Introdução - O uso da internet entre médicos e pacientes é prática cada vez mais freqüente na Medicina. Sua introdução, entretanto, incorre em implicações éticas, legais e econômicas além de influenciar a relação médico-paciente e o processo de trabalho médico. Objetivos - Identificar o uso da internet por médicos ginecologistas e obstetras da cidade de São Paulo na prática médica, sua influencia na relação médico-paciente e suas possíveis implicações éticas, legais e econômicas. Métodos - Foram enviados 1.120 questionários para médicos ginecologistas e obstetras da cidade de São Paulo, dos quais retornaram 152, o correspondente a 13,6% da amostra ou 6,1% do total dos médicos cadastrados na SOGESP. A análise quantitativa do comportamento do médico quanto ao uso da internet foi realizada por meio de proporções, médias e cálculos de desviospadrão conforme os dados obtidos através do questionário. A comparação entre o grupo de médicos que utiliza a internet na prática médica e o grupo que não a utiliza, sua distribuição segundo local e tipo de atendimento, recursos da internet utilizados, formação ou titulação acadêmica, idade e tempo de formado foi feita através do teste de associação do qui-quadrado. Através da técnica de Cluster Analysis, foram determinados 4 grupos segundo o perfil dos profissionais relacionado ao uso desta ferramenta. Conclusões - Os ginecologistas obstetras pesquisados utilizam a internet na prática médica para própria atualização através do acesso a base de dados, para obter informações sobre saúde e doença, para comunicação com pacientes ou para oferecer serviços às mesmas com diferentes assiduidades. Entretanto, este uso é ainda parcial, talvez relacionado ao receio de interferências negativas na relação com o paciente, além de preocupações quanto à implicações legais, éticas e principalmente econômicas que a introdução desta ferramenta possa causar no desenvolvimento da profissão. / Introduction - The use of internet by patients and physicians has increased and has been increasingly integrated into clinical practice. Moreover, the internet is changing the traditional doctor-pacient relationship and adds new ethical, legal and economic concepts to its practice. Objective To identify the use of internet by gynecologists and obstetricians who work in São Paulo city, its influence on the physician-patient relationship and the ethical, legal and economic aspects of its introduction into medical practice. Methods - A postal questionnaire was sent to 1.120 gynecologists and obstetricians of São Paulo city, 152 of which were returned, which represents a return rate of 13.6% and 6.1% of all the professionals of SOGESP. The quantitative analysis of the doctors` behavior related to the use of the internet has been made by calculation of averages, proportions and standard deviations. The comparison between these doctors who have introduced internet into their practice and those who haven`t, its distribution by professional activity and office location, internet tools utilized and personal characteristics have been undertaken using the chi-squared test. Four different groups have been determined by Cluster Analysis depending on the way this technology is used. Conclusions The gynecologists and obstetricians investigated in this research project use internet in their medical practice, for the updating of data collection, to obtain new information about health care, for communication with patients or offer their medical services by the Web. Although its use has been improved doctors are afraid of possible negative consequences regarding the physician-patient relationship and legal, economic and ethical consequences that this use may bring to clinical practice.

Introdução - O uso da internet entre médicos e pacientes é prática cada vez mais freqüente na Medicina. Sua introdução, entretanto, incorre em implicações éticas, legais e econômicas além de influenciar a relação médico-paciente e o processo de trabalho médico. Objetivos - Identificar o uso da internet por médicos ginecologistas e obstetras da cidade de São Paulo na prática médica, sua influencia na relação médico-paciente e suas possíveis implicações éticas, legais e econômicas. Métodos - Foram enviados 1.120 questionários para médicos ginecologistas e obstetras da cidade de São Paulo, dos quais retornaram 152, o correspondente a 13,6% da amostra ou 6,1% do total dos médicos cadastrados na SOGESP. A análise quantitativa do comportamento do médico quanto ao uso da internet foi realizada por meio de proporções, médias e cálculos de desviospadrão conforme os dados obtidos através do questionário. A comparação entre o grupo de médicos que utiliza a internet na prática médica e o grupo que não a utiliza, sua distribuição segundo local e tipo de atendimento, recursos da internet utilizados, formação ou titulação acadêmica, idade e tempo de formado foi feita através do teste de associação do qui-quadrado. Através da técnica de Cluster Analysis, foram determinados 4 grupos segundo o perfil dos profissionais relacionado ao uso desta ferramenta. Conclusões - Os ginecologistas obstetras pesquisados utilizam a internet na prática médica para própria atualização através do acesso a base de dados, para obter informações sobre saúde e doença, para comunicação com pacientes ou para oferecer serviços às mesmas com diferentes assiduidades. Entretanto, este uso é ainda parcial, talvez relacionado ao receio de interferências negativas na relação com o paciente, além de preocupações quanto à implicações legais, éticas e principalmente econômicas que a introdução desta ferramenta possa causar no desenvolvimento da profissão. / Introduction - The use of internet by patients and physicians has increased and has been increasingly integrated into clinical practice. Moreover, the internet is changing the traditional doctor-pacient relationship and adds new ethical, legal and economic concepts to its practice. Objective To identify the use of internet by gynecologists and obstetricians who work in São Paulo city, its influence on the physician-patient relationship and the ethical, legal and economic aspects of its introduction into medical practice. Methods - A postal questionnaire was sent to 1.120 gynecologists and obstetricians of São Paulo city, 152 of which were returned, which represents a return rate of 13.6% and 6.1% of all the professionals of SOGESP. The quantitative analysis of the doctors` behavior related to the use of the internet has been made by calculation of averages, proportions and standard deviations. The comparison between these doctors who have introduced internet into their practice and those who haven`t, its distribution by professional activity and office location, internet tools utilized and personal characteristics have been undertaken using the chi-squared test. Four different groups have been determined by Cluster Analysis depending on the way this technology is used. Conclusions The gynecologists and obstetricians investigated in this research project use internet in their medical practice, for the updating of data collection, to obtain new information about health care, for communication with patients or offer their medical services by the Web. Although its use has been improved doctors are afraid of possible negative consequences regarding the physician-patient relationship and legal, economic and ethical consequences that this use may bring to clinical practice.

Made available in DSpace on 2016-08-19T18:15:56Z (GMT). No. of bitstreams: 1 Erika Krogh.pdf: 139556 bytes, checksum: 216878ad89ff19e3e8bc335f8838580a (MD5) Previous issue date: 2008-10-25 / Introduction: A gynecological appointment in adolescence is usually surrounded by anxiety and ignorance for an adolescent. The lack of information and fear of new discoveries make that the adolescent delayed this first consultation. Objective: To identify determinant motivations for a gynecological appointment in adolescence. Method: Questionnaires were applied in the form of interview, in 45 female adolescents from 10 to 19 years in order to evaluate aspects related to knowledge and information to adolescents about the gynecologist and a gynecological appointment in the period from January to May of 2008. The participants were chosen at random from among the participants of Adolescentro - Vila Embratel. Results: The average age of adolescents was 14.5 years. The average age that patients seek medical care was 12.9 years. The menarche occurred between 10 to 12 years for most teenagers. Approximately 78% of the interviewees did not start sex life and 55.6% knew the area in which the gynecologist served, whereas only 37.8% had attended a gynecological consultation. The initiative of seeking medical care comes from the mothers in 82.4% of cases. The most quoted reason for the search by the gynecologist was routine gynecological. As the DST's and contraceptive methods, the adolescents who had a consultation, said to meet them at 100% and 70.6% respectively. Conclusion: It was concluded in this work that the demand for consultation on the initiative of a teenager is still very low, being the mother the determining factor for this search. The higher the education level, the family income and the knowledge of STD's, the greater the demand for a gynecological appointment. / Introdução: A consulta ginecológica na adolescência é geralmente cercada de ansiedade e desconhecimento para a adolescente. A falta de informação e o medo das novas descobertas fazem com que a adolescente protele esta primeira consulta. Objetivo: Identificar motivações determinantes para a consulta ginecológica na adolescência. Método: Foram aplicados questionários, na forma de entrevista, em 45 adolescentes do sexo feminino, de 10 a 19 anos , para avaliar aspectos relacionados ao conhecimento e informação das adolescentes sobre o ginecologista e a consulta ginecológica no período de janeiro a maio de 2008. As participantes foram escolhidas aleatoriamente, dentre as freqüentadoras do Adolescentro Vila Embratel. Resultados: A média de idade das adolescentes foi de 14,5 anos. A idade média que as pacientes buscaram atendimento ginecológico foi 12,9 anos. A menarca ocorreu entre 10 a 12 anos para a maior parte das adolescentes. Aproximadamente 78% das entrevistadas não iniciaram vida sexual e 55,6% conheciam a área em que atuava o ginecologista, sendo que somente 37,8% já compareceram a uma consulta ginecológica. A iniciativa de procurar atendimento ginecológico partiu das mães em 82,4% dos casos. O motivo de busca pelo ginecologista mais citado foi rotina ginecológica. Quanto as DST s e os métodos anticoncepcionais, as adolescentes que já foram a consulta, referiram conhecê-los em 100% e 70,6% respectivamente. Conclusão: Concluiu-se neste trabalho que a procura pela consulta ginecológica por iniciativa da adolescente ainda é muito baixa, sendo a mãe o fator determinante para essa busca. Quanto maior o nível de escolaridade, a renda familiar e o conhecimento das DST s, maior é a procura pelo atendimento ginecológico.

Aim: To investigate gynecologists’ and midwives’ views and experiences regarding work in abortion care in Sweden. Methods: Questionnaire to gynecologists (n=269) and midwives (n=258 comprising 48 questions, response 85%. The quantitative studies (articles I-III) were supplemented by a qualitative study (article IV), consisting of focus-group interviews with gynecologists and midwives/nurses. Results: From the questionnaire studies it was apparent that all the gynecologists had worked in abortion care, whilst not all midwives had done so. The male gynecologists were older than both their female colleagues and the midwives; they had most years of experience but were now working least with abortion patients. Both groups considered it absolutely right, that Sweden have legal abortion and that the law was being followed. Most thought that women should be allowed to have an abortion even after they had felt fetal movements. The midwives were generally somewhat more restrictive than the gynecologists. Half of all thought that the work with abortion patients brought something positive with it. Those having worked longest and most extensively, especially during the previous year were most liberal. Both groups felt that there was a difference between working with surgical and late abortions compared with medical abortions. One in four had had misgivings when involved in surgical and medical abortions, and one in two with abortions after the 18th week. All were positive about the transition to medical abortions, and roughly two thirds of the midwives thought that the primary care sector should be able to take care of these, whereas less than half of the gynecologists thought this. The majority considered it important to receive further and continuing professional development and ongoing guidance. From the focus-group interviews it was clear that the experiences of the gynecologists were largely connected with the technical development of abortion methods and those of the midwives/nurses with improved pain relief. The work was sometimes described in paradoxical terms and was occasionally experienced as frustrating, especially in connection with repeat abortions. Neither of the two groups, however, had had any doubts about participating in abortion. The gynecologists described how women now expected to get an abortion, whereas previously they had asked for one. The midwife/nurse group maintained that the meetings with the women had become considerably more frequent. The interaction between the two professional groups was marked by great trust in each other’s professional competence. Conclusions: Gynecologists and midwives working in abortion care support Swedish abortion legislation and have no doubts about participating in abortions, despite the fact that they have frequently experienced complex and difficult work situations. The character of the work is experienced as contradictory and frustrating, but also as challenging and rewarding. The awareness that the two professional groups have of the importance of continuing professional development and ongoing guidance should be acted on. Furthermore, their collective views and experiences should be made use of, so that abortion care can be developed, not only in order to promote women’s health, but also to improve the work environment for the abortion staff.

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

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

少子化問題使婦產科醫師的工作環境受到衝擊，人力短缺情形嚴重，為了解並預測未來婦產科醫療服務市場的供需情形，本研究使用1997-2011年健保資料庫數據，以及戶政司與經建會人口資料，分析婦產科醫師的人力變動特性及趨勢。 研究結果顯示，雖然產科醫師人數持續下滑，但由於出生人口持續降低，反而讓每1000出生人口對比醫生數有逐漸提高趨勢，人均年接生水準也可大致維持在固定水準。此外，新進婦產科醫師過少，7成以上的醫師又集中在45至64歲，未來當主要供給人力面臨退休年齡時，婦產科醫師總數將迅速減少，使婦產科醫師與女性人口醫病比隨之下滑。深究婦產科醫師人數減少的緣由，發現少子化的影響程度有超過7成6的比例，同時也發現，醫療環境不佳確實也會影響新進醫師的選擇。政府若欲解決婦產科醫師人力缺乏問題，需著重增加醫學生選擇進入婦產科的誘因。 / To examine the current supply of practicing obstetrician-gynecologists and project the future supply under low fertility rate, a discrete actuarial supply model was developed. Supply projections were examined using visiting information form the National Health Insurance research databases. We found the numbers of obstetrician is expected to continuously decline from its current level, whereas the number of obstetrician/gynecologists (OB/GYNs) per 1000 births will still increase because of the declining number of births. Besides, the number of obstetrician per 1000 births can be roughly maintained at a fixed level. Projections show that the total supply of OB/GYNs will sharply fall in recent years because the number of new physicians continues to diminish, while more than 70% of workforce is over 45 years old. Among two possible factors affecting growth or decline, the ones that seem most important is low fertility rate. These results highlight the necessity for developing a work environment that attracts young physician to obstetrics and gynecology.

In my study regarding gynecological examination, it turned out that women generally have a positive attitude to being examined gynecologically, but the experience is not the same as the situation can be experienced as omission. It also emerged that they experienced the feeling of stress and anxiety of exposing the sex. The solution to the women's experience in this problem only highlighted the gynecologist's approach or product design. Something that is increasing worldwide is the knowledge of the importance of the physical aspects of the environment for the patient in a care environment. Design and architecture are increasingly used in the design of care environments. What has emerged in many researches is that the patient's health has found well-being when the room has been designed according to the user's needs. This is a degree project in information design with a focus on spatial design. The purpose of the work has been to investigate, together with users, the gynecologist's experience, challenges and potential solutions together with theories, methods and previous research. Subsequently, a design proposal in the form of a concept has emerged, which can improve the room experience for the patient, which gynecologists can take part in when designing gynecological rooms. / I min studie gällande gynekologundersökning visade det sig att kvinnor generellt har en positiv attityd till att bli undersökt gynekologiskt men upplevelsen är inte detsamma då situationen kan upplevas utelämnande. Det framkom även att de upplevde känslan av stress och ångest av att blotta könet. Lösningen till kvinnornas upplevelse i detta problem lyfte endast gynekologens bemötande eller produktdesign. Något som ökar världen över är kunskapen om miljöns fysiska aspekters betydelse för patienten i en vårdmiljö. Design och arkitektur används allt mer vid utformning av vårdmiljöer. Det som framkommit i många forskningar är att patientens hälsa funnit välbefinnande när rummet har utformats utefter användarens behov. Detta är ett examensarbete i informationsdesign med inriktning rumslig gestaltning. Arbetets syfte har varit att tillsammans med användare undersöka gynekologrummets upplevelse, utmaningar och potentiella lösningar tillsammans med teorier, metoder och tidigare forskning. Därefter har ett gestaltningsförslag i form av ett koncept växt fram vilket kan förbättrad rumsupplevelsen för patienten som gynekologer kan ta del av vid utformning av gynekologrum.