Thesis (M.A.)--Georgia State University, 2005. / Title from title screen. Greg Jurkovic, committee chair; Sarah Cook, Julia Perilla, committee members. Electronic text (47 p.) : digital, PDF file. Description based on contents viewed June 19, 2007. Includes bibliographical references (p. 41-46).

Thesis (M.A.)--Duquesne University, 2009. / Title from document title page. Abstract included in electronic submission form. Includes bibliographical references (p. 56-62) and index.

Thesis (M.S.H.P.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / IMPORTANCE: With greater access to health care through health care reform it is important to know if quality of care for similar complaints differs across clinical settings. OBJECTIVE: Develop and pilot a chart review instrument to measure quality of care for patients presenting with urethritis and vaginitis. METHODS: List of sexually transmitted infection (STI) quality of care measures was reviewed by a panel of five STI experts representing Emergency Department (ED), Obstetrics/Gynecology (Ob/Gyn), Family Medicine (FM), Primary Care (PC) and Infectious Disease. Panel members grouped each measure into “standard” or “exceeds standard of care” in evaluation and management of male patients with penile discharge/dysuria or female patients with vaginal discharge. The chart review instrument was piloted on 50 charts per gender from the STI Clinic and matched charts, by patient presenting complaint, age, gender, and visit date, from PC, FM, ED, and Ob/Gyn (for vaginal discharge) in the same large safety-net hospital in Massachusetts. RESULTS: Twenty-four and 34 final measures in male and female patients, respectively, were selected on plurality of expert panel member’s categorization into “standard of care”. Measures were grouped into 7 clinical domains: history, examination, laboratory testing, additional screening, assessment, treatment, and counseling. Performance on the 7 domains ranged from 3.16-4.36 on male patients and 3.17-4.40 on female patients, with the highest scores in the STI Clinic. However, each clinical setting had particular documentation strengths and weaknesses: STI Clinic scored higher on laboratory testing, additional screening, and counseling, but scored lower on examination and assessment; ED scored higher on examination and treatment; PC and FM scored higher on laboratory testing for male patients and on examination and treatment for female patients; Ob/Gyn scored higher on treatment. All sites other than the STI Clinic scored poorly on additional screening and counseling. CONCLUSIONS: An instrument to discern standard of care and identify strengths and weaknesses in specific domains of clinical documentation for patients presenting with STI complaints can be rapidly developed and implemented to evaluate quality of care across care settings. Further research is needed on whether these findings can be integrated into site-specific quality improvement processes and linked to cost analyses. / 2031-01-01

As doenÃas sexualmente transmissÃveis (DST), o vÃrus da imunodeficiÃncia humana (HIV) e a sÃndrome da imunodeficiÃncia adquirida (Aids) constituem significativos problemas de saÃde pÃblica no Brasil e no mundo. Qualquer pessoa sexualmente ativa pode adquirir DST/HIV/Aids. Entretanto, o adolescente à considerado sujeito bastante vulnerÃvel. O estudo apresenta como objetivo geral avaliar a atuaÃÃo de enfermeiros na prevenÃÃo de DST/Aids com adolescentes no Programa SaÃde na Escola. Pesquisa de avaliaÃÃo com abordagem quanti-qualitativa, realizada de janeiro a novembro de 2013. Os sujeitos do estudo foram setenta e oito enfermeiros que atuavam no Programa SaÃde na Escola (PSE) de Fortaleza, CearÃ, Brasil. Para coleta de dados, foi adotada a entrevista semiestruturada e o checklist. Para organizaÃÃo e anÃlise dos dados, foi tomado por referÃncia o MÃtodo de InterpretaÃÃo dos Sentidos e a anÃlise estatÃstica descritiva por meio do software Excel. A pesquisa foi aprovada pelo Comità de Ãtica em Pesquisa da Universidade Federal do CearÃ, conforme parecer de n 209.337 de 28/02/2013. Os resultados apresentam que a grande maioria dos sujeitos da pesquisa nÃo realizou satisfatoriamente as aÃÃes preconizadas pelo MinistÃrio da SaÃde para o PSE e, por conseguinte, nÃo alcanÃaram os resultados esperados na linha de aÃÃo EducaÃÃo para SaÃde Sexual, SaÃde Reprodutiva e PrevenÃÃo das DST/Aids e de Hepatites Virais. Assim, por meio do checklist, a maioria afirma que nÃo foram realizados e alcanÃados as seguintes aÃÃes e resultados: nÃo houve, de forma contÃnua, encontros de mobilizaÃÃo e sensibilizaÃÃo na Ãrea; atividades que utilizassem metodologias participativas; formaÃÃo de estudantes nos temas; envolvimento dos educandos no planejamento, execuÃÃo e avaliaÃÃo das atividades; debates com a comunidade escolar sobre a importÃncia da participaÃÃo juvenil; inclusÃo das temÃticas nos projetos polÃtico-pedagÃgicos das escolas; aÃÃes educativas e participativas sobre os temas; adesÃo dos educandos e da comunidade escolar Ãs atividades desenvolvidas e disponibilizaÃÃo de preservativos nas escolas. Contudo, à oportuno destacar que alguns sujeitos do estudo afirmaram por meio de depoimentos que tais aÃÃes foram desenvolvidas com a periodicidade devida, utilizando-se de estratÃgias apropriadas. Todavia, importantes obstÃculos foram encontrados para a nÃo efetivaÃÃo dessas aÃÃes pela maioria dos profissionais, que perpassam por aspectos profissionais (habilidades e competÃncias), administrativos e gerenciais (papel das instÃncias gestoras envolvidas no programa) e do pÃblico envolvido (adolescentes e famÃlias). Neste sentido, o estudo obteve informaÃÃes fundamentais que sugerem a necessidade de modificaÃÃes urgentes no programa, a fim de que a atuaÃÃo do enfermeiro venha ser capaz de colaborar, de fato, na promoÃÃo da saÃde sexual e reprodutiva de adolescentes assistidos pelo PSE. E, nÃo somente isso, mas para que estes e os demais atores envolvidos consigam cumprir o objetivo central do programa de promover formaÃÃo e atenÃÃo integral a estudantes, levando a uma melhoria da qualidade de vida e saÃde destes sujeitos. / Sexually transmitted diseases (STDs), human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (Aids) represent significant public health problems in Brazil and the whole world. Any sexually active person is susceptible to contract STD/HIV/AIDS. Nonetheless, adolescents are considered very vulnerable subjects. The main objective of this study is to assess the performance of nurses in the prevention of STD/AIDS with adolescents in the School Health Program. This is an evaluation research with quantitative and qualitative approach, conducted from January to November 2013. The subjects in study were 78 nurses working in the School Health Program (SHP) in Fortaleza, CearÃ, Brazil. For data collection, we applied the semi-structured interview and the checklist. For data organization and analysis, we used the Method of Meanings Interpretation as reference and the descriptive statistical analysis through the Excel software. The Research Ethics Committee of the Universidade Federal do CearÃ, under protocol No. 209.337 of February 28, 2013, approved the study. The results show that the vast majority of the subjects in study did not satisfactorily perform the actions recommended by the Ministry of Health for the SHP and therefore did not achieve the expected results in the course of action on Education for Sexual Health, Reproductive Health, and Prevention of STD/AIDS and Viral Hepatitis. Thus, through the checklist, most people reported they did not perform nor achieve the following actions and results: continuous mobilization and sensitization meetings in the area; activities that used participatory methodologies; students training on the themes; students involvement in planning, implementation and evaluation of activities; discussions with the school community about the importance of adolescents participation; inclusion of themes in the political-educational school projects; educational and participatory activities on the themes; adherence of students and school community to the activities developed; and the provision of condoms in schools. However, it is worth mentioning that some subjects in study, through the interviews, reported that such actions happened with the proper periodicity, using appropriate strategies. Nevertheless, we identified several barriers for the non-implementation of these actions by most professionals, involving professional aspects (skills and competencies), administrative and managerial aspects (role of management levels involved in the program), and aspects of the public in question (adolescents and families). In this sense, the study obtained essential information that point to the need for urgent modifications in the program, so that the nursesâ performance collaborates effectively to the promotion of sexual and reproductive health of adolescents assisted by the SHP. Also, for these and the other actors involved fulfill the main objective of the program, which is promoting education and comprehensive care for students, thus leading to an improved quality of life and health of these subjects.

CoordenaÃÃo de AperfeÃoamento de Pessoal de NÃvel Superior / No panorama das DST/HIV/AIDS entre os adolescentes, a estratÃgia para controlar a transmissÃo à a prevenÃÃo, a fim de promover a sua saÃde. Na perspectiva de implementar novas estratÃgias, considerando as caracterÃsticas da adolescÃncia, sua vulnerabilidade, e da carÃncia de aÃÃes educativas a longo prazo, utilizou-se neste estudo, uma nova proposta adotada na escola: o plantÃo educativo individual do adolescente. Assim, o objetivo geral desta pesquisa foi avaliar a aplicaÃÃo de um plantÃo educativo sobre DST/HIV/AIDS com adolescentes de uma escola pÃblica em Imperatriz â MA. Pesquisa de intervenÃÃo, quase-experimental, quantiqualitativa, com delineamento longitudinal. Foram avaliados 250 adolescentes escolares entre janeiro e junho de 2013 em trÃs etapas. Na primeira, os adolescentes responderam um instrumento sobre o conhecimento, os comportamentos e as atitudes frente Ãs DST/HIV/AIDS antes de participar da intervenÃÃo educativa. Na segunda etapa, os estudantes participaram do plantÃo educativo. Na terceira etapa, os adolescentes responderam novamente um instrumento para avaliar se houve mudanÃa nos conhecimentos, comportamentos e nas atitudes em relaÃÃo Ãs DST/HIV/AIDS, 30 dias apÃs a intervenÃÃo educativa. Analisaram-se na amostra estratificada as caracterÃsticas sociodemogrÃficas, o conhecimento dos adolescentes quanto ao acesso e uso de serviÃos de saÃde, as fontes de informaÃÃo utilizadas sobre DST/HIV/AIDS, e, os conhecimentos, comportamentos e as atitudes quanto Ãs prÃticas sexuais seguras frente Ãs DST/HIV/AIDS antes e depois da intervenÃÃo educativa. Os dados foram analisados no software estatÃstico STATA versÃo 8.0. Os adolescentes possuem mÃdia de 15,5 anos de idade, sÃo solteiros (as) sem parceiro (a) fixo (75,6%), com predomÃnio do sexo feminino (52,4%) e renda familiar entre um e trÃs salÃrios mÃnimos (46%). Verificaram-se tendÃncias de aumento proporcional estatisticamente significante por sexo (p-valor=0,00), evidenciando maior nÃvel de instruÃÃo dos pais dos meninos. Houve tendÃncia de aumento estatisticamente significante com relaÃÃo ao sexo dos entrevistados (p-valor=0,02), sinalizando menor rendimento familiar entre as meninas. A maioria dos estudantes nÃo tem indicaÃÃo de serviÃos de saÃde pela escola (79,6%). As principais fontes de informaÃÃo fora da escola sobre DST/HIV/AIDS sÃo rÃdio/televisÃo/jornal (54%). Os adolescentes aumentaram o conhecimento sobre os sintomas (99,2%), as formas de transmissÃo da AIDS (100%) e o uso do preservativo para prevenir DST/HIV/AIDS (100%). Parcela substancial dos adolescentes (98,4%) acredita nÃo ter nenhuma possibilidade de adquirir o HIV. Os que tÃm atividade sexual possuem um parceiro (56,3%) e usaram preservativo na Ãltima relaÃÃo sexual (65,7%). Os adolescentes avaliaram o plantÃo educativo como muito bom (77,6%), referiram ter mudado os conhecimentos e os comportamentos em relaÃÃo Ãs DST/AIDS para melhor (79,6%) e manter o uso do preservativo nas relaÃÃes sexuais. Portanto, o plantÃo educativo na escola pode ser considerado uma nova estratÃgia de educaÃÃo em saÃde, jà que aumentou nos adolescentes o conhecimento e a adesÃo a comportamentos saudÃveis para a prevenÃÃo de DST/HIV/AIDS. / In the panorama of STD / HIV / AIDS among adolescents, the strategy is to control the transmission prevention in order to promote their health. From the perspective of implementing new strategies, considering the characteristics of adolescence, their vulnerability, and lack of educational long term was used in this study, a new proposal adopted in school: the duty of the individual educational teenager. The objective of this research was to evaluate the application of a duty education on STD / HIV / AIDS with adolescents from a public school in Imperatriz - MA. Intervention research, quasi-experimental, quantiqualitative, with a longitudinal design. Were evaluated 250 adolescent students between January and June 2013 in three stages. At first, the adolescents completed an instrument of knowledge, behaviors and attitudes of STD / HIV / AIDS before attending the educational intervention. In the second stage, students participated in educational duty. In the third stage, adolescents responded again an instrument to assess whether there was a change in knowledge, attitudes and behaviors related to STD / HIV / AIDS, 30 days after the educational intervention. Analyzed in stratified sample sociodemographic characteristics, knowledge of adolescents regarding the access and use of health services, the sources of information used on STD / HIV / AIDS, and the knowledge, behaviors and attitudes regarding safe sex practices forward to STD / HIV / AIDS before and after the educational intervention. The data were analyzed with statistical software STATA version 8.0. Adolescents have an average of 15.5 years of age, are unmarried (as) without a partner (a) fixed (75.6 %), predominantly female (52.4 %) and family income between one and three minimum wages (46 %). There were trends proportional increase was statistically significant by gender (p - value = 0.00), indicating higher levels of parental education of boys. There was a statistically significant increasing trend with respect to sex of respondents (p - value = 0.02), indicating lower household income among girls. Most students have no indication of health services by the school (79.6 %). The main sources of information outside of school on STD / HIV / AIDS are radio / TV / newspaper (54 %). Adolescents increased knowledge about the symptoms (99.2 %), the modes of transmission of AIDS (100 %) and the use of condoms to prevent STD / HIV / AIDS (100 %). Substantial portion of adolescents (98.4 %) believe have no chance of acquiring HIV. Those who have sexual activity have a partner (56.3 %) and condom use at last intercourse (65.7 %). Adolescents evaluated the educational duty as very good (77.6 %) reported having changed the knowledge and behaviors related to STD / AIDS to better (79.6 %) and maintain the use of condoms during sexual intercourse. Therefore, the shift in school education can be considered a new strategy of health education; it increased in adolescentâs knowledge and adherence to healthy behaviors for the prevention of STD / HIV / AIDS.

FundaÃÃo de Amparo a CiÃncia e Tecnologia de Pernambuco / O ensino e as pesquisas na Ãrea de enfermagem tÃm procurado adequar-se aos avanÃos das tecnologias de informaÃÃo e comunicaÃÃo. Percebeu-se entÃo a importÃncia de investigar a utilizaÃÃo de uma tecnologia digital na aprendizagem dos futuros profissionais de saÃde, em face da repercussÃo das infecÃÃes sexuais no sistema de saÃde e a relevÃncia da temÃtica para a formaÃÃo do enfermeiro. O foco desta investigaÃÃo foi avaliar o resultado da utilizaÃÃo de hipermÃdia educativa para aprendizagem de acadÃmicos de enfermagem sobre doenÃas sexualmente transmissÃveis. Trata-se de um estudo quase-experimental, aprovado pelo Comità de Ãtica em Pesquisa da Universidade Federal do CearÃ. Estrutura-se em quatro etapas: 1) construÃÃo da hipermÃdia; 2) validaÃÃo por especialistas; 3) avaliaÃÃo da aprendizagem; e 4) avaliaÃÃo pelos alunos. Na primeira etapa, fez-se um amplo resgate da literatura de modo a disponibilizar as principais referÃncias e consensos existentes sobre a temÃtica. Selecionaram-se as mÃdias e elaboraram-se o guia do aluno, os objetivos acadÃmicos e o conteÃdo dos mÃdulos. A hipermÃdia foi hospedada no ambiente virtual de aprendizagem SOLAR. Na segunda etapa, a hipermÃdia foi validada por nove especialistas de conteÃdo e trÃs especialistas tÃcnicos, definidos a partir de parÃmetros adaptados da literatura. Obteve-se Ãndice de validade do conteÃdo geral de 0,97 nos itens avaliados (objetivo, conteÃdo, relevÃncia, ambiente, funcionalidade, usabilidade e eficiÃncia). Na terceira etapa, participaram 58 acadÃmicos de enfermagem divididos em dois grupos semelhantes (controle e intervenÃÃo). O grupo controle participou da aula tradicional e o grupo intervenÃÃo utilizou a hipermÃdia no ambiente virtual de aprendizagem. Ambos responderam a um questionÃrio validado sobre o tema (prà e pÃs-teste). No pÃs-teste, a mÃdia de acertos obteve ganho de 4,20 (30,95%) questÃes no grupo controle e 6,65 (54,46%) questÃes no grupo intervenÃÃo. Hà evidÃncia de aumento da mÃdia no pÃs-teste (p=0,00) do grupo intervenÃÃo apontando a aprendizagem online como estratÃgia tÃo eficaz quanto a presencial e que pode ser utilizada como recurso de ensino complementar na formaÃÃo de enfermeiros. Na quarta etapa, a maioria dos acadÃmicos de enfermagem avaliou a hipermÃdia como adequada, tendo como base os antecedentes do conceito aprendizagem online (interaÃÃo e estÃmulo, ferramentas de comunicaÃÃo, material didÃtico, interesse e motivaÃÃo para aprender, dedicaÃÃo, disciplina e gerenciamento de tempo, papel do aluno). A atitude do aluno referente à motivaÃÃo (p=0,001) e ao fato dele acreditar ser responsÃvel por sua aprendizagem (p=0,004) tiveram relaÃÃo estatisticamente significativa no aumento do nÃmero de acertos do pÃs-teste. Conclui-se que a hipermÃdia sobre doenÃas sexualmente transmissÃveis està apta a facilitar o processo de ensino/aprendizagem dos acadÃmicos de enfermagem. Constitui-se em uma ferramenta de apoio ao ensino presencial que colabora com o processo de formaÃÃo profissional, tornando a aprendizagem ativa e significativa.

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.

As doenÃas sexualmente transmissÃveis (DST) sÃo importante causa de morbidade em todo o mundo, com considerÃveis repercussÃes mÃdicas, sociais e econÃmicas. Para traÃar o perfil epidemiolÃgico das DST em mulheres em idade fÃrtil de um pequeno municÃpio do interior do CearÃ, foi realizado um estudo de base populacional em Pacoti em janeiro e fevereiro de 2001. O estudo consistiu em questionÃrios estruturados, exame ginecolÃgico e diagnÃstico laboratorial para detecÃÃo de HPV, clamÃdia, tricomonas, gonorrÃia, sÃfilis e HIV. Participaram do estudo 734 mulheres entre 12 e 49 anos da zona urbana e rural do municÃpio (75% da populaÃÃo-alvo). Dentre essas, 592 haviam iniciado vida sexual e foram incluÃdas na anÃlise. As taxas de prevalÃncia foram: HPV 11,7% (IC 95%: 9,3-14,7), clamÃdia 4,5% (IC 95%: 3,0-6,6), tricomonas 4,1% (IC 95%: 2,7-6,1), gonorrÃia 1,2% (IC 95%: 0,5-2,6) e sÃfilis 0,2% (IC 95%: 0,0-1,1). Nenhum exame para HIV foi positivo. Apresentaram pelo menos uma DST 19,6% (IC 95%: 16,5-23,2) das mulheres. As DST foram mais prevalentes entre as adolescentes. A prevenÃÃo do cÃncer ginecolÃgico anterior mostrou forte efeito protetor contra ter DST (OR=0,4; IC 95%: 0,2-0,6). Foram identificados os seguintes fatores de risco: >2 parceiros na vida (OR=2,8; IC 95%: 1,8-4,4), idade da primeira gestaÃÃo <16 anos (OR=2,1; IC 95%: 1,1-4,1), nÃo saber se o parceiro tem outra parceira (OR=1,7; IC 95%: 1,0- 2,8), idade <20 anos (OR=1,9; IC 95%: 1,1-3,4), >1 parceiro nos Ãltimos 12 meses (OR=3,0, IC 95%: 1,4-6,7), inÃcio precoce da vida sexual (OR=2,0; IC 95%: 1,3-3,1) e nÃo habitar com o parceiro (OR=1,7; IC 95%: 1,1-2,7). Nenhum fator sÃcio-econÃmico mostrou associaÃÃo significativa a ter uma DST. O fator protetor e os primeiros trÃs fatores de risco acima mencionados foram independentemente associados a ter DST no modelo multivariado. As DST representam um importante problema na populaÃÃo estudada, e a identificaÃÃo dos fatores protetores e de risco pode orientar a implementaÃÃo de medidas de controle especÃficas que respeitem particularidades de gÃnero e faixa etÃria. O presente estudo permite inferir sobre a epidemiologia das DST em outros municÃpios de perfil semelhante. / Sexually transmitted diseases (STD) are an important cause of morbidity throughout the world with considerable medical and socio-economic repercussions. To assess the epidemiological situation of STD among women of reproductive age in a small municipality in the hinterland of CearÃ, a population-based study was conducted in January and February 2001. The study consisted of application of structured questionnaires, gynecological examination and laboratory diagnosis to detect HPV, chlamydia, trichomonas, gonorrhea, syphilis and HIV. A total of 734 women aged 12 to 49 years participated in the study (75% of the target population). Among these, 592 had initiated sexual life and were included in the present analysis. The following prevalences were found: HPV 11,7% (IC 95%: 9,3-14,7), chlamydia 4,5% (IC 95%: 3,0-6,6), trichomonas 4,1% (IC 95%: 2,7-6,1), gonorrhea 1,2% (IC 95%: 0,5-2,6) and syphilis 0,2% (IC 95%: 0,0-1,1). There was no case of HIV infection. At least one STD was detected in 19,6% (IC 95%: 16,5-23,2). STD were more prevalent among adolescents. A previous pap smear collection showed an important protective effect against STD (OR=0,4; IC 95%: 0,2-0,6). The following risk factors were identified: >2 partners in life (OR=2,8; IC 95%: 1,8-4,4), first pregnancy <16 years of age (OR=2,1; IC 95%: 1,1-4,1), not knowing if the partner has another partner (OR=1,7; IC 95%: 1,0-2,8), being <20 years of age (OR=1,9; IC 95%: 1,1-3,4), >1 partner in the last 12 months (OR=3,0; IC 95%: 1,4-6,7), early sexual debut (OR=2,0; IC 95%: 1,3-3,1) and not living with a partner (OR=1,7; IC 95%: 1,1-2,7). There was no significant association between STD and socio-economic variables. The above mentioned protective factor and the first three risk factors were independently associated with STD in the multivariate analysis. STD represent an important problem in the population studied, and the identification of protective and risk factors can guide the implementation of gender and age specific control measures. The present study allows to conclude about the STD epidemiology in other municipalities with similar characteristics.

This study investigated the nature of the relationship among child sexual abuse, interpersonal relationship capacity and psychological adjustment. Interpersonal relationship capacity included the constructs of attachment, measured by the Relationship Questionnaire, and object relations functioning, measured by the Bell Object Relations and Reality Testing Inventory. Psychological adjustment included the constructs of trauma-related symptoms, measured by the Trauma Symptom Inventory and supplemented by the Posttraumatic Stress Diagnostic Scale, and interpersonal problems, measured by the Inventory of Interpersonal Problems. Participants were 118 women from a clinical and community sample, including 58 women who reported a history of child sexual abuse and 60 women who reported no such history. Thirty-three women reported a history of intrafamilial child sexual abuse or both intrafamilial and extrafamilial child sexual abuse and 26 women reported a history of extrafamilial child sexual abuse only. The pattern of results indicated that child sexual abuse predicted both interpersonal relationship capacity and psychological adjustment and that interpersonal relationship capacity predicted psychological adjustment. In addition, a mediational model in which interpersonal relationship capacity mediates the relationship between child sexual abuse and psychological adjustment was supported. This suggests that relationship capacity may be a process through which the impact of child sexual abuse influences later psychological adjustment. No differences were found between women who had experienced intrafamilial child sexual abuse and women who had experienced extrafamilial child sexual abuse. When the separate components of each construct in the model were considered, attachment mediated the relationship between child sexual abuse and trauma-related symptoms and also mediated the relationship between child sexual abuse and interpersonal problems. Object relations functioning mediated the relationship between child sexual abuse and trauma-related symptoms, but did not mediate the relationship between child sexual abuse and interpersonal problems. Again, no differences were found between women who had experienced intrafamilial child sexual abuse and women who had experienced extrafamilial child sexual abuse. Results are discussed in terms of the implications for appropriate therapy approaches with survivors of child sexual abuse. / Graduate

M.A. / The study aimed to investigate the subjective experiences of sexually abused children who testify in criminal courts in South Africa. As few research studies have addressed this problem, particularly from a qualitative perspective, the researcher identified a need to explore the issue further. In addition, it was believed that it would be useful to examine the topic from a both-and perspective. In other words, to investigate the positive and the negative aspects of the experience. The impact of other systems, such as courtroom preparation programmes, and individuals on the research participants was also addressed by the study. The researcher's intention was to honour the four participant's individual narratives. Thus, working from a social constructionist framework was appropriate, as such a framework highlights the existence of multiple realities. Although there are similarities across the four narratives, each one represents a unique reality as experienced by the respective participants. The following points reflect some of the most salient findings of the research: • There appears to be a strong link between receiving positive support and coping with the task of testifying. • Attending a courtroom preparation programme seems to impact very favourably on a child's ability to testify in criminal court. • Testifying in sexual abuse cases can be both traumatic or stressful, for example, having to see and identify the alleged perpetrator, and healing or empowering, for example, being able to put an end to the abuse by speaking out. • Courtroom reforms have gone a long way towards improving conditions for child witnesses. Nevertheless, the current situation is still far from ideal as many inconsistencies and obstacles characterize the legal domain as it relates to child witnesses. • The participants emphasized that they have a right to be respected and heard. In order to respect and satisfy the rights and needs of child witnesses, further research needs to be undertaken to ascertain their actual needs. Children need to become active participants in the reform process.