Márcia Barbieri

Aderência dos Cursos de Graduação em Enfermagem às Diretrizes Curriculares Nacionais

Esta investigacao teve como objetivo identificar a aderencia dos Projetos Pedagogicos dos Cursos de Graduacao em Enfermagem (PPC/ENF) as Diretrizes Curriculares Nacionais (DCN) para esses cursos. Trata-se de um estudo descritivo, comparativo, entre os dados presentes nos PPC/ENF e os propostos nas DCN, tendo como base os relatorios dos processos avaliativos conduzidos pelo Instituto Nacional de Ensino e Pesquisa do Ministerio da Educacao e Cultura e disponibilizados para este estudo. A amostra foi constituida pelos relatorios para fins de reconhecimento e renovacao de reconhecimento, realizados no periodo de 2002 a 2006, relativos a 110 cursos de graduacao. Foram relacionados 60 aspectos do instrumento e destes foram selecionados 10. O estudo revelou que o indice de aderencia dos cursos de enfermagem as DCN/ENF foi 72%, considerado baixo, o que aponta para a necessidade das escolas/cursos buscarem melhor vinculacao entre a adocao das bases epistemologicas presentes nas DCN/ENF e as propostas nos PPC/ENF.The objective of this study was to evaluate the adherence of the Pedagogic Projects of Nursing Graduation Courses (PPC/ENF) to the National Guidelines for the Curriculum of Nursing Graduation Courses (DCN/ENF). It was a descriptive study that compared the information obtained from the reports of the PPC/ENF and the proposals of DCN/ENF, using data collected by INEP/MEC and made available for this study. The data base consisted of all reports from 110 nursing graduation courses that were seeking accreditation or renewal between 2002 and 2006. Sixty aspects of the evaluation were selected and 10. The study reports that the rate of adherence of the nursing courses to the DCN/ENF guidelines was low, 72%. These findings indicate there is a need for nursing courses/schools to adjust the epistemological bases of the DCN/ENF to the proposals of PPC/ENF.

Contraceptive counseling and use among 197 female kidney transplant recipients.

Background. There is growing interest about the quality of life of female transplant recipients, including their sexual and reproductive health. Although menstrual irregularity and infertility are common in women with advanced chronic diseases, most regain their reproductive function shortly after transplantation. Because an unplanned pregnancy soon after transplantation can expose both mother and fetus to considerable risk, it is recommended that these women should receive contraceptive counseling. However, the actual implementation and effectiveness of this recommendation has not been extensively studied. Methods. A total of 197 reproductive age, female, stable kidney graft recipients attending a large Brazilian transplantation clinic were interviewed. They were asked about menstrual pattern, sexual activity, counseling, and their use of contraceptive methods both before and after the transplant. Results. Before transplantation 70.6% reported menstrual irregularity, 91.9% of them were sexually active, 74.1% were counseled to use contraception and 86.3% used some contraceptive method. After the graft, 50.2% had menstrual irregularity, 79.7% were sexually active, 48.7% were advised to use contraceptives and 72.1% were actually using a method. After transplantation, there were 14 pregnancies in 11 women and 92.9% (13/14) of these were unplanned. Conclusions. Although most female kidney transplant recipients were sexually active both before and after transplantation, many were not counseled about the need for contraception and did not use any form of birth control. Health professionals involved in the management of these patients need to include contraceptive counseling as part of their routine care.

Prevenção da reincidência de gravidez em adolescentes: efeitos de um Programa de Planejamento Familiar

OBJECTIVE: to evaluate the effectiveness of an educational family planning program in preventing the recurrence of teen pregnancy. METHODS: this was a retrospective study conducted in the department of Family Planning of the Federal University of Sao Paulo. The sample consisted of 264 patients who had at least one pregnancy. RESULTS: participants reported an average age of menarche at 12.2 years old. Their first sexual intercourse occurred at 15 years old and their age at the first pregnancy was 16 years old. In addition, 73.5% of the participants reported more than one pregnancy. Following educational family planning program, use of condoms, and birth control pills were the most used contraceptives methods; 4.9% of teens had a recurrence of pregnancy. CONCLUSION: the findings of this study support the importance and effectiveness of an educational family planning program in preventing recurrence of teen pregnancy.Objective: to evaluate the effectiveness of an educational family planning program in preventing the recurrence of teen pregnancy. Methods: this was a retrospective study conducted in the department of Family Planning of the Federal University of São Paulo. The sample consisted of 264 patients who had at least one pregnancy. Results: participants reported an average age of menarche at 12.2 years old. Their first sexual intercourse occurred at 15 years old and their age at the first pregnancy was 16 years old. In addition, 73.5% of the participants reported more than one pregnancy. Following educational family planning program, use of condoms, and birth control pills were the most used contraceptives methods; 4.9% of teens had a recurrence of pregnancy. Conclusion: the findings of this study support the importance and effectiveness of an educational family planning program in preventing recurrence of teen pregnancy.

Etonogestrel implant in postpartum adolescents: bleeding pattern, efficacy and discontinuation rate

BACKGROUND The increasing rate of teenage pregnancies is a challenge to health professionals. New contraceptive methods have been developed to try to improve adherence in this group of patients. The study was conducted to evaluate the bleeding pattern, efficacy and discontinuation rate of etonogestrel implant (68 mg) inserted in postpartum adolescents. STUDY DESIGN The study population comprised 44 postpartum adolescents managed at the Family Planning Sector of São Paulo Federal University. The implant was inserted, on average, 102 days after delivery. Patients were followed prospectively during four 90-day periods. RESULTS All 44 patients completed the 12 months of follow-up, resulting in a study discontinuation rate of 0%. No implants were removed. There were no pregnancies during the study. After 1 year of use, frequent and prolonged bleeding were reported by less than 5% of the patients and amenorrhea occurred in 38.6% of the users. Laboratory parameters indicated a significant increase in hemoglobin and hematocrit among users. CONCLUSION These findings suggest that the etonogestrel implant is a safe and effective contraceptive method that is well accepted by adolescents after a pregnancy.

The T 380A intrauterine device: a retrospective 5-year evaluation

BACKGROUND The undue resistance to intrauterine device (IUD) use seen in several settings does not seem to occur in the Family Planning Unit of UNIFESP-EPM (São Paulo Federal University, Brazil). In fact, the Copper T 380A IUD in this clinic has reached an outstanding importance and this motivated us to present our differing experience. The prevalence of this method in this clinic is as high as 40%. This contrasts to the low use in the rest of the country, where tubal ligation is by far the most used contraceptive method (40%) and where IUD is inexpressive (1.1%). STUDY DESIGN This is a retrospective study of the records of 118 users of Copper T 380A IUD inserted at the clinic and who were followed during 5 years. RESULTS The cumulative pregnancy rate was 0.8%. The main cause for discontinuation of the study was loss to follow-up (21.3%). Other reasons for the withdrawal of the device were personal option (13.6%), dislocation (11.7%) and pregnancy wish (3.4%). There was no withdrawal by pelvic inflammatory disease. Bleeding (0.8%) was not an important cause for withdrawal, and there were no withdrawals due to pain. The continuation rate at 5 years was 46.7%. The structured service and an adequate educative program perhaps could explain at least partially the good performance of IUD use in this clinic. There was an amazing prevalence of the components of the metabolic syndrome. This could represent contraindications for hormonal contraception, and, in consequence, it could influence the increased option for and continuation of the IUD. CONCLUSION These data show a good performance of the IUD for long duration, in relation to other studies, and this should be considered as a reliable alternative to the high prevalence of female sterilization in this country.

Extended regimens of the combined contraceptive vaginal ring containing etonogestrel and ethinyl estradiol: effects on lipid metabolism

BACKGROUND Oral contraceptives used for extended periods of time have been studied because of their potential benefits; however, there have been few publications on extended regimens of vaginal contraceptive rings. The aim of this study was to evaluate modifications in the lipid profile of women using the vaginal ring continuously over a 1-year period. STUDY DESIGN This prospective cohort enrolled 75 women (18-37 years) who used a contraceptive vaginal ring releasing 120 mcg of etonogestrel and 15 mcg of ethinyl estradiol daily continuously for 84 days, followed by a 7-day ring-free interval, during 1 year. At baseline and every 3 months during the 1-year study period, blood was collected to assess cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides and apolipoproteins A-I and B. The ANOVA test was used to analyze differences in the results of these exams over time. RESULTS After 1 year of continuous contraceptive use, there was a significant increase in triglycerides as well as in total and HDL-C levels. There was a nonsignificant decrease in the mean concentration of LDL-C during the study period. Apolipoprotein A-I increased and apolipoprotein B decreased, but the apolipoprotein A-I/apolipoprotein B ratio did not change significantly. CONCLUSION The combined contraceptive vaginal ring used on an extended regimen causes changes in the lipid profile metabolism of users. Despite the vaginal route of administration, the steroids released by the ring caused significant changes in lipids and lipoproteins, which were typical of those seen with ethinyl estradiol given either orally or parenterally.

Vírus HPV e câncer de colo de útero

This article refers to a review of literature about the HPV virus and the cervical neoplasia, aiming at raising aspects of the virus infection which influences in the natural development of the uterine cervical cancer such as: the type of virus, the duration and the persistence of the infection and also the association with the manifestations of the preceding lesions up to the evolution of the neoplasia. It was possible to notice the strong association of the infection with the evolution of the cervical neoplasia, however, studies to better elucidate certain aspects of the infection of the HPV virus that acts on the uterine cervix are still necessary so that the actions of prevention and fight against the disease will be more efficient.This article refers to a review of literature about the HPV virus and the cervical neoplasia, aiming at raising aspects of the virus infection which influences in the natural development of the uterine cervical cancer such as: the type of virus, the duration and the persistence of the infection and also the association with the manifestations of the preceding lesions up to the evolution of the neoplasia. It was possible to notice the strong association of the infection with the evolution of the cervical neoplasia, however, studies to better elucidate certain aspects of the infection of the HPV virus that acts on the uterine cervix are still necessary so that the actions of prevention and fight against the disease will be more efficient.This article refers to a review of literature about the HPV virus and the cervical neoplasia, aiming at raising aspects of the virus infection which influences in the natural development of the uterine cervical cancer such as: the type of virus, the duration and the persistence of the infection and also the association with the manifestations of the preceding lesions up to the evolution of the neoplasia. It was possible to notice the strong association of the infection with the evolution of the cervical neoplasia, however, studies to better elucidate certain aspects of the infection of the HPV virus that acts on the uterine cervix are still necessary so that the actions of prevention and fight against the disease will be more efficient.

Um olhar sobre as avaliações de Cursos de Graduação em Enfermagem

This study aimed, starting from the index of adherence of the Pedagogical Projects of the Undergraduate Nursing Courses to the National Curriculum Rules for these Courses, to analyze qualitatively potentialities and weak points of the courses. It is a descriptive, comparative study, between the present data in the PP/UNC and the proposed in the NCR/UNC, having as basis the reports of the evaluation processes conducted by the INEP/MEC. The sample was composed by the reports used for approval and reapproval, conducted in the period from 2002 through 2006, concerning 12 undergraduate courses. One analyzed 8 courses located in the superior part and 4 in the inferior. The study revealed strong and weak points of the courses in the three dimensions of the evaluation reports, and shows needs in the colleges/courses to search for a better use of the epistemologic bases present in the NCR/UNC and proposed in the PP/UNC.A investigacao teve como objetivo, partindo do indice de aderencia dos Projetos Pedagogicos dos Cursos de Graduacao em Enfermagem as Diretrizes Curriculares Nacionais, analisar qualitativamente potencialidades e fragilidades dos cursos. Estudo descritivo, comparativo, tendo como base os relatorios dos processos avaliativos conduzidos pelo INEP/MEC. Amostra constituida pelos relatorios para fins de reconhecimento e renovacao de reconhecimento, realizados no periodo de 2002 a 2006, relativos a 12 cursos de graduacao. Foram analisados 8 cursos localizados nos quartis superior e 4 no inferior. O estudo revelou fortalezas e fraquezas dos cursos nas tres dimensoes dos relatorios de avaliacao, e aponta para a necessidade das escolas/cursos buscarem melhor vinculacao entre a adocao das bases epistemologicas presentes nas DCN/ENF e as propostas nos PPC/ENF.

Diagnósticos de enfermagem em mulheres que freqüentam serviço de planejamento familiar

The purpose of this study was to identify nursing diagnoses in women enrolled in a family planning program. An instrument of data collection was elaborated according to the Functional Health Patterns. The sample consisted of 100 adult women. Forty-nine nursing diagnoses, of which 9 with a frequency equal or higher to 45.0% were identified. Further studies are still needed in institutions that offer assistance in the area of family planning in order to examine if the nursing diagnoses found in these women can be generalized to the population.

Extended regimens of the contraceptive vaginal ring versus hormonal oral contraceptives: effects on lipid metabolism

BACKGROUND Combined oral contraceptives used in an extended regimen have been studied because of their potential benefits; however, there have been few publications on extended regimens of contraceptive vaginal rings. The aim of this study was to assess the effects of these two extended regimens on the lipid metabolism of women using these contraceptive methods during 1 year. STUDY DESIGN This prospective study enrolled 150 women: 75 used a vaginal contraceptive ring (11.7 mg etonogestrel and 2.7 mg ethinyl estradiol), and 75 used oral contraceptives (30 mcg ethinyl estradiol and 150 mg desogestrel). Both groups used their respective method for 84 days followed by a 7-day pause during 1 year. At baseline and every 3 months during the study period, blood was collected to assess total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides and apolipoprotein (apo) A-I and B. The analysis of variance test was used to analyze differences in the results of these exams over time. RESULTS A total of 62 vaginal ring and 61 oral contraceptive users completed the study. There were no significant differences in the discontinuation rate, mean total cholesterol and fraction levels, apo B concentration or apo A-I/apo B ratio. Vaginal ring users had significantly higher apo A-1 levels than oral contraceptive users. CONCLUSION Despite the vaginal route of administration, the steroids released by the ring had the same effects on the lipid metabolism and lipoprotein levels typically seen with ethinyl estradiol given either by oral or parenteral routes.