Orientador: Maria Suely Kofes / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Filosofia e Ciencias Humanas / Made available in DSpace on 2018-08-14T18:26:37Z (GMT). No. of bitstreams: 1 Manica_DanielaTonelli_D.pdf: 27562844 bytes, checksum: 196d5ece7ff29d671d0abd5fad6e99ab (MD5) Previous issue date: 2009 / Resumo: Essa tese como fio condutor a trajetória do médico baiano Elsimar Coutinho. Autor dos livros "Menstruação, a sangria inútil", "O sexo do ciúme" e "O descontrole da natalidade no Brasil", entre outros, Coutinho é conhecido pela apologia da supressão da menstruação e pela defesa da adoção de políticas de controle da natalidade no Brasil. As narrativas (auto)biográficas de Coutinho revelam uma longa trajetória de pesquisas científicas na área da contracepção e reprodução humana, e permitem acessar as diversas associações em jogo no processo de estabilização da contracepção, seus embates e sentidos. (...continua) / Abstract: The object of this dissertation is the trajectory of the medical doctor Elsimar Coutinho, author of the books "Menstruation, the useless bleeding", "The sex of jealousy" and "The birth discontrol in Brazil", among others. Coutinho is known by the apology of menstruation suppression and the defense of the necessity of birth control as a state policy in Brazil. Coutinho's (auto)biographical narratives reveal a long trajectory of scientific researches in the areas of contraception and human reproduction, and allow us to acess the diverse associations at stake in the process of stabilization of contraception, its clashes and senses. (¿to be continued) / Doutorado / Mestre em Antropologia Social

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A Medicina Baseada em EvidÃncias veio fortalecer a assistÃncia ao paciente oferecendo maior seguranÃa ao profissional de saÃde na sua conduta clÃnica e na elaboraÃÃo de protocolos nos serviÃos. O dispositivo intra-uterino (DIU), com mais de um sÃculo de experimentaÃÃo como mÃtodo contraceptivo, pela sua eficÃcia e com poucas contra-indicaÃÃes, continua sendo bastante utilizado nas clÃnicas de assistÃncia à mulher. Qual a sua eficÃcia e como à caracterizada a demanda por DIU, sÃo perguntas relevantes que esta monografia procura responder, tendo como marco referencial o ServiÃo de Planejamento Familiar (SPF) da Maternidade-Escola Assis Chateaubriand. Para isto utilizou um banco de dados de acompanhamento das clientes do serviÃo desde 1980 atà 2005, que permitiu nÃo apenas, uma comparaÃÃo temporal das caracterÃsticas sÃcio-demogrÃficas destas em dois perÃodos distintos (fases inicial e atual do SPF), mas tambÃm possibilitou a construÃÃo do Ãndice de Pearl. As evidÃncias empÃricas mostraram uma significativa mudanÃa no perfil da demanda por mÃtodos anticonceptivos e uma grande eficÃcia do DIU, com um Ãndice de Pearl de apenas 0,02 / Evidence based medicine reinforced quality of attention to patients, giving to professionals safe directions in their clinic decisions and helping on the elaboration of health service protocols. The IUD has been submitted to more than a century of research as a contraceptive method. The results show a high efficacy with few side-effects and its acceptance is still high among women who attend contraception health services. How is characterized the demand for IUD? Is the IUD an efficient method? These are the two relevant questions addressed in this essay, for which study group include those women registered in the Family Planning Service (FPS) of the Maternidade-Escola Assis Chateaubriand. To perform this task, this work used a follow-up data set for this clientele, which not only allowed socio-demographic comparisons in two distinct periods of time (beginning and actual phases of the SFP), but also made possible the calculation of the Pearl Index. The empirical evidences showed a significant change in the profile of demand for anti-conceptive methods, and a great efficacy of the IUD, with a Pearl Index of only 0,02

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

Os contraceptivos de progestagênios isolados, como o implante de etonogestrel, representam uma opção para uso no puerpério. Classicamente, recomenda-se seu uso, a partir da sexta semana após o parto, mas sabe-se que para um grupo de pacientes de risco para curtos intervalos intergestacionais (com baixa adesão ou pouco acesso às orientações contraceptivas neste período), os mesmos podem ser prescritos no puerpério imediato. Porém, mais estudos são necessários para avaliar a segurança materna e neonatal/infantil do implante de etonogestrel (ETG), quando inserido no puerpério imediato. O objetivo do presente estudo foi avaliar dados de segurança materna (clínicos e metabólicos) e neonatal (clínicos) do uso do implante de ETG no puerpério imediato, durante as primeiras 12 semanas após o parto. Foram randomizadas 40 pacientes, entre 18-35 anos, no Ambulatório de Pré-Natal de Baixo Risco do HCFMRP-USP, para dois grupos: 20 para uso doimplante liberador de etonogestrel (ETG), inserido 24-48 horas após o parto; e 20 para uso de 150 mg de acetato de medroxiprogesterona de depósito (AMP-D), a partir da 6ª semana de puerpério (grupo de controle). Os parâmetros clínicos avaliados foram: pressão arterial (PA), peso materno e neonatal, índice de massa corpórea (IMC), circunferência abdominal (CA) e taxa de manutenção de lactação até a 12ª segunda semanade puerpério. Os parâmetros laboratoriais avaliados foram: marcadores hepáticos (lesão e colestase): fosfatase alcalina (FA), gama-GT (?-GT), transaminase glutâmico-pirúvica (TGP),transaminase glutamínica oxalicética (TGO), bilirrubinas totais (BT), bilirrubina direta (BD), bilirrubina indireta (BI), albumina; marcadores inflamatórios: interleucina (IL)-6, fator de necrose tumoral alfa (TNF-?), proteína C reativa (PCR); lipidograma; hemograma e glicemia. As pacientes apresentavam características clínicase laboratoriais basais semelhantes. Observou-se redução do PA, triglicérides, LDL-colesterol, PCR, FA e elevação do peso dos recém-nascidos, da hemoglobina, plaquetas (mais pronunciada no grupo ETG) glicemia, TGP, BT, BD (mais pronunciada no grupo ETG), BI, albumina e durante as primeiras 12 semanas, em ambos os grupos, sem diferença entre eles. No entanto, o peso, IMC e CA reduziram-se mais no grupo ETG do que no grupo de controle entre o basal e a 6 a semana após o parto (ETG: - 4,64 ± 2,71Kg vs. controle: - 2,60 ± 2,45Kg, p=0,017; ETG: - 1,77 ± 1,06Kg/m 2 vs. controle: - 0,97 ± 0,95Kg/m 2 , p=0,026; ETG: -15,30 ± 6,72cm vs.controle: - 9,05 ± 5,84cm, p=0,003; respectivamente); os níveis de leucócitos apresentaram um aumento entre seis e 12 semanas no grupo de controle (ETG: - 440 ± 113céls/µL vs. controle: + 254 ± 377céls/µL, p= 0,005), com declínio entre o período basal e 12 semanas, semelhante em ambos os grupos; o nível de IL-6, apesar de declinar em ambos os grupos, apresentou variação estatisticamente maior entre o basal e 12 semanas no grupo ETG (ETG: -14,30 ± 20,33pg/mL vs.controle: - 6,09 ± 7,23pg/mL, p=0,035); os níveis de TNF-?elevaram-se apenas no grupo de controle, após seis semanas do uso de AMP-D (ETG: - 0,55 ± 2,46pg/mL vs. controle: + 2,21 ± 3,18pg/mL, p=0,001); os níveis de CT e HDL declinaram nos dois grupos com maior queda no grupo de controle, entre seis e 12 semanas pós-parto (ETG: - 7,4 ± 15,01mg/dL vs.controle: - 28,55 ± 17,71mg/dL, p=0,001; ETG: - 0,15 ± 5,02mg/dL vs.controle: - 12,45 ± 7,32mg/dL, p<0,0001; respectivamente); os valores da TGO reduziram mais no grupo de controle em relação ao grupo ETG na variação entre basal e 12 semanas pós-parto (ETG: - 0,40 ± 9,36U/L vs. controle: - 6,05 ± 8,07U/L, p=0,048). Todos os valores estavam dentro dos limites de normalidade para a faixa etária estudada. As demais variáveis e a taxa de manutenção da lactação exclusiva não diferiram entre os grupos. Podemos concluir que a inserção do implante liberador de ETG no pós-parto imediato não foi associada a efeitos clínicos deletérios maternos ou neonatais, nem a alterações laboratoriais maternas significativas. / Progestogen-only contraceptives like the etonogestrel (ETG) implant represent an option for use during the postpartum period. Its use isclassically recommended after the sixth postpartum week, but for patients at risk for short intergestational intervals (with low compliance or with little access to contraceptive guidelines during this period) these contraceptives can be prescribed during the immediate puerperium. However, further studies are needed to assess the maternal and neonatal/infantile safety of this device when inserted during the immediate puerperium. The objective ofthe present study was to assess maternal (clinical and metabolic) and neonatal (clinical) safety data regarding the use of the ETG implant during the immediate postpartum period and the first 12 postpartum weeks. Forty patients aged 18-35 years attended at the Low Risk Prenatal Care Program of HCFMRP-USP were randomly assigned to two groups: 20 subjects use of the ETG-releasing implant inserted 24-48 hours after delivery, and 20 for use of 150 mg depot medroxyprogesterone acetate (DMPA) starting during the 6 th week postpartum (control). The following clinical parameters were assessed: arterial pressure (AP), maternal and neonatal weight, body mass index (BMI), abdominal circumference (AC); liver markers: alkaline phosphatase, gamma glutamyl transferase (?-GT), glutamic pyruvic transaminase (GPT), glutamic oxaloacetic transaminase (GOT), total bilirubins (TB), direct bilirubin (DB), indirect bilirubin (IB), albumin; inflammatory markers: interleukin-6 (IL)-6, tumor necrosis factor alpha (TNF-?), C reactive protein (CRP); lipid profile; blood count; glycemia, and rate of breastfeeding mothers up to the 12 th week of the puerperium. The basal clinicaland laboratory characteristics of the two groups were similar. We observed a reduction of AP, triglycerides, LDL-cholesterol, CRP and alkaline phosphatase, and an increase in newborn weight, hemoglobin, platelets (more pronounced in the ETG group), glycemia, GPT,TB,DB (more pronounced in the ETG group), IB and albumin during the first 12 weeks in both groups, with no difference between them. However, weight, BMI and AC were lower in the EGT group compared to control up to the 6th week after delivery (ETG: - 4.64 ± 2.71Kg vs. control: - 2.60 ± 2.45Kg, p=0.017; ETG: - 1.77 ± 1.06Kg/m 2 vs. control: - 0.97 ± 0.95Kg/m 2 , p=0.026; ETG: -15.30 ± 6.72cm vs. control: - 9.05 ± 5.84cm, p=0.003; respectively); white cell count increased between six and 12 weeks after delivery in control group (ETG: - 440 ± 113céls/µL vs. control: + 254 ± 377céls/µL, p= 0.005), with a decrease between basal evaluation and 12 weeks after delivery in both groups; IL-6 decrease in both groups however the variation was statistically different between basal and 12 weeks only in ETG group (ETG: -14.30 ± 20.33pg/mL vs.control: - 6.09 ± 7.23pg/mL, p=0.035); TNF-?levels was higher only in the control group six weeks after DMPA administration (ETG: - 0.55 ± 2.46pg/mL vs. control: + 2.21 ± 3.18pg/mL, p=0.001); HDL levels decrease in both groups however it was more pronounced in control group between six and 12 weeks postpartum (ETG: - 7.4 ± 15.01mg/dL vs.control: - 28.55 ± 17.71mg/dL, p=0.001; ETG: - 0.15 ± 5.02mg/dL vs.control: - 12.45 ± 7.32mg/dL, p<0.0001; respectively); TGO levels was lower in control group than in ETG between basal evaluation and 12 weeks postpartum (ETG: - 0.40 ± 9.36U/L vs. control: - 6.05 ± 8.07U/L, p=0.048). All values were within normal limits for the age range studied. The other variables and the maintenance of exclusive lactation were similar between the groups. In conclusion, ETG releasing implant insertion during the immediate postpartum period was not associated with deleterious maternal or neonatal clinical effects or with significant laboratory alterations.

Orientador: Luis Guillermo Bahamondes / Texto em português e inglês / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T20:29:30Z (GMT). No. of bitstreams: 1 Carreiro_AndreaVieira_M.pdf: 1988152 bytes, checksum: 99fabc9a0c745335c75b48e2ed5c8c61 (MD5) Previous issue date: 2014 / Resumo: Introdução: Um dos motivos para o não-uso ou uso incorreto de métodos anticoncepcionais (MAC) é a associação que as usuárias fazem entre o MAC e alterações na sexualidade. Este uso inadequado aumenta o risco de gravidez não-planejada. Os long-acting reversible contraceptives (LARC) apresentam altos índices de continuidade e alta efetividade. Há poucos estudos sobre LARC e sexualidade. Objetivo: Avaliar a influência dos LARC sobre a função sexual, a freqüência de relações sexuais semanais e sobre a qualidade de vida, comparando com as usuárias de métodos não-LARC. Métodos: Mulheres entre 18 e 49 anos de idade, aguardando consulta no Ambulatório de Planejamento Familiar da Unicamp e que utilizavam diferentes MAC, foram convidadas a participarem do estudo e a preencherem três questionários auto-respondidos, entre eles o Female Sexual Function Index (FSFI) e o World Health Organization Quality of Life Questionnaire abbreviated version(WHOQOL-BREF). O período de coleta foi de Fevereiro de 2011 a Maio de 2012. Resultados:Tivemos 4.330 pacientes durante o período de coleta, 34% de recusa na participação (1.474) e exclusão de outras 1.318 (30.4%) por não preencherem os critérios de inclusão. Entre as 1.538 participantes, 768 eram usuárias de LARC e 770 de não-LARC. Não houve, neste estudo, diferença entre os grupos de MAC quanto a sexualidade, qualidade de vida ou frequência de relações sexuais semanais. Outras variáveis avaliadas através de análise múltipla por regressão (que não o MAC), estiveram relacionadas a diferenças significativas desses parâmetros. Conclusão: Não houve, neste estudo, diferença na função sexual, no número de relações sexuais semanais ou na qualidade de vida entre as usuárias de LARC e as usuárias de métodos não-LARC / Abstract: Introduction: One of the reasons for non-use or inconsistentuse of contraceptive methods is the association that users make between the contraceptive and negative changes in sexuality. This incorrect use increases the risk of unplanned pregnancy. The long-acting reversible contraceptives (LARC) have high rates of continuity and high effectiveness. There are few studies on LARC and sexuality. Objective: Evaluate the influence of LARC on sexual function, on the weekly frequency of sexual intercourses and on quality of life of users, and comparethese results with non-LARC methods. Methods: Women between 18 and 49 years old, waiting their scheduled appointment at the clinic, users of different types of contraceptives, were invited to participate in the study and to complete three self-administered questionnaires, including the Female Sexual Function Index (FSFI) and the World Health Organization Quality of Life Questionnaire abbreviated version (WHOQOL-BREF). Participants were included in the study from February 2011 to May 2012. Results: We had 4,330 patients during the data collection period, 34% refusing participation (1,474) and other 1,318 (30.4%) did not meet the criteria for inclusion. Among the 1,538 participants, 768 were LARC users and 770 were non-LARC users. We found nodifferences on sexuality, quality of life, and frequency of weekly sexual intercourses between the contraceptive groups. Other variables evaluated by multiple regression analysis were related to significant differences of these parameters. Conclusion: There was no difference on sexual function, quality of life or number of weekly sexual intercourse between LARC and non-LARC users / Mestrado / Fisiopatologia Ginecológica / Mestra em Ciências da Saúde

Orientadores: Arlete Maria dos Santos Fernandes, Elizabeth João Pavin / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T14:21:00Z (GMT). No. of bitstreams: 1 SilvadosSantos_Priscilla_M.pdf: 1821889 bytes, checksum: c110ddab19340961ac150d3b6f057876 (MD5) Previous issue date: 2013 / Resumo: O acetato de medroxiprogesterona de depósito (AMPD) é um contraceptivo de uso trimestral, considerado seguro e altamente eficaz, dispensado pelo setor público de vários países entre eles o Sistema Único de Saúde, SUS. Usuárias de contraceptivos hormonais frequentemente se preocupam com efeitos imediatos do uso, entre eles o ganho de peso corporal. Os estudos sobre variação de peso em usuárias de AMPD mostram resultados controversos e, entre os que mostram ganho de peso em gordura em parte das usuárias, não é clara a etiologia do ganho. Poucos estudos avaliaram a ingestão alimentar e gasto energético destas usuárias. Objetivos: Avaliar a ingestão alimentar, ganho de peso e a composição corporal em novas usuárias do contraceptivo acetato de medroxiprogesterona de depósito (AMPD). Desenho do estudo: Ensaio clínico com 20 usuárias de DPMA e 20 de dispositivo intrauterino de cobre (DIU TCu380A), pareadas por idade (±1) e IMC (±1), seguidas por 12 meses. Incluídas mulheres saudáveis, de 18-40 anos, sem antecedentes que pudessem interferir no peso corporal, não obesas e nunca usuárias de AMPD. Avaliou-se a ingestão alimentar (recordatório alimentar), composição corporal (DXA), medidas de cincunferência e dobras cutâneas. As variáveis foram: sociodemográficas, hábitos, valor energético total (VET), gasto energético, peso, IMC, percentagem e medidas de gordura em dobras, relação cintura-quadril e medidas de massa gorda, magra, massa total e razão androide-ginecóide. Resultados: A idade variou de 20-38 anos, mediana de 29 e 30,5 anos, e médias de IMC 24,8 e 24,5kg/m2, respectivamente nos grupos AMPD e DIU. Não houve diferenças no ganho de peso e composição corporal entre os grupos. Aos 12 meses foi observado, no grupo de usuárias de AMPD, aumento nas circunferências da cintura e quadril, aumento significativo do VET associado à maior ingestão de carboidratos, gorduras e proteínas, e do gasto energético associado ao grupo de AMPD. 8/20 usuárias de AMPD ganharam ?5% de peso (média 4,6kg), e apresentaram maiores variações nos depósitos e centralização da gordura em relação às demais usuárias. Conclusões: As usuárias de DPMA apresentaram aumento do apetite aos 12 meses. Estudos deverão comprovar estes resultados em outras populações de mulheres / Resumo: O acetato de medroxiprogesterona de depósito (AMPD) é um contraceptivo de uso trimestral, considerado seguro e altamente eficaz, dispensado pelo setor público de vários países entre eles o Sistema Único de Saúde, SUS. Usuárias de contraceptivos hormonais frequentemente se preocupam com efeitos imediatos do uso, entre eles o ganho de peso corporal. Os estudos sobre variação de peso em usuárias de AMPD mostram resultados controversos e, entre os que mostram ganho de peso em gordura em parte das usuárias, não é clara a etiologia do ganho. Poucos estudos avaliaram a ingestão alimentar e gasto energético destas usuárias. Objetivos: Avaliar a ingestão alimentar, ganho de peso e a composição corporal em novas usuárias do contraceptivo acetato de medroxiprogesterona de depósito (AMPD). Desenho do estudo: Ensaio clínico com 20 usuárias de DPMA e 20 de dispositivo intrauterino de cobre (DIU TCu380A), pareadas por idade (±1) e IMC (±1), seguidas por 12 meses. Incluídas mulheres saudáveis, de 18-40 anos, sem antecedentes que pudessem interferir no peso corporal, não obesas e nunca usuárias de AMPD. Avaliou-se a ingestão alimentar (recordatório alimentar), composição corporal (DXA), medidas de cincunferência e dobras cutâneas. As variáveis foram: sociodemográficas, hábitos, valor energético total (VET), gasto energético, peso, IMC, percentagem e medidas de gordura em dobras, relação cintura-quadril e medidas de massa gorda, magra, massa total e razão androide-ginecóide. Resultados: A idade variou de 20-38 anos, mediana de 29 e 30,5 anos, e médias de IMC 24,8 e 24,5kg/m2, respectivamente nos grupos AMPD e DIU. Não houve diferenças no ganho de peso e composição corporal entre os grupos. Aos 12 meses foi observado, no grupo de usuárias de AMPD, aumento nas circunferências da cintura e quadril, aumento significativo do VET associado à maior ingestão de carboidratos, gorduras e proteínas, e do gasto energético associado ao grupo de AMPD. 8/20 usuárias de AMPD ganharam ?5% de peso (média 4,6kg), e apresentaram maiores variações nos depósitos e centralização da gordura em relação às demais usuárias. Conclusões: As usuárias de DPMA apresentaram aumento do apetite aos 12 meses. Estudos deverão comprovar estes resultados em outras populações de mulheres / Abstract: The depot medroxyprogesterone acetate (DMPA) is a contraceptive used quarterly, considered safe and highly effective, dispensed by the public sector in several countries, including the Health System of Brazil. Hormonal contraceptive users often care about the immediate effects of the use, such as the change in body weight. Studies about weight change in DMPA users show controversial results, and among which show weight gain in fat part of the users, it isn't clear the etiology this gain. Few studies have assessed food intake and energy expenditure of these users. Objectives: To evaluate food intake, weight gain and body composition in new users of depot medroxyprogesterone acetate (DMPA) as a contraceptive. Study design: A clinical trial followed up 20 DMPA users and 20 copper intrauterine device (TCu380A IUD) users, paired for age (±1 year) and body mass index (BMI ± 1kg/m2), for a 12-month period. Healthy, non-obese women aged 18-40 years with no prior conditions that could affect their body weight and who had never used DMPA were enrolled. Food intake (food intake recording), body composition (dual-energy X-ray absorptiometry), circumferences and skinfold thickness were evaluated. Sociodemographic variables, habits, total energy intake, energy expenditure, weight, BMI, body fat percentage, skinfold thickness, waist-to-hip ratio, fat and lean body mass, total body mass and android-gynoid fat ratio were evaluated. Results: Median age was 29 and 30.5 years and mean BMI was 24.8 and 24.5kg/m2 in the DMPA and IUD groups, respectively. There were no differences in weight gain or body composition between the groups. At 12 months, an increase was found in waist and hip circumference in the DMPA users, as well as a significant increase in total energy intake associated with greater carbohydrate, fat and protein intake, and a significant increase in energy expenditure. In the DMPA group, 8/20 users gained ?5% in weight (mean 4.6kg), with more variations in fat deposits and centralization. Conclusions: Appetite was greater in DMPA users at 12 months. Studies should be conducted to confirm these results in other populations of women / Abstract: The depot medroxyprogesterone acetate (DMPA) is a contraceptive used quarterly, considered safe and highly effective, dispensed by the public sector in several countries, including the Health System of Brazil. Hormonal contraceptive users often care about the immediate effects of the use, such as the change in body weight. Studies about weight change in DMPA users show controversial results, and among which show weight gain in fat part of the users, it isn't clear the etiology this gain. Few studies have assessed food intake and energy expenditure of these users. Objectives: To evaluate food intake, weight gain and body composition in new users of depot medroxyprogesterone acetate (DMPA) as a contraceptive. Study design: A clinical trial followed up 20 DMPA users and 20 copper intrauterine device (TCu380A IUD) users, paired for age (±1 year) and body mass index (BMI ± 1kg/m2), for a 12-month period. Healthy, non-obese women aged 18-40 years with no prior conditions that could affect their body weight and who had never used DMPA were enrolled. Food intake (food intake recording), body composition (dual-energy X-ray absorptiometry), circumferences and skinfold thickness were evaluated. Sociodemographic variables, habits, total energy intake, energy expenditure, weight, BMI, body fat percentage, skinfold thickness, waist-to-hip ratio, fat and lean body mass, total body mass and android-gynoid fat ratio were evaluated. Results: Median age was 29 and 30.5 years and mean BMI was 24.8 and 24.5kg/m2 in the DMPA and IUD groups, respectively. There were no differences in weight gain or body composition between the groups. At 12 months, an increase was found in waist and hip circumference in the DMPA users, as well as a significant increase in total energy intake associated with greater carbohydrate, fat and protein intake, and a significant increase in energy expenditure. In the DMPA group, 8/20 users gained ?5% in weight (mean 4.6kg), with more variations in fat deposits and centralization. Conclusions: Appetite was greater in DMPA users at 12 months. Studies should be conducted to confirm these results in other populations of women / Mestrado / Fisiopatologia Ginecológica / Mestra em Ciências da Saúde

Orientador: Simone Appenzeller / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T19:14:15Z (GMT). No. of bitstreams: 1 Pereira_KarinaDanielle_M.pdf: 1028779 bytes, checksum: 901fb7a5f4993b6c8133e68fb9913463 (MD5) Previous issue date: 2013 / Resumo: Lúpus Eritematoso Sistêmico (LES) é uma doença crônica, autoimune e multissistêmica, caracterizada por períodos de atividade e remissão, que apresenta maior prevalência no sexo feminino, habitualmente durante o período reprodutivo. Assim, o interesse em identificar fatores que se correlacionem à saúde reprodutiva nessas pacientes tem sido crescente. Objetivo: Avaliar a saúde reprodutiva, em mulheres com LES e mulheres sem histórico de doença autoimune. Elucidar o papel da atividade e dano da doença, ansiedade e depressão, qualidade de vida e imagem corporal na saúde reprodutiva de mulheres com LES. Método: Foram selecionados pacientes consecutivos com LES acompanhadas na Unidade de Reumatologia da UNICAMP entre 2011/2012. Avaliação da saúde sexual e reprodutiva (SPEQ), atividade da doença (SLEDAI), dano cumulativo (SDI), transtornos de humor (BAI, BDI), avaliação da qualidade de vida (SF-36) e questões sobre imagem corporal (BCQ) foram realizadas. Resultados: Duzentos e sessenta e oito pacientes e 132 controles foram incluídas na pesquisa. Mulheres com LES apresentaram pior saúde reprodutiva que mulheres sadias (p<0,05), 49,25% das pacientes e 15,15% das controles não faziam uso de qualquer método contraceptivo (p=0,01), disfunção sexual foi observado em 80,9% das pacientes e em 20,41% das controles (p=0,01). Presença de transtornos do humor (ansiedade e depressão) (p=0,01), fadiga (p=0,01), piora da imagem corporal (p=0,02), e baixa qualidade de vida (p=0,03), foram significativamente mais frequentes em mulheres com LES quando comparadas a mulheres saudáveis. Observamos uma associação entre pior saúde reprodutiva e ansiedade (p=0,001), fadiga (p=0,001) e baixa qualidade de vida (p=0,002). Conclusão: Aspectos relacionados à saúde reprodutiva necessitam de uma atenção especial dos profissionais e devem ser abordados rotineiramente, propiciando melhor qualidade de vida das pacientes e de seus parceiros, melhorando assim o impacto da doença / Abstract: Systemic lupus erythematous (SLE) is a chronic, multisystem autoimmune and characterized by periods of activity and remission, which is more prevalent in women, usually during the reproductive period. Thus, the interest in identifying factors that correlate reproductive health in these patients has been increasing. Objective: To assess reproductive health in women with SLE and women without a history of autoimmune disease, unrelated, and elucidate its association with disease activity and damage, anxiety and depression, quality of life and body image. Methods: We selected consecutive patients with SLE followed in the Rheumatology Unit of Campinas between 2011/2012. Assessment of sexual and reproductive health (SPEQ), disease activity (SLEDAI), cumulative damage (SDI), mood disorders (BAI, BDI), assessment of quality of life (SF36) and questions about body image (BCQ) were performed. Two hundred and sixty-eight patients and 132 controls were included in the survey. Results: Women with SLE had poorer reproductive health healthy women (p <0.05), 49.25% of patients and 15.15% of controls were not using any method of contraception (p=0.01), sexual dysfunction was observed in 80.9% of patients and 20.41% of the controls (p=0.01). Presence of mood disorders (anxiety and depression) (p=0.01), fatigue (p=0.01), worsening of body image (p=0.02), and low quality of life (p=0.03), were significantly more prevalent in SLE patients compared to healthy women. We observed an association between poor reproductive health and anxiety (p= 0,001), fatigue (p= 0.001) and poor quality of life (p= 0.002). Conclusion: Aspects related to reproductive health require special attention from professionals and should be addressed routinely providing better quality of life for patients and their partners, thus enhancing the impact of the disease / Mestrado / Clinica Medica / Mestra em Clínica Médica

Submitted in fulfillment of the requirements for the Master of Health Sciences in Nursing, Durban University of Technology, Durban, South Africa, 2017. / Background. Unintended pregnancy is a major global challenge among sexually active women of childbearing age. Non-use of modern contraception and inconsistent use of short term contraceptive methods are the main reasons associated with unintended pregnancy. Long acting reversible contraceptives (LARCs) have proven to be highly effective with good continuation rates, and are cost-effective compared to other methods, when used more than one year. However, there is low uptake of LARC methods globally and in South Africa. Aim of the study. The aim of the study was to determine factors influencing the uptake of LARC methods among women at the primary health care (PHC) clinics in eThekwini District. Methodology. A quantitative, descriptive survey was used in this study. Purposive sampling of six fixed PHC clinics from the three sub-districts was done. Convenience sampling resulted in 371 participants. A survey questionnaire in English and isiZulu was used to collect data. Data was analysed using SPSS version 23.0. Inferential statistics were used to determine the relationship between the variables. Results. The results of this study revealed that the contraceptive injection was most common LARC used, and the least used method was the intrauterine contraceptive device. The side effects were the main reasons for discontinuation with LARCs and all other contraceptive methods. Irregular vaginal bleeding was the main side effect cited by respondents associated with contraceptive implant usage. The respondents had positive attitudes and perceptions towards LARCs; however, the majority of respondents were not interested in using LARC methods. Common myths and misconceptions were not negatively associated with LARCs, since respondents disagreed with them all. / M

Early adolescent pregnancy implies increased social and medical risks. There is lack of understanding of the mechanisms behind early sexual debut and pregnancy. This contributes to the difficulties to meet the educational and health care needs of adolescents. In Nicaragua, few reproductive health interventions target adolescents and even fewer studies focus on sexual and reproductive health in this age group. Therefore, the aim of this thesis is to analyze the background of adolescent pregnancy in Nicaragua, for future interventions. Focus group discussions and in-depth interviews were carried out with young and adult women and men from different social backgrounds in the city of León. Results were used in the planning of a cross-sectional household study carried out in 1993, covering a population of 43,765 in 50 randomly selected clusters in rural and urban León. Reproductive histories were obtained from all women aged 15 to 49 years (n= 10,867), corresponding to 176281 person years of reproductive life. Random sub-samples of men (n=388) and women (n=413) were interviewed in privacy about their age at sexual debut, contraceptive use and reproductive history. The background to early adolescent pregnancy was further analyzed in a matched case-referent study of girls who got their first pregnancy before 17 years of age (146 cases, 242 randomly selected age-matched referents). Economic deprivation and disturbed family relations with an unsatisfied craving for parental affection influence adolescent sexual behavior. Girls' romanticism, belief in virginity until marriage and the contrasting male machismo culture contribute to a lack of empowerment of adolescents. At 15 years of age, 25% of boys and girls had had their sexual debut, and at 18 years this was the case for 85% of boys and 53% of girls. Among girls, the latency period from sexual debut to the end of first pregnancy was only 22 months, indicating very limited access to contraceptive counseling and services. At 17 years of age, one fourth had become pregnant. Contraceptive use was 54% among sexually active adolescents, aged 15-19 years, pills being the most common method. Among adults, female sterilization was the most common method, followed by Intra Uterine Device (IUD) and pilL Condom use was low as well as the use of traditional methods. Low educational attainment was a strong determinant for lack of contraception. Age at sexual debut and age at first pregnancy had been increasing, and fertility rate had declined in Nicaragua from the 1970s to the 1990s. The increase in women’s education was found to be the strongest explanatory factor behind this transition in fertility. Girls who had successfully completed at least 5 years of schooling had lower risk for early pregnancy. This protective effect of education was found for groups with high as well as low socioeconomic status. The background of adolescent pregnancy consists of a complex interaction of socio­economic, familial and cultural factors. Lack of political will to challenge current values, religious influence in sexual and educational issues, romanticism and lack of empowerment, especially among adolescent women, are also influencing elements. Contraceptive use is still low among sexually active teenagers in Nicaragua, and pregnancy follows soon after first intercourse. There is a strong need for family life education at schools and health services geared to adolescents. Non-use of contraception is associated with poverty and lack of education. The association between education and fertility decline, and the protective effect of education in preventing early pregnancies, even among poor families, indicates that education is a powerful tool in breaking the vicious cycles of poverty and early pregnancy. / digitalisering@umu

Preventivmedel för kvinnor innefattar en betydande andel biverkningar. Hittills har män inte upplevt några allvarliga biverkningar av de testade preventivmedlen för män, trots detta är det biverkningarna som stoppat preventivmedel för män från att lanseras på marknaden. I denna studie argumenteras för att en möjlig förklaring till detta ligger i skilda riskuppfattningar om preventivmedel för män och kvinnor. Studien undersöker riskuppfattningar om preventivmedel samt hur individers egenskaper kan påverka denna riskuppfattning. Studien analyserar hur altruism, riskbenägenhet, föreställningar om könsroller och kön påverkar riskuppfattningar om preventivmedel för män respektive för kvinnor. För att undersöka detta utfördes en enkätundersökning bland 413 studenter vid Linköpings universitet. Respondenterna fick uppge sina uppfattningar om risker kring preventivmedel för antingen män eller kvinnor, samt förhålla sig till påståenden och besvara frågor om altruism, riskbenägenhet och könsroller. Vilka preventivmedel (för män eller kvinnor) en respondent tillfrågades att beakta bestämdes slumpmässigt. Datamaterialet analyserades sedan med hjälp av linjär regressionsanalys. Resultaten visar att respondenterna uppfattar biverkningarna från preventivmedel som värre för kvinnor än för män, där riskbenägenheten hos respondenterna spelade störst roll i deras riskuppfattning. Risksökande och mer altruistiska individer upplever riskerna som större medan den föreställningar om könsroller hade en liten påverkan på resultatet. Avslutningsvis visar resultaten en viss könsbias och den största skillnaden mellan könen är att män som är mindre altruistiska ser mindre risker med preventivmedel medan kvinnor som är mer altruistiska ser mer risker med preventivmedel. / Contraception for women entail a considerable amount of side effects. Even though men so far have not experience serious side effects from the tested contraceptive for men. These side effects have proven to inhibit the availability of male contraception on the market. In this study argumentation is made that one possible explanation for this dwells in a difference in risk perception between contraception for men versus for women, were side effects for contraception for men is preceded as more severe. The aim of this study is to evaluate four traits in individuals which arguably is affecting this risk perception, these are traditional views of gender roles, altruism, risk attitude and a difference in perceptions between genders. To test this, a survey with 413 respondents was conducted at Linköping University. The respondents had to report their perceptions about risks regarding contraception for either men or women, as well as respond to statements about altruism, risk attitudes and traditional gender roles. It was randomized what kind of contraception (for men or for women) the respondents answered. The data material was analyzed through linear regressions. The results show that the respondents, both the women and the men, perceive side effects for contraceptive for women as more severe were their risk attitude have the biggest effect on their risk perception. Furthermore, individuals who are more altruistic and risk seeking perceive larger risks with contraception while the individuals view on traditional gender roles have negligible effect on the respondent’s risk perception. A gender bias dwells in the respondents answer and the biggest difference between the genders is that men who are less altruistic see less risks with contraception while women who are more altruistic see more risks with contraception.