María Teresa Urrutia S

¿POR QUÉ LAS MUJERES NO SE TOMAN EL PAPANICOLAU?: BARRERAS PERCIBIDAS POR UN GRUPO DE MUJERES INGRESADAS AL PROGRAMA DE CÁNCER CERVICOUTERINO AUGE

SUMMARY Background: At the beginning of the 70s, the exam of cervical cytology was introduced in Chile. The adherence to this exam has demonstrated its utility for the opportune search of the pathology and mortality decrease. Objective: To examine perceptions about the Papanicolau (PAP) test from the perspectives of Chilean women with premalignant lesions. Method: Descriptive, qualitative, and cross-sectional study in a group of 237 women from AUGE program in the Southeast Metropolitan Public Health Service, Santiago, Chile. Results: The principal reasons for not having had a PAP test were procrastination; the problems related to the PAP test procedure like fear, embarrassment, discomfort, and lack of time; and lack of knowledge. Conclusion: All the reasons given by the Chilean women in this study have been described in the international literature. Health professionals are in a position to change the perspective that the women have, and therefore for increasing the education and cervical cancer screening for women. Results of this study can serve as a guide for education programs and can be applied in clinical practice.

Anemia en las embarazadas de la comuna de Puente Alto, Chile

Background: Micronutrient deficiencies, specially iron, render pregnant women as one of the most vulnerable groups to have anemia. Aim: To report the prevalence of anemia during pregnancy and its associated features in women attending public clinics in the Puente Alto County. Material and methods: We studied 1683 pregnant women aged 18 years old or more. Hemoglobin concentration was determined using the cianmetahemoglobin method. Anemia was defined using the 5th percentile cut-off for each week of gestational age as proposed by R Yip from the Centers of Disease Control, 1989. The influence of maternal age, parity, nutritional status classified using weight/height, diseases and smoking habits on hemoglobin concentration were analyzed using logistic regression with a stepwise procedure. Results: Thirteen percent of the study population was anemic. The single factor significantly associated with anemia was nutritional status. Twenty one percent of women with a low weight for height were anemic. Conclusions: These results support the concept that pregnant women with a low weight for height have the greatest risk for anemia and should be specially benefited with preventive or treatment programs to avoid this problem (Rev Med Chile 2003; 131: 520-525).

CARACTERÍSTICAS Y EVOLUCIÓN DE LA SEXUALIDAD EN MUJERES HISTERECTOMIZADAS

RESUMENEstudio analitico longitudinal prospectivo, sobre caracteristicas de sexualidad y su evolucion a los 6meses en 104 mujeres histerectomizadas de un hospital publico de Santiago. La recoleccion de los datosfue a traves de una entrevista. Para el analisis se utilizo t Student, Q de Cochrane y Kappa. El reinicio dela vida sexual fue en promedio a los 52,7 + 27 dias posthisterectomia. No hubo diferencias significativasen la frecuencia de relaciones sexuales; presencia y frecuencia de orgasmo; percepcion de deseo sexualy grado de excitacion sexual. La prevalencia de incontinencia y dispareunia disminuyeron significativamentey la satisfaccion sexual de la mujer mejoro a los seis meses. Se concluye que al igual que en estudiosinternacionales, la sexualidad de las mujeres no se afecta negativamente despues de la histerectomia y seplantea la importancia de la educacion sexual en estas mujeres.PALABRAS CLAVES: Sexualidad, histerectomiaSUMMARYProspective longitudinal analytic study on sexuality characteristics and its evolution within 6 months ina group of 104 hysterectomized women from a public hospital in Santiago. Data compilation was done bymeans of an interview. For the analysis, t Student test, Q Cochrane and Kappa test were used. The newbeginning of sexual life started at an average of 52.7 + 27 days after hysterectomy was done. There wasno significant change in sexual intercourse frequency, presence and orgasm frequency, perception of sexualdesire and degree of sexual excitement. Incontinence prevalence and dyspareunia decreased dramaticallyand womens sexual satisfaction improved after 6 months. Therefore, just like some international studies,womens sexuality is not negatively affected after hysterectomy and the issue on sexual educationsignificance in those women raises.KEY WORDS: Sexuality, hysterectomy

CALIDAD DE VIDA EN MUJERES HISTERECTOMIZADAS

SUMMARY Hysterectomy affects 20% of the feminine Chilean population; its greater incidence is in fertile women between 35 to 49 years. This surgery by stopping the reproductive cycle of the woman, repercussions that strongly threatens her female sense, it can cause alterations of self-esteem, dysfunction of relationships, conflict with her social environment, among others. This bibliographical study intends to show how hysterectomy affects the quality of life and its different dimensions among users, in order to contribute to the knowledge of the subject and to contribute to health professionals with scientific evidence for a better facing. In spite of the impact of the hysterectomy in the quality of life of these women, investigations studying this relation are little. When comparing the quality of life between healthy women and hysterectomyzed ones, these had similar quality levels of life, in the dominions: physical operation, corporal pain, sexual behavior and psychological dimension. The hysterectomyzed woman evidences better quality of life in the previously named dominions than women with gynecological problems. It is concluded that hysterectomy by itself, does not affect the quality of life of these women, nevertheless, it arises the necessity of new investigations on the subject. It is important to emphasize the importance in the support and education to the woman who lives his process.

CALIDAD DE VIDA EN MUJERES CON CÁNCER CÉRVICO UTERINO

SUMMARY Background: Cervical cancer is the fourth most frequent cause of death among women in Chile, and the leading cause of death among women between the ages of 20 and 44. Effective screening methods and opportune treatment has resulted in a growing number of women whose illness is in remission, making an evaluation of the quality of life of these women over the stages of the illness worthwhile. Objective: This article reviews how different aspects of the patient’s quality of life (QOL) are affected by cervical cancer. Results: The literature contains many measures of QOL, most of which are generic QOL instruments, as well as a wide range of questionnaires used to evaluate specific aspects of QOL. The sexual dimension of QOL suffers the most marked deterioration for women with cervical cancer. The treatment method employed determines the effect on sexual QOL: while radiotherapy produces local physical alterations which directly affect sexual QOL, surgery principally affects the psychological aspects of sexuality. Conclusion: This review concludes that QOL in women with cervical cancer deteriorates over all its dimensions, most especially sexual QOL. This makes it important to consider QOL when evaluating these patients. Opportune intervention is suggested, especially in those aspects that deteriorate most.

EDUCACIÓN DE MUJERES HISTERECTOMIZADAS: ¿QUÉ DESEAN SABER?

Antecedentes: La histerectomia (HT) es una de las intervenciones mas frecuentes en ginecologia, por lo tanto resulta de relevancia evaluar lo que las mujeres desean para enfrentar este proceso. Objetivo: Conocer las necesidades educativas de un grupo de mujeres sometidas a histerectomia. Metodo: Estudio descriptivo, de corte transversal, con una muestra de 120 usuarias. Se realizo una entrevista para conocer la educacion recibida y la deseada, y asi establecer la necesidad educativa de las mujeres. Resultados: El 100% de ellas senala que sus parejas no recibieron educacion acerca de la HT. El 46,7% declara recibir la educacion por parte del medico y el 80% desearia hubiese sido la matrona. El 45% recibe la educacion al fijar la fecha de la cirugia y el 78% desearia haberla recibido antes de este momento. El 47% recibe la educacion en el hospital y el 46% desea recibirla ahi. El 75% refiere recibir educacion en forma verbal-individual y el 47,5% le hubiese gustado de manera audiovisual-individual. Se educa a mas del 50% de las mujeres solo en 3 topicos de los 16 evaluados. Los principales temas en los cuales fueron educadas no coinciden con aquellos deseados por las mujeres. Conclusion: Se concluye que las necesidades de las mujeres no son satisfechas en su totalidad y se destaca la importancia del rol educativo por parte de los profesionales del area

Intervenciones educativas para la prevención del cáncer cervicouterino

Antecedentes: El cancer cervicouterino (CC) se ha convertido en los ultimos anos en el cancer mas comun en la mujer. La deteccion precoz a traves del screening de PAP ha sido insuficiente, siendo indispensable buscar nuevas estrategias para prevenirlo, una de las cuales es la incorporacion de intervenciones educativas. Objetivos: Conocer las intervenciones educativas destinadas a la prevencion del CC e identificar sus caracteristicas principales. Metodo: Se realizo busqueda bibliografica en MEDLINE, ProQuest, Scielo y metabuscador Tripdatabase, seleccionandose para su analisis, 15 articulos que respondian al objetivo planteado. Analisis: Las intervenciones educativas utilizadas para la prevencion del CC abordan temas como el conocimiento general sobre CC, PAP y HPV, las creencias sobre CC, y las actitudes preventivas entre otros. Los folletos educativos y las sesiones de discusion son las metodologias mas utilizadas en este tipo de intervenciones, midiendose la efectividad de estas a traves de la aplicacion de pre y post test, ya sea inmediatamente despues de la intervencion, o a lo largo del tiempo. Se observa que este tipo de intervenciones educativas son efectivas para mejorar aspectos como el nivel de conocimiento en la poblacion y la adquisicion de conductas preventivas (adherencia a la toma de PAP). Conclusion: Considerando los beneficios de las intervenciones educativas en la prevencion del CC, se hace fundamental ampliar su utilizacion, no olvidando que su empleo implica la prevencion de la enfermedad, pudiendose evitar muertes de mujeres jovenes y el aumento de la carga de salud por enfermedad de un pais.

EMBARAZO ECTÓPICO: FACTORES DE RIESGO Y CARACTERÍSTICAS CLÍNICAS DE LA ENFERMEDAD EN UN GRUPO DE MUJERES CHILENAS

SUMMARY Background: The ectopic pregnancy (EP) is one of the most important causes of maternal death during the first quarter of pregnancy. During the last decades the incidence rates have increased. Objective: This study intends to establish the risk factors associated with this pathology, within a population of chilean women. Method: 50 ectopic pregnancy women were studied, and were compared to 100 puerperal women during the same period of time. Results: The significant risk factors for EP were: antecedents of gynecological and abdominal surgeries, antecedent of IUD during conception, number of sexual couples, alcohol consumption. Conclusion: The risk factors for EP in a chilean population are similar to those described in the international literature; is emphasized the importance of the early derivation to avoid in the women physics and psychological damage.

RELACIÓN ENTRE RENDIMIENTO LABORAL Y SÍNDROME PREMENSTRUAL

RESUMENEl Sindrome Premenstrual (SPM) afecta a gran cantidad de mujeres en edad reproductiva y secaracteriza por una repeticion ciclica de sintomas fisicos y psicologicos que, en algunos casos, puedenllegar a ser lo suficientemente severos como para interferir en los patrones de vida. El objetivo de estarevision bibliografica es conocer como afecta el SPM el rendimiento laboral de las mujeres. A pesar de lassignificativas repercusiones personales y economicas, existen pocas investigaciones que estudien larelacion entre SPM y rendimiento laboral. Sin embargo, la literatura es concluyente en senalar que laproductividad laboral es un importante dominio de la vida de la mujer adversamente afectado por el SPM,manifestado en un aumento de la tasa de ausentismo laboral y reduccion de la productividad. Se concluye,segun la literatura revisada, que el SPM afecta el rendimiento laboral, lo que sugiere a los profesionalesde la salud tomar un rol activo en la derivacion y tratamiento oportuno, para de esta forma lograr un aumentoen la productividad laboral de las mujeres.PALABRAS CLAVE: Sindrome premenstrual, productividad laboralSUMMARYThe premenstrual syndrome (PMS) affects a large quantity of women of reproductive age, and itcharacterizes because of a cyclic recurrence of physical and psychological simptoms that, in some cases,might become severe enough as to interfere with a persons life pattern. The objective of this paper is togather a bibliographic revision that will lead us to know how PMS affects the working performance of women.Although the repercussions in this matter are very significant, there are only a few studies about the relationand interdependence between this syndrome and the efficiency at work. However, some literatureestablishes that the PMS largely affects the working productivity of women, which is manifested in reductionof productivity and larger rates of working absenteeism. The conclusion we support after having checkedpapers, reports and literature written about PMS is that this syndrome does affect the working performanceof those how suffer it, by enhancing the rates of labor absenteeism and reducing productivity at work. Thissuggests that health professionals should take a more active role in the treatment of this disease, in orderto achieve the goal of increasing the productivity at work for women.KEY WORDS: Premenstrual syndrome, work productivity

Asociación entre la composición corporal de la embarazada y la composición corporal del recién nacido

Objetivo: estudiar la asociacion entre la composicion corporal de la madre al final del embarazo y la composicion corporal del recien nacido. Sujetos: se estudiaron 224 embarazadas y sus recien nacidos atendidos en el servicio de salud sur-oriente de Santiago, Chile. Metodos: la composicion corporal de la embarazada fue calculada a traves de la tecnica de dilucion con deuterio descrita por Schoeller; la composicion corporal del recien nacido se estimo con el metodo antropometrico de Dauncey. La asociacion entre la composicion corporal materna y del recien nacido fue estudiada por analisis de correlacion y de regresion multiple. Resultados: la masa magra y masa grasa materna (MMM y MGM, respectivamente), talla materna y la edad gestacional (EG) se correlacionaron significativamente con la MG del recien nacido (r= 0,38, 0,24 , 0,15 y 0,14; p = 0,0001, 0,0002, 0,01 y 0,03, respectivamente), asi como tambien con la MM del RN (r = 0,34, 0,23, 0,25 y 0,27; p = 0,0001, 0,0004, 0,0001 y 0,0001, respectivamente). El analisis de regresion mostro influencias significativas de MMM, MGM y EG sobre MG del RN (p = 0,0001, 0,0008 y 0,03, respectivamente) y de MMM, MGM, EG y sexo femenino sobre la MM del RN (p= 0,0001, 0,001, 0,0004 y 0,01, respectivamente); siendo la MMM mayor que la MGM en ambas regresiones lineales multiples. Conclusion: La MMM influye mas que la MGM en ambos compartimientos nutricionales del recien nacido (MM y MG del RN), lo que es compatible con observaciones recientes que asignan un importante rol en el crecimiento fetal al agua corporal total y a la expansion del volumen plasmatico de la madre