Maria Yolanda Makuch

Atenção ao planejamento familiar no Brasil hoje: reflexões sobre os resultados de uma pesquisa

This two-component study (descriptive cross-sectional and qualitative) assessed the availability of contraceptives in primary care clinics in Brazilian municipalities. The family planning program was also analyzed as part of the countrys Family Health Strategy. Phone interviews were held with local health managers to obtain information on contraceptive supply in a selected sample of municipalities. Four municipalities were selected and visited for the qualitative analysis, using direct observation and semi-structured interviews with health professionals and managers. Descriptive statistical and multiple logistic regression analyses were performed. Content analysis technique was used for qualitative data. According to the results, family planning activities are often not integrated with other health activities. Health professionals and managers failed to understand family planning as part of primary health care and felt unable to assist patients. Family planning in Brazil is marked by the unavailability of contraceptives in public health programs.

The prevalence of perinatal depression and its associated factors in two different settings in Brazil

BACKGROUND The prevalence of antepartum and postpartum depression (PPD) and its association with certain risk factors was evaluated. METHOD The Edinburgh Postnatal Depression Scale (EPDS) was applied and sociodemographic data was obtained at the beginning of the third trimester of pregnancy and at 4-6 weeks postpartum. RESULTS The prevalence of depression was 24.3% during pregnancy (n=600 women) and 10.8% in the postpartum period (n=555). The factors independently associated with antepartum depression were the absence of a partner (PRadj 1.93; 95%CI: 1.44-2.58), a lower socioeconomic class (1.75; 1.18-2.60), being non-white (1.48; 1.09-2.01) and multiparity (1.32; 1.01-1.74). For postpartum depression, the factors were the occurrence of psychological violence (PRadj 3.31; 95%CI: 2.02-5.43), use of alcohol during pregnancy (2.14; 1.33-3.45), being non-white (1.85; 1.11-3.08) and physical violence (2.14; 1.13-4.08). The sensitivity of depression during pregnancy as a predictor of PPD was 75%, while specificity was 81%. There were no differences between the two settings. LIMITATIONS EDPS does not diagnose depression and as a screening instrument it could overestimate the true prevalence of depression. CONCLUSIONS The use of the EPDS instrument during pregnancy would allow a screening for identifying women at higher risk of developing PPD and then a proposal of specific interventions to manage this condition. Postpartum depression was prevalent in around 10% of the women and was associated with unfavorable sociodemographic conditions including the use of alcohol and with the occurrence of psychological and physical violence.

Uso de álcool e drogas e sua influência sobre as práticas sexuais de adolescentes de Minas Gerais, Brasil

This article summarizes the findings of a survey including 5,981 students from public schools in Minas Gerais State, Brazil. The analysis assessed the influence of drug use on sexual practices. Among the boys engaged in relationships with casual partners who stated having used illicit drugs, 55.7% reported consistent condom use, as compared to 65.4% among those not reporting such habits. Among boys engaged in relationships with stable partners who reported illicit drug use, consistent condom use was reported by 42.7%, versus 64.1% among those not reporting such habits. In the subgroup of boys engaged in stable relationships who did not report illicit drug use, consistent condom use was less frequent among those that used alcohol/cigarettes, compared to those who did not drink or smoke (60.7% vs. 71.1%). Girls were less likely than boys to use condoms consistently, regardless of the nature of their relationships, without a noticeable influence of drug use. Policies to prevent drug abuse, sexually transmitted diseases, and unplanned pregnancy should be fully integrated.

Changes in sexual behavior following a sex education program in Brazilian public schools

Este artigo descreve a avaliacao de possiveis mudancas no comportamento sexual de adolescentes que participaram de um programa de educacao sexual implementado em escolas publicas selecionadas em quatro municipios de Minas Gerais, Brasil. O programa esta inserido no contexto dos direitos reprodutivos, discute os riscos de praticas sexuais inseguras e enfoca os aspectos positivos da sexualidade. Utilizou-se um desenho quase-experimental com pre e pos-teste e grupo controle nao-equivalente. Foram incluidos 4.795 questionarios na analise dos resultados. O programa conseguiu dobrar o uso consistente do preservativo com parceiro casual e aumentar em 68% o uso de metodos anticoncepcionais modernos na ultima relacao sexual. A intervencao nao teve efeito sobre a idade da primeira relacao sexual ou na pratica de atividades sexuais. Concluindo, o programa foi eficaz em gerar mudancas positivas no comportamento sexual de adolescentes sem antecipar ou estimular a pratica sexual.

Evaluation of a birth preparation program on lumbopelvic pain, urinary incontinence, anxiety and exercise: a randomized controlled trial

BackgroundAntenatal preparation programmes are recommended worldwide to promote a healthy pregnancy and greater autonomy during labor and delivery, prevent physical discomfort and high levels of anxiety. The objective of this study was to evaluate effectiveness and safety of a birth preparation programme to minimize lumbopelvic pain, urinary incontinence, anxiety, and increase physical activity during pregnancy as well as to compare its effects on perinatal outcomes comparing two groups of nulliparous women.MethodsA randomized controlled trial was conducted with 197 low risk nulliparous women aged 16 to 40 years, with gestational age ≥ 18 weeks. Participants were randomly allocated to participate in a birth preparation programme (BPP; n=97) or a control group (CG; n=100). The intervention was performed on the days of prenatal visits, and consisted of physical exercises, educational activities and instructions on exercises to be performed at home. The control group followed a routine of prenatal care. Primary outcomes were urinary incontinence, lumbopelvic pain, physical activity, and anxiety. Secondary outcomes were perinatal variables.ResultsThe risk of urinary incontinence in BPP participants was significantly lower at 30 weeks of pregnancy (BPP 42.7%, CG 62.2%; relative risk [RR] 0.69; 95% confidence interval [CI] 0.51-0.93) and at 36 weeks of pregnancy (BPP 41.2%, CG 68.4%; RR 0.60; 95%CI 0.45-0.81). Participation in the BPP encouraged women to exercise during pregnancy (p=0.009). No difference was found between the groups regarding to anxiety level, lumbopelvic pain, type or duration of delivery and weight or vitality of the newborn infant.ConclusionsThe BPP was effective in controlling urinary incontinence and to encourage the women to exercise during pregnancy with no adverse effects to pregnant women or the fetuses.Trial registrationClinicaltrials.gov, (NCT01155804)

Long-term follow-up of women and men after unsuccessful IVF

The experience of 92 couples, who had unsuccessfully undergone one or more IVF cycles at a university clinic, was evaluated 3-8 years following their last failed attempt. One member of each couple completed a telephone questionnaire regarding life events during their last IVF cycle performed at the clinic and at the time of the interview. Some couples had continued further treatment and some had not. Multivariate correspondence analysis was used to analyse the data. Regarding the long-term experience of couples who had undergone further treatment, for men the main experiences were psychological problems and having adopted a child. For women, the main experiences were related to problems of self-image, psychological problems, loss of hope, and having adopted a child. These women also presented a strong association with problems in their marital relationship and with adoption. For the group that did not undergo further treatment, the women showed a strong association with considering adoption, and a less intense association with psychological problems and loss of hope. The men presented psychological problems and having adopted a child as associated variables. Comparison between men and women showed that recognizing the impossibility of conceiving a child and giving up treatment were strongly associated. Men and women who had not continued with further treatment were more affected in the long term than those who had undergone further treatment after IVF failure.

Premenstrual syndrome as reported by Brazilian women

To describe the perspectives and attitudes of Brazilian women toward premenstrual syndrome (PMS).

Menstrual bleeding: perspective of Brazilian women.

BACKGROUND Menstrual patterns, induced amenorrhea and the use of some contraceptive methods which induce non-bleeding are issues under debate among health professionals and women. The objective of the study was to describe perspectives and attitudes of Brazilian women regarding menstruation and its interference in daily activities. STUDY DESIGN A semistructured questionnaire was applied to nonpregnant, nonlactating women between 18 and 45 years old, who were menstruating, consulting at public health services for other complaints than gynecological or reproductive health care, and staff members and teachers of public universities in one city of each geographic region of Brazil and the Federal District. RESULTS Of the 885 women interviewed, 51.5% were aged 20-29 years, almost 60% reported normal frequency of bleeding, 22% and 43% reported interference of menstruation in their school activities and in the relationship with their partner, respectively. The value attributed to each interference (<5; ≥ 5; in a scale up to 10) was >5 for more than 60% of the women in all evaluated domains. The most common reason for disliking menstruation was inconvenient and/or discomfort, and for liking menstruation were feeling healthy and confirmation of not being pregnant. The variables associated to liking menstruation were attending <8 years of school and low economic class, having more than one child and no history of premenstrual tension. CONCLUSION A great proportion of the interviewed women disliked having menstruation even when they did not present menstrual-related problems. However, some women still preferred monthly menstruation because they felt healthy and it was a free pregnancy test.

Inequitable access to assisted reproductive technology for the low-income Brazilian population: a qualitative study

BACKGROUND In Brazil, access to infertility care, including assisted reproductive technology (ART) is restricted. This is a second report of a study which evaluated the availability and access of low-income couples to ART services. The objective was to assess the perspective of health professionals and patients with respect to access to ART procedures within the public health network METHODS Qualitative case studies were conducted in five centres offering ART in the public sector. Semi-structured interviews were conducted with 19 health professionals based at these centres and 48 patients (men and women). Data were analysed using thematic content analysis. RESULTS All services implemented ART procedures using resources already available. In all except one centre, patients had to pay for the drugs used for the procedures and, in some cases, a fee to cover operative costs and supplies. These charges were incompatible with the financial possibilities of the majority of the low-income Brazilian population. The waiting time for access to ART varied between 3 months and 6 years. In the perspective of both patients and health professionals, the government should help centres to offer ART procedures at no cost to low-income populations. CONCLUSIONS The low-income Brazilian population has limited access to ART procedures at the public services. The implementation of ART services cannot be based only on initiatives of the professionals involved but must be part of public health policies. One possible solution is to provide ART at lower cost, making it accessible for a large part of the population.

Upright position during the first stage of labor: a randomised controlled trial

Background. Evaluation of the upright position during the first stage of labor on pain, patient satisfaction, obstetrical and perinatal outcomes in nullipara women. Methods. This prospective, randomised, controlled trial included a group of 54 women who were informed and encouraged to adopt the upright position, and a control group of 53 women who were not given this information. The difference between groups was evaluated using the χ2, Wilcoxon and Fishers Exact tests. Significance was defined as p<0.05. Risk ratios and 95% confidence intervals were calculated. Results. No statistically significant differences were found between the groups in baseline characteristics, obstetrical and perinatal outcomes; however, there was a preference among women in both groups for the upright position. Conclusions. The upright position during the first stage of labor did not contribute towards a shorter duration of labor; however, it proved to be a safe and well‐accepted option for the women of this study.