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Mendonç. Carneiro M, Gusmao C, Nakano F, Polisseni F, Coutinho L, Ferreira MC. P–471 Preconception and infertility care across South America: availability of policy, guidelines, recommendations and services. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.470] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
What are the available preconception care policies, guidelines, recommendations and services as well as infertility care in South America ?
Summary answer
Preconception recommendations offered by both governament and medical societies in South America were fragmented and inconsistent and public fertility care is available in seven countries.
What is known already
Promoting preconception health can potentially improve women’s health and pregnancy outcomes. Evidence-based interventions exist to reduce many maternal behaviors and chronic conditions that are associated with adverse pregnancy outcomes such as tobacco use, alcohol use, inadequate folic acid intake, obesity, hypertension, and diabetes. Paternal factors are also influence pregnancy outcomes but male preconcepction health has received little attention so far and he focus remains on women.
Study design, size, duration
Cross-sectional evaluation including ann electronic search and investigation of preconception policy, guidelines, recommendations and services available to healthcare professionals and the general public in south America (N = 11 countries): Argentina, Bolívia, Brasil, Chile, Colômbia, Ecuador, , Paraguay, Peru, Suriname, Uruguay and Venezuela) that took place in June 2020.
No ethical approval was obtained as we used only public avalialble online information.
Participants/materials, setting, methods
Eleven South American countries) were included Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, , Paraguay, Peru, Suriname, Uruguay and Venezuela.we searched Google using advanced search setup for each country with the following words: Preconception care; Pre-pregnancy care; Before pregnancy; Conception; Pregnancy planning; Preconceptual and variations and Policy; Guidelines, Recommendations and services. Data from the Latin American Registry (REDLARA, 2017) and the Latin American Federation of Societies of Obstetrics and Gynecology (FLASOG) was also obtained .
Main results and the role of chance
Government preconcepction care recommendations were available in 10 countries and 11 had family planning guidelines. Seven countries offered either public clinics or financial aid for infertile couples. According to REDLARA 2017 report there are 122 registered centers in South America but the region host much more. The Brazilian registry shows 154 IVF clinics in 2018. Although most countries offered guidance on major issues including folic acid supplementation (n = 10), nutrition (n = 10), Vaccination (n = 11), alcohol consumption (n = 11), smoking (n = 10), relevant health topics such physical activity (n = 7) and obesity (n = 7) were left out in 58,3% of the countries. Medical societies provided guidelines on preconcpection care in 7 countries and for other health issues: folic acid supplementation (n = 5), nutrition (n = 5), Vaccination (n = 6), alcohol consumption (n = 4), smoking (n = 4), physical activity (n = 4)and obesity (n = 2). When male preconception care was considered, only two countries have public guidelines whereas no medical society provided specific recommendations for men. Sexually transmitted diseases (STD) was another topic of interest for both public (n = 10) and medical societies (n = 4). STD guidelines were heterogenous and focused more on treatment rather than prevention. FLASOG however displayed guidelines for peconception care and STD prevention.
Limitations, reasons for caution
The search was performed only in Google as it is the most opular search engine. We did not include other search pages asuch as Yahoo and limited our search to the first 3 pages for each search term as people rarely examine more thatn the first there pages.
Wider implications of the findings: Current reccomendations are heterogeneous, fragmented and inconsitent and there is a lack of interest on male reproductive health y. Public fertility care is only available in 7 countries. Collaborative research among countries is necessary so as to develop evidence-based guidelines for preconcepction and fertility care for both men and women.
Trial registration number
not-applicable
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Affiliation(s)
- M Mendonç. Carneiro
- Universidade Federal de Minas Gerais, Obstetrics and Gynecolofy, Belo Horizonte, Brazil
| | - C Gusmao
- Clínica GENESIS, Human Reproduction, Brasilia, Brazil
| | - F Nakano
- –Medicina Reprodutiva Campinas, Human Reproduction, Campinas, Brazil
| | - F Polisseni
- Universidade Federal de Juiz de Fora, Obsterics and Gynecology, Juiz de Fora, Brazil
| | - L Coutinho
- Universidade Federal de Juiz de Fora, Obsterics and Gynecology, Juiz de Fora, Brazil
| | - M C Ferreira
- Universidade Federal de Minas Gerais, Obstetrics and Gynecolofy, Belo Horizonte, Brazil
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Vaz-Silva J, Carneiro MM, Ferreira MC, Pinheiro SVB, Silva DA, Silva-Filho AL, Witz CA, Reis AM, Santos RA, Reis FM. The vasoactive peptide angiotensin-(1-7), its receptor Mas and the angiotensin-converting enzyme type 2 are expressed in the human endometrium. Reprod Sci 2009; 16:247-56. [PMID: 19164480 DOI: 10.1177/1933719108327593] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Angiotensin (Ang)-(1-7) is one of the major active components of the renin-angiotensin system, produced from cleavage of Ang II by angiotensin-converting-enzyme type 2 (ACE2), which acts through a specific G protein-coupled receptor, Mas. We have investigated whether the human endometrium expresses these components during menstrual cycle. By radioimmunoassay, Ang-(1-7) was detected in endometrial wash fluid at picomolar concentrations. Using immunofluorescence, both the peptide and its receptor were identified in cultured endometrial epithelial and stromal cells. By immunohistochemistry, Ang(1-7) was localized in the endometrium throughout menstrual cycle, being more concentrated in the glandular epithelium of mid- and late secretory phase. This pattern corresponded to the ACE2 mRNA, which was more abundant in epithelial cells than in stromal cells (2-fold increase, p < 0.05) and in the secretory vs. proliferative phase (6.6-fold increase, p < 0.01). The receptor Mas was equally distributed between epithelial and stromal cells and did not change during menstrual cycle. The physiological role of this peptide system in normal and pathological endometrium warrants further investigation.
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Affiliation(s)
- J Vaz-Silva
- Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Abstract
Activins and inhibins are growth factors involved in cell differentiation and proliferation. Human breast tissues such as normal mammary tissue, fibroadenoma, and breast cancer express inhibin and activin mRNA and proteins. Activin A and its binding protein, follistatin, are also present in human milk during the first week of lactation. Using immunohistochemistry, we have observed that the inhibin/activin alpha, betaA, and betaB subunits are present in normal breast tissue regardless of menstrual cycle phase or menopause, as well as in fibrocystic disease, and breast tumors. The mRNAs encoding all three activin/inhibin subunits are expressed in breast carcinoma, fibroadenoma, and normal mammary tissue. The betaA subunit gene expression is higher in either local or metastatic breast carcinoma than in normal tissue. In addition, dimeric activin A is detectable in homogenates of breast cancer tissue at concentrations twice as high as in non-neoplastic adjoining tissue. Recent evidence suggests that some of the activin A produced by breast carcinoma is released into systemic circulation. In women with breast cancer, serum activin A levels are often elevated, and a significant decrease is observed in the first and second days following tumor excision. The role of activin and inhibin as endocrine and/or paracrine factors in the breast is still uncertain. Activin has complex effects on cell growth during branching morphogenesis, but it is generally considered as an inhibitor of cell proliferation as in vitro studies have shown that activin A treatment of breast cancer cells arrests cell growth. Inhibin is generally considered as a tumor suppressor, but its possible role in the breast is less understood.
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Affiliation(s)
- F M Reis
- Department of Obstetrics and Gynecology, University of Minas Gerais, Belo Horizonte, Brazil.
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Abstract
In modern organizations leadership has been emphasized, since it is considered fundamental to the execution of the objectives of a company. It is through leadership that the ability of influencing the behavior of others is developed, facilitating the accomplishment of activities. The study has as its objective the investigation of the head nurse's leadership, considering the opinion of assistant nurses in four units of a public hospital. The study has shown that nurses who are in managerial position, present a leadership profile centered on the service and on individuals.
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