[Characteristics of anticontraception methods used in São Paulo State, Brazil (correction)]

Venous thromboembolism in women: new challenges for an old disease

In countries that have controlled classic causes of maternal death, such as eclampsia and hemorrhage, venous thromboembolism (VTE) has become the major concern. Prevention of VTE during pregnancy and postpartum by applying guidelines and implementing pharmacoprophylaxis is still the best strategy to reduce occurrence of this complication. Hormonal contraceptives and hormone replacement therapy also increase the risk of VTE, but women cannot be deprived of their benefits, which increase their freedom at childbearing age and reduce their symptoms at menopause. Both indiscriminate use and unmotivated prohibition are inappropriate. Contraceptive and hormone replacement methods should be chosen with care, evaluating the patients’ contraindications, eligibility criteria, and autonomy. This article presents a nonsystematic review of recent literature with the aim of evaluating and summarizing the associations between VTE and clinical situations peculiar to women.

Differences in the Access to Sterilization between Women Living and Not Living with HIV: Results from the GENIH Study, Brazil

BACKGROUND

In many countries, young women of reproductive age have been especially affected by the HIV epidemic, which have fostered research to better understand how HIV infection influences and shapes women´s fertility and reproductive and sexual decisions. In Brazil, few studies have focused on the impact of the HIV epidemic on contraceptive choices among women living with HIV (WLHIV).

OBJECTIVE

This study evaluates the impact HIV infection may have in the access to female sterilization in Brazil, using a time-to-event analysis.

METHODS

A cross-sectional quantitative study (GENIH study) was conducted between February 2013 and April 2014 in the city of São Paulo, comparing two probabilistic samples of 975 WLHIV and 1,003 women not living with HIV (WNLHIV) aged 18 to 49. Sexual and reproductive data was collected retrospectively in order to reconstruct women's reproductive trajectories. Given the objectives of this study, the analysis was restricted to women with parity one or more and, in case of WLHIV, to those sterilized after HIV diagnosis and not infected through vertical transmission. The final sample analysis included 683 WNLHIV and 690 WLHIV. A series of multivariable-adjusted Cox models estimated the probability of being sterilized after HIV diagnosis, compared with WNLHIV. Models were adjusted for schooling, race/color, and stratified by parity at last delivery (1-2, 3+). Hazard ratios were calculated for female sterilization, and separately for interval and postpartum procedures (performed in conjunction with caesarean section or immediately after vaginal delivery). Additionally, information regarding unmet demand for female sterilization was also explored.

FINDINGS

No statistical difference in the overall risk of sterilization between WLHIV and WNLHIV in the two parity-related groups is observed: HR = 0.88 (0.54-1.43) and 0.94 (0.69-1.29), respectively, among women with 1-2 children and those with three and more. However, significant differences regarding the impact of HIV infection at sterilization are observed depending on the timing and the type of sterilization procedure. The probability of obtaining an interval sterilization is significantly lower for WLHIV compared to those not living with HIV. The reverse occurs regarding postpartum sterilization. Although sterilization is mainly performed in conjunction with caesarean section in Brazil, it is evident that caesarean sections are not the sole factor increasing the risk of sterilization among WLHIV.

CONCLUSION

The results indicate barriers in the access to services offering interval sterilization for WLHIV and certain facilitation in obtaining the procedure in conjunction with caesarean section. Health policy makers at local and national levels should promote institutional changes in order to facilitate access to interval sterilization and to confront the sensitive discussion of WLHIV's eligibility for postpartum sterilization. It is also urgent to increase access to a wider range of contraceptive methods for WLHIV and promote dual method protection strategies. Moreover, since condom use may decrease in the future in the context of the preventive effect of antiretroviral therapy, promoting dual methods will expand the choices regarding the reproductive rights of women living with HIV.

Comparison of postprandial lipemia between women who are on oral contraceptive methods and those who are not

BACKGROUND

Postprandial Lipemia (PPL) is a physiological process that reflects the ability of the body to metabolize lipids. Even though the influence of oral contraceptives (OC) on PPL is not known, it is a known fact that their use increases fasting lipid values.

OBJECTIVE

To compare the PPL between women who are on OC and those who are not.

METHODS

A prospective analytical study which assessed eutrophic women, aged between 18 and 28 years old, who were irregularly active and with fasting triglycerides ≤ 150 mg/dL. They were divided into two groups: oral contraceptive group (COG) and non-oral contraceptive group (NCOG). Volunteers were submitted to the PPL test, in which blood samples were collected in time 0 (12-hour fasting) and after the intake of lipids in times 180 and 240 minutes. In order to compare the triglyceride deltas, which reflect PPL, the two-tailed Mann-Whitney test was used for independent samples between fasting collections and 180 minutes (Δ1) and between fasting and 240 minutes (Δ2).

RESULTS

Forty women were assessed and equally divided between groups. In the fasting lipid profile, it was observed that HDL did not present significant differences and that triglycerides in COG were twice as high in comparison to NCOG. Medians of Δ1 and Δ2 presented significant differences in both comparisons (p ≤ 0.05).

CONCLUSION

The results point out that women who are irregularly active and use OC present more PPL in relation to those who do not use OC, which suggests that in this population, its chronic use increases the risk of heart conditions.

Burden of maternal bipolar disorder on at-risk offspring: a controlled study on family planning and maternal care

INTRODUCTION

Bipolar disorder (BD) is a highly incapacitating disease typically associated with high rates of familial dysfunction. Despite recent literature suggesting that maternal care is an important environmental factor in the development of behavioral disorders, it is unclear how much maternal care is dysfunctional in BD subjects.

OBJECTIVE

The objective of this study was to characterize maternal care in DSM-IV/SCID diagnosed BD type I subjects compared to healthy controls with (PD) and without (NPD) other psychiatric diagnoses.

MATERIALS AND METHODS

Thirty-four BD mothers and 106 controls underwent an interview about family planning and maternal care, obstetrical complications, and mother-child interactions. K-SADS-PL questions about violence exposure were used to ascertain domestic violence and physical/sexual abuse.

RESULTS

BD mothers were less likely to have stable unions (45.5%; p<0.01) or to live with the biological father of their children (33.3%; p<0.01), but had higher educational level and higher rates of social security use/retirement. They also had fewer children and used less contraceptive methods than controls. Children of BD women had higher rates of neonatal anoxia, and reported more physical abuse (16.1%; p=0.02) than offspring of NPD mothers. Due to BD mothers' symptoms, 33.3% of offspring suffered physical and/or psychological abuse.

LIMITATIONS

Post hoc analysis, and the use of questions as a surrogate of symptoms as opposed to validated instruments.

CONCLUSION

This is one of few reports confirming that maternal care given by BD women is dysfunctional. BD psychopathology can lead to poor maternal care and both should be considered important environmental risk factors in BD, suggesting that BD psychoeducation should include maternal care orientation.

[The satisfaction with surgical sterilization provision among the users of the unified health system in a city of São Paulo state]

OBJECTIVES

To evaluate the satisfaction with the surgical sterilization performed by Unified Health System (SUS) and to detect factors that can influence the choice between tubal ligation and vasectomy.

METHODS

A total of 235 women and 78 men who were sterilized in a five years time period were interviewed. The studied variables included their socio-demographic features, their reason for sterilization, their opinion on the access to the surgery, the counseling, hospital services and the satisfaction with the procedure.

RESULTS

Most were married or lived together, had an average of 3.4 living children and a mean of 6.7 years of schooling. They declared that the average monthly per capita income was R$ 212.81. The most of them belonged to the social status C. They were white and Catholics. The most of them found easy to obtain the surgery and the waiting time was appropriate. They become satisfied with the counseling and 99% were satisfied with sterilization. However, one fourth, incorrectly, found that sterilization was easy to reverse. A study on the couples showed important differences on choosing vasectomy or tubal ligation.

CONCLUSIONS

The results show that it is necessary for improvement in the information provided to the candidates to sterilization. Although they are satisfied now, they could not be in the future. The evaluation from the perspective of the health service user should take into account not only their opinion, but also their interests.

Atendimento à demanda pela esterilização cirúrgica na Região Metropolitana de Campinas, São Paulo, Brasil: percepção de gestores e profissionais dos serviços públicos de saúde

A presente pesquisa descreve a percepção de gestores e profissionais de serviços públicos de saúde de municípios da Região Metropolitana de Campinas, São Paulo, Brasil, acerca do atendimento à demanda pela esterilização cirúrgica voluntária. Trata-se de estudo qualitativo, em quatro municípios, onde se realizaram entrevistas semi-estruturadas com 26 gestores e profissionais de saúde envolvidos no atendimento às solicitações de esterilização cirúrgica. Apontaram-se dificuldades para agendamento de consultas nos ambulatórios de planejamento familiar ou centros de referência e número insuficiente de cirurgias que podiam ser agendadas semanalmente nos hospitais credenciados. Enfatizou-se a falta de estrutura física e recursos humanos tanto nas unidades básicas de saúde, quanto nos ambulatórios de planejamento familiar ou centros de referência. Houve críticas aos critérios legais para autorizar a esterilização, bem como se mencionaram adaptações para torná-los mais adequados à situação de cada município. Gestores e profissionais de saúde entendiam que, apesar dos esforços empenhados, o atendimento à demanda pela esterilização cirúrgica na Região Metropolitana de Campinas estava prejudicado pela centralização em ambulatórios de planejamento familiar ou centros de referência, que, na prática, tinham que suprir as deficiências da oferta de ações de planejamento familiar em geral na rede básica de cada município.

Frequency and characteristics of induced abortion among married and single women in São Paulo, Brazil

This article presents the results of a study in the city of São Paulo, Brazil, aimed at estimating the frequency of induced abortion among women 15 to 49 years of age. The objective was to characterize the occurrence of induced abortion by comparing the ideal number of children, age, and contraceptive use between married and single women. Based on random sampling, 1,749 interviews were held, including 764 married women, 658 single women, and 327 with other marital status. The analysis included: mean number of abortions per woman by analysis of variance and proportions of abortions and pregnancy, using the chi-square test. The mean abortion rate for married women (45 per thousand) did not differ statistically from that of single women. However, the pregnancy rate was much lower in single women, and when single women became pregnant they used abortion more frequently; while fewer than 2% of pregnancies in married women ended in induced abortions, among single women the abortion rate exceeded 18%. Therefore, the priority in the reproductive health field should be to invest in the supply and dissemination of appropriate contraceptive methods for women's early sexually active life.

Características reprodutivas e utilização de serviços preventivos em saúde por mulheres em idade fértil: resultados de dois estudos transversais de base populacional no extremo Sul do Brasil

Em 1995 e 2004 foram realizados dois estudos transversais representativos com mulheres de 15 a 49 anos em Rio Grande, Rio Grande do Sul, Brasil, visando avaliar alguns indicadores básicos de saúde. A amostra incluiu 1.339 mulheres em 1995 e 1.311 em 2004. Aplicou-se questionário padronizado no domicílio investigando sobre características demográficas, sócio-econômicas, reprodutivas e utilização de serviços preventivos de saúde. A análise consistiu em comparar estes indicadores nos dois estudos pelo teste do qui-quadrado. Observou-se melhoria nas condições de habitação, saneamento, escolaridade, mas piora da renda familiar. A idade média de início das atividades sexuais diminuiu, a taxa de gravidez na adolescência aumentou em 33% assim como aumentou a realização de exame citopatológico de colo uterino em 48% e mama em 30%. A utilização de métodos contraceptivos diminuiu 3%, enquanto o uso de preservativos masculinos passou de 8% para 21%. Esforços deveriam ser feitos não somente visando incentivar a realização de exames de mama e citopatológico de colo uterino como também de retardar o início das atividades sexuais e de promover o uso de métodos contraceptivos, especialmente de preservativos.

Uso de substâncias psicoativas e métodos contraceptivos pela população urbana brasileira, 2005

OBJETIVO: Analisar a relação entre os padrões de utilização de preservativos e outros métodos contraceptivos e o consumo de álcool e drogas. MÉTODOS: Estudo exploratório com base em dados de amostra probabilística com 5.040 entrevistados residentes em grandes regiões urbanas do Brasil, com idades entre 16 e 65 anos, em 2005. Os dados foram coletados por meio de questionários. Empregou-se a técnica de árvores de classificação Chi-square Automatic Interaction para estudar o uso de preservativos por parte de entrevistados de ambos os sexos e de outros métodos contraceptivos entre as mulheres na última relação sexual vaginal. RESULTADOS: Entre adultos jovens e de meia idade, de ambos os sexos, e jovens do sexo masculino vivendo relacionamentos estáveis, o uso de preservativos foi menos freqüente entre os que disseram utilizar substâncias psicoativas (álcool e/ou drogas ilícitas). O possível efeito modulador das substâncias psicoativas parece incidir de forma mais clara sobre as práticas anticoncepcionais de mulheres maduras, com inter-relações mais complexas, entre as mulheres mais jovens, onde a inserção em diferentes classes sociais parece desempenhar papel mais relevante. CONCLUSÕES: Apesar das limitações decorrentes de um estudo exploratório, o fato de se tratar de amostra representativa da população urbana brasileira, e não de populações vulneráveis, reforça a necessidade de implementar políticas públicas integradas dirigidas à população geral, referentes à prevenção do consumo de drogas, álcool, infecções sexualmente transmissíveis e HIV/Aids e da gravidez indesejada nos marcos de promoção da saúde sexual e reprodutiva.

Use of contraceptive methods by sexually active teenagers in Pelotas, Rio Grande do Sul State, Brazil

This study aimed to assess the prevalence of contraceptive use by adolescents. A cross-sectional study was performed from March to September 2002 in a representative sample of adolescents 15 to 18 years of age in the urban area of Pelotas, Rio Grande do Sul State, Brazil. Multiple-stage sampling was used, and in the 448 census tracts located in the urban area, 90 were sampled and households were visited in each tract. Information was collected on sexual initiation and use of contraceptive methods. Chi-square test was used to compare proportions. The sample included 960 adolescents. 88% of subjects reported the use of any contraceptive method. Condoms were the most commonly used method (63.2%). Low adolescent schooling was the only variable associated with increased risk of non-use of contraceptives. Condom use was higher among males, adolescents whose mothers had 9 or more years of schooling, and those reporting several sexual partners in the previous year. Condoms were the most commonly used contraceptive method.

Características dos candidatos à esterilização cirúrgica e os fatores associados ao tipo de procedimento

Em 1999, a Secretaria Municipal de Ribeirão Preto, São Paulo, Brasil, implantou a oferta de métodos de esterilização cirúrgicos, de acordo com a legislação vigente. Este estudo objetivou caracterizar os candidatos à esterilização cirúrgica e estudar as variáveis associadas ao tipo de procedimento. Foram pesquisados 95 prontuários de candidatos e realizada análise estatística por meio de regressão logística e do teste exato de Fisher, considerando-se o nível de significância de p = 0,05. A maioria dos candidatos são casais estáveis, de baixa escolaridade e baixa renda, satisfeitos com o número de filhos e que já haviam tentado limitar a prole com o uso de anticoncepcionais reversíveis. A média de idade era de 34,2 anos; 45,3% se submeteram à esterilização feminina; 35,8%, à vasectomia, e 18,9% não obtiveram o procedimento. A chance de o homem, com 35 anos ou mais, fazer vasectomia é 6,1 vezes a do homem mais jovem (OR = 6,1; IC95%: 2,4-16,4); submetem-se à vasectomia mais homens casados do que os que coabitam (OR = 4,0; IC95%: 1,5-12,4) e mulheres com quatro filhos ou mais fazem mais laqueadura do que aquelas com menos de quatro filhos (OR = 3,1; IC95%: 1,1-8,5).

Conhecimento sobre anticoncepcionais em uma população de 15 anos ou mais de uma cidade do Sul do Brasil

A prevalência de uso de anticoncepcional no Brasil é alta; porém, é freqüente seu uso incorreto e inadequado, sugerindo escasso conhecimento sobre os métodos. Assim, avaliou-se o conhecimento sobre métodos anticoncepcionais mais utilizados por meio de um escore (0-10) e fatores associados a este conhecimento. Foi realizado um estudo transversal de base populacional, com 3.542 indivíduos de 15 anos ou mais, residentes na zona urbana de Pelotas, Rio Grande do Sul. A média de escore de conhecimento foi de 4,65 (dp = 2,07), sendo 5,02 (dp = 2,10) para as mulheres e 4,18 (dp = 1,92) para os homens. Menor idade, maior escolaridade, relato de gravidez indesejada e uso de método anticoncepcional exclusivo ou combinado ao longo da vida mostraram-se associados a um maior escore de conhecimento entre os homens, enquanto, para as mulheres, os determinantes de maior conhecimento foram maior idade, viver com companheiro, maior escolaridade, melhor nível econômico, não ter religião e uso de método anticoncepcional exclusivo ou combinado ao longo da vida. Apesar da alta prevalência de uso de anticoncepcional (75,3%), é limitado o conhecimento sobre os métodos mais utilizados, ciclo menstrual e período fértil.

Factors associated with reproductive options in HIV-infected women

A cross-sectional study was conducted in Campinas, Brazil, in HIV-infected women to evaluate factors associated with reproductive practices. A total of 112 HIV-infected women, 13 to 45 years old, with previous sexual experience were included in the study. Three groups were compared: pregnant women aware of their infection before current pregnancy, sterilized women who had made their reproductive choice after serodiagnosis and women using any reversible contraceptive method. Fisher's Exact Test and multivariate correspondence analysis were used in the statistical analysis. Among women interviewed, 23% were pregnant, 18% had been sterilized and 59% were using a reversible contraceptive method. Being younger was associated with reproductive practices that preserved the possibility of having a child. Reversible contraceptive users had fewer pregnancies and more often reported a desire to have children compared to the other groups. Partner's desire for parenthood was associated with pregnant and sterilized women. The clinical condition of the women and their partners, the serologic status of partner nor counseling about contraceptive choices influenced reproductive practices.

Avaliação da assistência às gestantes: o caso do município de São José do Rio Preto, São Paulo, Brasil

OBJETIVOS: detectar mudanças em indicadores de qualidade da assistência às mulheres que tiveram filhos no município de São José do Rio Preto, entre 1997 e 2001, a partir da fixação de percentual máximo de cesarianas. MÉTODOS: a população alvo foi de mulheres residentes e que tiveram filhos nos hospitais do município em 1997 e 2001 e em especial aquelas atendidas por hospitais cuja maioria de leitos era financiada pelo Sistema Único de Saúde. Trata-se de estudo descritivo com desenho de corte transversal que utilizou dados primários e secundários. Os primários foram coletados através de inquérito domiciliar realizado por amostragem e os secundários obtidos das Declarações de Nascidos Vivos do Sistema de Nascidos Vivos. RESULTADOS: entre 1997 e 2001 constatou-se redução da gravidez na adolescência e aumento da escolaridade das mulheres. Observou-se que as proporções de cesárea diminuíram nos hospitais selecionados e que houve aumento no número de consultas no pré-natal. Não houve alterações no peso ao nascer, Apgar, idade gestacional e nas proporções das mulheres que achavam o parto normal o mais indicado. Os indicadores relacionados com a amamentação apresentaram melhoria. CONCLUSÕES: verificou-se a melhoria em alguns dos indicadores avaliados, embora o acolhimento nos serviços mereça ser problematizado em São José do Rio Preto.

Provision of female sterilization in Ribeirão Preto, São Paulo, Brazil

Forty percent of Brazilian married women from 15 to 49 years of age have undergone surgical sterilization. The 1988 Brazilian Constitution states that all scientifically proven contraceptive methods should be available to all citizens, but it was only in 1997 that specific family planning legislation was approved. This study examines physicians' perceptions and attitudes towards the current provision of female sterilization and its legal implications, as well as women's experience with obtaining and undergoing sterilization. The study design included: (1) an investigation of the hospitals and health professionals and (2) a survey of women sterilized in combination with cesarean delivery in 1998. The survey showed they had a median of 3 living children, 60.0% had been sterilized between 30 and 39 years of age, and 61.0% had paid for the procedure. Many women reported previous method failure and adverse effects with hormonal contraceptives. Women with less schooling and lower socioeconomic status had more children and had begun childbearing and had been sterilized at younger ages than women with more schooling and higher socioeconomic status. Inequalities related to reproduction were strongly associated with teenage pregnancy and inadequate knowledge about contraceptives.