Background: In 2011, 45% of the 6.1 million pregnancies in the United States were unintended. Of the unintended pregnancies, 50% were attributed to contraceptive failure or method non-adherence. Long-acting reversible contraceptives (LARCs) are birth control methods consisting of intrauterine devices (IUDs) and the birth control implants that are the most effective forms of reversible contraceptives. LARCs are 20 times more effective than other birth control methods; yet only 5.6% of women are choosing LARCs. Despite multiple pharmacological and non-pharmacological interventions prior to the procedure, 35% of women reported having moderate pain and 42% of women had severe pain associated during the IUD placement Purpose: The purpose of this quality improvement project was to identify health care providers’ knowledge and practice of pain management methods for IUD insertion in iparous women at a military medical treatment facility (MTF). Methods: This DNP quality improvement (QI) project used a quantitative descriptive methodology with a pretest-posttest design and educational intervention to identify the current practice and knowledge primary care providers have regarding appropriate pain management for iparous women when placing an IUD. Results: The providers’ responses reflect a self-efficacy represented by a knowledge increase in the areas of the limited benefit of premedication with either oral analgesics or cervical softening agents, placing an IUD based on the patient’s menstrual cycle, incorporating the use of a local analgesic, and the connection between counseling and patient satisfaction. Limited provider knowledge can be suggested by the varied responses regarding the topic of a CPG. Self-efficacy stayed stable for the areas of post-procedural NSAID use and having the time for counseling regarding expected pain during the procedure. Conclusion: Improving provider knowledge, skill, and counseling techniques can help decrease the expected and perceived pain for iparous women having an IUD placed leading to an increase of women having IUDs placed. An ultimate goal is to increase IUD use and retention, leading to decreased unintended pregnancy rates, lower maternal and newborn mortality, and improving patient satisfaction when having an IUD placed.

Endometriosis is a chronic disease that is thought to potentially begin at menarche and progress through a woman’s reproductive years. Adolescents with endometriosis present with dysmenorrhea and chronic pelvic pain. Endometriosis can be treated with medical and surgical management. Levonorgestrel intrauterine devices (LNG-IUD) are an effective option for medical management in adolescents. The primary objective of this study was to determine the rate of IUD insertion after laparoscopy for endometriosis in adolescents. The secondary objective was to compare the characteristics of the adolescent population with and without an IUD placed at the time of surgery. The medical records of 109 adolescent patients </= 21 years old were retrospectively reviewed for patient demographic information and surgical information. In our cohort, 36% of patients had an IUD placed at the time of laparoscopic surgery for endometriosis. Patients with an IUD placed at the time of surgery had a significantly higher BMI than patients who did not have an IUD placed (p = 0.004). The most reported symptoms were dysmenorrhea (77.1%) and chronic pelvic pain (94.5%). Patients with an IUD placed had higher rates of excision of endometriosis while patients who did not have an IUD placed had higher rates of ablation of endometriosis (p = 0.003, p = 0.05). Dysmenorrhea and pelvic pain are commonly reported by adolescent patients with endometriosis. LNG-IUDs are often placed at time of excision of endometriosis surgery for adolescents and further studies are warranted to see if they are effective in the long term postoperative medical management of adolescents who have completed surgery.

Orientador: Luis Guillermo Bahamondes / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-14T21:06:45Z (GMT). No. of bitstreams: 1 Canteiro_Renata_M.pdf: 1520573 bytes, checksum: 430ed31c6f7893af060873188cd2b55a (MD5) Previous issue date: 2009 / Resumo: Introdução e objetivos: O dispositivo intrauterino (DIU), apesar de ser um método contraceptivo altamente eficaz e adequado para a maioria das mulheres, nem sempre é recomendado para mulheres nuligestas. Alguns artigos apontaram para taxas de expulsão e gravidez aumentadas neste grupo de mulheres e outros sugeriram a adoção de DIU menores para nuligestas. Esta discussão tem se tornado mais evidente devido ao grande número de gravidezes indesejadas entre adolescentes (as quais, em sua maioria, são nuligestas), evidenciando a necessidade de métodos contraceptivos adequados a este perfil de usuárias. Restam dúvidas sobre a necessidade de novos DIU menores ou de formatos diferentes. Além disso, a avaliação do comprimento da cavidade uterina com o ultrassom, método mais moderno e preciso que o histerômetro, pode orientar para a necessidade de modelos de DIU diferenciados para nuligestas. O objetivo deste trabalho foi avaliar o comprimento da cavidade uterina em mulheres nuligestas e com gestação prévia através da histerometria e do ultrassom. Sujeitos e métodos: Foram avaliadas 570 mulheres (17 a 52 anos) distribuídas em 260 nuligestas e 310 com gestação prévia. Resultados: A diferença entre os valores médios obtidos pela histerometria e pelo ultrassom foi de 0,28cm. O comprimento da cavidade uterina em nuligestas e mulheres com gestação prévia foi 3,84 ± 0,03 e 4,25 ± 0,03, respectivamente, (p < 0,001) pela histerometria e 3,70 ± 0,03 e 3,84 ± 0,03 (média ± EPM), respectivamente pelo ultrassom (p = 0,006). Conclusões: O comprimento da cavidade uterina, avaliado por ambas as técnicas, foi maior entre as mulheres com gestação prévia que entre nuligestas. Esta foi em média maior que 3,6cm, que é o comprimento da maioria dos DIU disponíveis atualmente (TCu 380A) e o sistema liberador de levonorgestrel (LNG-IUS; 3,2cm). Entretanto, um terço das mulheres apresentou valores abaixo dessa medida. Isto permite especular que há poucas razões para o desenvolvimento de novos DIU com comprimento menor, embora exista a possibilidade de um terço das mulheres não se ajustar ao tamanho atual. / Abstract: Introduction and objectives: Due to the controversies about the necessity of new shorter intrauterine devices (IUDs) for nulliparous women in order to reduce expulsion rate, the length of the endometrial cavity was measured in women with different parities by uterine sound and ultrasound. Materials and methods: We evaluated 570 women (17 to 52 years old) distributed on 260 nulliparous and 310 parous. Results: The difference between mean values obtained by the uterine sound and by ultrasound was 0.28 cm. The length of the endometrial cavity on nulliparous and parous women was 3.84 ± 0.03 and 4.25 ± 0.03, respectively (p < 0.001) when assessed by the uterine sound and 3.70 ± 0.03 and 3.84 ± 0.03 (mean ± SEM), respectively when assessed by ultrasound (p = 0.006). Conclusions: The endometrial cavity length evaluated by the two techniques showed a mean value greater than 3.6 cm which is the length of the most worldwide available IUD (TCu380A) and the levonorgestrel-releasing intrauterine system (LNG-IUS). This allows us to speculate that there is no rationale to develop new IUDs with shorter length, because the actual models are fitted to most of the women, including nulliparous. / Mestrado / Ciencias Biomedicas / Mestre em Tocoginecologia

The purpose of this research project is to develop a clinical practice guideline for contraceptive counseling to include long acting reversible contraceptive (LARC) recommendations for the adolescent population. LARCs, which include intrauterine devices and implants, are the top-tier contraceptive for nulliparous women yet they are only used in less than 6% of women under 19 years old. There is no LARC clinical practice guideline that addresses the adolescent’s unique developmental and psychosocial needs that arise. A clinical practice guideline with adolescent-specific recommendations will strengthen counseling especially for long-acting reversible contraceptives. The review of literature searched PubMed, CINHAL, National Guideline Clearinghouse, Google Scholar and the Cochrane Library using search terms "LARCs," and "contraceptive counseling." The search yielded over 35,000 results; titles and abstracts were reviewed using pre-determined inclusion and exclusion criteria. The final source documents included forty-eight applicable manuscripts, which were graded using the United States Preventative Task Force (USPSTF) scale. The evidence was then sorted by similar findings and practice recommendations. The findings were used to formulate practice statements, which were then input into the Bridge-wiz software. The program generated recommendations and assigned a strength rating, and the clinical practice guideline was written from these recommendations. Finally, four clinical experts were identified using snowball sampling; they each participated in the final appraisal using the AGREE II tool. Based on the analysis of the review of literature, fifteen evidenced-based recommendations emerged. The recommendation topics included: best-practices for recommending LARCs, using developmentally appropriate teaching, providing youth-friendly services, and eliminating potential barriers to LARC uptake in adolescents. There are fifteen practice recommendations that increase adolescent uptake of LARCs. Limitations for the project included the absence of an internal review committee to grade the evidence and assign a strength to each recommendation. The use of Bridge-wiz software and the USPSTF evidence scale minimized bias. Providers can facilitate use of LARCs among adolescents by using developmentally appropriate and comprehensive contraceptive counseling. If more adolescents chose a LARC as their primary form of contraception, then overall teenage pregnancies may decrease. Further research is needed to understand other barriers and possible interventions.

Today, intrauterine devices (IUDs) are used by over 100 million women worldwide, making it the most popular reversible method of birth control. Approximately only 2% of American women, however, choose to use this method of birth control. The purpose of this study was to explore clinical services providers' (CSP) behavioral intention to provide the IUD. An instrument based on the theory of reasoned action (TRA) surveyed National Association of Nurse Practitioners in Women's Health (NPWH). A total of 695 participants appropriately completed the survey, resulting in approximately a 30% response rate. Pearson Product Moment Correlations assessed the linear relationship(s) among summed scales and individual instrument items. Hierarchical regression identified the level of variance accounted for by TRA scales and the knowledge scale. Consistent with TRA tenets, statistically significant associations were found among TRA constructs and behavioral intention; whereas knowledge, while a statistically significantly correlated variable with behavioral intention, was not a predictor of behavioral intention. Future research should continue to explore factors of IUDs use, including those not a part of TRA. Health educators should plan programs to assist in health information delivery, and develop social marketing campaigns to help women seeking family planning services become effective consumers of health information about IUDs.

BACKGROUND: One in ten sexually active adolescents in the United States become pregnant each year. Significant differences in unintended pregnancy and use of long-acting reversible contraceptive (LARC) methods: the sub-dermal implant, the copper intrauterine device (IUD) and hormonal IUDs, exist between socioeconomic strata as well as ethnic and racial groups. Women using LARC are 20 times less likely to experience a pregnancy than women using short-acting reversible methods. Thus, LARCs present a major opportunity for the prevention of unintended pregnancy. PURPOSE: Characterize contraceptive use, demographics, and behavioral characteristics of a novel population: young women presenting to an urban Pediatric Emergency Department (PED) in order to better understand the contraceptive needs of this population. METHODS: We characterized the current LARC usage. Using an anonymous paper-based questionnaire, we surveyed women ages 16-21 years regardless of chief complaint presenting to our PED regarding their demographics, health care access, sexual history, and history of contraceptive use. We conducted a cross-sectional analysis of demographic characteristics for current LARC and non-LARC users (n=331) using chi-squared for categorical variables and student's t-test for continuous variables. RESULTS: No significant differences were found between women currently using LARC and those not using LARC, however current LARC usage in our population was 15.8%, about three times that documented in the most recent national studies conducted in 2013. CONCLUSION: Current LARC use is particularly high in our urban PED setting. More research is necessary to determine if this is part of a larger national trend or if the early implementation of no-cost contraception in Massachusetts and changes in provider or patient attitudes towards LARC may explain the large observed difference in LARC usage.

No description available.

Bakgrund:Spiral är en högeffektiv preventivmedelsmetod och har tidigare enbart rekommenderats till kvinnor som fött barn. Dessa riktlinjer har förändrats och spiral är ett förstahandsalternativ till unga kvinnor. Barnmorskor ger trots det varierande information kring spiral till unga kvinnor. Syfte: Att belysa barnmorskors uppfattning av spiral som preventivmedelsmetod till unga kvinnor.Metod:Fenomenografisk forskningsmetod med induktiv ansats användes i studien. Sju barnmorskor intervjuades med semistrukturerade frågor i Västra Götaland.Resultat: Resultatet presenteras i tre beskrivningskategorier och fem uppfattningar: rätt information är av betydelse; unga kvinnors sexuella erfarenhet är av betydelse; Omgivningens kunskap varierar.Konklusion:Resultatet visar att individanpassad information är av stor vikt och att unga kvinnor ska få möjlighet till ett informerat val. Barnmorskor uppfattar att spiral är en effektiv preventivmedelsmetod till unga kvinnor som har debuterat sexuellt. Till de kvinnor som inte haft penetrerande samlag, rekommenderas en annan preventivmedelsmetod. Hur information om spiral ges är viktigt för följsamheten i användningen. De unga kvinnorna bör ha en realistisk bild av spiral och det är betydelsefullt att barnmorskor informerar om både för- och nackdelar. Genom att barnmorskorna är uppdaterade och inhämtar ny forskning kan rätt kunskap kring spiral förmedlas. / Background: Intrauterine device is an effective contraceptive method and was earlier only recommended for women who have had given birth. These guidelines have changed, and intrauterine device is a first choice for young women. Still midwives give various information about intrauterine device to young women.   Purpose: To illustrate midwives’ perceptions of intrauterine device to young women.Method: Phenomenographical research with an inductive approach was used in the study. 7 midwives were interviewed with semi-structured questions in western Sweden. Result: The midwives’ perceptions of intrauterine device as a contraceptive method to young women are presented in three descriptive categories and five perceptions: Rightinformation is of meaning; Young women’s sexual experience are of relevance; The environment’s knowledge varies.Conclusion: Midwives perception is that intrauterine deviceis an effective contraceptive method for young women who have had their sexual debut. For the young women who haven’t lost their virginity other contraceptive methods are preferred. How the information about intrauterine device is given is important for adherence among young women. The young women should have a realistic imageof the intrauterine device and there for it’s important that the midwives provide both advantages and disadvantages when they give information.If Midwives are updated and stays ahead with research they can provide a better knowledge of the intrauterine device.

Embora o dispositivo intrauterino (DIU) seja pouco usado no Brasil, ele é o método contraceptivo reversível mais usado no mundo. Trata-se de um método seguro, altamente eficaz e com resultados positivos na saúde das populações. Por meio da prevenção de gestações não planejadas, atua na redução da morbidade e mortalidade materna, mortalidade infantil e abortos inseguros. Pesquisas recentes, contudo, mostram que o acesso ao DIU nos serviços de Atenção Básica à Saúde nem sempre é facilitado, sendo permeado por barreiras organizacionais que contribuem para sua subutilização. Tais barreiras podem restringir o pleno exercício dos direitos sexuais e reprodutivos das mulheres brasileiras. Objetivo: Identificar barreiras organizacionais para disponibilização do DIU nos serviços de Atenção Básica à Saúde e elaborar, como produto desta dissertação, uma síntese destas barreiras, destinada aos gestores de saúde, com suas implicações e recomendações. Método: Estudo quantitativo, descritivo. A coleta de dados foi realizada por meio do preenchimento de um instrumento estruturado, online, pelos 79 profissionais responsáveis pela área técnica de Saúde da Mulher. O cenário do estudo foi a macrorregião Sul de Minas Gerais. A análise dos dados foi realizada por meio do software Stata, versão 14.0, e descrita por meio de número absoluto e proporções. Resultados: A maioria dos municípios possui protocolo de atenção à saúde da mulher (55,7%). Destes, 77,3% elaboraram seu próprio protocolo, mas 29,6% não treinaram a equipe de saúde para usá-lo. Dentre todos os municípios participantes, 15,2% não disponibilizam DIU, sendo que alguns também não referenciam a mulher para outros serviços (8,3%). Dentre aqueles que disponibilizam o DIU, a grande maioria não possui protocolo específico (68,7%); uma parcela não adota a gravidez como condição impossibilitante da inserção do DIU (10,5%) e, por outro lado, adotam condições menos relevantes como infecção vaginal (80,6%). Como critério para acesso ao DIU, 86,5% referiram prescrição médica, 71,6% realização de exames, 44,6% idade acima de 18 anos e 24,4% participação em grupos. Como exames necessários, foi citado o Papanicolaou (94,7%), teste de gravidez (63,2%) e exame de sangue (29,8%). Quanto ao local de disponibilização, 83,7% não o disponibilizam nas Unidades Básicas de Saúde. Como profissional que insere o DIU, 97,0% referiram médico e nenhum citou o enfermeiro. Quanto aos grupos de planejamento reprodutivo, 43,0% dos municípios não os realizam. Por fim, 86,1% dos trabalhadores reportaram não haver dificuldades para obtenção do DIU. Conclusão: Foram identificadas barreiras organizacionais que dizem respeito ao uso de protocolos, também barreiras relacionadas à disponibilização e inserção do DIU, e barreiras relativas aos grupos de planejamento reprodutivo. / Introduction: Although the intrauterine device (IUD) is little used in Brazil, it is the most used reversible contraceptive method in the world. It is about a safe method, highly effective and with positive results in the health of populations. By means of preventing unplanned pregnancies, it works to reduce maternal morbidity and mortality, infant mortality and unsafe abortions. Recent research, however, show that access to IUD in Primary Health Attention services is not always facilitated, being permeated by organizational barriers that contribute to their underutilization. Such barriers may restrict the full exercise of sexual and reproductive rights of Brazilian women. Objective: To identify organizational barriers for providing IUD in the Primary Health Attention services and elaborate, as a product of this dissertation, a summary of these barriers, which is intended for health managers, with their implications and recommendations. Method: Qualitative, descriptive study. Data collection was performed by completing, online, a structured instrument, by 79 professionals responsible for the technical field of Womens Health. The study setting was the macro-region in the southern of Minas Gerais. Data analysis was performed using Stata software, version 14.0, and described by absolute number and proportions. Results: Most municipalities have attention protocol to womens health (55.7%). Of these, 77.3% developed its own protocol, but 29.6% did not train health staff to use it. Among all participating municipalities, 15.2% do not offer IUD, and some did not refer women to other services (8.3%). Among those, which provide the IUD, the vast majority do not have specific protocol (68.7%); a portion does not adopt pregnancy as an impeditive condition of insertion of the IUD (10.5%) and, on the other hand, adopt less relevant conditions such as vaginal infection (80.6%). As a criterion for accessing the IUD, 86.5% reported prescription, 71.6% exams, 44.6% aged over 18 years old and 24.4% participation in groups. As required exams, it was quoted the Pap smear (94.7%), pregnancy test (63,2%) and blood tests (29,8%). As a place of availability, 83.7% do not provide in the Basic Health Units. As a professional to insert the IUD, 97.0% reported the doctor and none cited the nurse. Municipalities do not realize reproductive planning group at 43.0%. Finally, 86.1% of workers reported not having difficulties in obtaining the IUD. Conclusion: Organizational barriers were identified concerning the use of protocols, also barriers related to the availability and IUD insertion, and barriers related to the reproductive planning groups.

Submitted by Johnny Rodrigues (johnnyrodrigues@ufcg.edu.br) on 2018-04-16T19:27:36Z No. of bitstreams: 1 MARIA DAS NEVES GUEDES CAVALCANTI BEZERRA - DISSERTAÇÃO PPG-CEMat 2014..pdf: 1961977 bytes, checksum: 48356976ff3729c606e179600ae156ad (MD5) / Made available in DSpace on 2018-04-16T19:27:36Z (GMT). No. of bitstreams: 1 MARIA DAS NEVES GUEDES CAVALCANTI BEZERRA - DISSERTAÇÃO PPG-CEMat 2014..pdf: 1961977 bytes, checksum: 48356976ff3729c606e179600ae156ad (MD5) Previous issue date: 2014-05-30 / A pesquisa teve como objetivo realizar análise comparativa entre os contraceptivos DIU`s utilizados comercialmente. Dentro desse objetivo buscou-se: propor bases comparativas entre composição dos DIU TCu 380 A e endoceptivos hormonais; determinar a possível oxidação dos DIU‟s de Cobre; determinar o tipo de polietileno utilizado em ambos os DIU‟s. A pesquisa foi desenvolvida no Laboratório de Avaliação e Desenvolvimento de Biomateriais do Nordeste - CERTBIO, localizada na Unidade Acadêmica de Engenharia de Materiais, na Universidade Federal de Campina Grande/UFCG. Foram utilizadas duas amostras de Dispositivos Intrauterinos usualmente utilizados, descritos adiante: DIU TCu 380 A e Endoceptivo Medicamentos. Foram avaliadas as composições químicas dos DIU‟s e o tipo de polietileno, através das seguintes técnicas: Microscopia Óptica (MO), Microscopia Eletrônica de Varredura (MEV/EDX), Espectroscopia na Região de Infravermelho com Transformada de Fourier (FTIR), Difração de Raios X (DRX) e Calorimetria Exploratória Diferencial (DSC). Pode-se comprovar também a partir da análise de EDS a presença do sulfato de bário em ambos os DIU‟s, onde o mesmo é utilizado para tornar o DIU visível em raios X. Comprovou-se a presença de silício e oxigênio no tronco do DIU com levonorgestrel indicando ser o mesmo constituído por uma polidimetilsiloxano como informado pelo fabricante. Pode-se comprovar pela análise de FTIR, que o material formador dos corpos principais de ambos os DIU‟s era polietileno pela análise do espectograma. A análise de DRX corroborou com os resultados obtidos na análise de FTIR, que indicavam que o material dos dispositivos se tratava de polietileno, apresentando um espectograma típico de PE. Pode-se comprovar também, que o fio e os anéis do DIU TCu 380 A eram compostos por cobre. A análise de DSC mostrou ser o polietileno constituinte de ambos os DIU‟s, um polietileno de baixa densidade (LDPE). Diante do exposto podese concluir que ambos os DIU‟s possuem corpo formado por polietileno de baixa densidade, porém, possuem processamentos diferentes, onde a estrutura do DIU levonorgestrel apresenta superfície com acabamento mais refinado em relação ao DIU TCu 380 A. / The research aims to perform comparative analysis between contraceptives - IUD`s used commercially. Within this objective we sought: to propose a comparative basis between composition of TCu 380A IUD and Hormonal Endoception; determine the possible oxidation of copper IUDs; determining the type of polyethylene used in both IUD's. The research was conducted at the Laboratory of Biomaterials Evaluation and Development of the Northeast - CERTBIO, located in the Academic Unit of Materials Engineering, Federal University of Campina Grande / UFCG. TCu 380A and Sterile Endoception: two samples of intrauterine devices commonly used, as described below were used. Chemical compositions of IUDs and type of polyethylene were evaluated using the following techniques: Optical Microscopy (OM), Scanning Electron Microscopy (SEM / EDX) Spectroscopy in the Region with Infrared Fourier Transform Spectroscopy (FTIR), X-Ray Diffraction (XRD) and Differential Scanning Calorimetry (DSC). It can also prove from the EDS analysis the presence of barium sulphate in both IUD's, where it was used to make the IUD visible on x-rays proved the presence of silicium and oxygen in the stem of the IUD levonorgestrel indicating that it comprises a polydimethylsiloxane as reported by the manufacturer. Can be proved with FTIR analysis of the forming material of the principal of both bodies was polyethylene IUD‟s for examining the spectrogram. XRD analysis corroborated the results obtained with FTIR analysis of the material indicated that the devices it was polyethylene having a typical PE spectrogram. One can also show that the wire rings and the TCu 380 were composed of copper. The DSC analysis showed to be a constituent of both polyethylene IUDs Low Density Polyethylene (LDPE). Given the above it can be concluded that both IUDs have bodies formed of low density polyethylene, but have different processing, where the structure of the IUD levonorgestrel has finer surface finish compared to TCu 380 A.