatórios ou são puérperas internadas na maternidade do HCPA. O instrumento foi um questionário para auto-preenchimento. Análise de dados foi realizada por SPPS 18 e InfoStat. Resultados: A média de idade das entrevistadas foi de 16,05 anos (DP 1,33). Para analisar as perguntas verdadeiro/falso sobre assertivas acerca do DIU, criou-se a variável identificada como conhecimento correto, que correspondia ao acerto das 7 questões Não se encontrou associação entre conhecimento correto e possibilidade de uso de DIU (variável "usaria DIU") (Teste Exato de Fischer, p = 0,4, poder de 99,5%). Nas análises individuais para cada uma das assertivas de verdadeiro ou falso e a variável “usaria DIU", apenas a assertiva "A pílula é um método mais seguro que o DIU" emergiu como marginalmente significativa (Yates, bi-caudal 0,08, poder 60%). Observou-se uma associação entre maior escolaridade e conhecimento correto sobre o DIU (p=0,03, teste exato de Fischer). O principal motivo de recusa para uso encontrado foi informação insuficiente (26,3%) e medo da colocação (10,5%). Conclusões: O conhecimento correto de que a pílula não é um método mais seguro que o DIU significativamente influencia o uso do DIU no futuro. O fato das demais assertivas não determinarem maior escolha pelo DIU demonstra que o fato de desconhecerem que estarão mais protegidas com o uso de um LARC limita o uso do DIU. É fundamental informar as equipes de saúde que o DIU é um método mais efetivo e que não existe nenhum impeditivo para seu uso em adolescentes. / Background: The TCu380A IUD is a contraceptive method with high efficacy and continuity. The ACOG recommends that it should be offered as the first line of contraception for adolescents, despite parity. Lack of knowledge and appropriate information about the method can be a decisive factor for nonchoice. Objectives: to evaluate the degree of knowledge about the IUD and to identify the main reasons for not choosing the contraceptive method for adolescents between 13 and 19 years of age. Material and Methods: A cross-sectional, prospective study which the objective was to evaluate the knowledge about IUDs and the outcome was the prevalence of IUD possible use. The sample consisted of 38 patients who were attended at Gynecology and Obstetrics clinic or were hospitalized at the maternity (puerperium period) of the hospital. The instrument was a self-completion questionnaire. Data analysis was performed by SPPS 18 and InfoStat. Results: The average age of the interviewers was 16.05 years (SD 1.33). To analyze the true / false assertive questions about the IUD, we created the variable identified as correct knowledge, which corresponded to the correctness of the 7 questions There was no association between correct knowledge and the possibility of using IUDs. (Fischer's Exact Test, p = 0.4, 99.5% power). In the individual analyzes for each of the assertions of true or false and the variable would use IUDs, only the assertive " The pill is a safer method than the IUD " emerged as marginallly significant (Yates, two-tailed p = 0.08, power 60%). There was an association between higher education and correct knowledge about the IUD (p = 0.03, Fischer's exact test). The main reason for the refusal to use IUD was insufficient information (26.3%) and fear of insertion (10.5%). Conclusions: The correct knowledge that the pill is not a safer method than the IUD significantly influences the possibilty of IUD use in the future. The fact that the other assertions do not determine a greater choice for the IUD demonstrates that lack of knowledge that they would be more protected with the use of a LARC limits the IUD use. It is critical to inform health teams that the IUD is a more effective method and that there is no impediment to expand its use in adolescents and reduce the rate of pregnancy in adolescence.

Orientador: Luis Guillermo Bahamondes / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-11-07T16:42:18Z (GMT). No. of bitstreams: 1 Juliato_CassiaRaquelTeatin_D.pdf: 2310620 bytes, checksum: fd8518fdd702439cfec0703cbfc61af7 (MD5) Previous issue date: 2006 / Resumo: O objetivo deste estudo foi avaliar a densidade mineral óssea (DMO) em usuárias de dois tipos de contraceptivos injetáveis combinados (CIC) mensais e comparar com controles. SUJEITOS E MÉTODOS: Estudo de corte transversal com 97 mulheres de 20 a 45 anos, usuárias de CIC com 25mg de acetato de medroxiprogesterona e 5mg de cipionato de estradiol (AMP/CypE2, Cyclofemina) por 12 a 82 meses (n=64) ou 50mg de enantato de norestisterona e 5mg de valerato de estradiol (NET-EN/ValE2, Mesigyna) por 12 a 60 meses (n=33), pareadas por idade (± 1ano) e índice de massa corpórea (IMC, kg/m2) (± 1) com usuárias de DIU TCu 380A como grupo de controle. A DMO foi avaliada nas regiões distal e ultradistal do rádio, no braço não dominante, utilizando a técnica de absorciometria óssea, com feixe duplo de raios-X (DXA). RESULTADOS: A DMO no midshaft da ulna foi de 0,457 ± 0,007 nas usuárias de Cyclofemina® e 0,465 ± 0,007 nos controles. Nas usuárias de Mesigyna® a DMO foi 0,463 ± 0,008 e 0,458 ± 0,009 nos controles. No rádio distal, a DMO foi 0,399 ± 0,011 e 0,401 ± 0,010 nas usuárias de Cyclofemina® e controles, e 0,400 ± 0,009 e 0,388 ± 0,10 nas usuárias de Mesigyna® e controles, respectivamente. Não houve diferença na DMO entre as usuárias de CIC e o grupo de controle. Não houve diferença entre as usuárias dos dois tipos de CIC e também não houve diferença entre as usuárias de CIC com relação ao tempo de uso menor ou igual e a partir de três anos. CONCLUSÕES: Mulheres com idade entre 20 e 45 anos, usuárias de CIC com AMP/CypE2 ou NET-EN/ValE2, apresentaram DMO similar entre os dois tipos de CIC e controles (usuárias do DIU TCu 380A), quando pareadas por idade e IMC / Abstract: BACKGROUND: The objective of this study was to compare bone mineral density (BMD) between users of two kinds of once-a-month combined injectable contraceptives (CIC) and controls. SUBJECTS AND METHODS: This crosssectional study included 97 women of 20 to 45 years of age, using CIC containing either 25 mg of medroxyprogesterone acetate and 5 mg of estradiol cypionate (MPA/E2Cyp, Cyclofemina) (for 12 to 82 months) or 50 mg of norethindrone enanthate and 5mg of estradiol valerate (NET-EN/E2Val, Mesigyna) (for 12 to 60 months) matched by age (± 1 year) and body mass index (BMI, kg/m2) (± 1) with users of the TCu 380A intrauterine device as controls. BMD was evaluated at the midshaft of the ulna and at the distal section of the radius of the nondominant forearm using double X-ray absorptiometry. RESULTS: The BMD at the midshaft of the ulna was 0.457 ± 0.007 and 0.465 ± 0.007 in the MPA/oE2Cyp group and controls, respectively, and 0.463 ± 0.008 and 0.458 ± 0.009 in the NET-EN/oE2Val group and controls, respectively. At the distal radius, the BMD was 0.399 ± 0.011 and 0.401 ± 0.010 in users of MPA/oE2Cyp and controls, respectively and 0.400 ± 0.009 and 0.388 ± 0.010 in users of NET-EN/oE2Val and controls, respectively. There were no differences in BMD between users of either CIC and non-users at either section of the forearm studied. There were also no differences in BMD between users of the two CIC at either section of the forearm. CONCLUSIONS: Women aged 20 to 45 years old, currently using one of these two kinds of CIC, presented similar BMD to controls paired by age and BMI (kg/m2) and similar between both CIC / Doutorado / Tocoginecologia / Doutor em Tocoginecologia

Rwanda experienced genocide from April to July 1994 during which over 800,000 people were murdered. Among the far-reaching changes that followed this event among individuals and in society overall, the Rwandan Demographic and Health Surveys (DHS) showed that contraceptive prevalence declined from 13% in 1992 to 4% in 2000 among married women of reproductive age. This dissertation has two hypotheses concerning Rwandan women's fertility preferences and behavior following the genocide. It is hypothesized that, first, high levels of conflict reduced women's desire for a child or for additional children and second, that women who experienced relatively high levels of conflict were more likely to act on their wish to not have a child or another child by using modern contraceptives than were women who experienced relatively low levels of conflict. The study's logistic regression dependent (outcome) variables were desire for a or another child and the use of modern contraceptives; the source for these data was the 2000 DHS. Three groups of independent variables were included: socio-demographic variables, also from the 2000 DHS, included age, number of living children, education level, urban/rural residence and socio-economic status; availability of family planning services, assessed using women's perception of distance as a barrier to obtaining health care for themselves, from the 2000 DHS, and quality of health services, assessed with data from the 2001 Service Provision Assessment; and experience of conflict, measured as the percentage of the 1994 commune populations that resided in refugee camps in 1995. Communes were considered `high migration' if 10 percent or more of their populations migrated to camps and `low migration' if less than 10 percent of their populations migrated to camps. Women who lived in high migration communes were considered to have relatively high experience of conflict and those who lived in low migration communes were consider dot have relatively low experience of conflict. Analysis showed that residents of high migration communes were significantly less likely to want a or another child as compared to residents of low migration communes (OR = .74); it appeared that the social environment of high migration had a dampening effect on desire for children. The analysis also showed that residents of high migration communes were significantly less likely to use a modern contraceptive method than were those of low migration communes (OR = .57), even though they were less likely to want a or another child and even when family planning services were reasonably available. The reasons for these results are unclear, and many factors may contribute. The generalized trauma experienced by the population may have had a numbing effect, in which taking action in any domain was difficult. Women may have felt pressured by society to have children as the society emerged from war, despite their own preferences. The population may also have distrusted government health facilities - the only source of services for most - in light of the interactions with officials during and after the genocide. However, another set of reasons specific to women and women's health may also have influenced the findings. There is a pervasive social stigma around reproductive health; these services have generally lagged behind other primary health care components. Moreover, rape was used as a weapon of war in the genocide; these experiences may have reduced women's willingness to seek reproductive health services specifically. Finally, the Rwandan genocide and its preparation were decidedly misogynistic; this pervasive dehumanization may have made it particularly difficult for women to seek care for their sexual and reproductive health needs and desires. This complex personal, social, physical and political context may explain why Rwandan women who may not have wanted a child or additional children nonetheless did not consistently act on their desires in the years following the 1994 genocide. The dissertation includes a series of essays providing the author's personal perspective on working in Rwanda in the 1980s and 1990s and being present in the country at the start of the genocide in April 1994.

Libya, one of less advanced countries, has experienced extensive demographic change in recent decades. Although, efforts have been made to collect descriptive statistics relating to population change (such as Censuses), there has been no serious explanations of demographic change by academics of the reasons behind population trends in Libya.This thesis sought to explore in a rigorous fashion the extent to which socio-economic circumstances, particularly increased levels of female education, has influenced female fertility behaviour. This hypothesis was examined for the population of El Gebel El Akhdar, Libya.The study was based on a sample of 600 married women categorised by location (urban and rural), age (below and above 45 years) education level and socio-economic status. Quantitative and qualitative techniques were used to understand fertility differentials for both the older and younger women included in the survey both in urban and rural areas. It was demonstrated that there were important changes in female fertility behaviour taking place both in relation to the intermediate variables (marriage, post-partum infecundability, contraception) as presented in Bongaarts? theory (1982, 1985) and in relation to socio-economic factors (education, occupation, income, age difference of partner, place of birth and residence). Female education was given special attention in the research following the general research framework of Jeffery and Basu theory (1996).Females with higher educational attainment, and thus higher employability, were characterised by relatively higher ages at first marriage, a smaller family size and a concurrently positive attitude towards approval and use of family planning and using contraceptive. They also engaged in a period of shorter breastfeeding. The inverse emerged as true for uneducated women.In addition to the effect of education on fertility, it emerged that change in female fertility behaviours and attitudes were also influenced by the interaction of many other socio-economic factors such as income, occupation, and partner age difference. On the contrary, the place of birth and place of residence did not help to explain fertility outcomes.

Pregnancy intention is extensively examined in the literature and the concept of "unintended" pregnancy is considered a significant health problem. Large efforts have been made to reduce negative health consequences presumably associated with pregnancies that are unexpected, unwanted, or mistimed but have had limited impact. A study was conducted to examine contextual issues surrounding women's experiences with pregnancy intention its intersection with knowledge, perceptions, and use of emergency contraception in a population of female university students. The project was a mixed method study including a survey examining demographic characteristics, sexual history, and knowledge and use characteristics in addition to interviews exploring prospective perceptions of pregnancy intention. An integrative review informed the background of the study demonstrating the need for expansion of current concepts of pregnancy intention that inform measurement and subsequent interventions. Quantitative survey results provide new information including higher rates of use in comparison to previous studies but persistence of misinformation. Qualitative interview findings illustrate a process by which individual agency in terms of sexual and pregnancy decision making is influenced by a precursor of the embodiment of convictions and empowerment. Combined conclusions confirm the need of exploring the role of the social context on pregnancy intention, suggest ways in which nurses can empower women to be their own agents of health, and start discussions of how intervention approaches to pregnancy intention can be improved.

The Title X Family Planning Program (Public Law 91-572), enacted by President Richard Nixon in 1970, provides federal funds for voluntary, confidential family planning services to all women, regardless of their age or economic status. This federal legislation aspired to prevent unintended pregnancies and poor birth outcomes to those in most need. However, over the past three decades, Title X has faced political, financial and social challenges. Despite its enormous success in improving the health and well-being of women and children by decreasing unintended pregnancies, the need for abortions and providing key comprehensive preventive services, without a newfound political will similar to that during which it was conceived, the future of Title X may be in jeopardy. This study grounded theoretically and methodologically in a feminist policy analysis approach, critically examined the maturation of Title X by employing a mixed methodology design that consisted of a thematic analysis on Title X's legislative history and the conduction and analysis of oral histories. In Phase I, themes were extracted from the federal bills included in Title X's legislative history, which assisted in the identification of the issues that this policy has endured. In Phase II, a semi-structured interview guide was developed based upon the themes and findings from the thematic analysis as well as from pre-determined constructs from McPhail's Feminist Policy Analysis Framework, to explore key informants' perceptions, recollections and experiences regarding the Title X program. By examining Title X through a feminist lens, various issues were exposed and critically examined, including issues that are typically ignored by traditional policy analyses. Moreover, understanding the historical underpinnings and evolutions of a policy and recognizing past failures and achievements are necessary in order to make informed future decisions. Implications for research, practice and policy are discussed.

Master of Medicine / The number of unwanted pregnancies has not decreased in recent years and this should be addressed. Emergency contraception may be effective when used correctly having the advantage that it can be used after an episode of unprotected sexual intercourse (when regular contraception has failed or was not used). In this research project I set out to explore some of the major reasons why there are still many unwanted pregnancies in Australia. I decided to focus on the use and non-use of emergency contraception, e.g. emergency contraception pill (ECP) “method failures” are not well understood because the actual mechanisms of action are still unclear. There is evidence ECP can effectively interfere with follicle growth and ovulation. It is much less clear is whether ECP is able to interfere with fertilization and implantation, in a way, which may make it acceptable to those who have strong religious beliefs in fertilization being the start of new life. Emergency contraception has the potential to prevent many unwanted pregnancies when unprotected intercourse has occurred. It has relatively high efficacy in many studies, but true method failures are not well understood. By contrast, many unwanted pregnancies occur for “social reasons” where emergency contraception has not been used. I set out to study changes in knowledge and usage of emergency contraception in these groups of Australian women seeking termination of pregnancy: 1. Before a dedicated emergency contraception pill (ECP) pack (Postinor) became available in Australia 2. One year after dedicated ECP became available on prescription 3. One year after the ECP pack became available “over the counter” without prescription. Ninety-nine women were recruited during their presentation with a request for ECP at the six Family Planning Clinics in Australia. All women took LNG 1.5mg in a single dose during the clinic consultation. A blood sample was taken immediately prior to ingestion of the ECP for estimation of serum LH, oestradiol and progesterone levels to calculate the day of the menstrual cycle. Based on these endocrine data we estimated the timing of ovulation to within a ±24-hour period with an accuracy of around 80%. Women were followed up 4-6 weeks later to ascertain pregnancy status. The effectiveness of ECP when taken before and after ovulation was determined. Three women in this study became pregnant despite taking the ECP (pregnancy rate 3%). All three women who became pregnant had unprotected intercourse between day -1 and 0 and took the ECP on day +2, based on endocrine data. Day zero was taken as ovulation day. Among seventeen women who had intercourse in the fertile period of the cycle and took the ECP after ovulation occurred (on day +1 to +2) we could have expected 3 or 4 pregnancies, based on Wilcox et al data. Three pregnancies were observed. Among 34 women who had intercourse on days –5 to –2 of the fertile period, and took ECP before or around ovulation, four pregnancies could have been expected, but none were observed. The major discrepancies between women’s self-report of stage of the cycle and the dating calculation based on endocrine data were observed in this study. These data are supportive of the concept that the LNG ECP has little or no effect on post-ovulation events, but is highly effective before ovulation. Our interpretation of the data in terms of timing of treatment relative to ovulation may explain why EC with LNG works sometimes and fails at other times. A larger study is needed to prove this hypothesis. To investigate other reasons for such a high rate of unwanted pregnancy, which probably has a larger impact we looked into womens knowledge of and attitude towards ECP. Seven hundred and eighteen women participated in this study by answering a questionnaire consisting of 15 questions on their demographic and reproductive characteristics as well as the knowledge about the ECP, e.g. 208 women were enrolled before the ECP was marketed in Australia in 2001, 308 after it was marketed and 202 after it became available over the counter (Group 1, 2, and 3, respectively). We found that the participants who have heard about ECP were significantly younger (p<0.005). The mean age of women who have never heard about of ECP was 29.8 years compared to 26.3 years in women who have heard about ECP. More women were aware about the ECP after it became available over the counter. Women in group 2 had higher educational level in comparison to women in group 2 and 3 (p<0.005). There was significant trend in increased use of ECP in women of higher educational level (p<0.005). The use of ECP did not increase significantly with improved availability and access to the ECP amongst women presenting for termination of pregnancy. Wider availability of he ECP pack in Australia and an easier access to it has increased women’s awareness about the ECP. However, the use of ECP has not increased. This study provides better understanding of mechanism of action of LNG ECP and an explanation to the method failure. It also reveals poor knowledge about ECP despite its wider availability and accessibility. Improving these is a worldwide challenge for family planners and all health professionals.

En 2002, en Iran, d'après la dernière enquête socio-démographique représentative au niveau national, le taux de fécondité totale était de 1,9 enfants par femme. Ce nombre d'enfants reflète la spectaculaire baisse de la fécondité dans les villes et les villages du pays. Si au moment de son enclenchement, à la fin des années 1950, la baisse de la fécondité n'a concerné que les villes, la poursuite de cette diminution et son accélération dans les années 1980 dépasse largement leur cadre. Depuis la fin des années 1970, la baisse de la fécondité s'est observée jusque dans les villages les plus reculés, entraînant ainsi l'ensemble du pays dans une révolution culturelle majeure. La baisse de la fécondité dans les villages iraniens résulte de profondes transformations du monde rural. Les villages qui étaient auparavant coupés du reste du pays se sont progressivement ouverts sur l'extérieur. La réforme agraire des années 1960 a été sans conteste le point de départ de ces bouleversements. Puis, la Révolution islamique a constitué un deuxième temps fort des transformations rurales. Dans leur volonté de « voler au secours des déshérités », les dirigeants de la nouvelle République ont mis en place des programmes de développement qui ont eu des retombées importantes sur la vie des villageois. Ainsi, depuis les années 1960, les zones rurales se sont intégrées à la fois politiquement, économiquement et socialement au reste du pays. Cette intégration, qui a eu des répercussions sur l'entrée en union, le recours à la contraception et le désir d'enfants, semble être à l'origine de la forte baisse de la fécondité en milieu rural.