The Participation Guide provides simple tips and tools to involve affected individuals and groups in the various stages of health and development communication programs. This Guide provides examples of how to include those most marginalized that a health or development communication program is meant to empower. These people could include low-income women of reproductive age, youth, orphans and vulnerable children, people living with HIV/AIDS (PLHA), or staff from organizations working with affected individuals or groups The Guide's intended audience includes program officers, program staff, and development practitioners interested in effectively involving those directly concerned in the health and development communication programs they support. (excerpt)
A religious oriented approach to addressing FGM / C among the Somali community of Wajir, Kenya.
The purpose of this approach is to educate the community on the harms of FGM/C, both religiously and medically, so that they question the rationale for its continuation. The first step in the approach is to de-link Islam and FGM/C. It is important for the community to understand the Shariah implications of this practice and be made aware of the fact that Islamic Shariah upholds human rights and dignity and that FGM/C violates these rights. As long as this practice is wrongly justified as Islamic, nothing else will make sense to the community, not even the many protocols and legislations that prohibit and outlaw the practice. These are man-made laws according to them and hence they cannot bind them. But are there any God-made laws that actually support this practice? We can answer this question by weighing the practice against Islamic teachings and prove that there is no sunnah 'cut' in Islam. Knowledge that the practice is traditional and is in conflict with Islamic principles is a sure convincingway that can help in questioning the practice. (excerpt)
Hormonal contraception and bone health.
Hormonal contraceptives, which include birth control pills, injections, implants, the patch and the vaginal ring, all use hormones to keep a woman from getting pregnant. These hormones can have other health effects for women, many of them beneficial, besides just preventing pregnancy. However, some questions have been raised about how particular hormonal contraceptives, DMPA (depot medroxyprogesterone acetate with trade names of Depo-Provera, Depo-Clinovir and others) and NET-EN (norethisterone enantate or Noristerat, Norigest, Doryxas and others), may affect the health of women's bone. (excerpt)
Does hormonal contraception modify the risk of STI acquisition?
There are many factors that increase the chance of developing an STI. The most common ones are: having multiple sexual partners, having sexual intercourse with partners who have more than one sexual partner, not using condoms during intercourse, the presence of genital ulcer disease, young age, and previously having had an STI. What is not established is whether a woman's use of hormonal contraceptives may increase her risk of developing an STI. Hormonal methods include combined pills, combined injections, progestin-only injections such as DMPA (depot medroxyprogesterone acetate), progestin-only pills, the patch, the vaginal ring and implants. Numerous studies have investigated this subject, however the answers are not clear. What is clear is that none of these methods protects a woman from acquiring an STI; therefore, providers should counsel women at risk of infection to use condoms during each act of intercourse, even if they are already using another contraceptive method. (excerpt)
Violence against women is any act of gender-based violence resulting in physical, sexual, or mental suffering to woman, including the threat of violence, pressure, or arbitary deprivation of freedom, both at the community or individuals level. In Indonesia, a country whose population is almost 90% Moslim, Islamic teachings are very often used to legitimize various acts of violence against women. Unfortunately, violence against women is also supported by the patriachal system present in almost all Indonesian ethnic groups. The Women's Rights Commission researched violence against women for three years, from 2003 to 2005. Cases of such violence were on the rise, from 5.934 cases in 2003, to 14.020 cases in 2004, to 20.391 cases in 2005. Of those, 4.886 cases ( 29.41%) were the result of domestic violence, 3.82% were of intimate partner violence, and 421 cases ( 2,53%) were against girl children. (excerpt)
Armenia 2005 Demographic and Health Survey. Key findings.
The 2005 Demographic and Health Survey in Armenia (ADHS) is the second undertaking of its kind. It is a nationally representative survey designed to provide information on fertility levels, sexual activity, fertility preferences, knowledge and use of contraception, breastfeeding practices, nutritional status of women and children under five years, childhood mortality, maternal and child health, abortion, adult health, women's empowerment, and knowledge, attitudes and behaviors related to HIV/AIDS and other sexually transmitted diseases. The information collected by the ADHS updates the health and demographic indicators collected during the previous DHS survey in 2000. The fieldwork for the ADHS was conducted from September through December 2005. The survey collected information from 6,707 households, 6,566 women age 15-49 and 1,447 men age 15-49. The data are statistically significant at the national level, for urban and rural residence, and for the eleven administrative regions (Yerevan, Aragatsotn, Ararat, Armavir, Gegharkunik, Lori, Kotayk, Shirak, Syunik, Vayots Dzor, and Tavush). (excerpt)
The effect of antenatal care on professional assistance at delivery in rural India.
Delivering births in a medical institution or at home with professional medical assistance has been shown to promote safe motherhood and child survival. Yet three-quarters of births in rural India continue to take place at home, most of them without the assistance of any trained health worker. This study examines the role of antenatal care (ANC) in promoting professional assistance at delivery, using data from India's 1992-93 and 1998-99 National Family Health Surveys (NFHS-1 and NFHS-2). We estimate the effect of number of antenatal care visits (0, 1-2, 3+) on professional assistance at delivery (no assistance, professional assistance at home, delivery in a medical institution), using multinomial logistic regression, controlling for demographic, geographic, and socioeconomic factors, pregnancy complications, and two measures of access to health facilities. The results indicate that, after controlling for other variables (including ANC), pregnancy complications and access to health facilities do not have much effect on assistance at delivery. By contrast, ANC has a large effect on assistance at delivery, even after all other variables are controlled. The effect of ANC on professional assistance at delivery is larger in South India than in North India, and predicted percentages receiving professional assistance are higher in South India than in North India. A policy implication is that increased antenatal care coverage can be an effective means of increasing professional assistance at delivery, especially delivery in a medical institution. (author's)
Egypt Demographic and Health Survey 2005.
The 2005 Egypt Demographic and Health Survey (2005 EDHS) interviewed a nationally representative sample of 19,474 ever-married women age 15-49. The survey is the eighth in a series of Demographic and Health Surveys conducted in Egypt. As in previous surveys, the main purpose of the 2005 EDHS was to provide detailed information on fertility, family planning, infant and child mortality, maternal and child health and nutrition. The survey also collected information on the levels of knowledge of infectious diseases including HIV/AIDS and hepatitis C. In addition, the 2005 EDHS included anemia testing and special modules on child labor, domestic violence, and female circumcision. (excerpt)
HIV / AIDS data from the 2005 Ethiopia Demographic and Health Survey.
The 2005 Ethiopia Demographic and Health Survey (EDHS) included HIV testing of over 10,000 women and men. The 2005 EDHS shows that 1.4 percent of Ethiopians age 15-49 are HIV positive. HIV prevalence is higher among women than men overall, and significantly higher in urban areas. Both male and female urban residents have higher rates of HIV infection than their rural counterparts. For the most part, HIV infection rises with age until age 35-39 for women and age 40-44 for men. With the exception of women age 30-34, HIV prevalence is higher among women than men in all age groups. The risk of HIV infection increases with higher levels of education. This relationship is especially true among women. Women with a secondary school education are more than five times as likely to have HIV as women with no education. (excerpt)
Ethiopia Demographic and Health Survey 2005.
The 2005 Ethiopia Demographic and Health Survey (EDHS) is a nationally representative survey of 14,070 women age 15-49 and 6,033 men age 15-59. The EDHS is the second comprehensive survey conducted in Ethiopia as part of the worldwide Demographic and Health Surveys (DHS) project. The primary purpose of the EDHS is to furnish policymakers and planners with detailed information on fertility, family planning, infant, child, adult and maternal mortality, maternal and child health, nutrition and knowledge of HIV/AIDS and other sexually transmitted infections. In addition, in one of two households selected for the survey, women age 15-49 and children age 6-59 months were tested for anaemia, and women age 15-49 and men age 15-59 were tested for HIV. The 2005 EDHS is the first survey in Ethiopia to provide population-based prevalence estimates for anaemia and HIV. (excerpt)
HIV-1 infection and fertility in Dar es Salaam, Tanzania.
The objective of this study was to examine the association of HIV-1 infection with rates of pregnancy and pregnancy loss in Dar es Salaam, Tanzania. A retrospective cohort study of 1,006 HIV-infected women and 485 uninfected women was employed. In multivariate analyses controlling for other predictors of pregnancy, the association of HIV-seropositivity with a woman's reported number of pregnancies was of borderline significance (RR = 1.13, 95% CI =1 .00, 1.27). HIV infection was not associated with pregnancy loss in multivariate analysis. The adjusted pregnancy rate ratio comparing HIV-positive women at the earliest stages of infection to all uninfected women was 1.22 (95% CI = 1.04, 1.42). HIV infection was not associated with female fertility when comparing women in the most advanced stages of infection to all uninfected women. We conclude that HIV-1 infected women had higher pregnancy rates than uninfected women. This association disappeared when analyses were limited to women with advanced disease. Abstract word count: 150. (author's)
The aim was to develop a simple risk scoring scheme for the prediction of cesarean delivery due to cephalopelvic disproportion (CPD) in Lamphun Hospital, Thailand. A case-control study was conducted including 116 pregnant women with cesarean delivery due to CPD and 307 pregnant women delivering by normal labor. Obstetric information was retrieved from medical records. Risk indicators measurable at the time of admission were analyzed by a stepwise logistic regression to obtain a set of statistically significant predictors. Regression coefficients were transformed into item scores and added up to a total score. Risk of cesarean delivery due to CPD was analyzed using total scores as the only predictor. A risk scoring scheme was developed from five obstetric predictors: maternal age, height, parity, pregnancy weight gain and symphysis-fundal height. Item scores ranged from 0 up to 3.5 and the total score from 0-14.5. The scheme explained, by the area under the receiver operating characteristic curve, 88% of cesarean delivery due to CPD. The likelihood of cesarean delivery due to CPD in pregnant women with low risk (scores below 5), moderate risk (scores 5-9.5) and high risk (scores 10 and over) were 0.09, 0.86 and 10.11, respectively. The risk of cesarean delivery due to CPD may be forecasted by a simple scoring scheme using five predictors that correctly identified women with low, moderate and high risk. This scheme may be applicable to physicians and midwives for identifying high-risk pregnant women in order to take appropriate action. (author's)
Considering the differing but potentially supplementary properties of visual inspection of the cervix with acetic acid (VIA) and the cytological examination (CYTO) of cervical smears for the screening of cervical cancers, we examined the performance of these two tests and their combinations for the screening of cervical cancer in different health care settings. In this cross-sectional diagnostic test performance evaluation study of 4235 female subjects in the reproductive age group, we assessed the screening performance of four strategies: VIA alone, CYTO alone, VIA and CYTO combined in a parallel fashion, and VIA and CYTO combined in tandem. Subjects were recruited from three settings: Hospital, Urban Community and Rural Community. Colposcopy was used as the reference standard. Screening performance was assessed using sensitivity, specificity, post-test probabilities and likelihood ratios (LR), diagnostic odds, area under receiver operating characteristic curve and LR x/2. Both VIA and CYTO when used alone had a low sensitivity but high specificity, especially in the Rural Community setting. A combination of the results of VIA and CYTO improved the diagnostic accuracy but the strategy using a parallel combination of VIA and CYTO was the most accurate. In general, all screening strategies using VIA and CYTO showed a modest screening performance. In the settings of varying levels of health care and low resources, caution is needed for a generalized use of VIA for cervical cancer screening. Further evaluation of the cost-effective ways of combining VIA and CYTO is needed in these circumstances. (author's)
Impact of use of combined oral contraceptive pill on the quality of life of Japanese women.
The aim was to evaluate the impact of combined oral contraceptive pill (OC) use on quality of life (QOL) among Japanese women, we performed a prospective study using the Japanese version of the World Health Organization Quality of Life (WHOQOL) questionnaire. Women who consulted Chayamachi Lady's Clinic to get a prescription for OC for the first time were recruited for our questionnaire study and asked to complete the WHOQOL questionnaire twice, before taking OC and more than 3 months after beginning OC use. Two hundred and seventeen women responded to our questionnaire before taking OC and 110 patients completed the questionnaire. The patients were divided into six groups based on the reason they wanted to take OC: contraception, relaxation of dysmenorrhea, regulation of menstrual cycles, improvement of acne, remission of menorrhagia, and improvement of premenstrual tension syndrome (PMS). WHOQOL scores showed significant improvement in all domains of the dysmenorrhea group, all domains but the social of over all participants, the social and overall domain of the irregular cycle group, physical, environmental, and overall domain of the acne group, and psychological and overall domain of the PMS group. The WHOQOL score worsened in the social domain of the contraception group; however, the score in the overall domain of that group improved. These results indicate that OC can provide higher QOL for women with problems involving menstrual pain and/or hormonal abnormalities. However, those using OC for contraception only were found to be unsatisfied with taking OC in a relationship with their partners. (author's)
Sexual attitudes and risk-taking behaviors of high school students in Turkey.
The risk of sexually transmitted diseases is high but opportunities of sexual education for adolescents are limited in Turkey. The aim of this study was to evaluate sexual attitudes and behaviors and to determine the predictors of sexual initiation among adolescents. A questionnaire designed by the researchers was administered to 861 senior year high school students in their classrooms. The rates of masturbation and sexual intercourse and the median partner numbers among males were higher than females. The rates of having negative feelings after the first sex among females were higher than males. The rates of having sexual intercourse and the mean age at first sexual intercourse among males were similar to developed countries. However, the use of a condom at first intercourse was low. Lower academic performance and grade repetition experience among males and cigarette smoking among both gender groups were related to having sexual intercourse. This is one of the first studies about sexual risk-taking behaviors among high school students in Turkey. Differences found between gender groups regarding attitudes and behaviors reflect the social structure in Turkey. These findings may be helpful in producing effective solutions for improving education and preventive health care. (author's)
If proven effective, vaginal microbicides and diaphragms will likely be part of a larger HIV prevention model that includes condoms and other prevention strategies. It is, therefore, important to understand how introducing new prevention methods may affect overall patterns of sexual risk behavior. Data presented were collected as part of a safety and feasibility study of ACIDFORM gel with a diaphragm among 120 women in South Africa. Interviews were administered at enrollment and months 1, 3, 5, and 6 of the trial. Focus groups were conducted at trial exit. Frequency of sex increased significantly after enrollment. This increase appears to be owing to perceived protection from HIV and greater sexual pleasure afforded by the gel. Male condom use was high overall but increased significantly from enrollment. Data suggest this is because of increased partner involvement, increased negotiating power afforded by study participation, and provision of free condoms perceived to be of high quality. (author's)
This qualitative investigation explored the experiences and contexts of stigma and discrimination among HIV-positive and high-risk kothi-identified men who have sex with men (MSM) in Chennai, India, and ramifications for HIV prevention. MSM were recruited through community agencies (n = 10) and public sex environments (n = 8), along with three key informants. In-depth, semistructured interviews were conducted, audiotaped, and transcribed. Narrative thematic analysis and a constant comparative method were used to identify themes. Findings revealed multiple intersecting social and institutional contexts and experiences of stigmatization, discrimination, and violence across police, community, family, and health care systems, as well as illuminating consequences for MSM. Multisystemic structural violence places kothis at extreme vulnerability for HIV infection and AIDS. Public mass media antidiscrimination campaigns, education and training of health care providers and police, funding of indigenous MSMcommunity organizations, and decriminalization of consensual sex between same-sex adults may help to combat stigma, discrimination, and violence against MSM, which is fundamental to effective HIV prevention. (author's)
Effect of pregnancy on HIV disease progression and survival among women in rural Uganda.
The objective was to investigate the effect of pregnancy on HIV disease progression and survival among HIV-infected women in rural Uganda, prior to the introduction of anti-retroviral therapy (ART). From a clinical cohort established in 1990, we selected records from HIV-infected women of reproductive age. We conducted two analyses: (1) all HIV-infected cases contributing to analysis of CD4 decline, using a linear regression model with random intercepts and slopes; (b) incident cases with known date of seroconversion contributed to analyses of median time to CD4 less than 200 cells/microl, AIDS and death. A total of 139 women were included in the analysis of CD4 decline. Women who subsequently became pregnant had higher CD4 counts at enrolment and had a slower CD4 decline than those who did not become pregnant. In women who became pregnant, CD4 decline was faster after pregnancy than before (P less than 0.0001). The survival analyses showed no significant differences between women who became pregnant and those who did not with respect to median time to CD4 count less than 200, AIDS or death. The initial comparative immunological advantage possessed by fertile women before they become pregnant is subsequently lost as a result of their pregnancy. Women should be informed about the potential negative effect of pregnancy on their immunological status and should be offered contraception. In resource-limited settings, women determined to become pregnant should be given priority for ART if eligible. (author's)
The objective was to determine predictors of death among children 2-59 months old admitted to hospital with severe pneumonia. Prospective observational study from April 1994 to May 2000 to investigate serious infections in children less than 5 years old admitted to a tertiary care government hospital in a rural province in central Philippines. The quality of clinical and laboratory work was monitored. The WHO classification for severe pneumonia was used for patient enrolment. There were 1249 children with severe pneumonia and no CNS infection. Thirty children died. Using univariate analysis, the following factors were significantly associated with death: age 2-5 months, dense infiltrates on chest radiography and presence of definite bacterial pathogens in the blood. Stepwise logistic regression analysis revealed the following independent predictors of death: age 2-5 months, weight for age z-score less than)2 SD, dense infiltrates on chest radiography and definite pathogens isolated in the blood. When the results of chest radiographs and blood cultures were not included to mimic facilities available at first-level facilities, age 2-5 months and weight for age z-score less than)2 SD remained independent predictors of death. When resources are limited, children with lower chest wall indrawing (severe pneumonia) who are 2-5 months old or moderately to severely malnourished should be referred for immediate higher-level care. (author's)
The objective was to describe the implementation of a cost-sharing system for emergency obstetric care in an urban health district of Ouagadougou, Burkina Faso and analyse its results after 1 year of activity. Service availability and use, service quality, knowledge of the cost-sharing system in the community and financial viability of the system were measured before and after the system was implemented. Different sources of data were used: community survey, anthropological study, routine data from hospital files and registers and specific data collected on major obstetric interventions (MOI) in all the hospitals utilized by the district population. Direct costs of MOI were collected for each patient through an individual form and monitored during the year 2005. Rates of MOI for absolute maternal indications (AMI) were calculated for the period 2003-2005. The direct cost of a MOI was on average 136US$, including referral cost. Through the costsharing system this amount was shared between families (46US$), health centres (15US$), Ministry of Health (38US$) and local authority (37US$). The scheme was started in January 2005. The rate of cost recovery was 91.3% and the balance at the end of 2005 was slightly positive (4.7% of the total contribution). The number of emergency referrals by health centres increased from 84 in 2004 to 683 in 2005. MOI per 100 expected births increased from 1.95% in 2003 to 3.56% in 2005 and MOI for AMI increased from 0.75% to 1.42%. The dramatic increase in MOI suggests that the cost-sharing scheme decreased financial and geographical barriers to emergency obstetric care. Other positive effects on quality of care were documented but the sustainability of such a system remains uncertain in the dynamic context of Burkina Faso (decentralization). (author's)
The objectives were to investigate the determinants of delay in seeking healthcare for sexually transmitted infections (STIs) among Vietnamese women attending the National Institute of Dermatology and Venereology (NIDV), through assessing to what extent women's sociodemographic backgrounds and their knowledge, attitudes and practices (KAP) relating to STIs/STI prevention influence their delay in seeking healthcare for STIs. A face-to-face semistructured interview of 60 women over 18 years old attending the NIDV, who were diagnosed with an STI by clinicians from the NIDV and volunteered to participate in the study. The relationship between demographic and KAP variables and delay (7 days or more between onset of symptoms and seeking care) and the interval of delay were assessed using x/2, Fisher's exact, Mann-Whitney U and Kruskal-Wallis tests. Of those women reporting delay before first seeking care, 82% delayed by greater than or equal to 7 days. Women with lower education and from rural or remoteareas waited significantly longer before first seeking care than those with higher education and from urban areas. Women who delayed in seeking care knew significantly less routes of STI transmission and engaged significantly more in sex while having symptoms than women who did not delay in seeking care. No relationships existed between delay behaviours and women's income, age or attitudes towards STIs/STI prevention. Early healthcare-seeking behaviour for STIs could be facilitated through improving women's basic knowledge regarding STIs, changing their sexual behaviour and creating a social support environment for early care-seeking. (author's)
The objectives were to determine whether the process of informing research participants that they would be tested for the presence of a biological marker of semen exposure would reduce bias in their reports of unprotected sex. A randomised trial of 210 female sex workers from Mombasa, Kenya, was conducted, where half the group had advance knowledge (via the request for informed consent) that they would be tested for prostate-specific antigen (PSA) in their vaginal fluid before they reported on sex and condom use for the past 48 h. The other half were invited to participate (via additional informed consent) in the test for PSA after they had already consented to be questioned and reported on these sexual behaviours. A trained nurse instructed participants to self-swab to collect vaginal fluid specimens, which were tested for PSA using ELISA. Reporting of unprotected sex did not differ between those with advance knowledge of the test for PSA and those without this knowledge (14.3% v 11.4%, respectively; p = 0.27). Surprisingly, more women with advance knowledge (15.8%) had discrepant self reports and PSA results than women without advance knowledge (9.1%); however, the difference was not statistically significant (OR 1.9; 95% CI 0.8 to 4.5). Knowing that one's answers to a questionnaire could be verified with a biological marker of semen exposure did not make respondents more likely to report unprotected sex. (author's)
Challenging oral contraception after weight loss by bariatric surgery.
As surgical weight loss becomes more commonly performed in fertile women, adequate contraception is more frequently becoming an issue. The purpose of this article is to appraise the literature to ascertain whether the use of oral contraception is effective and adequate after bariatric surgery. The literature search revealed that the combination of lower oral contraception dosages and surgical gastrointestinal disturbances might place patients at higher risks of unintended pregnancy. Until clinical trials show its efficacy, physicians should use oral contraception with prudence after bariatric surgery. (author's)
Adolescents need to be aware that there is a method of preventing pregnancy even after an unprotected intercourse. Limited information is available on the awareness of young adolescents and the effects of selling emergency contraception (EC) over-the-counter, and the findings are controversial. The aims of this study were to investigate awareness and use of EC among Finnish girls aged 12-18 years in 1999-2003, and to assess the effect of the 2002 nonprescription status on the use. A self-administered questionnaire was sent to a population-based sample of 12-18-year-olds girls in 1999, 2001, and 2003. Response rate was 83% in 1999 (N=4,369), 79% in 2001 (N=4,024) and 77% in 2003 (N=3,728), altogether N=12,121. Logistic regression model was used to examine the association of unawareness and use of EC with socio-economic background and health behaviour. In 2001, nearly all 14-18-year-olds and a majority of 12-year-olds were aware of EC. Among 12-14-year-olds, a slight increase in awareness between 1999 and 2003 was observed but this was not related to non-prescription status. Health-compromising behavior (alcohol use, smoking), dating and having good school achievement were related to higher awareness of EC. Nine percent of 14-18-year-olds had used EC once and 1% three times or more. No statistically significant change in EC use was found after non-prescription status. EC use increased with increasing alcohol consumption, particularly at age 14. Smoking, dating, and poor school achievement were related to increased use as well as not living in nuclear family. A lower use was observed if living in rural area or father's education was high. Mother's education was not related to use. Adolescent girls were well aware of the existence of emergency contraception even before the non-prescription status. Over-the-counter selling did not increase the use. (author's)
Vulnerability and sexual and reproductive health among Zambian secondary school students.
The present study aimed to explore secondary school students' needs in relation to sexual and reproductive health in order to inform efforts to improve the quality of health services available to young people. The study involved data collection from 716 11-22-year-old students in four secondary schools in an urban area in Zambia. Students completed a questionnaire and were invited to write down any inquiries they had regarding sexuality and reproduction. Findings revealed that boys and girls lack adequate information about human reproduction and STIs, including HIV. To avoid misconceptions and myths, they also need clear information on contraceptives and masturbation. Responses indicate that young people would welcome guidance and support related to contraception, pregnancy, abortion and STIs/HIV, but also on love and relationships. Culture, religion and gender are important factors influencing sexuality and sexual abuse. These issues need to be taken into consideration when developing youth-friendly programmes for young people. (author's)
Passionate uprisings: young people, sexuality and politics in post-revolutionary Iran.
This paper examines the sexual and social practices of young people in contemporary Iran. Young people in urban areas live under the rubric of a fundamentalist, Islamist regime which restricts social freedoms such as premarital heterosexual contact, homosexual encounters, dancing, alcohol consumption and large group gatherings. Drawing on close focus research and individual and group inteviews, this paper seeks to analyse young people's responses to these constraints. Findings suggest that many young adults use their 'rebellious' social behaviour to make political statements against a regime that dissatisfies them; saying, in their own words, that they are enacting and bringing about a 'sexual revolution'. (author's)
This paper explores how contradictory social structures influence power relations between "Vietnamese brides" and their Taiwanese family members. By analyzing two aspects of interaction between "Vietnamese brides" and their husbands' families, i.e. , how the families require them to integrate into Taiwanese society and what strategies they employ to escape from these constraints, we argue that contradictory social relations together with commodified marriage and liminality help them to develop strategies of escape into the "hidden space." The development of these strategies indicates one thing: hegemony is never fully achieved - it is always negotiated and contested. (author's)
A Bayesian multinomial model to analyse spatial patterns of childhood co-morbidity in Malawi.
Children in less developed countries die from relatively small number of infectious disease, some of which epidemiologically overlap. Using self-reported illness data from the 2000 Malawi Demographic and Health Survey, we applied a random effects multinomial model to assess risk factors of childhood co-morbidity of fever, diarrhoea and pneumonia, and quantify area-specific spatial effects. The spatial structure was modelled using the conditional autoregressive prior. Various models were fitted and compared using deviance information criterion. Inference was Bayesian and was based on Markov Chain Monte Carlo simulation techniques. We found spatial variation in childhood co-morbidity and determinants of each outcome category differed. Specifically, risk factors associated with child co-morbidity included age of the child, place of residence, undernutrition, bednet use and Vitamin A. Higher residual risk levels were identified in the central and southern-eastern regions, particularly for fever, diarrhoea and pneumonia; fever and pneumonia; and fever and diarrhoea combinations. This linkage between childhood health and geographical location warrants further research to assess local causes of these clusters. More generally, although each disease has its own mechanism, overlapping risk factors suggest that integrated disease control approach may be cost-effective and should be employed. (author's)
'Isto foi sempre assim': The politics of land and human mobility in Chimanimani, central Mozambique.
Based on recent field-work inside the Trans-Frontier Conservation Area (TFCA) of Chimanimani in Sussundenga District, Mozambique, this article tries to make sense of apparently contradictory dynamics in two rural communities of the northern Mozambican side of the TFCA. On the one hand, African traditional authorities are favouring immigration in the territories under their influence, while, on the other, the same authorities are agreeing with their communities to adopt controls on people's identity and movements of the kind reminiscent of colonial passes or Frelimo's guias de marcha. The article interprets this contradiction by placing current social processes in a historical perspective and by examining the impact of recent government reforms, particularly decentralisation, a new land law and new approaches to natural resource management. The article argues that in the context of the opportunities and challenges introduced by these policies, particularly traditional authorities' responsibilities for tax collection and notions of territorially bounded rural community, Chimanimani traditional authorities are making use of old and new instruments - community borders and guias - to preserve particular individual and group interests. (author's)
[Sexualities and HIV / AIDS vulnerability in China, an anthropological perspective]
Using an anthropological approach, sexuality is studied as a social object, and this idea which is pluralist and wide-ranging, depending location, plays the role of a heuristic in 'contextualised' studies on sexuality during a period when AIDS is spreading worldwide. The HIV/AIDS epidemic, which is recognised as one of the most pressing public health problems globally, and in particular in developing countries, and as a 'social' disease because of the implications and representations associated with it, has stimulated, or caused to be developed, studies on sexuality despite the risk that these studies will be used as a mere tool for epidemiology - which should be assessed in each context - and despite the risk associated with implicit moralisation of sexuality in terms of attempts by the scientific community to establish standards and thresholds of legitimacy for sexuality. The way the epidemic is treated in society is closely linked with medical care for it, and has facilitated recognition of thediversity of 'sexual cultures' which take shape in an open and dynamic context of affective, social, political and economic interactions and relationships. Following an introduction which provides pointers to the theory, methodology and Chinese context, the following are examined: 1) sexual transmission of HIV and the epidemic dynamic; 2) its situation within society and the position of sexual minorities; 3) the development of studies on sexuality. Discussion of such themes contributes to documentation, in a specific social context, the social phenomena of sexual commerce in the same way as emergence and recognition of groups of minority sexual orientation, and of their rights, although these rights are still timidly granted in a limited context, and the way in which these groups negotiate with other participants in traditional normative structures (the family) or official structures. Finally, we should note that, in the context of prevention and care of HIV/AIDS in China, the idea of 'sexual health' acts asa heuristic for studies of sexuality, which recently have been produced in ever-greater numbers and on increasingly diverse subjects, and in defending social and individual rights. (author's)
[Diarrhoea-causing agents in children aged less than five in Tunja, Colombia]
The objectives were determining the prevalence and type of infectious ADD-causing agents in a sample of children aged less than five who consulted the IPS in Tunja during 2004. A cross-sectional study was designed. Data was obtained by surveying 129 children younger than 5 suffering from ADD. Samples of faeces were obtained following outpatient consultation at San Rafael Hospital and SaludCoop's clinic in Tunja. Rotavirus was found in 48.1 % of cases, Shigella in 0.8 %, E. coli in 13.9 %, Campylobacter in 2.3 %, Giardia lamblia in 12.4 % and E. hitolytica in 7 %. The causative agent could not be identified in 15.5 % of cases. The statistical association grew with age for Rotavirus (p<0.01), E. coli (p<0.05) and campylobacter (p<0.001). Rotavirus is the major causative agent of ADD in children younger than one year and, generally, in children aged less than five. The prevalence found was similar to data reported in studies carried out in Facatatativá, Bogotá, Santander, Manizales and the Chocó in Colombia and studies carried out in Venezuela, Peru and Mexico. (author's)
[Cervical cytology in Soacha, Colombia: social representation, barriers and motivation]
A social representation of the Pap smear is given in this article, as are the barriers against it and the motivation for practicing it, aimed at adjusting preventative health services in a particular Colombian town. A phenomenological, qualitative study was carried out, using focal groups and workshops for validating the results. A theoretical sample was designed to find differences according to age, health system affiliation and dwelling place within the municipality in question. Atlas ti software was used for giving the analysis a narrative interpretation. The Pap smear is associated with infection and pre-cancer and cancer prevention. Cultural barriers, misinformation being spread by peers, a lack of social networks and the particularly poor quality of Colombian public health services were identified. Attempts to make the Pap smear as objective as possible were found to be satisfactory, even though no logical relationship was found between knowledge of the Pap smear and its practice. Older women have the social representation of risk implicit in an acute infection model. Lack of opportunity for a having a Pap smear appointment and delays in presenting the corresponding report have a negative impact on cancer control. (author's)
[Breast cancer in the Pedro Claver hospital in Bogota, 2004]
The objective was reviewing new cases of breast cancer attending Clinica San Pedro Claver, Bogotá, Colombia, during 2004. Patients were recruited from the meeting offered by the service which all new breast cancer patients attend. Hospitalised patients, outpatients, clinical meetings, consulting rooms, operating room schedules and pathology reports were consulted to ensure that a true crosssection was included. The information was recorded in an Excel file and analysed using EPIINFO software. Breast cancer was diagnosed in 220 patients. Average age was 59; 18 % were aged less than 40. Infiltrative ductal cancer (84,1 %) was the most frequently found histological type. Distribution by stage showed that most patients presented stage 0 to stage II (62.7 %). Tumours measured 2 or more centimetres in 78 % of the patients. 83 % of the patients had surgery and 60 % chemotherapy. However, these scores were lower in patients aged more than 69 (58.3 % for surgery and just 13.9 % for chemotherapy, p<0.05). Hormono-therapy was prescribed for 40.9 % of the patients. Breast cancer is the more frequent found carcinoma. Clinica San Pedro Claver's cancer records revealed the personal, clinical and therapeutic characteristics of new female breast cancer patients attending this hospital during 2004. Most patients were in early breast cancer stages; however, detecting a greater number of non-palpable lesions should still be stressed. Treating elderly patients (those older than 69 regarding that found for younger patients) and the quality of procedures, hormonal receptor reports and therapeutic decision should also be evaluated in an attempt to explain the low percentage of hormone treatment currently being used in the hospital. (author's)
[Basic standards for Colombian paternity testing laboratories, 2005]
The Commission for Accreditation and Surveillance of Laboratories Practicing DNA Paternity Tests (created by the Colombian Law 721/2001) set up a sub-commission to review the current basic Colombian standards required for paternity testing laboratories and make specific recommendations re the pertinent technical aspects in Colombia, taking ISO 17025 as current reference. This document contains such recommendations for Colombia. (author's)
The objective was evaluating the frequency of 17 practices being used in managing the main causes of maternal and perinatal morbidity and mortality in some hospitals in Bogotá between August 2004 and March 2005. A cross-sectional study was carried out. The data related to 3,108 women who gave birth at gestational age greater than 24 weeks. The following percentages were obtained for each variable evaluated: having a perinatal record card (79.4 %), taking iron and folic acid supplement (87.3 %), syphilis screening (69.5 %), bacteriuria screening (69,7 %), constant accompaniment during giving birth (42.0 %), not taking enemas (99.4 %), not shaving the perinea (93.0 %), selective episiotomy in first-time mothers (56,5 %), adopting a squatting or seated position when giving birth (7.9 %), active management of birth in gestation greater than 41 weeks (14.7 %), active management of birth (73.5 %), administering prophylactic antibiotics during a caesarean birth (61.2 %), treating severe pre-eclampsia (76.5 %) and eclampsia (20.0 %) with magnesium sulphate, administering corticoids for inducing foetal maturation in mothers having a high risk of predetermined birth (51.6 %), exclusive maternal lactation, having no restrictions (99.1 %) and joint mother-newborn accommodation (91.2 %). Effective methodologies are required for guaranteeing adherence to maternal and perinatal attention regulations and guidelines and those administrative and management decisions facilitating compliance with them. (author's)
[Choice of and preference for home child-birth in Callao, Peru]
The objective was to identify the personal factors and prenatal attention associated with choosing the home for giving birth. The study included 52 cases (fertile women whose last childbirth had been at home) and 208 controls (fertile women residing in the same geographical area). The study was carried out in the Pachacútec micro- network. Analysis was both bivariate and multivariate. The cases' average age was 28 (6.5 SD) and 26 for controls (6.1 SD). Bivariate analysis demonstrated a significant association for different factors but these they were not confirmed when multivariate analysis was applied. The risk factors were the home as foreseen place for childbirth w=34.8 (p=0,0); OR=31.7 (CI=10.1;99.8) and prenatal attention supplier w=7.0 (p=0.0); OR=0.1 (CI=0.0;0.5). The home as foreseen place for childbirth and prenatal attention supplier were the factors which were highly associated with home childbirth. (author's)
[Use and determinants of Pap smear in a rural Colombian municipality 1998-1999]
The objectives were to determine the prevalence of Pap smear use and identifying the factors associated with Pap test performance. A cross-sectional study was carried out on volunteer women recruited from a local programme for detecting cervical cancer in Mogotes, Colombia. Prevalence ratios (PR) were calculated. Papanicolau smear use was the outcome being measured. Information about demographic characteristics, clinical factors, history of cancer in the family, lifestyle factors and using birth control methods was collected. Pap smear use prevalence was 67.3 %. Age group, using birth control methods (PR:1.4; 95 % CI:1.2-1.7) and living in rural settings (PR:0.9; 95 % CI:0.8-1.0) were the factors associated with Pap test performance. This data suggests that living in rural settings is associated with decreased opportunities for performing Pap tests. (author's)
[Domestic violence against Mexican teenagers]
The objective was to assess students' perception of domestic violence. The study was carried out in a random sample representative (n=5,982) of high-school students aged between 13 and 19 years in Chiapas and San Luis Potosi, Mexico, in 2003. The students answered a self-administered questionnaire on sexual education, sexuality, pregnancy and risk behavior, and domestic violence. Considering the effects of the sample design, a logistic regression analysis was carried out in order to verify the association between socioeconomic and demographic characteristics and risk of domestic violence. The multivariate statistical analysis confirmed that female students are more vulnerable to domestic violence in both states studied (Chiapas: OR=1.87, p=0.01; San Luis: OR=1.53, p=0.00). Moreover, alcohol (Chiapas: OR=2.52, p=0.00; San Luis: OR=1.93, p=0.00) or drug use (Chiapas: OR=2.27, p=0.02; San Luis: OR=1.82, p=0.01) were the two most significant variables for students exposure to domestic violence. The association between alcohol consumption and student's age increases the risk of violence. The youngest students had 51% (Chiapas) and 73% (San Luis) more risk of experience violence by a relative than older students. Teenagers remain one of the most vulnerable population groups to domestic violence due to their physical, affective, economic and social dependence on other adults. The study was one of the first attempts to measure domestic violence against students. (author's)
[Co-occurrence of physical violence against partners and their children in health services]
The objective was to profile the co-occurrence of physical violence against partners and their children in a population attending a health care service, according to different socioeconomic and demographic characteristics. A cross-sectional study on family violence and pre-term delivery was carried out in the city of Rio de Janeiro, Brazil, in 2000. Households of women living with a partner and at least one child (or stepchild) aged less than 18 years were eligible to the study (n=205). Socioeconomic, demographic, and life style variables for the family couple were considered as potential predictors of violence. The outcome variable was assessed at four levels: no physical violence in the household; physical violence against partners, physical violence against at least one child or co-occurrence of both. A multinomial logit model was used for projecting the respective prevalences according to a range of selected descriptors. The risk factors associated to greater risk of the outcome were: maternalage >/=25; partner with less than eight years of schooling; presence of >/=2 children under the age of five in the household; and alcohol/illicit drug abuse by the partner. In households with all those characteristics, the joint projected prevalence of violence against partners and their children was 90.2%, and as much as 60.6% accounted for the co-occurrence of both. In the absence of those factors, estimates were significantly lower (18.9% and 0.2%, respectively). Health providers should not only anticipate a situational gradient, but also be aware there is an increasingly higher risk of violence comprising the whole family group. (author's)
[Maternal knowledge about children's danger signs in acute diarrhoea in an IMCI's frame]
IMCI ( Integrated Management Childhood Illness) is a sort of strategy for childhood attention that aims to reduce mortality by prevalent diseases in population below 5 years old. In acute diarrhoea the IMCI's preventive activities are to promote the maternal knowledge about danger signs, to look for opportune care and to improve oral hydration therapy (ORT). The objectives were to establish maternal knowledge about children's danger signs in acute diarrhoea below 5 years old. To determine hydration practices in acute diarrhoea. A descriptive study was carried out in Hospital del Norte of Popayán, Colombia, first level of attention health centre for establishing mother's knowledge of danger signs in acute diarrhoea. A survey based of an instrument from IMCI to 204 mothers chosen consecutively was applied. Variables measured were: maternal age, sex, child age, region (urban-rural), socioeconomic status, bond to the Colombian Social Security National System, scholarship, number of sons, coexistence with partner, coexistence with child's grandmother. The knowledge variable was determined from a dichotomy way. The mother's knowledge was established if she knew 2 or more danger signs in acute diarrhoea. Only 54% of mothers knew at least 2 danger signs in diarrhoea. Mothers used: Homemade liquids, 49%; commercial ORT, 49%; homemade serum, 23%. The fact of living with the grandmother was independent associated with an increase in maternal knowledge (p < 0.05). Since nearly half of the mothers don't know a danger sign makes necessary an educational intervention in acute diarrhoea and to divulge IMCI's recommendations. In this intervention grandmothers must be included. (author's)
To assess the relationship between maternal body mass index (BMI) at early gestation and the newborns' anthropometry, 105 mother-infant dyads from a public Maternity Hospital in Valencia Venezuela, were studied during 1998-2000. Weight and height of adult women between 10 and 15 weeks of gestation were used to calculate BMI according to Atalah's reference (Low weight, Normal, Over weight). Term newborns were assessed using gestational age calculated according to the Capurro method. Their weight, height, and head circumference were recorded, and were characterized using a Venezuelan reference. Newborns whose birth weight (BW) was £ 10th percentile were considered "small for gestational age" (SGA), and those with BW³ 90th percentile as "large for gestational age" (LGA). One-way ANOVA and Tukey's Post Hoc test were used for group comparisons. There were 41.9% of "low weight" mothers, and 13.4% of SGA newborns. There were differences in the newborns' weight and height according to "Low weight" maternal BMI with "Normal" and "Over weight" maternal BMI (p<0.05). A high prevalence of nutritional deficit was observed from the beginning of the gestational period, as well as a relationship between maternal BMI and the newborn's anthropometry. (author's)
[Assessment of 24 years of infant growth monitoring in a rural area of Senegal (1969-1992)]
Undernutrition in young children in developing countries is associated with an increased risk of death. But in several studies, a decrease in mortality was not associated with any decrease in the prevalence of undernutrition. A rural population of Casamance (Senegal) has been under yearly demographic surveillance by The French National Institute of Demographic Studies (INED) since 1985. Between 1960-1964 and 1990-1994, under-5 and child (1-4 years) mortality rates dropped from 312 to 127 and from 201 to 68 per 1,000, respectively. Since 1961, French Catholic nuns who are also professional nurses have been in charge of a private village dispensary located in a rural area of Casamance. This dispensary delivers permanent, high quality service and is widely attended. Growth monitoring programme: A growth-monitoring programme, supported by Cathwell, was initiated in 1969 for 0-5-year-old children (0-3 from 1985). Children were weighed wearing light clothes to the nearest 10g. Weights were recorded in aregister that also contained information concerning identity (name, sex, date of birth) and address. All weights were plotted on growth charts kept by the mothers. During the sessions, the nurses provided nutrition education messages (i.e., preparation of high-energy and nutrient-dense infant gruels using local foods), advice on illness management (oral rehydration during diarrhoea) and hygiene (well and water-jar disinfection, construction of pit-latrines), importance of vaccination. From 1975, they also distributed free chloroquine during the malaria transmission season (May-November) for prevention and early presumptive treatment. Most likely thanks to this programme, infant and child mortality reached a low level at the end of the 1980s. In 1990, plasmodium resistance to chloroquine appeared, increasing malaria mortality. Methods: All weight measurements taken in 1969-1994 were entered into a database. This paper presents an analysis of weight measurements taken at 3-23 months of age from 1969-1992. A total of 4,636 infants were weighed at least once, but only 3,912 infants (1,983 boys and 1,929 girls) were available for the analysis, 724 being excluded due to missing data. The average coverage of the programme during the month of February was 88% for infants aged 3-23 months. Mean weight was examined at three target ages: 5, 11 and 15 months. Not only did the nutritional status not improve between 1969 and 1989, it even deteriorated in some years for all three age-cohorts. The nutritional status of infants in this community did not differ significantly from that of 12-23 month-old Senegalese children in the 1992-1993 Demographic and Health Survey (DHS). Seasonal differences in mean weight and the prevalence of underweight became significant in the rainy season since 1975. Underweight for the 15-month-old children increased over time during the rainy season. These findings were unexpected, since malaria morbidity is thought to be at least partially responsible for seasonal variations in the nutritional statusof young children, and despite the fact that the nurses began a malaria control programme in 1975. The rapid transition towards lower childhood mortality observed in this rural area of Casamance (Senegal), was not concomitant with any improvement in infants' nutritional status from 1969 through 1992. Focused public health interventions such as vaccinations and malaria prevention probably did not improve the nutritional status. Paradoxically, growth monitoring may have been more helpful in improving health than growth. Targeted specific nutritional interventions are needed to significantly improve growth of children in this community. (author's)
[Postpartum anxiety: prevalence and risk factors]
Postpartum anxiety (PPA) is highly prevalent and has important consequences on mother and newborn. The aim of the present study was to estimate the prevalence of PPA and its risk factors, in a sample of women attending a private setting. A cross-sectional study was performed with 299 women, at a routine gynecological visit, from August 2000 to May 2003. The Spielberger State-Trait Anxiety Inventory (STAIT) and a questionnaire with sociodemographic data and obstetric data were used. Inclusion criteria were: women with no past or present history of depression, psychiatric treatment, alcohol or drug abuse and whose children were alive. The prevalences of PPA-trace and PPA-state, that evaluate characteristics of personality and transitory anxiety, respectively, were estimated with 95% confiance intervals (CI). Odds ratios and 95% CI were used to examine the association between PPA and exposure variables. Hypothesis testing was done by the x/2 test or x/2 test for linear trend, when categories were ordered. A p value < 0.05 was considered to be statistically significant. The prevalences of PPA-state and PPA-trace were 44.8% (CI 95%: 39.1 - 50.7) and 46.1% (CI 95%: 40.4 - 52.0, respectively). Formal agreement between scales was moderate (kappa = 0.55; p[Sexual violence: Recommended procedures and results of emergency care for women victims of rape]
Gender-based violence is related to the power imbalance between men and women that is present, to a greater or lesser degree, in all societies. It was recognized as a human rights problem by the UN relatively recently. It includes emotional, physical and sexual violence. Sexual violence is the extreme form of gender violence, usually accompanied by the other types of violence. Its prevalence is difficult to determine, but it most probably affects at least one third of women some time in their life. It has multiple consequences to women's physical and gynecological health, which depends in great part on the quality of the care the woman received immediately after the assault. Unfortunately, most emergency health services, including those in women's hospitals, are rarely prepared to provide the correct care for these women. Care should be multidisciplinary and involves crisis treatment, meticulous clinical examination with complementary auxiliary methods, treatment of physical lesions, prevention ofpregnancy and of sexually transmitted infections and AIDS, and follow-up for at least six months after the aggression. (author's)[Maternal and perinatal factors related to fetal macrosomia]
The purpose was to identify maternal and perinatal factors related to neonates with birthweight >/=4,000 g. Cross-section cohort study with 411 consecutive cases of fetal macrosomia (FM) which occurred from March 1998 to March 2005. Data were compared to 7,349 cases of fetal birthweight >/=2,500 and < 3,999 g which occurred in the same period. Maternal variables (maternal age, parity, diabetes, previous cesarean section, meconium-stained amniotic fluid, cephalopelvic disproportion, main cesarean section indications) and perinatal variables (birth injury,<71-min and 5-min Apgar score, fetal and early neonatal mortality range, need of neonatal intensive care unit) were analyzed. For statistical analysis the x/² test with Yates correction and Student's t test were used with the level of significance set at 5%. FM was significantly associated with older mothers, more parous and <71-min Apgar score (p<0.05; OR=1.8; 95% CI: 1,4-2.5) and <75-min Apgar score (p<0,05; OR=2.3; 95% CI: 1.3-4,1), diabetes mellitus (p<0.05; OR=4.2; 95% CI: 2.7-6.4), meconium-stained amniotic fluid (p<0.02; OR=1.3; 95% CI: 1.0-1.7), need of neonatal intensive care unit (p<0,05; OR=2.0; 95% CI: 1.5-2.7), early neonatal mortality (p<0,05; OR= 2.7; 95% CI: 1.0-6.7), cesarean section (p< 0.05; OR= 2.03; 95% CI: 1,6-2,5) and cephalopelvic disproportion (p< 0.05;OR= 2.8; 95% CI: 1.6-4,8). There was nostatistical difference between birth injury and fetal mortality range. In the FM group the main cesarean section indications were repeat cesarean sections (11.9%) and cephalopelvic disproportion (8.6%); in the normal birthweight group, repeat cesareans (8.3%) and fetal distress during labor (3.9%). In spite of the characteristic limitations of a retrospective evaluation, the analysis demonstrated which complications were associated with large fetal size, being useful in obstetric handling of patients with a diagnosis of extreme fetal growth. FM remains an obstetric problem of difficult solution, associated with important maternal and perinatal health problems, due to the significant observed rates of maternal and perinatal morbidity and mortality in developed and developing countries. (author's)[Breast cancer mammographic screening in public and private health care systems]
The purpose was to evaluate the characteristics of mammography use and the social demographic profile of women accessing public and private health care services. A cross-sectional study was carried out in the city of Taubaté, southeast Brazil. Six-hundred and forty-three women who under went mammographic examinations in the available healthcare services were interviewed, 472 of them in public and 171 in private health services. The social demographic and reproductive profiles of the women interviewed and the characteristics of the mammography use, such as the proportion of the women interviewed who had been previously screened, the age when the screening began, the interval between the screenings and their frequency, were evaluated by means of the Fisher exact, Wilcoxon and x/2 tests. The mean age of the interviewed women was similar in both studied groups. The proportion of women previously screened - 54.2 and 79.5% in public and private services, respectively - as well as the age when the screening began - 46.8 years (SD 10.2%) in public services and 40.2 years (SD 7.7) in private services - differed significantly (p<0.01). Twenty-five percent of women older than 50 years did not follow the adequate standards of periodic screening. The way of accessing health services has influenced the proportion of women previously screened and the age at which this screening began, being more adequate in the private health system. Although there was a later start in the public health services, the age when the mammographic screening began was earlier than the current official recommendations. There has been a failure of compliance with mammographic screening in women older than 50 years, in both researched groups. (author's)[Quality of life in breast cancer survivors]
Breast cancer is one of the most common malignancies among women. Its diagnosis and treatment have social, economic, physical, emotional/psychological and sexual repercussions. The main parameters used to assess the results of anticancer therapy are disease-free survival and overall survival. More recently, quality of life (QOL) has been considered an additional parameter. No consensus exists about the definition of QOL. However, most definitions take into account multidimensional and subjective aspects of QOL. The identification of factors related to QOL and comprehension of how these factors contribute to the perception of QOL are reasons for debate, since the concept of QOL is directly related to the social and cultural context in which the individual is inserted. Age at diagnosis, chemotherapy, type of surgery, climacteric symptoms, relationship between the couple, and sexuality are several factors associated with QOL in women with breast cancer. QOL associated with different antineoplastic therapies may help patients and physicians choose the best therapeutic modality. Towards this end, the current article addresses various aspects of QOL of breast cancer women, and presents the state-of-the-art knowledge on the topic. (author's)[Contraceptive methods in the public health service ("Sistema Unico de Saude") in Maringa-PR]
The purpose was to evaluate the contraceptive methods adopted by the public health system of Maringá County, Paraná, regarding the orientations for using them, indications, contraindications and reasons for interrupting these methods, as well as the profile of the female users. Transversal descriptive study, performed through 284 home interviews with women selected from the 62 groups of the Family Health Program, after their free and informed consent, and after the questionnaire had been approved by the Ethics in Research Committee involving human beings of the State University of Maringá (Universidade Estadual de Maringá - UEM). Before applying the questionnaires, they were pretested, focusing on the following sections: characterization of the interviewee, socioeconomical factors and contraceptive methods. Results were analyzed using the Statistical Package for the Social Sciences software 12.0 version. Most women were white, married, between 35 and 49 years old, with high school education, working without salary, and from D and E economical classes. Of them, 22.5% were smokers and 4.9% alcohol users. Contraceptive pills were adopted by 50.3% of the women; condom by 28.1% and tubal ligature by 32%, following, in general, the health professional orientation. Reasons for interrupting the contraceptive methods were the wish to get pregnant, preference for a permanent method, and also because of the side effects of the pill. Smoking was the most prevalent risk factor for pill use. Only 35.9% of the interviewed women started using the pill after a previous medical visit, and almost in the same proportion, 33.6%, without visit before starting to use it. It was observed that the indications of the contraceptive method to be used, and the orientations accomplished by the health professionals were satisfactory, despite the high levels of tubal ligature and the detection of relative contraindications for pill users with more than 5 years of use. (author's)[Early placental maturation evaluated by ultrasound and perinatal prognosis]
The purpose was to describe perinatal and obstetric characteristics of pregnant women with ultrasonographic early placental aging. Using a retrospective, descriptive, series of cases, with group comparison, the authors analyzed the data of 146 pregnant women, whose diagnosis of placental early aging (presence of grade II placenta before 32 gestational weeks or grade III, before 35 gestational weeks), and maternal-fetal conditions had been recorded in the medical charts at the "Maternidade Prof. Monteiro de Moraes", Recife, Pernambuco - Brazil, from January 2000 to December 2002, where they had been attended as inpatients. The exclusion criteria were diagnoses of: premature amniorrhexis, multiple pregnancies, acute premature detachment of a normally located placenta, and fetal malformation. The clinical and obstetric complications were: hypertensive diseases, intrauterine growth restriction, changes of amniotic fluid volume, infections, maternal diabetes, falciform anemia, HIV seropositivity, drug addiction, renal lithiasis, epilepsy and bronchial asthma. In the medical records, 106 pregnant women were identified as having clinical and obstetric complications (Gwith group) and 40 as not having any of these complications (Gwithout group). For group comparisons, x/2 and exact Fisher statistical tests were used, with significance level of 0.05. Gwith group was associated with higher incidence of oligoamnion (27.3%), intrauterine growth restriction (44.3%) and caesarean section prior to labor (36.8%). Compared to Gwithout, the Gwith group was characterized by high incidence of: fetal death, prematurity (58.8% versus 40%), lower 5th minute Apgar index, birth weight less than 2.500g (67.9% versus 40%); small body size for gestational age (39.2% versus 10%) and more severe intercurrents events. Perinatal prognosis does not depend upon placental early aging, but on clinical and obstetric maternal complications. (author's)[Prenatal diagnosis and vaginal delivery in osteogenesis imperfecta: a case report]
Osteogenesis imperfecta is a connective tissue disorder due to quantitative and qualitative anomalies in type 1 collagen, genetically transmitted by a dominant or recessive autosomal gene, leading to bone fragility. We report a case of a 19-year old G1PO patient referred to our institution following a screening ultrasound that demonstrated short limb fetal extremities. A level 3 scan was performed which evidenced an irregular cranial shape and compression of the cephalic pole with moderate transducer pressure. Limb shortening, decreased echoes and fractures of long bones were found on our scan evaluation. A vaginal delivery occurred at 35 weeks of gestation. The male newborn, weighing 1.990 grams had 6 and 8 in Apgar scores. The neonate was clearly abnormal, presenting irregular cranial shape, with poor ossification on X-ray, blue sclera, fractures and limb deformities. Postnatal evaluation was satisfactory and the neonate was discharged in good conditions. Prenatal diagnosis is important for an adequate pregnancy follow-up. Postnatal outcome was not related to vaginal delivery, as there were no recent fractures in the newborn. (author's)[Low educational level as a limiting factor in the fight against anemia in pregnant women]
The purpose was to evaluate the impact of supplementary ferrous sulfate and dietary counseling on hemoglobin levels in pregnant women. A total of 197 pregnant women were evaluated during antenatal care at a health center. The treatment group consisted of 105 women who were prescribed 60 mg dietary iron per day, received dietary counseling and had hemoglobin measured by a portable photometer between the 14th and 20th week of pregnancy. The treatment group was reevaluated according to hemoglobin levels and food intake by a semiquantitative food frequency questionnaire after the 34th week of pregnancy. The control group consisted of 92 women in a cross-sectional study, at no less than 34 weeks of pregnancy. Hemoglobin was analyzed by a portable photometer and anemia was defined concentrations of less than 11 g/dL. All pregnant women had their weight and height measured. Hierarchical logistic regression model was developed for the multivariate analysis. Prevalence of anemia at the end of the third trimester was 31.6% in the treatment group and 26.1% in the control group (p=0.43). Use of the prescribed supplement was reported by 65% of women in the treatment group, of which 67.7% interrupted the treatment at some point. Principal reasons for interrupting treatment were forgetting (43.2%) and nausea or vomiting (27.2%). Risk of anemia in the third trimester was three times higher in women with less than 8 years of schooling. Use of ferrous sulfate was not shown to be associated with lower prevalence of anemia. The results suggest that structural changes in socioeconomic conditions are needed in order to alter the current situation regarding iron deficiency anemia. (author's)[Beneficial interventions for maternal mortality prevention in the prenatal period]
Maternal mortality rate (MM) is a health quality indicator that is directly influenced by the economic, cultural and technological level of a country. Official data of MM in Brazil, although underestimated, point to the lack of quality in pregnancy, childbirth and puerperium care services. This characteristic is common in developing countries, where poorer pregnant women as well as those facing greater difficulty to quality care access are found. Prenatal care cannot prevent major childbirth complications, which are important causes of MM; however, some interventions during the prenatal period can favor maternal prognosis and prevent MM. In this setting, this study brings a scientifically based update concerning effective interventions for maternal mortality prevention during the prenatal period. The most important strategies consist of a tripod with specific interventions related to maternal health promotion, risk prevention and assurance of nutritional support during gestation, in addition to criteria to investigate gestational risk and inclusion of the pregnant woman in the basic component of the prenatal care model. It ends with the definition of priorities in the prevention of MM related to eclampsia/preeclampsia and reinforces the importance of normalization of reference systems for obstetric emergency cases. (author's)[Maternal factors and perinatal results in placental abruption: a comparative study of two periods]
The purpose was to compare the maternal factors, clinical aspects and perinatal results in placental abruption during two periods. Retrospective analysis of placental abruption cases that occurred from January 1, 1994 through December 31, 1997 (period 94-97), and from April 4, 2001 through March 3, 2005 (period 01-05), in singleton delivery with birthweight higher than 500 g and after 20 weeks of gestation. The following factors were analyzed: maternal age, previous obstetric history, prenatal care, premature rupture of membranes, obstetric and/or clinical intercurrent events, vaginal bleeding, uterine tonus, fetal anomaly, mode of delivery, hemoamnion and maternal complication (hysterectomy, uterine atony, disseminated intravascular coagulation, acute renal failure, and maternal death), and the perinatal results. The rate of placental abruption was 0.78% (60 cases) in the period 94-97 (n=7692 deliveries), and 0.59% (51 cases) in the period 01-05 (n=8644 deliveries), without significant difference. A significant difference was observed between the periods 94-97 and 01-05 regarding mean number of previous gestations (3.5±2.4 and 2.6±1.8, p=0.04), patients without prenatal care (13.3 and 2.0%, p=0.03) and maternal intercurrences (38.3 and 64.7%, p=0.01). No significant difference was observed related to vaginal bleeding, tonus abnormalities and perinatal results, between the periods, but a higher proportion of hemoamnion in 94-97 was found when compared to 01-05 (28.3 and 11.8%, p=0.03). In spite of obstetrical advances, maternal complications and perinatal results were similar in the analyzed periods. The severity and the unexpected results emphasize the importance of prevention and adequate control of associated factors, when this pathology is approached. (author's)The purpose was to evaluate association between CD4+ cell count and cervical intraepithelial lesion severity in HIV-infected women. Cross-sectional study of 87 HIV-infected patients which were confirmed by previous serologic examinations. All had cervical HPV diagnosed by polymerase chain reaction (PCR). All patients underwent anamnesis, physical examinations and colposcopy. Cervix biopsy was performed when indicated by colposcopical examination. Histopathological results followed Richart's classification, adapted by Wright, and CD4+ cell count and cervical intraepithelial lesion severity association was analysed by comparison of means using analysis using analysis of variance (ANOVA).Among 60 biopsied women 24 were found (40.0%) with CIN I, eight (13.3%) with CIN II, three (5%) with CIN III, 14 (23.3%) with chronic cervicitis and 11 with cytopathic effect of HPV, without cell polarity loss. This corresponds to 35 (58.3%) women with intraepithelial lesion of low grade (CIN I + HPV) and 11 (18.3%) with intraepithelial lesion of high grade (CIN II + CIN III). There was no significant association between CD4+ cell count mean and cervical intraepithelial lesion severity (p=0.901).There was no association between CD4+ cell count and cervical intraepithelial lesion severity diagnosed by histopathological examination. (author's)[Stress and anxiety in infertile women]
The purpose was to assess the frequency of stress and anxiety levels in infertile women, in order to obtain data for specific psychological intervention. A cross-sectional study involving 152 infertile (mean age 30.3±5.4 years), and 150 healthy control women (25.7±7.9 years). All patients were evaluated with the Lipp's Inventory of Stress Symptoms and the State-Trait Anxiety Inventory. Considered dependent variables were: stress frequency and anxiety scores (state and trait). Statistical analysis was performed by the 2 and Mann-Whitney tests, and logistical regression to test associations between response variables and considered risk factors. Statistical significance was defined as p<0.05. The stress was more frequent in the infertile group than in the control group (61.8 and 36.0%, respectively); however, no significant differences were observed between groups in relation to stress phases and predominant symptoms. With respect to anxiety, there were no significant differences between infertile and control groups as to median state scores (39.5 and 41.0, respectively) and anxiety trait scores (44.0 and 42.0, respectively). Factors significantly associated with greater risk for high anxiety scores in the infertile group were: unawareness of the causal factor, diagnostic phase investigation, and lack of children from other marriages. It can be concluded that infertile women are more vulnerable to stress; however, they are capable of adapting themselves to stressful events without serious physical or psychological compromise. (author's)The purpose was to compare the uterine cervix measurements and funneling obtained by two- and three-dimensional transvaginal sonography during pregnancy. A prospective, descriptive study, with group comparison, was carried out between April 2004 and February 2005 in 74 pregnant women, who were between the 19th and 24th week of pregnancy, regardless of risk factors for premature delivery. The ultrasound examination of the cervix was carried out only once in the same patient and by only one observer. The measurements of the cervix by two-dimensional ultrasound were made at the time of the test and by three-dimensional ultrasound at intervals of 7 to 15 days after the two-dimensional ultrasound. The measurements of cervical length, funnel width and length were taken by two-dimensional ultrasound in the sagittal plane and by three-dimensional in the sagittal plane as well as in coronal plane. There was no significant difference between the averages of the measurements of the cervix obtained by two- and three-dimensional ultrasound in the sagittal plane (p=0.23); however, there was a difference in the averages of the measurements of the cervix obtained by two-dimensional ultrasound in sagittal plane and three-dimensional ultrasound in the coronal plane (p=0.009) and between three-dimensional ultrasound in the sagittal and coronal planes (p=0.001). The kappa test (0.86) showed no superiority of either the two-dimensional and three-dimensional ultrasound in the visualization of the cervical funnel. No statistically significant difference was observed between the methods when the average of the measurements of funneling was compared (p>0.05). There were differences between two-dimensional and three-dimensional ultrasound of cervical length, only using the coronal plane of the three-dimensional ultrasound. (author's)[Comparative study of female surgery contraception access: microlaparoscopy versus minilaparotomy]
The purpose was to compare in a retrospective way, 51 women who underwent tubal ligation, 30 through microlaparoascopy (Gmicrol) and 21 through minilaparotomy (Gminil). The analyzed parameters were: total time for accomplishment of the procedure and the surgical technique, time of hospital stay and return to the habitual activities after the surgery, postoperative pain, morbidity, satisfaction degree and esthetic effect, considering values of p < 0.05 as significant, and also standard cost. Gmicrol took less time to accomplish the surgery than the Gminil (43 against 57 minutes respectively, p < 0.05), less time to accomplish the surgical technique (6.48 against 30.32 minutes respectively, p < 0.05), and lower hospital stay (9,90 hours as against 41,7 hours respectively, p < 0.05). There was no significant difference between the two groups regarding time to return to the habitual activities after surgery. To evaluate postoperative pain, a scale of 0-10 it was applied. Gmicrol present a lower pain score on the 1st and 2nd postoperative days (1.13 and 0.26 to Gmicrol and 4.52 and 1.14 to Gminil, respectively, p < 0.05). There was no significant difference between immediate postoperative the most common complaint being pain at the site of pain and that on the 3rd postoperative day. Gminil presented a higher morbidity rate incision. To evaluate the satisfaction degree and esthetic effect, numeric values were attributed to as good, regular, poor and very bad as answered by the patiets. Gmicrol presented a higher satisfaction degree (p < 0.05) and better esthetic effect as compared to Gminil (p < 0.05). The microlaparoscopy standard cost was R$ 109.30 being lower than that of minilaparotomy. Tubal ligation by microlaparoscopy, under local anesthesia and conscious sedation presented some advantages compared to minilaparotomy. (author's)The purpose was to describe, in participants of the Brazilian Study of Gestational Diabetes (EBDG), the percentile distribution of uterine height by gestational age and to validate the use of percentiles of the chart derived by the "Centro Latino-Americano de Perinatologia" (CLAP), used as reference in predicting abnormal fetal growth. The EBDG is a cohort study of 5564 pregnant women older than 19 years, followed through and after delivery. Interviews and standardized anthropometry were performed at baseline between 20-28 weeks. Medical records covering prenatal and delivery periods were then reviewed following a standardized approach. Analyses pertain to 3539 women with gestational age confirmed by ultrasound. Diagnostic properties of the 10th and the 90th percentiles of both charts (EBDG and CLAP) as predictors of abnormal neonatal weight were determined. Uterine height was higher in EBDG than in the CLAP chart at every gestational week, being 1-4 and 2-6 cm greater, at the 10th and 90th percentiles respectively. The CLAP 10th percentile classified as small the uterine heights of only 0.3 to 1.7% of Brazilian women, while the 90th percentile classified as large the uterine heights of 42 to 57% of the sample. The sensitivity of CLAP percentile 10 in the prediction of small for gestational age varied from 0.8 to 6% and the specificity of CLAP percentile 90 in the prediction of large for gestational age, from 46 to 61%. The CLAP uterine height reference chart does not reflect the current uterine growth pattern of pregnant Brazilians, limiting its clinical applicability in the detection of abnormal fetal growth, especially intrauterine growth restriction. (author's)[Should semen analysis be requested for men with a history of previous fertility?]
The purpose was to determine if the previous fertility history can predict current fertility status of a patient examined for couple's infertility. Retrospective study involving semen analyses from 183 consecutive subfertile patients evaluated from September 2002 to March 2004. We excluded those patients who had undergone radio or chemotherapy, orchiectomy or vasectomy. Mean values of all analyses were used for patients with multiple semen analysis. Patients with more than 20x10/6 sperm/mL, motility higher than 50% and with normal strict sperm morphology higher than 14% were considered normal. Patients were divided into two groups, according to the fertility status: primary infertility (118 patients) and secondary infertility (65 patients). Data were analyzed according to the x/2 test and the Student t-test. No differences were detected in the mean age between patients with primary infertility, 37.3 ± 6.3, and secondary infertility, 38.1 ± 5.9; p=0.08. In the group of patients with primary infertility, 51.9% (61 patients) had a normal sperm concentration, 70.3% (83 patients) had normal sperm motility and 26.3% (31 patients) had normal sperm morphology. In the group of patients with secondary infertility, 53.8% (35 patients) had normal sperm concentration, 75.4% (49 patients) had normal sperm motility and 32.3% (21 patients) had normal sperm morphology. No significant differences were detected in sperm concentration (21.3x10/6/ml versus 23.1x10/6/mL; p=0.07), motility (45.2 versus 48.1%; p=0.08) and morphology (6.1 versus 6.4%; p=0.09) between groups of patients with primary and secondary infertility. Semen analysis should be requested even in cases of prior male fertility. Physicians should not presume a patient to have a normal semen analysis based on his previous history of initiating a pregnancy. (author's)[Hormonal contraception and antiretroviral therapy among HIV-infected women]
There is much controversy regarding the relationship between the use of hormonal contraceptives and the risk of acquiring Human immunodeficiency virus (HIV), and little is known about the effects of hormonal contraception in HIV-infected women (adverse events, menstrual disorders, disease progression, antiretroviral therapy interactions). The aim of the present study was to review available data regarding HIV vulnerability and transmission associated with hormonal contraceptives and the use of these contraceptives by women on antiretroviral therapy, with emphasis on drug interactions. In conclusion, it was not possible to offer evidence-based recommendations for the use of hormonal contraceptives among HIV-infected women under antiretroviral therapy. Infectious disease specialists and gynecologists providing care should be cautious about potential drug interaction leading to increase in adverse events, individualizing contraceptive drugs, route, and dosage, according to the antiretroviral therapy under use. (author's)[Management of chronic pelvic pain in women]
Chronic pelvic pain is a debilitating and highly prevalent disease with a major impact on quality of life and work productivity, beyond significant costs to health services. The dilemma of managing patients with chronic pelvic pain continues to frustrate physicians confronted with these complaints, in part because its pathophysiology is poorly understood. Consequently, its treatment is often unsatisfactory and limited to temporary symptom relief. In the present revision, we discuss the adequate management of chronic pelvic pain. We point out that a comprehensive medical history and physical examination should include special attention to gastrointestinal, urological, gynecological, muscle-skeletal, neurological, psychiatric, and endocrine systems. Thus, a multidisciplinary approach is recommended. Additionally, we emphasize that, although useful, specific surgical procedures, such as laparoscopy, should be indicated only to selected patients, mainly after excluding irritable bowel syndrome and pain of myofascial origin. (author's)[Growth of full term low and adequate birth weight infants during the first two years of life]
The objective was to assess the growth pattern of full term low and adequate birth weight infants during the first two years of life and to identify the determinants at the time of the greatest growth deceleration. A prospective cohort study was conducted with 148 full term infants in five small towns of the state of Pernambuco, Northeastern Brazil. Newborns were recruited from maternities between January 1993 and January 1994 and their anthropometric measurements were taken at one, two, four, six, 12 and 24 months of life. Risk factors were analyzed using multivariable linear regression. The increment of mean weight-for-age and length-for-age were more evident for low birth weight when compared with adequate weight infants, especially during the first two months after birth. From this point onward it was observed a progressive mean growth deceleration in both indexes up to 12 months of life. All infants had similar weight and length growth patterns. However, adequate birth weight infants remainedin an upper level. Socioeconomic variables explained 23% of variation for weight-for-age, followed by 4% for birth weight. Socioeconomic condition was also the factor mostly affecting length-for-age, explaining 28% of its variation, followed by birth weight, maternal height and diarrhea. The study results suggest that interventions aiming to adequate growth should focus on prenatal care and social and environmental factors during childhood as a way of ensuring full expression of the genetic potential of this population. (author's)[Low birth weight in Maniema (Democratic Republic of Congo)]
This study sought to examine birth outcomes in the general population in the Democratic Republic of Congo (DRC). Specifically we wanted to see if the proportion of low birth-weight infants (<2,500g), including preterm infants, differed from that of most developing countries in view of the political disturbances in DRC over the past eight years. We studied birth weight in two maternity units in the province of Maniema from November 2003 to October 2004: there were 938 births, 450 at Kama and 488 at Kipaka. The rate of low birth weight (LBW) (<2,500g) infants was 164 per 1,000 live births at Kama and 270 per 1,000 live births at Kipaka. This rate was higher at Kipaka than at Kama, probably because commerce has improved living conditions at Kama (x/2=16.79, p<0.001). The study also confirmed the importance of maternal age, especially the 14-17 year age group, in low birth weight (including preterm births). The relative risk associated with this age group was 2.2 at Kama (95% CI: 1.3-3.7) and 1.5 at Kipaka (95% CI: 1.1-2.1). These results suggest that low birth weight (including preterm birth) remains a public heath problem in DRC, as in other developing countries. They also confirm that very young mothers are most likely to have low birth-weight infants and they stress the importance of resources for preventing preterm birth and improving care of low birth-weight infants, born before or at term. (author's)[Vasovasostomy: our experience]
From August 1997 to December 2004 we performed 47 vasovasostomies for vasectomy reversal in the same number of patients. Only 42 patients are available for follow-up, with a mean follow-up of at least six months. Mean age is 40.7 years for the patients and 30.8 for the couples. The two-layer technique was applied under microscope magnification in the first 22 patients; single layer technique was performed in the others. Overall spermatozoid patency rate was 71.42%, and pregnancy rate was 32.45%. Surgical technique did not have influence on results. Better prognosis is expected in young men; the longer the interval between vasectomy and reversal, the lower the patency rate. Regarding pregnancy rate, it is not influenced by delay of reversal. (author's)[Knowledge about contraceptives in a population 15 years or older in a southern Brazilian city]
In Brazil, prevalence of contraceptive use is high, but incorrect and inappropriate use is frequent, suggesting limited knowledge about methods. This study thus evaluated the knowledge about the most widely used contraceptive methods, measured through a score (0-10) and related factors. A population-based cross-sectional study was performed, with 3,542 subjects ages 15 or older, residing in the urban area of Pelotas, Rio Grande do Sul State. The mean overall knowledge score was 4.65 (sd = 2.07): 5.02 (sd = 2.10) for women and 4.18 (sd = 1.92) for men. Lower age, higher schooling, a report of unwanted pregnancy, and any lifetime use of contraceptive methods (exclusive or combined) were associated with higher knowledge scores among men, while for women, the determinants of higher knowledge were higher age, living with a partner, higher schooling, higher socioeconomic status, not reporting a religion, and any lifetime use of contraceptive methods (exclusive or combined). Despite high prevalence of any lifetime contraceptive use (75.3%), knowledge is still limited about the most widely used methods, as well as about the menstrual cycle and fertile period. (author's)[Ethical conflicts in health care for adolescents]
The goal of this research was to identify ethically conflicting situations experienced by health professionals during health appointments with adolescents in order to create a protocol for action to help professionals make decisions and to protect the clients. The study used an observational cross-sectional method through interviews with health professionals at the Center for Studies on Adolescent Health, Rio de Janeiro State University, to obtain data from cases involving bioethical, ethical, and legal conflicts. Seventy-four professionals reported 149 cases, in which there were 250 conflicts identified through posterior qualitative analysis. The conflicts were interconnected, but for didactic reasons they were mentioned here separately. They included: secrecy and confidentiality, illicit activities, violence, contraception in girls less than 15 years of age, negligence, autonomy, and recording of confidential information on patient medical records. We conclude that there are constant ethical conflicts during health appointments with adolescents, and that bioethics is a useful instrument for solving them. It is also essential to be familiar with the prevailing legislation, to consult pertinent organizations, and to evaluate situations individually. (author's)[Prevalence of physical inactivity in adult women in Sao Leopoldo, Rio Grande do Sul, Brazil]
The aim of this study was to evaluate the prevalence of physical inactivity and associated factors in adult women (20-60 years) in São Leopoldo, Rio Grande do Sul, Brazil. A cross-sectional population-based study was carried out in 40 census tracts of the city. Physical inactivity was defined as no leisure-time physical activity or light-intensity activities no more than once a week. Of the 1,026 women interviewed, 380 (37.0%; 95% CI: 34.0-40.0) were classified as inactive. Another 609 (59.3%) reported moderate or vigorous activities less than three times a week. In the crude analysis, physical inactivity was higher among non-white women, those with higher parity, with less schooling, low income, and obese. After adjustment, only the effect of body mass index remained statistically significant. Local and national policies for counseling and environmental improvements are necessary to reverse the high prevalence of physical inactivity observed in the community. (author's)In recent decades the Brazilian population has undergone intense changes in its nutritional conditions, especially with an increase in obesity. According to the National Survey on Health and Nutrition in 1989, 32.0% of adults were overweight. However, distribution of the problem is not homogeneous. The highest prevalence occurs among poor women in the Southeast. Understanding this apparent paradox requires the search for approaches capable of overcoming simplistic interpretations about eating practices. Thus, the objective of this study was to understand obesity combined with poverty, focusing beyond economic determinants on constraints of a cultural and symbolic nature. From this perspective, the study analyzed the daily lives of poor women who used a Municipal Health Center and resided in the Rocinha slum in Rio de Janeiro. The results showed the complexity of the relationship between obesity and poverty. Cultural and material life aspects as well as different concepts of eating and the body proved to be fundamental elements for the analysis of the multiple facets of obesity in Brazil. (author's)A prospective study was undertaken in 1,520 children less than 15 years of age in São José de Ribamar, Maranhão, Brazil, from June 1994 to January 1995, to evaluate the prevalence and characteristics (socioeconomic, environmental, and behavioral) associated with infection by Leishmania chagasi. Montenegro skin test (MST) and enzyme-linked immunosorbent assay (ELISArK39 and CRUDE) test were used to detect infection. The statistical analysis used the 2 test with Yates correction and a p value less than 0.05 was considered statistically significant. Prevalence of infection was 61.7% as measured by MST, 19.4% according to ELISA (rK39), and 19.7% by ELISA (CRUDE). Association was detected between leishmaniasis in the family, water supply, application of insecticide, and infection by L. chagasi using MST. No association with infection by L. chagasi was detected using ELISA rK39 or CRUDE. More effective control measures are needed to reduce prevalence and to detect asymptomatic cases in this high percentage of infected children. (author's)This study investigates the concordance of clinical and demographic data under the Unified National Health System (SUS) in Brazil, comparing authorizations for high-complexity oncological procedures in breast cancer with a random sample of 310 corresponding medical records in Rio de Janeiro State, Brazil. Concordance was verified using kappa (K), prevalence-adjusted bias-adjusted kappa (PABAK), weighted-kappa (KW), intraclass correlation (ICC), and relative frequency statistics. 95% confidence intervals were estimated, and Landis and Koch criteria were applied for concordance interpretation. Assuming PABAK as the most appropriate statistic for the variables analyzed, we observed a moderate concordance for cancer staging, PABAK = 0.63 (95% CI: 0.56-0.70), and for morphological diagnosis, PABAK = 0.84 (95% CI: 0.72-0.96). For date of birth and date of diagnosis, ICCs were 0.96 (95% CI: 0.95-0.96) and 0.92 (95% CI: 0.90-0.94), respectively. Concordance regarding municipality of residence was 52.9%. The study indicates that, except for municipality of residence, the data concordance comparing authorizations for procedures and patient medical records in Rio de Janeiro allows its application to epidemiological and health services research, as well as for health planning purposes. (author's)The objective was to verify the occurrence of iron deficiency and associated factors in infants. This cross-sectional study included 365 infants (defined here as 6-24 months of age) treated at a primary care center in Belém, Pará, Brazil. Irondeficiency anemia (hemoglobin < 11g/dl and ferritin < 12µg/l) was diagnosed in 55.1% of the sample, depletion of body iron reserves (hemoglobin < 11g/dl and ferritin < 12µg/l) in 15.3%, and iron sufficiency (hemoglobin < 11g/dl and ferritin < 12µg/l) in 18.1%. The results of the logistic regression model showed associations between iron deficiency (ferritin < 12µg/l) and: 6-12 month age group, OR (odds ratio) = 3.67 and 95% CI: 1.93-7.04; non-utilization of iron-fortified formula as the first milk used after interrupting breastfeeding, OR = 1.93 and 95% CI: 1.04-3.60; and per capita income = 1 minimum wage, OR = 2.69 and 95% CI: 1.30-5.59. The occurrence of iron deficiency was high, showing the need to adopt effective measures to prevent this important publichealth problem. (author's)Community surveys are essential to estimate health indicators, evaluate health programs, and define health interventions. In 2002, a cross-sectional survey of children under five was conducted in 18 areas of the poorest counties in North and Northeast Brazil. Nine areas were visited by volunteer community health workers (CHW) under the Children's Mission, and the others were not visited. Using a standard questionnaire, trained interviewers collected information at the household level for 1,528 children, 782 of whom were visited monthly by CHWs and 772 were not. All the children and their families were living below the poverty line; 40.0% of the parents were illiterate, per capita daily income was about US$0.30, and household conditions were substandard. However, most were living less than 1km from a public health service and almost all children who were referred to these services received medical care. Prenatal care was also poor in terms of number of medical visits and laboratory tests. Children visited by CHWs from the Children's Mission received better care in terms of growth monitoring, number of medical check-ups, and prenatal iron supplementation. (author's)This article evaluates a policy for breastfeeding promotion, protection, and support in primary health care units in Rio de Janeiro State, Brazil, analyzing the assumptions, interventions, and results based on a log-frame model. A systematic review sought to identify effective procedures and strategies for extending breastfeeding duration, constituting the basis for creating "Ten Steps" in the "Breastfeeding-Friendly Primary Care Initiative" launched in Rio de Janeiro State in 1999. A corresponding evaluation method was developed and applied to verify the performance of 24 primary health care units from different parts of the State. A direct association was found between the practical implementation of these steps and prevalence of exclusive breastfeeding, as well as with mothers' satisfaction. An analysis of meanings ascribed by pregnant women and mothers to the support provided for breastfeeding identified five categories: "no support", "doubtful support", "encouragement", "guidance", and "partnership". The evaluation model allowed staff at the health care units to recognize opportunities for improving the program, in order to reverse the current low prevalence of exclusive breastfeeding. (author's)[Knowledge, attitudes, and practices related to the Pap smear among women with cervical cancer]
Despite screening programs, Brazil has a high cervical cancer mortality rate. The objective of this cross-sectional study was to analyze knowledge, attitudes, and practices related to the Pap smear and to understand why women fail to submit to this screening test. A structured questionnaire was used to interview 138 women: 90 with high grade intraepithelial neoplasia and 48 with invasive cervical cancer. Inadequate practices were more frequent among women with invasive cancer. In terms of difficulties in obtaining medical care, more than 80% of women reported lack of motivation, 60% reported that physicians failed to conduct a complete physical examination, and some 50% reported that physicians' schedules were busy. Having a Pap smear usually depended on a physician's request and the woman being symptomatic. Women over than 56 years old showed more frequent inadequate knowledge, attitudes and practices. However, those with more schooling were more knowledgeable of the Pap smear procedure. Age and less schooling could be barriers against women participating in screening programs , but socioeconomic problems must also be considered for improving practices related to the Pap smear. (author's)The objective was to determine the prevalence of lactose malabsorption and its association with skin color and age in children and teenagers attending public schools in Porto Alegre, Brazil. A cross-sectional study was performed with 225 subjects between 8 and 18 years attending two public schools in Porto Alegre, Brazil. Patients were randomly selected. Subjects were classified according to skin color (white and nonwhite) and age group (8 to 12 and 13 to 18 years). Lactose malabsorption was diagnosed using the breath hydrogen test after ingestion of 250 ml of whole cow milk. The test lasted for 3 hours, with collections after fasting and 60, 120, and 180 minutes after milk ingestion. Malabsorption was determined in the presence of increase of >20 ppm in hydrogen concentration regarding the basal levels. Two-hundred and twenty-five students were studied, with a mean age ± standard deviation of 12.2 ± 2.0 years. The subjects consisted of 134 females (59.6%); 154 white (68.4%); and 71 nonwhite. Lactose malabsorption was observed in 19/225 cases (8.4%). It was diagnosed in 8/154 white patients (5.2%) and in 11/71 nonwhite patients (15.5%) (P= 0.02). Regarding the age group, we found 15/143 cases of malabsorption in students between 8 and 12 years (10.5%), and 4/82 cases in students between 13 and 18 years (4.9%) (P = 0.227). The prevalence of lactose malabsorption in students attending public schools in Porto Alegre is significant, especially if we consider that the physiological doses (250 ml of milk) were used for diagnosis. The malabsorption rate was higher among nonwhite children, which confirms the influence of race on primary adult type hypolactasia. No association was observed between lactose malabsorption and age group. (author's)The objective was to compare two methods of iron supplementation (fortified formula versus medicinal iron drops) to prevent iron deficiency anemia in preterm infants. Sixty six premature infants weighing between 1000-2000g were included in the study. Forty infants completed the whole follow-up period, divided into 2 groups: Group A: 20 infants fed with iron fortified formula (11 mg Fe/l); Group B: 20 infants fed with powder cow's milk supplemented with 2 mg Fe/kg/day, as drops of ferrous sulfate. At two and 12 months 2 ml of blood were collected to measure hemoglobin, hematocrit, serum iron, total iron binding capacity (TIBC), serum ferritin and free erythrocyte porphyrins. At the 6th month, 1 ml of blood was drawn for hemoglobin and hematocrit determinations. Statistical analysis used the Student t test and x/2, with p<0.05. There were no significant differences between the groups in terms of body weight and weight gain; hemoglobin, hematocrit, serum iron levels and TIBC saturation indexes were similar in both groups at two months but significantly higher in group A at 12 months of age, while free erythrocite porphyrins levels remained stable in Group A and increased significantly in Group B (p< 0.05). Ferritin levels were normal in both groups at two months and declined sharply by 1 year of age, but only 4 (20%) infants of Group A showed levels < 10ng/ml, against 12 (60%) of the Group B (p< 0.02). The iron fortified formula was significantly more efficient than medicinal iron drops to prevent iron deficiency anemia of preterm infants. (author's)[Weight / length ratio: is it a good index to assess nutritional status of full-term newborns?]
An accurate assessment of the nutritional status of an infant at birth is very important, since it provides information on early identification of pathological events related to intrauterine growth acceleration or retardation. Anthropometric ratios such as weight/ length and mid-arm circumference/head circumference may be used as alternative tools for this purpose. The main objective of this study was to verify the correlation between triceps skinfold thickness with Rohrer Index, Body Mass Index, weight/length ratio, and mid-arm circumference/head circumference ratio. A cross-sectional study was carried out with 390 fullterm newborns delivered at the Maternity Ward of Instituto Materno Infantil of Pernambuco, from May to July 1999. The newborns had their birthweight, length, head and mid-arm circumferences and triceps skinfold thickness measured. The results showed that among the anthropometric indices studied the weight/length ratio showed the strongest correlation with triceps skinfold thickness(r = 0.63, P< 0.001) followed by mid-arm circumference/head circumference ratio (r = 0.59, P< 0.001). Rohrer index showed the weakest correlation (r = 0.43, P< 0.001). Multiple linear regression analyses revealed that weight/length ratio correlated best with skinfold thickness. We concluded that among the studied indices, weight/length ratio showed to be the best alternative to assess the nutritional status of infants at birth. (author's)[Determinant factors of anemia in children]
The objective was to present a review about the main determining factors of anemia in children under 5 years old. Information was collected from articles published in indexed national and international scientific journals, technical books and publications of international organizations. Anemia constitutes the world's nutritional problem of great magnitude, and children under 5 years old form the group with the highest risk. Similarly to any other public health problem, the origin of anemia is multi-causal. Therefore, in this article the attempt is to interpret its direct or indirect relation with possible determinant factors and the main concordant or discordant findings in epidemiological studies. Social and economic conditions, child's health care conditions, child's nutritional state, presence of morbidity, food consumption and biological aspects are among these factors. The role of the diet is emphasized with respect to the consumption and bioavailability of iron, and child's age as the main determinants. Bearing in mind the magnitude of the problem and the extent of its risk factors reviewed in this study, the implementation of urgent prevention and treatment measures for iron-deficiency anemia are required. It is important to highlight that a single strategy may have little success if other measures are not taken simultaneously; the role of nutritional education being relevant, together with other implemented actions. Children under 2 years old and children who live in rural and deprived areas should be considered as priorities in programs to combat anemia. (author's)[The use of CRIB score for predicting neonatal mortality risk]
The objective was to examine the clinical risk index for babies (CRIB) predictive value for hospital death; to identify the score variable with the best predictive value and to compare CRIB score capability to predict hospital mortality to birth weight, gestational age and base excess. CRIB score was obtained through a prospective way from 100 newborns with birthweight of 1,500 g or less or gestational age less than 31 weeks, who were admitted consecutively to the Neonatal Unit of Hospital das Clínicas, Universidade Federal do Paraná. Fifty-five newborns were female and 45 were male, the average of birthweight was 1,078 ± 0.277 g and gestational age was 29.2 ± 2.8 weeks. Twenty-one patients died. The mortality rate in the CRIB groups 1, 2, 3 and 4 was, respectively 6.6%; 46.2%; 87.5% and 100.0%. The score accuracy for mortality was confirmed (area under the ROC curve = 0.877) and the best score variable to predict hospital death was maximum base excess (area under the ROC curve = 0.795). Compared with birthweight and gestational age, CRIB was significantly better to predict mortality. Besides being useful to predict hospital death, CRIB was a simple score to be applied. Based on these results, we recommend its inclusion in the routine of neonatal units. (author's)[Growth of small for gestational age preterm infants]
The objective was to describe the linear growth and growth velocity of preterm infants born small for gestational age according to variables such as weight, length and head circumference, from birth to three months of corrected age. Prospective study of one hundred preterm infants born small for gestational age from 28 to 36 weeks after birth and classified as small according to the weight for their gestational age. The anthropometric data was obtained at birth, and continued to be measured weekly until the probable delivery date and monthly until three months of corrected age. Growth curves were calculated according to the mean values adjusted by the polynomial function of Count model. The infants' growth curves for the three variables were much below the ones of the preterm infants with adequate size for gestational age until the fortieth week. However, the head circumference growth reached the 10th percentile curve of the NCHS at the fortieth week, and the 25th percentile at three months of corrected age. The weight growth curve reached the 10th percentile curve around one month and a half for males and two months and a half for females. The length growth curve reached the 10th percentile for males at three months of corrected age and it almost reached that percentile for females after the same period of time A tendency of recovering weight and length related to preterm infants with adequate size and term newborns was observed. The head circumference showed an obvious and early recovery. (author's)[Adolescents' knowledge about adolescence, puberty and sexuality]
The objective of this research was to evaluate the level of knowledge about adolescence, pubertal development and sexuality among adolescents from 10 to 14 years old at municipal public schools in Feira de Santana-Bahia, 2000. Cross-sectional study, with a randomized and proportional sample out of a population of 6,419 students in the municipal Public System. The level of knowledge was analyzed according to age, sex and educational level. Data was collected by means of a specific confidential questionnaire, which was pre-tested. A scale of values (score - satisfactory, reasonable and unsatisfactory) was established according to the percentage and proportional number of right answers regarding general and specific topics. Statistical inference was calculated by chi-square (x/2) with a significance of 5% as well as the bivariate and multivariate analysis, calculating the simple and adjusted prevalence, through stratified analysis. Adolescents showed unsatisfactory level of information about terms, particularly those at the age of 10 (69.2%) and 11 years (70.6%), female (61.7%) and the ones in the 4th (82.8%) and 5th (61.1%) grades. The level of knowledge according to sex, adjusted by age and educational level, showed that females are 1.3 and 1.27 times more likely to present an unsatisfactory level of knowledge than males. The level of knowledge according to educational level, adjusted by age, showed that those subjects between 4th and 5th grades are 2.32 times more likely to present an unsatisfactory level of knowledge if compared to students of 6th and 8th grades, with significant differences (p<0.05). The high prevalence of unsatisfactory level of knowledge with significant association between 4th and 5th grades and females points to the necessity of educative actions regarding health and sexuality in the beginning of adolescence at municipal public schools. (author's)The aim of this study was to evaluate the clinical, laboratory and histopathological characteristics and the response to immunosuppression in children and adolescents with autoimmune hepatitis (AIH). The present research is a descriptive study consisting of 39 children and adolescents with AIH who receive care at the Department of Pediatric Gastroenterology of Hospital das Clínicas (UFMG) from 1986 to 1998. Children's age ranged from 1.6 to 17 years (mean 8.7 ± 3.49), most of them were females (87.2%). There were three types of clinical presentations: chronic (53.9%), acute (41%), and serious hepatic failure (5.1%). The most relevant laboratory parameters were the aminotransferases and g-globulin increase. Antinuclear antibodies were positive in 66.7% of the patients, while smooth muscle antibodies were positive in 52.8% and anti-LKM1 in 3% of the patients. In the histopathology the most important findings were the piecemeal necrosis (93.7%), moderate to severe portal inflammation (78.1%), definitive or incomplete cirrhosis (76.9%), absence of lesion of biliary ducts (93.7%) and presence of rosettes (90.6%). During the treatment, 77.8% obtained complete resolution, associated to side effects in 27.8% of them. Seven patients died (17.9%). During the treatment there was significant z score reduction (p< 0.05) for height/age. After carrying out this study, we observed that the typical characteristics of AIH were: female sex, several clinical presentations, increased aminotransferase, and hypergammaglobulinemia. Histopathology showed a predominance of incipient and/or definitive cirrhosis associated with moderate to severe portal inflammation and piecemeal necrosis. Treatment using corticosteroids and azathioprine, turned out to be effective. However, the reduction in the height/age z score probably represents an adverse effect of corticoid treatment. (author's)[Anemia in infancy: etiology and prevalence]
The objective was to verify the prevalence of anemia, iron deficiency anemia and iron deficiency in infants, at a Public Health Unit in the city of Goiânia - Brazil; to analyze and to correlate the hematologic and biochemical variables. A cross-sectional study was carried out. One hundred and ten full-term infants of the 120 mothers interviewed were included. The infants aged between six and twelve months and there were not twins. Socioeconomic and hematologic data was obtained. Venous blood was taken from fasting infants in order to carry out a complete hemogram through electronic cell counting, serum iron, serum ferritin and C-reactive protein, which were used in the evaluation of the etiology of iron deficiency in the anemic infants. Children with hemoglobin < 11g/dL were considered anemic. The prevalence of anemia was 60.9%. In the diagnosis of the iron deficiency etiology in infants without an inflammation process, when considering the alteration of hemoglobin plus two more indices among meancorpuscular volume (MCV) or mean corpuscular hemoglobin (MCH) or serum ferritin or serum iron, the prevalence of the iron deficiency was 87%. Nevertheless, when red cell distribution width (RDW) was included in the indices, the prevalence was 97.8%. In the non-anemic infants, considering ferritin and RDW, the prevalence of iron deficiency observed was 28%. The best correlation among hematologic and biochemical variables were between hemoglobin and hematocrit (r = 0.946), and MCH with MCV (r = 0.950). The main etiology in infants was iron deficiency anemia and its prevalence varied according to different parameters and criteria. (author's)[Iron, copper and zinc in adolescents during pubertal growth spurt]
The objective was to examine iron, copper and zinc nutritional status and their correlation with Body Mass Index (BMI), serum and dietetic levels in adolescents during the pubertal growth spurt. A descriptive cross-sectional study involving a sample of 47 adolescents out of 360 patients (19 boys, whose ages ranged from 12.3 to 16 years and 28 girls, whose ages ranged from 11.1 to 13.6 years), who were seen at a clinic for adolescents from March to December 1999. The variables analyzed were: Diet (24 hours Dietary Recall, Food Frequency Intake Questionnaire and Food Register Methods) to determine iron, copper and zinc intake; anthropometry (weight and height) to check BMI; biochemistry (measure of serum iron level through a Diagnóstica kit in vitro; ferritin through Immulite kit, and atomic absorption spectrophotometry for biochemical evaluation of serum iron, ferritin, copper and zinc. Spearman coefficient correlation was used for statistical analysis. Forty seven adolescents during pubertal growth spurt showed adequate ingestion: iron (95% and 36%), copper (53% and 57%) and zinc (21% and 21%) in males and females, respectively. Most of them were eutrophic according to the BMI percentiles. Biochemically, boys presented normal values for serum iron and zinc in the whole sample, 95% for copper and 84% for ferritin. Girls also presented normal values for iron and zinc values in the whole sample, 96.4% for copper and 96% for ferritin. There were no statistically significant correlation between BMI and serum Fe, ferritin, Cu