CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Objetivou-se comparar os achados de infecÃÃes vaginais em gestantes obtidos por meio do fluxograma de corrimento vaginal com exames presentes na prÃtica clÃnica. O estudo foi do tipo avaliativo, com delineamento transversal e abordagem quantitativa, desenvolvido no Centro de Parto Natural LÃgia Barros Costa em Fortaleza - CE, com amostra composta por 104 gestantes. Os dados foram coletados por meio de entrevista e exame ginecolÃgico de Janeiro a Julho de 2011. Foi realizada anÃlise estatÃstica, utilizando frequÃncia absoluta, mÃdia e Desvio PadrÃo. Realizou-se, tambÃm, testes de sensibilidade, especificidade, valores preditivos positivo e negativo, acurÃcia e as razÃes de verossimilhanÃa positiva e negativa, em que se estabeleceu significÃncia para valor de p<0,1. O projeto de pesquisa foi aprovado pelo Comità de Ãtica em Pesquisa da Universidade Federal do CearÃ, conforme protocolo n 298/10. As gestantes apresentaram mÃdia de idade de 23,7 anos, parceria fixa (78; 75%), mÃdia de 12,3 anos de estudo e renda familiar entre um e dois salÃrios mÃnimos (59; 56,7%). A menarca ocorreu em mÃdia com 12,8 anos e a sexarca com 16 anos. NÃo apresentavam histÃria pregressa de IST (90; 86,5%) e nÃo realizavam exame citolÃgico periodicamente (58; 55,8%). Houve predomÃnio de mulheres multÃparas (58; 55,8%), com uma mÃdia de 20,24 semanas gestacionais. As queixas ginecolÃgicas mais predominantes foram: corrimento vaginal (87; 83,7%), odor de secreÃÃo vaginal (45; 43,3%), dispareunia (36; 34,6%), prurido (27; 26%), disÃria (12; 11,5%), sinusorragia (6; 5,8%) e febre (4; 3,9%). Encontrou-se uma prevalÃncia de 13,5% de positividade para pelo menos uma das trÃs infecÃÃes vaginais investigadas de acordo com o exame a fresco. Observou-se predominantemente o pH de valor 5 (50; 48,1%) e o teste de aminas negativo (66; 63,5%). O fluxograma nÃo se mostrou eficaz na identificaÃÃo de candidÃase, apresentando uma baixa sensibilidade (0,0%) e Valor Preditivo Positivo (0,0%), uma alta especificidade (97,9%), Valor Preditivo Negativo (90,2%) e acurÃcia (88,5%), alÃm de RazÃo de VerossimilhanÃa Positiva nula e RazÃo de VerossimilhanÃa Negativa igual a 1. Para tricomonÃase, apresentou baixa sensibilidade (50%), especificidade (46%), Valor Preditivo Positivo (3,6%) e acurÃcia (46,2%), um alto Valor Preditivo Negativo (95,8%), RazÃo de VerossimilhanÃa Positiva igual a 0,9 e RazÃo de VerossimilhanÃa Negativa de 1,08. Para vaginose bacteriana, mostrou-se satisfatÃrio, com uma alta sensibilidade (100%), Valor Preditivo Negativo (100%) e acurÃcia (74%), uma baixa sensibilidade (64%) e Valor Preditivo Positivo (51,8%), alÃm de RazÃo de VerossimilhanÃa Positiva igual a 2,7 e RazÃo de VerossimilhanÃa Negativa nula. Conclui-se que o emprego da abordagem sindrÃmica das infecÃÃes vaginais em gestantes precisa ser reavaliada, visto que o fluxograma nÃo foi eficaz em identificar infecÃÃes como candidÃase e tricomonÃase. Os esforÃos para o desenvolvimento de testes simples e mais acessÃveis devem ser contÃnuos. Entretanto, devem-se empregar tÃcnicas mais avanÃadas, como o exame a fresco, na prÃtica clÃnica, com intuito de aprimorar as prÃticas em saÃde sexual e reprodutiva, evitando a disseminaÃÃo de infecÃÃes, reduzindo tratamentos desnecessÃrios e melhorando a qualidade de vida das gestantes. / The aim was to compare the findings of vaginal infections in pregnant women obtained from the vaginal discharge flowchart with tests present in the clinical practice. This was an evaluation study, with a transversal delineation and quantitative boarding, developed in the Center of Natural Birth LÃgia Barros Costa in Fortaleza â CE, with a sample of 104 pregnant women. The data was collected through interviews and gynecological examination from January to July of 2011. Statistical analysis was carried through, using absolute and average frequency and Standard Deviation. It was also conducted tests of sensitivity, specificity, predictive positive and negative values, accuracy and reasons of positive and negative probability, where it was established a significance value of p< 0,1. The research project was approved by the Research Ethics Committee of the Federal University of the CearÃ, under the protocol n 298/10. The pregnant women presented an average age of 23,7 years, fixed partnership (78; 75%), average of 12,3 years of study and family income between one and two minimum wages (59; 56,7%). The menarche occurred with an average age of 12,8 years and the first sexual intercourse with 16 years. They did not present history of STDs (90; 86.5%) and did not take cytological examinations regularly (58; 55,8%). The majority of the women are multiparous (58; 55.8%), with an average of 20,24 weeks of gestation. The predominant gynecological complaints were: vaginal discharge (87; 83.7%), vaginal secretion odor (45; 43.3%), dyspareunia (36; 34.6%), itch (27; 26%), dysuria (12; 11.5%), sinusorragia (6; 5.8%) and fever (4; 3,9%). It was observed a prevalence of 13,5% of positivity for at least one of three vaginal infections investigated according to the fresh examination. It was observed predominantly a pH value of 5 (50; 48.1%) and whiff test negative (66; 63,5%). The flowchart did not reveal efficient in the identification of candidiasis, presenting a low sensitivity (0.0%) and positive predictive value (0.0%), a high specificity (97.9%), negative predictive value (90.2%) and accuracy (88.5%), as well as null positive likelihood ratio and negative likelihood ratio equal to 1. For trichomoniasis, it presented low sensitivity (50%), specificity (46%), positive predictive value (3.6%) and accuracy (46.2%), a high negative predictive value (95.8%), positive likelihood ratio equal to 0,9 and negativo likelihood ratio 1,08. For bacterial vaginosis, it revealed satisfactory, with a high sensitivity (100%), negative predictive value (100%) and accuracy (74%), a low sensitivity (64%) and positive predictive value (51.8%), as well as positive likelihood ratio equal to 2,7 and null negative likelihood ratio. In conclusion, the use of a syndromic boarding for vaginal infections in pregnant women needs to be reevaluated, since the flowchart was not efficient in identifying infections such as candidiasis and trichomoniasis. The efforts for the development of simple and accessible tests must be continuous. However, more advance and techniques, like the fresh examination, in the practical clinic, aiming to contribute to the improvement of the sexual health and reproductive practices, preventing the dissemination of infections, reducing unnecessary treatments and improving the quality of life of these women.

O magnésio (Mg) é um íon intracelular, co-fator essencial de mais de 300 reações enzimáticas, envolvido principalmente nas reações de geração de energia (ATP). Sua deficiência tem sido associada a complicações durante a gravidez, como préeclâmpsia, eclâmpsia, restrição do crescimento fetal intrauterino e mortalidade fetal. Deste modo, este estudo observacional de corte transversal teve como objetivo avaliar o estado nutricional em Mg de mulheres saudáveis no terceiro trimestre gestacional atendidas no pré-natal do Hospital Universitário da Universidade de São Paulo. A amostra foi composta por 52 gestantes saudáveis, entre a 26ª e 42ª semana gestacional, com média de idade de 28,1 (5,9) anos, que realizavam pré-natal no HU/USP. Elas foram submetidas a avaliação antropométrica (peso e altura), dietética (Mg), por meio do recordatório alimentar de 24 h e registro alimentar de 3 dias, e bioquímica (Mg plasmático, eritrocitário e urinário). Foi observado que todas as gestantes tinham inadequação no consumo alimentar de Mg. Das gestantes, 38,5% apresentaram baixa excreção urinária de Mg, porém a concentração de Mg nos outros parâmetros, plasma e eritrócito, não mostrou deficiência deste mineral. Foram observadas correlações significativas entre a ingestão alimentar de Mg e as seguintes variáveis: pressão arterial sistólica (r = - 0,297; p = 0,032), Mg eritrocitário (r = 0,285; p = 0,041) e tendência a ser significativa com a pressão arterial diastólica (r = -0,247; p = 0,078). As gestantes atendidas no HU/USP apresentaram inapropriado consumo alimentar do Mg, que se refletiu em alterações na excreção urinária deste mineral, porém sem afetar os demais compartimentos biológicos estudados. / Magnesium (Mg) is an intracellular ion, an essential co-factor for over 300 enzymatic reactions, involved mainly in energy (ATP) generation. Its deficiency has been associated to complications during pregnancy such as preeclampsia, eclampsia, restriction to intrauterine fetal growth and fetal mortality. So, this observational cross-section study aimed to evaluate the nutritional status concerning Mg in healthy women in the third trimester of pregnancy received prenatal care at the University Hospital of the University of São Paulo (HU/USP). The sampling comprised 52 healthy pregnant women between the 26th and the 42nd week of pregnancy, with a mean age of 28.1 (5.9) years, who received prenatal care at the HU/USP. They were submitted to anthropometric (weight and height), dietary (Mg), through the food recall 24 h and food record of 3 days, and biochemical (plasma, erythrocytic and urinary Mg) evaluations. It was observed that all pregnant women presented an inadequate Mg intake from food. An amount of 38.5% of the pregnant women showed low urinary Mg excretion, but Mg concentrations within the other parameters, that is, plasma and erythrocytic Mg, did not show deficiency of this mineral. Significant correlations were observed between Mg intake from food and the following variables: systolic blood pressure (r = - 0.297; p = 0.032), erythrocytic Mg (r = 0.285; p = 0.041) and a trend to be significant with diastolic blood pressure (r = - 0.247; p = 0.078). The pregnant women assisted at HU/USP presented inadequate intake of Mg from food, which was reflected in alterations in the urinary excretion of this mineral, although it was not affected in the other biological compartments studied.

Alicerçado em trabalhos contidos na literatura internacional sobre a implicação dos micoplasmas nas aIterações do trato geniturinário e sobretudo nas chamadas \"falhas da reprodução\", o presente estudo teve como objetivo, além da introdução de uma tecnologia de pesquisa desses microrganismos acessível ao laboratório clínico de rotina diagnóstica, também determinar as taxas de colonização de Mycoplasma hominis e de Ureaplasma urealyticum em gestantes pertencentes a uma classe de baixo nível sócio-econômico. Estas gestantes, em número de 74 (setenta e quatro), foram divididas em dois grupos: um grupo de 37 (trinta e sete) gestantes que possuía histórico anterior de alterações perigestacionais como: abortos, natimortos, prematuros, etc., e que constituíram o Grupo de Risco; e o outro constituído de 37 (trinta e sete) gestantes com gestações anteriores normais, Grupo Controle. Utilizando-se os materiais e métodos adaptados às condições de nosso meio, foram encontrados os seguintes resultados: a proporção de micoplasmas isolada foi de 94,6% no grupo de risco e de 81,2% no grupo controle. Do grupo de risco, Ureaplasma urealyticum foi isolado de vlnte e um pacientes (56,8%), Mycoplasma hominis de dois (5,4%) e ambos foram encontrados em seis pacientes (16,2%). No grupo controle, Ureaplasma urealyticum foi encontrado em 18 pacientes (48,6%), Mycoplasma hominis não foi isolado de nehuma (0,0%), enquanto que a associação Ureaplasma urealyticum e Mycoplasma hominis foi observado em seis casos (16,2%). Foi ainda verificado que onze (30,5%) gestações terminaram anormalmente no grupo de risco, sendo quatro (11,1%) de pacientes que não possuíam quaisquer alterações clínicas que as justificassem. No grupo controle, nenhuma alteração foi verificada entre os casos notificados. A análise estatística, dos resultados, permitiu verificar que não houve diferenças significantes entre os grupos estudados. / Abstracts Not Available

Magister Public Health - MPH / Background: Early HIV testing is a crucial step for pregnant women in preventing mother-to-child transmission of HIV. In the public sector nearly all pregnant women presenting at antenatal clinics are screened for HIV. However, according to a large medical-aid administrator in South Africa, only 21.96% of pregnant women on their medical aid claimed for an HIV test as part of their antenatal care in 2012. Despite having frequent opportunities when consulting with pregnant women, general practitioners tend to be reluctant to offer HIV screening to these privately insured patients. In South Africa, private sector general practitioners are reimbursed for their services at pre-determined, negotiated rates. Previous studies indicate that monetary incentives over and above the negotiated rate may motivate health providers to promote screening to patients, and this may lead to increases in the uptake of testing. Due to limited resources within the public health sector, general practitioners are seen as key resources in a public private partnership to assist government achieve strategic health outcomes such as improved access to quality healthcare and improved compliance to treatment plans. Methodology: A quasi-experimental, ‘before and after’ study design, was conducted among 2,934 Metropolitan Health network general practitioners in South Africa who managed a pregnant woman on a medical aid. The same populations of general practitioners were used in the pre and post analysis with the general practitioners receiving information about the benefits of HIV testing in pregnant women before and after. The only difference was with the intervention related to a new HIV Counselling and Testing incentive process. Data was extracted from the billing system of a private medical insurance company in South Africa>. Quantitative data and stratification was analysed using the Statistical Package for the Social Science software, version 16.0 and Epi Info version 7.1.0.6. The effectiveness of the intervention was assessed by comparing the pre intervention period between April 2011 and September 2012, and post intervention period between March 2013 and August 2014. A subgroup analysis was done to determine variations in the name it, by general practitioners and patient characteristics. Results: There was no significant difference in HIV testing by general practitioners in this network preand post the intervention (21.99% vs. 21.96%, p=0.939). Compared to general practitioners aged 25-44 years, general practitioners older than 65 years old were 13% less likely to test (OR 0.87, CI: 0.74-1.01) and general practitioners between 45 and 65 years were 9% less likely to do an HIV test (OR 0.91, CI: 0.85-0.98). This study found that as patients’ age increased, they were more likely to be tested: beneficiaries aged 35- 44 years were 15% more likely to be tested compared to beneficiaries aged 15-24 years (OR 1.15, CI: 1.1-1.21). Beneficiaries who had a vaginal delivery were less likely to be tested compared to women who chose caesarean as a delivery method (OR 0.87, CI: 0.84-0.9). Medium income beneficiaries were more likely to be tested compared to low income beneficiaries (OR 1.09 CI: 1.03-1.16) and beneficiaries from the “high income” scheme grouping were less likely to be tested (OR 0.87, CI: 0.82-0.92) compared to the low income scheme grouping. The timing and frequency rates of HIV testing, for both caesarean and vaginal deliveries, occurred most between months two and six, peaking at month four. Overall, Eastern Cape and Mpumalanga had the lowest testing rates compared to all the other provinces (OR 0.96 CI: 0.89-1.05). Conclusions: Most general practitioners’ HIV testing rates of pregnant women in the private sector behaviour analysed in this study remained the same, despite the presence of a financial incentive. This study’s findings suggest that healthcare provider behaviour to comply with clinical guidelines and best practice, has no association with the presence of financial incentives, especially with increased administration tasks to access the incentive. These study findings emphasise the need to continue to strive for improved compliance especially by older general practitioners’ to adhere to clinical best practice and national HIV screening guidelines of pregnant women. The aspiration of achieving the highest quality of care in both private and public sector are principles that should continue to be pursued especially where private sector general practitioners’ will be used to offer public health services in the future National Health Insurance.

No description available.

People who have been diagnosed HIV positive often experience distress and anxiety due to uncertainties pertaining to the implications of an HIV positive status. These individuals are often reluctant to seek counselling and treatment due to the fear of being rejected and discriminated against (Parker, et al., 2002). There are limited formal networks for HIV support and psychological help in the South African context. Considering this, structured support groups were implemented for recently diagnosed HIV positive pregnant women. These women were recruited from ante natal clinics in Atteridgeville and Mamelodi as part of the Serithi project. Six support groups were implemented and facilitated by various experts including Masters students, of whom the researcher was part. This project is part of the larger study of the Serithi project in which interviews were conducted with three hundred and seventeen HIV positive pregnant women from disadvantaged locations of Tshwane. Based on these interviews, a support group intervention was developed. This research forms part of the evaluation of the support group intervention. The aim of this study was to explore the experiences of women who attended the support groups. Women who had attended 7-10 sessions were selected and interviewed individually using semi-structured interviews. With the permission of the participants, the discussions were tape recorded and transcribed. The data was analyzed, using qualitative research methods, from an interpretative phenomenological approach. This involved systematically studying meanings, themes and general descriptions of experiences by the research participants. The main findings in this study showed that women who participated in support groups adopted positive coping and behaviour that is conducive to their livelihood, learned more about HIV and AIDS, seem to have a positive future outlook and are overall empowered. These findings support previous research and literature in regards to the importance of social support in the form of support groups in effectively assisting HIV positive women in their journey to adjust to psychosocial consequence of the disease. / Dissertation (MA)--University of Pretoria, 2012. / Psychology / unrestricted

In order to determine the effects of aerobic fitness on pregnancy and the newborn 20 primigravid subjects were studied throughout their gestational period and immediately post-partum. The subjects were classified as trained (T=10) or untrained (UT=10) based on the heart rate response to submaximal cycle ergometry testing done in each trimester. Case room reports were reviewed after delivery. There was no difference between groups in the length of gestational period (T=40.75;UT=40.75 weeks) nor weight gained versus prepregnancy measures (T=13.92; UT=13.30 kgs). The first stage of labour was extended in the UT, 13hrs.58.8min. vs 1lhrs.18.Omin. UT had a longer second stage, 90.57 vs 70.0 mins. for T. Stage 3 was also prolonged in UT, 15.17 vs 7.43 mins. In both groups analgesia and/or anaesthesia was used equally. Two of the 10 T females had caesarean sections vs 3 of the 10 in the UT group. The mean apgar scores at 1 and 5 minutes were: T=7.70, 9.20; UT=7.90, 9.33, respectively. The birth weights of the T babies were marginally larger than the UT newborns (3733.00 vs 3679.97 gms). The T newborns were 8 males and 2 females, and the UT were 5 males and 5 females. All babies were healthy and without apparent abnormalities. There appears to be no positive or negative effects of maternal fitness on the newborn. The reduction in the active stage of labour in the T group may reflect their improved fitness levels. / Education, Faculty of / Curriculum and Pedagogy (EDCP), Department of / Graduate

No description available.

Orientador: Elaine Pereira da Silva Tagliaferro / Resumo: O trabalho está dividido em duas publicações cujos objetivos foram: a) realizar uma revisão integrativa da literatura, identificando e descrevendo a intenção de amamentar em gestantes e fatores associados (Publicação 1); b) investigar o nível da intenção de amamentar e variáveis associadas entre gestantes que estão no terceiro trimestre de gravidez (Publicação 2). Para a Publicação 1, foram consultadas as bases de dados Medical Literature Analysis and Retrieval System Online (PubMed/Medline), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) e Scopus, através dos descritores intenção/intention and aleitamento materno/breastfeeding or breast feeding por três revisores independentes. A Publicação 2 é um estudo observacional transversal, realizado mediante a coleta de dados em entrevista e questionário semi-estruturado e autoadministrado. A pesquisa foi realizada com 653 gestantes no terceiro trimestre de gestação. Para a variável resposta intenção de amamentar foi utilizada a escala Infant Feeding Intentions (IFI), traduzida e adaptada para o português do Brasil. As variáveis independentes incluíram características demográficas e socioeconômicas, da gestação, do aleitamento materno, da família, de assistência à saúde, biológicas e hábitos. A revisão integrativa realizada na Publicação 1 incluiu 17 estudos transversais quantitativos/mistos desfecho para intenção de amamentar de forma exclusiva em gestantes. Observou-se variação da prevalência da intenção de a... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

MCur / Department of Advanced Nursing Science / Antenatal care is the health care that women receive during pregnancy before the delivery of a baby; it aims to detect and treat existing health problems and to screen for complications that may develop in pregnancy. The aim of the study was to explore and describe knowledge and attitudes of pregnant women towards antenatal care services in Mbombela Municipality, Mpumalanga Province, South Africa. A qualitative, explorative, descriptive and contextual approach was used. The sample selected for the study from the population of pregnant women consisted of 18 pregnant women who attended ANC at six PHC facilities in Mbombela Municipality. Non-probability, purposive sampling was used to select the PHC facilities and the participants. Data was collected through in-depth individual interviews. The open coding method was used to analyse the data. To ensure that ethical considerations were taken into consideration, permission to conduct the study was obtained from the University of Venda Ethics Committee and the Mpumalanga Department of Health. Participation in the study was voluntary and the ethically approved protocol of informed consent, anonymity and confidentiality were adhered to. Trustworthiness was ensured by considering the criteria of transferability, credibility, dependability and applicability. The results from the study indicated that pregnant women knew about ANC services, but their knowledge of the best time to initiate ANC, as well as the procedures and importance of ANC was poor. The study found that the participants had favourable and unfavourable attitudes to ANC services. This indicates that there is a need for intensive health education regarding ANC services in the area. Findings from the study led to recommendations that there is a need to review ANC programmes to improve the knowledge of pregnant women and communities and also to address the challenges faced by women when accessing ANC services. / NRF