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Monteiro IP, Azzi CFG, Bilibio JP, Monteiro PS, Braga GC, Nitz N. Prevalence of sexually transmissible infections in adolescents treated in a family planning outpatient clinic for adolescents in the western Amazon. PLoS One 2023; 18:e0287633. [PMID: 37352297 PMCID: PMC10289307 DOI: 10.1371/journal.pone.0287633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/09/2023] [Indexed: 06/25/2023] Open
Abstract
Sexually transmitted infections (STIs) are among the most common public health problems worldwide, especially among adolescents and young adults, who account for almost 50% of all STI patients. Studies on the subject in the western Amazon are limited. This study aimed to evaluate the prevalence of STIs (chlamydia, gonorrhea, trichomoniasis, herpes simplex virus, syphilis, human immunodeficiency virus [HIV], hepatitis B, and hepatitis C) in adolescents treated at a family planning outpatient clinic in the western Amazon: Porto Velho, Rondônia, Brazil. A total of 196 adolescents were enrolled. During the gynecological examination, endocervical samples were collected to test for four STIs (chlamydia, gonorrhea, trichomoniasis, and herpes simplex virus), and blood samples were collected for the detection of HIV, syphilis, and hepatitis B and C. The mean age was 17.3 ± 1.5 years, the age at sexarche was 14.4 ± 1.6 years, and 54.6% of participants had their first sexual intercourse at 14 years or younger. Only 1.0% of the adolescents used condoms in all sexual relations, and 19.9% had casual partner(s) in the last year. In the evaluation of prevalence, we found that 32% of the adolescents had at least one STI, with the most prevalent being chlamydia (23%), followed by trichomoniasis (5.6%), herpes simplex (4.6%), and gonorrhea (3.1%). No positive cases of hepatitis B, hepatitis C, or HIV were detected, but 1% of the adolescents tested positive for syphilis. These indicators will support more effective health care strategies aimed at improving the quality of life of populations in this region of the western Amazon. In conclusion, our findings demonstrated high rates of STIs in the studied patients, reinforcing the need to expand epidemiological studies to implement more appropriate public policies and intervention strategies to prevent STIs in adolescents and other vulnerable populations in the western Amazon.
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Affiliation(s)
- Ida Peréa Monteiro
- Municipal Health Department, Mãe Esperança Municipal Maternity, Porto Velho, Rondônia, Brazil
| | - Camila Flávia Gomes Azzi
- Molecular Biology Laboratory, Central Laboratory of Public Health of Rondônia, Porto Velho, Rondônia, Brazil
| | - João Paolo Bilibio
- Faculty of Medicine, Centro Universitário de Brusque–UNIFEBE, Brusque, Santa Catarina, Brazil
| | | | - Giordana Campos Braga
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Nadjar Nitz
- Faculty of Medicine, Interdisciplinary Laboratory of Biosciences, University of Brasília, Brasília, Brazil
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Okano SHP, Pellicciotta GGM, Braga GC. Contraceptive Counseling for the Transgender Patient Assigned Female at Birth. Rev Bras Ginecol Obstet 2022; 44:884-890. [PMID: 35793692 PMCID: PMC9948521 DOI: 10.1055/s-0042-1751063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Although almost 0.7% of the Brazilian population identifies as transgender, there is currently no training for healthcare professionals to provide comprehensive care to these patients, including the discussion of reproductive planning. The use of testosterone promotes amenorrhea in the first months of use; however, this effect does not guarantee contraceptive efficacy, and, consequently, increases the risks of unplanned pregnancy. The present article is an integrative review with the objective of evaluating and organizing the approach of contraceptive counseling for the transgender population who were assigned female at birth. We used the PubMed and Embase databases for our search, as well as international guidelines on care for the transgender population. Of 88 articles, 7 were used to develop the contraceptive counseling model. The model follows the following steps: 1. Addressing the information related to the need for contraception; 2. Evaluation of contraindications to the use of contraceptive methods (hormonal and nonhormonal); and 3. Side effects and possible discomfort associated with the use of contraception. The contraceptive counseling model is composed of 18 questions that address the indications and contraindications to the use of these methods, and a flowchart to assist patients in choosing a method that suits their needs.
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Affiliation(s)
- Sérgio Henrique Pires Okano
- Universidade de Ribeirão Preto, Ribeirão Preto, SP, Brazil.,Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Giordana Campos Braga
- Universidade de Ribeirão Preto, Ribeirão Preto, SP, Brazil.,Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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de Jesus GR, Rodrigues NP, Braga GC, Abduch R, Melli PPDS, Duarte G, Quintana SM. Assistance to Victims of Sexual Violence in a Referral Service: A 10-Year Experience. Rev Bras Ginecol Obstet 2022; 44:47-54. [PMID: 35092959 PMCID: PMC9948278 DOI: 10.1055/s-0041-1740474] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the assistance provided to women victims of sexual violence and their participation in the follow-up treatment after the traumatic event, presenting a sociodemographic profile, gynecological background, and circumstances of the event, and reporting the results, acceptance, and side effects of prophylaxis for sexually transmitted infections (STIs) and pregnancy. METHODS A retrospective cohort study comprising the period between 2007 and 2016. All women receiving medical care and clinical follow-up after a severe episode of sexual violence were included. Records of domestic violence, male victims, children, and adolescents who reported consensual sexual activity were excluded. The present study included descriptive statistics as frequencies and percentages. RESULTS A total of 867 medical records were reviewed and 444 cases of sexual violence were included. The age of the victims ranged from 10 to 77 years old, most of them self-declared white, with between 4 and 8 years of education, and denying having a sexual partner. Sexual violence occurred predominantly at night, on public thoroughfare, being committed by an unknown offender. Most victims were assisted at the referral service center within 72 hours after the violence, enabling the recommended prophylaxis. There was high acceptance of antiretroviral therapy (ART), although half of the users reported side effects. Seroconversion to human immunodeficiency virus (HIV) or to hepatitis B virus (HBV) was not detected in women undergoing prophylaxis. CONCLUSION In the present cohort, the profile of victims of sexual violence was low-educated, young, white women. The traumatic event occurred predominantly at night, on public thoroughfare, being committed by an unknown offender. Assistance within the first 72 hours after sexual violence enables the healthcare center to provide prophylactic interventions against STIs and unwanted pregnancies.
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Affiliation(s)
- Gabriel Ramalho de Jesus
- Gynecology And Obstetrics Department, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Natália Pavoni Rodrigues
- Gynecology And Obstetrics Department, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Giordana Campos Braga
- Gynecology And Obstetrics Department, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Renata Abduch
- Gynecology And Obstetrics Department, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Patricia Pereira Dos Santos Melli
- Gynecology And Obstetrics Department, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Geraldo Duarte
- Gynecology And Obstetrics Department, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Silvana Maria Quintana
- Gynecology And Obstetrics Department, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Andrade MS, Bonifácio LP, Sanchez JAC, Oliveira-Ciabati L, Zaratini FS, Franzon ACA, Pileggi VN, Braga GC, Fernandes M, Vieira CS, Souza JP, Vieira EM. Fatores associados à morbidade materna grave em Ribeirão Preto, São Paulo, Brasil: estudo de corte transversal. CAD SAUDE PUBLICA 2022; 38:e00021821. [DOI: 10.1590/0102-311x00021821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/16/2021] [Indexed: 11/22/2022] Open
Abstract
Este estudo investigou os fatores associados à morbidade materna grave entre mulheres atendidas em maternidades públicas do Município de Ribeirão Preto, São Paulo, Brasil. Trata-se de um estudo quantitativo, analítico, transversal. Participaram 1.098 puérperas com parto em uma das quatro maternidades públicas do município. A coleta de dados ocorreu entre 3 de agosto de 2015 e 2 de fevereiro de 2016, a partir de entrevistas face a face, obtenção de informações dos prontuários e dos cartões da gestante. Para a análise de dados, considerou-se como variável dependente a ocorrência de morbidade materna grave, ou seja, quando a mulher era classificada como near miss materno ou condição potencialmente ameaçadora à vida a partir dos critérios de elegibilidade da Organização Mundial de Saúde. Calculou-se a razão do near miss materno, odds ratio (OR), intervalo de 95% de confiança (IC95%) e regressão logística múltipla. A razão do near miss materno foi de 3,6 casos por mil nascidos vivos. As complicações ocorreram principalmente na gravidez (53,8%) e os distúrbios hipertensivos foram os mais frequentes (49,4%). A análise de regressão múltipla mostrou associação entre morbidade materna grave e gestação de risco (OR = 4,5; IC95%: 2,7-7,7) e com trabalho de parto induzido (OR = 2,1; IC95%: 1,2-3,9). A ocorrência de morbidade materna grave, principalmente na gestação, com destaque para as síndromes hipertensivas, aponta para a necessidade de melhor rastreamento e manejo da elevação dos níveis pressóricos no pré-natal. A associação entre morbidade materna grave e gestação de risco também remonta ao pré-natal, para a demanda de uma maior atenção às mulheres classificadas como risco gestacional. A qualidade da assistência é ponto chave para o enfretamento da morbimortalidade materna no país.
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De Nadai MN, Vieira CS, Monteiro IMU, Juliato CRT, Franceschini SA, Yamaguti EMM, Braga GC, Bahamondes L. Practical training of health care providers in insertion of contraceptive implants: findings from two Brazilian centres. EUR J CONTRACEP REPR 2021; 26:499-502. [PMID: 34219584 DOI: 10.1080/13625187.2021.1942448] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Lack of information and myths or inadequate training of health care providers in the guidance and management of contraceptives could negatively affect choice and eventually continuation rates. Our objectives were to evaluate the impact of clinical and theoretical training of health care professionals on insertion and removal of etonogestrel (ENG)-implant regarding this contraceptive, including pre- and post-training knowledge about insertion and removal techniques, clinical characteristics, side effects and outcomes. MATERIAL AND METHODS We conducted a cross-sectional study in which a questionnaire was sent to health care providers after they received clinical training in the management of ENG-implant. RESULTS After training, 78.2% of the 139 participants initiated to offer and inserted up to 5 implants/month and 17.6% between 6 to 10/month. None of the interviewees reported having difficulty with insertions after training, and 87.9% reported feeling very confident for removal. CONCLUSION Theoretical and practical training appeared important to prepare health care professionals, clarify doubts and promote higher rates of use of contraceptive implants in Brazil, contributing to reduce the rates of unintended pregnancies.
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Affiliation(s)
- Mariane N De Nadai
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of São Paulo. Avenida Bandeirantes, Ribeirão Preto, Brazil
| | - Carolina S Vieira
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of São Paulo. Avenida Bandeirantes, Ribeirão Preto, Brazil
| | - Ilza M U Monteiro
- Department of Obstetrics and Gynecology, Faculty of Medical Science, University of Campinas, Campinas, Brazil
| | - Cassia R T Juliato
- Department of Obstetrics and Gynecology, Faculty of Medical Science, University of Campinas, Campinas, Brazil
| | - S A Franceschini
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of São Paulo. Avenida Bandeirantes, Ribeirão Preto, Brazil
| | - E M M Yamaguti
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of São Paulo. Avenida Bandeirantes, Ribeirão Preto, Brazil
| | - G C Braga
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of São Paulo. Avenida Bandeirantes, Ribeirão Preto, Brazil
| | - L Bahamondes
- Department of Obstetrics and Gynecology, Faculty of Medical Science, University of Campinas, Campinas, Brazil
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Vieira CS, Braga GC, Cruz Lugarinho PT, Stifani BM, Bettiol H, Barbieri MA, Cardoso VC, de Carvalho Cavalli R. Sociodemographic factors and prenatal care behaviors associated with unplanned pregnancy in a Brazilian birth cohort study. Int J Gynaecol Obstet 2020; 151:237-243. [PMID: 32652559 DOI: 10.1002/ijgo.13305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/23/2020] [Accepted: 07/08/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To identify the sociodemographic factors and prenatal behavior characteristics associated with unplanned pregnancy. METHODS A cross-sectional survey was conducted of mothers of newborns enrolled in a birth cohort in Ribeirão Preto, Brazil. Questionnaires were administered to postpartum women. Multiple logistic regression was used to identify sociodemographic predictors of unplanned pregnancy and to evaluate the association with adherence to prenatal care recommendations. RESULTS The cohort included 7608 mothers: 7541 (99.1%) answered the interview and 4056 (53.8%) had an unplanned pregnancy. Adolescents were more likely to have an unplanned pregnancy (odds ratio [OR] 1.87; 95% confidence interval [CI] 1.50-2.34) as were women over 40 (OR 1.74; 95% CI 1.22-2.47). Pregnancy during adolescence (OR 1.27; 95% CI 1.09-1.48), being single (OR 7.56; 95% CI 5.98-9.56), having two or more previous births (OR 1.73; 95% CI 1.52-1.97), and being of a lower socioeconomic status were also predictors. Lack or late initiation of prenatal care, attendance at less than six prenatal visits, drinking alcohol, and smoking during pregnancy were associated with unplanned pregnancy. CONCLUSION Unplanned pregnancies disproportionately affect women at extremes of age, single, and of low socioeconomic status. These women are less likely to adhere to prenatal care.
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Affiliation(s)
- Carolina Sales Vieira
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Giordana Campos Braga
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Bianca Maria Stifani
- Department of Obstetrics, Gynecology, and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Heloisa Bettiol
- Department of Pediatrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Marco Antônio Barbieri
- Department of Pediatrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Viviane Cunha Cardoso
- Department of Pediatrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Ricardo de Carvalho Cavalli
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
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Andrade MS, Bonifácio LP, Sanchez JAC, Oliveira-Ciabati L, Zaratini FS, Franzon ACA, Pileggi VN, Braga GC, Fernandes M, Vieira CS, Souza JP, Vieira EM. [Severe maternal morbidity in public hospitals in Ribeirão Preto, São Paulo State, Brazil]. CAD SAUDE PUBLICA 2020; 36:e00096419. [PMID: 32696827 DOI: 10.1590/0102-311x00096419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 12/12/2019] [Indexed: 11/22/2022] Open
Abstract
This study analyzed the occurrence of severe maternal morbidity, the most frequent diagnostic criteria, and the quality of obstetric care in public hospitals in Ribeirão Preto, São Paulo State, Brazil. A quantitative surveillance survey of severe maternal morbidity used World Health Organization (WHO) criteria for potentially life-threatening conditions and maternal near miss. Cases were identified from August 1, 2015, to February 2, 2016. The sample included 259 women with severe maternal morbidity (potentially life-threatening conditions/maternal near miss) during the gestational and postpartum cycle, hospitalized for childbirth in the four public institutions providing obstetric care in the city. The descriptive analysis was based on absolute and relative rates of diagnostic criteria for potentially life-threatening conditions and maternal near miss, besides description of the women in the sample (sociodemographic characteristics, obstetric history, and prenatal and childbirth care). Quality of care indicators set by the WHO based on morbimortality were also calculated. There were 3,497 deliveries, 3,502 live births in all the hospitals in the city, two maternal deaths, and 19 maternal near miss. Maternal near miss ratio was 5.4 cases per 1,000 live births, and the maternal mortality ratio was 57.1 deaths per 100,000 live birth. The mortality rate among cases with severe maternal outcome (maternal near miss plus maternal death) was 9.5%. The study revealed important potentially life-threatening conditions and maternal near miss rates. The occurrence of deaths from hemorrhagic causes highlights the need to improve the quality of obstetric care. The findings can potentially help improve local policy for obstetric care.
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Bonifácio LP, Franzon ACA, Zaratini FS, Vicentine FB, Barbosa-Júnior F, Braga GC, Sanchez JAC, Oliveira-Ciabati L, Andrade MS, Fernandes M, Fabio SV, Duarte G, Pileggi VN, Souza JP, Vieira EM. PRENACEL partner - use of short message service (SMS) to encourage male involvement in prenatal care: a cluster randomized trial. Reprod Health 2020; 17:45. [PMID: 32252789 PMCID: PMC7132868 DOI: 10.1186/s12978-020-0859-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/08/2020] [Indexed: 12/26/2022] Open
Abstract
Background The partner has an important role when he participates of the prenatal care as showed in the positive results relate to the mother and the child health. For this reason it is an important strategy to bring future fathers closer to health services and to improve their link with paternity. Aim To evaluate whether the implementation of SMS technology, through the PRENACEL program for the partner as a health education program, is a useful supplement to the standard prenatal monitoring. Methods A parallel cluster randomized trial was carried out, with the clusters representing primary care health units. The 20 health units with the largest number of pregnant women in 2013 were selected for the study. There was a balance of the health units according to the size of the affiliated population and the vulnerability situation and these were allocated in intervention and control health units by the randomization. The partners of the pregnant women who started prenatal care prior to the 20th week of gestation were the study population of the intervention group. The participants received periodic short text messages via mobile phone with information about the pregnancy and birth. In the control group units the partners, together with the women, received the standard prenatal care. Results One hundred eighty-six partners were interviewed, 62 from the PRENACEL group, 73 from the intervention group that did not opt for PRENACEL and 51 from the control group. A profile with a mean age of 30 years was found and the majority of respondents (51.3%) declared themselves as brown race/color. The interviewees presented a mean of 9.3 years of study. The majority of the men (95.2%) cohabited with their partner and 63.7% were classified as socioeconomic class C. The adherence to the PRENACEL program was 53.4%. In relation to the individual results, there was a greater participation of the PRENACEL partners in the prenatal consultations, as well as a greater presence of them accompanying the woman at the moment of the childbirth when compared to the other groups. Conclusion The study showed that a health education strategy using communication technology seems to be a useful prenatal care supplement; the intervention had a good acceptability and has a promising role in men’s involvement in prenatal, labour and postpartum care of their partners. Trial registration Clinical trial registry: RBR-54zf73, U1111–1163-7761.
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Affiliation(s)
- Lívia Pimenta Bonifácio
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil.
| | - Ana Carolina Arruda Franzon
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Fabiani Spessoto Zaratini
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Fernanda Bergamini Vicentine
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Francisco Barbosa-Júnior
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Giordana Campos Braga
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil.,Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Jazmin Andrea Cifuentes Sanchez
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Lívia Oliveira-Ciabati
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Magna Santos Andrade
- Department of Education, College of Nursing, State University of Bahia (UNEB), Senhor do Bonfim, Bahia, Brazil
| | - Mariana Fernandes
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Suzi Volpato Fabio
- Women Health Programme, Ribeirao Preto Health Department, Ribeirao Preto, São Paulo, Brazil
| | - Geraldo Duarte
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Vicky Nogueira Pileggi
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - João Paulo Souza
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Elisabeth Meloni Vieira
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
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Franzon ACA, Oliveira-Ciabati L, Bonifácio LP, Vieira EM, Andrade MS, Sanchez JAC, Braga GC, Nogueira-Pileggi V, Fernandes M, Souza JP. A communication and information strategy in health and preparation for childbirth: a randomized cluster trial (PRENACEL). CAD SAUDE PUBLICA 2019; 35:e00111218. [PMID: 31618382 DOI: 10.1590/0102-311x00111218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 03/29/2019] [Indexed: 11/22/2022] Open
Abstract
PRENACEL is a study that incorporates two innovative approaches to maternal and perinatal health: the need to improve women's level of satisfaction with the birthing experience and an assessment of the impacts of information and communication technologies in health. The approaches involve a communication program via short cellphone text messages, developed for Brazilian pregnant women in prenatal care in the Brazilian Unified National Health System. The analysis aims to determine whether the program contributes positively to women's perceived preparedness for childbirth. A randomized cluster trial was performed in 20 primary care units in Ribeirão Preto, São Paulo State, in 2015 and 2016. Data were collected for 1,210 women from interviews and patient charts. The data were submitted to two analytical models, per protocol and intention-to-treat. Women that had received information from the PRENACEL program during pregnancy were more likely to feel prepared for labor and delivery and to feel that prenatal care had helped them feel more prepared. There were also positive impacts on bonding with the newborn and breastfeeding in the delivery room and on knowledge of obstetric interventions. No differences were seen in the other maternal and perinatal outcomes, including women's satisfaction with the birthing care. PRENACEL can help expand women's access to strategic information for them to feel better prepared for the birthing experience.
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Affiliation(s)
| | | | | | | | - Magna Santos Andrade
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brasil
| | | | - Giordana Campos Braga
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brasil
| | | | - Mariana Fernandes
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brasil
| | - João Paulo Souza
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brasil
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10
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Vieira CS, de Nadai MN, de Melo Pereira do Carmo LS, Braga GC, Infante BF, Stifani BM, Ferriani RA, Quintana SM. Timing of postpartum etonogestrel-releasing implant insertion and bleeding patterns, weight change, 12-month continuation and satisfaction rates: a randomized controlled trial. Contraception 2019; 100:258-263. [PMID: 31145885 DOI: 10.1016/j.contraception.2019.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 05/06/2019] [Accepted: 05/08/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To evaluate whether timing of etonogestrel (ENG) implant insertion during the postpartum period affects maternal bleeding patterns, body mass index (BMI) and 12-month satisfaction and continuation rates. STUDY DESIGN This is a secondary analysis of an open, randomized, controlled trial. Postpartum women were block-randomized to early (up to 48 h postpartum) or delayed (6 weeks postpartum) insertion of an ENG implant. Bleeding patterns and BMI were evaluated every 90 days for 12 months. At 12 months, we measured implant continuation rates and used Likert and face scales to measure users' satisfaction. The level of significance was 0.4% (adjusted by Bonferroni test for multiplicity). RESULTS We enrolled 100 postpartum women; we randomized 50 to early and 50 to delayed postpartum ENG implant insertion. Bleeding patterns were similar between groups. Amenorrhea rates were high in both groups during the follow-up (52%-56% and 46%-62% in the early and delayed insertion group, respectively). Prolonged bleeding episodes were unusual in both groups during the follow-up (0-2%). Maternal BMI was similar between groups and decreased over time. Twelve-month continuation rates were similar between groups (early insertion: 98% vs. delayed insertion: 100%, p=.99). Most participants were either very satisfied or satisfied with the ENG implant in both groups (p=.9). CONCLUSION Women who underwent immediate postpartum insertion of the ENG implant have similar bleeding patterns, BMI changes, and 12-month satisfaction and continuation rates compared to those who underwent delayed insertion. IMPLICATIONS Our results from a secondary analysis of a clinical trial support that satisfaction, continuation and bleeding patterns do not differ when women received contraceptive implants immediately postpartum or at 6 weeks. However, the emphasis on infant growth in the trial and easy access to delayed placement may have influenced results.
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Affiliation(s)
- Carolina Sales Vieira
- Department of Gynecology and Obstetrics, Medical School of Ribeirao Preto, University of São Paulo, Brazil. Avenida Bandeirantes, 3900 Campus Universitário Monte Alegre, CEP: 14049-900, Ribeirão Preto, SP, Brazil.
| | - Mariane Nunes de Nadai
- Department of Gynecology and Obstetrics, Medical School of Ribeirao Preto, University of São Paulo, Brazil. Avenida Bandeirantes, 3900 Campus Universitário Monte Alegre, CEP: 14049-900, Ribeirão Preto, SP, Brazil
| | - Lilian Sheila de Melo Pereira do Carmo
- Department of Gynecology and Obstetrics, Medical School of Ribeirao Preto, University of São Paulo, Brazil. Avenida Bandeirantes, 3900 Campus Universitário Monte Alegre, CEP: 14049-900, Ribeirão Preto, SP, Brazil
| | - Giordana Campos Braga
- Department of Gynecology and Obstetrics, Medical School of Ribeirao Preto, University of São Paulo, Brazil. Avenida Bandeirantes, 3900 Campus Universitário Monte Alegre, CEP: 14049-900, Ribeirão Preto, SP, Brazil
| | - Bruna Fregonesi Infante
- Women' s Health Reference Center of Ribeirão Preto. Avenida Wanderley Taffo, 330 Quintino Facci II, CEP: 14070-000, Ribeirão Preto, SP, Brazil
| | - Bianca M Stifani
- Department of Obstetrics, Gynecology and Women's Health of Albert Einstein College of Medicine / Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Rui Alberto Ferriani
- Department of Gynecology and Obstetrics, Medical School of Ribeirao Preto, University of São Paulo, Brazil. Avenida Bandeirantes, 3900 Campus Universitário Monte Alegre, CEP: 14049-900, Ribeirão Preto, SP, Brazil
| | - Silvana Maria Quintana
- Department of Gynecology and Obstetrics, Medical School of Ribeirao Preto, University of São Paulo, Brazil. Avenida Bandeirantes, 3900 Campus Universitário Monte Alegre, CEP: 14049-900, Ribeirão Preto, SP, Brazil; Women' s Health Reference Center of Ribeirão Preto. Avenida Wanderley Taffo, 330 Quintino Facci II, CEP: 14070-000, Ribeirão Preto, SP, Brazil
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Oliveira-Ciabati L, Vieira CS, Franzon ACA, Alves D, Zaratini FS, Braga GC, Sanchez JAC, Bonifácio LP, Andrade MS, Fernandes M, Quintana SM, Fabio SV, Pileggi VN, Vieira EM, Souza JP. PRENACEL - a mHealth messaging system to complement antenatal care: a cluster randomized trial. Reprod Health 2017; 14:146. [PMID: 29116028 PMCID: PMC5678588 DOI: 10.1186/s12978-017-0407-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 10/31/2017] [Indexed: 11/19/2022] Open
Abstract
Background The aim of this study was to determine whether PRENACEL (a bi-directional, mobile-phone based, short text message service (SMS)) increases the coverage of recommended antenatal care (ANC) practices. Methods A parallel, cluster-randomized trial in which 20 public primary Health Care Units (PHCUs) were randomly allocated to the intervention (10 PHCUs) or control (10 PHCUs) group. The study population included pregnant women aged 18 or above with a gestational age of 20 weeks or less. Pregnant women receiving ANC in intervention PHCUs were invited through leaflets and posters to register in PRENACEL. Women who registered in PRENACEL received a weekly set of short text messages with health education and health promotion content related to pregnancy and childbirth and were also able to clarify ANC queries through SMS. All women received routine ANC. The primary outcome was the proportion of women with high ANC Score, a composite measure of coverage of recommended ANC practices. Chi-square or Fisher’s exact tests and multivariate log-binomial regression were used to analyze the outcomes. Results A total of 1210 eligible women received ANC in the participating PHCUs and took part of this study (770 in the intervention group and 440 in the control group). 20.4% (157/770) of intervention-group women registered in PRENACEL, but only 116 read all messages (73.9% of women who registered in PRENACEL, 116/157). The adjusted intention-to-treat analysis suggested no difference between intervention and control groups in the primary outcome (Adjusted Relative Risk (AdjRR): 1.05 (95% Confidence Interval (CI): 1.00–1.09). Both crude and adjusted per-protocol analysis suggested a positive effect of PRENACEL (Crude RR (95% CI): 1.14 (1.06–1.22), AdjRR (95% CI): 1.12 (1.05–1.21). The multivariate analysis also suggests that the PRENACEL group (women who read all SMS) had higher mean ANC score [48.5 (±4.2) vs 45.2 (±8.7), p < 0.01], higher proportion of women with ≥6 ANC visits (96.9% vs. 84.8%, p = 0.01), and higher rates of syphilis testing (40.5% vs. 24.8%, p = 0.03) and HIV testing (46.6% vs. 25.7%, p < 0.01) during ANC. Conclusions A bi-directional, mobile-phone based, short text message service is potentially useful to improve the coverage of recommended ANC practices, including syphilis and HIV testing. Trial registration Clinical trial registry: RBR-54zf73, U1111–1163-7761. Resumo Introdução O objetivo deste estudo foi determinar se o PRENACEL, um serviço bidirecional de mensagens curtas de texto (SMS) com base na telefonia celular, aumenta a cobertura das práticas recomendadas de cuidados pré-natais (PN). Métodos um ensaio paralelo, aleatorizado por conglomerados, no qual 20 unidades básicas de saúde (UBS) foram alocadas aleatoriamente para o grupo de intervenção (10 UBS) ou controle (10 UBS). A população estudada incluiu gestantes com idade igual ou superior a 18 anos com idade gestacional de 20 semanas ou menos. As gestantes que receberam PN em UBS intervenção foram convidadas através de folhetos e cartazes para se inscreverem no PRENACEL. As mulheres que se registraram no PRENACEL receberam um conjunto semanal de SMS com conteúdo de educação e promoção da saúde relacionadas à gravidez e parto e também puderam esclarecer dúvidas relacionadas ao PN através de SMS. Todas as mulheres receberam PN de rotina. O desfecho primário foi a proporção de mulheres com um alto escore de PN, uma medida da cobertura das principais práticas recomendadas no PN. Resultados um total de 1.210 mulheres participaram deste estudo (770 no grupo de intervenção e 440 no grupo de controle). 20,4% (157/770) das mulheres do grupo de intervenção demonstraram interesse e foram registradas no PRENACEL, mas apenas 116 leram as mensagens (73,9%, 116/157). A análise ajustada de intenção de tratamento sugeriu ausência de efeito da intervenção no desfecho primário (Risco Relativo (RR) ajustado: 1,05, Intervalo de Confiança (IC) de 95%: 1,00–1,09). A análise por protocolo sugeriu um efeito positivo do PRENACEL [RR bruto (IC 95%): 1,14 (1,06–1,22), RR ajustado (IC 95%): 1,12 (1,05–1,21)]. A análise multivariada sugeriu que as mulheres que leram os SMS apresentaram a maior média do escore de PN [48,5 (±4,2) vs 45,2 (±8,7), p < 0,01], maior proporção de mulheres com ≥6 consultas (96,9% vs. 84,8%, p = 0,01) e maiores taxas de teste de sífilis (40,5% vs. 24,8%, p = 0,03) e HIV (46,6% vs. 25,7%, p < 0,01) durante o PN. Conclusões o sistema PRENACEL é potencialmente útil para melhorar a cobertura das práticas recomendadas de PN, incluindo testes de sífilis e HIV. Electronic supplementary material The online version of this article (10.1186/s12978-017-0407-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lívia Oliveira-Ciabati
- Department of Social Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Carolina Sales Vieira
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Ana Carolina Arruda Franzon
- Department of Social Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Domingos Alves
- Department of Social Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Fabiani Spessoto Zaratini
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Giordana Campos Braga
- Department of Social Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil.,Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | | | - Lívia Pimenta Bonifácio
- Department of Social Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Magna Santos Andrade
- Department of Social Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Mariana Fernandes
- Department of Social Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Silvana Maria Quintana
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Suzi Volpato Fabio
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil.,Women Health Programme, Ribeirao Preto Health Department, Ribeirao Preto, Brazil
| | - Vicky Nogueira Pileggi
- Department of Social Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil.,Department of Pediatrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Elisabeth Meloni Vieira
- Department of Social Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - João Paulo Souza
- Department of Social Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil.
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Pileggi VN, Braga GC, Bellissimo-Rodrigues F, Souza JP. A rapid review of personal protective measures for preventing Zika virus infection among pregnant women. Bull World Health Organ 2016. [DOI: 10.2471/blt.16.182592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Vicky Nogueira Pileggi
- Social Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Campus Universitário s/n – Monte Alegre, 14048-900, Ribeirão Preto, São Paulo, Brazil
| | - Giordana Campos Braga
- Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Fernando Bellissimo-Rodrigues
- Social Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Campus Universitário s/n – Monte Alegre, 14048-900, Ribeirão Preto, São Paulo, Brazil
| | - João Paulo Souza
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Braga GC, Ferriolli E, Quintana SM, Ferriani RA, Pfrimer K, Vieira CS. Immediate postpartum initiation of etonogestrel-releasing implant: A randomized controlled trial on breastfeeding impact. Contraception 2015. [PMID: 26209863 DOI: 10.1016/j.contraception.2015.07.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Breast milk volume has never been evaluated when the etonogestrel (ENG) implant was inserted immediately postpartum. Thus, this study evaluated if the immediate postpartum insertion of the ENG implant alters breast milk volume. STUDY DESIGN Twenty-four postpartum women and their newborns (NBs) were randomized into two groups: Implant group (ENG implant inserted within 48 h after delivery) and Control group (absence of contraceptive method). The primary outcome was the amount of breast milk intake by the NBs in the first 6 weeks after delivery. Five and ten grams of deuterium (D(2)O) were orally administered to the postpartum women on the day of randomization (day 0) and on the 29th study day, respectively. Saliva samples were collected from the mother-NB pairs prior to each D(2)O dose administration and after D(2)O ingestion (periodic collection). The amount of breast milk ingested by the NBs was estimated by the amount of deuterium (D(2)O) ingested by the NBs through breastfeeding, using mass spectrometry in the saliva samples. RESULTS Twenty-four postpartum women and their NB were randomized (12 per group). The median of breast milk intake by NBs following the two D(2)O doses were similar between groups {first D(2)O dose [Implant: 340 mL/day (240-420 mL/day) vs. CONTROL 330 mL/day (300-530 mL/day), p=.54]; second D(2)O dose [Implant: 845 mL/day (770-980 mL/day) vs. CONTROL 785 mL/day (680-980 mL/day), p=.63]}. The exclusive breastfeeding rate and NB weight were similar between groups in the first 6 weeks postpartum. CONCLUSION ENG implant insertion immediately postpartum does not alter the volume of breast milk intake by NBs. IMPLICATIONS Considering the benefits of immediate postpartum initiation of ENG implant on reducing unintended pregnancy and pregnancy recurrence, especially in vulnerable populations, our study adds safety data on breastfeeding effect of this practice.
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Affiliation(s)
- Giordana Campos Braga
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900 - Campus Universitário - Monte Alegre, CEP: 14049-900, Ribeirão Preto, SP, Brazil.
| | - Eduardo Ferriolli
- Department of Internal Medicine, Ribeirao Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900 - Campus Universitário - Monte Alegre, CEP: 14049-900, Ribeirão Preto, SP, Brazil
| | - Silvana Maria Quintana
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900 - Campus Universitário - Monte Alegre, CEP: 14049-900, Ribeirão Preto, SP, Brazil
| | - Rui Alberto Ferriani
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900 - Campus Universitário - Monte Alegre, CEP: 14049-900, Ribeirão Preto, SP, Brazil; National Institute of Hormones and Women's Health, CEP: 14049-900, Ribeirão Preto, SP, Brazil
| | - Karina Pfrimer
- Department of Internal Medicine, Ribeirao Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900 - Campus Universitário - Monte Alegre, CEP: 14049-900, Ribeirão Preto, SP, Brazil
| | - Carolina Sales Vieira
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Avenida Bandeirantes, 3900 - Campus Universitário - Monte Alegre, CEP: 14049-900, Ribeirão Preto, SP, Brazil; National Institute of Hormones and Women's Health, CEP: 14049-900, Ribeirão Preto, SP, Brazil
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Abstract
Objective: obtaining information on the factors associated with episiotomy will be useful in sensitizing professionals to the need to minimize its incidence. Therefore, the objective of this study was to evaluate risk factors for episiotomy in pregnant women who had undergone vaginal delivery at a university maternity hospital in northeastern Brazil. Methods: a case-control study was conducted with pregnant women submitted to episiotomy (cases) and pregnant women not submitted to episiotomy (controls) between March 2009 and July 2010 at the Professor Fernando Figueira Integral Medicine Institute (IMIP) in Recife, Brazil, in a ratio of 1 case to 2 controls. The study variables consisted of: whether episiotomy was performed, demographic, obstetric and fetal characteristics (primiparity, analgesia, instrumental delivery, fetal distress, etc.), external factors (day and time of delivery, professional attending delivery) and factors directly related to delivery. Odds ratios (OR) and 95% confidence intervals (95%CI) were calculated. Multivariate analysis was performed to determine the adjusted risk of episiotomy. Results: a total of 522 women (173 cases and 349 controls) were included. It was found that deliveries with episiotomy were more likely to have been attended by staff physicians (OR = 1.88; 95%CI: 1.01 - 3.48), to have required forceps (OR = 12.31; 95%CI: 4.9 - 30.1) and to have occurred in primiparas (OR = 4.24; 95%CI: 2.61 - 6.89). The likelihood of a nurse having attended the delivery with episiotomy was significantly lower (OR = 0.29; 95%CI: 0.16 - 0.55). Conclusion: episiotomy was found to be strongly associated with deliveries attended by staff physicians, with primiparity, and with instrumental delivery, and was less common in deliveries attended by nurses.
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Braga GC, Brito MB, Ferriani RA, Oliveira LC, Garcia AA, Pintão MC, Vieira CS. Oral anticoagulant therapy does not modify the bleeding pattern associated with the levonorgestrel-releasing intrauterine system in women with thrombophilia and/or a history of thrombosis. Contraception 2014; 89:48-53. [DOI: 10.1016/j.contraception.2013.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 06/24/2013] [Accepted: 06/30/2013] [Indexed: 10/26/2022]
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Araújo JS, Pérez JRO, Oliveira V, Braga GC, Peixoto ECTM. MONENSINA SÓDICA NO CONSUMO E DIGESTIBILDADE APARENTE DAS FIBRAS EM DETERGENTE NEUTRO E ÁCIDO DA DIETA EM OVINOS. AVS 2007. [DOI: 10.5380/avs.v12i1.9224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objetivou-se avaliar os efeitos da adição da monensina sódica na dieta de ovinos sobre o consumoe os coeficientes de digestibilidade aparente da fibra em detergente neutro (FDN) e ácido (FDA) num ensaio dedigestibilidade “in vivo”, utilizando-se 16 ovelhas, não prenhes e não lactantes, mestiças, com peso e desviopadrão médios de 55,11 ± 3,11 kg, em delineamento inteiramente ao acaso, com quatro tratamentos (0; 25; 50 e75 mg de monensina/animal/dia). Os animais foram alimentados à vontade, com dietas à base de cana-deaçúcar,farelo de soja, grão de milho moído e mistura mineral como dieta básica. Houve efeito significativo dosníveis de monensina sobre os consumos das fibras em detergentes neutro e ácido da dieta. Os coeficientes dedigestibilidade aparente da FDN e da FDA não diferiram estatisticamente entre os tratamentos. Os níveis demonensina sódica utilizados diminuíram os consumos e os coeficientes de digestibilidade aparente daFDNe daFDA.
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