Impact of hepatitis C virus eradication with direct-acting antivirals on glycidic metabolism

ABSTRACT Objective: To compare the glucose metabolism of patients with chronic hepatitis C virus infection treated with direct-acting antivirals (DAAs) in pretreatment and sustained viral response (SVR) periods. Materials and methods: This was an intervention pre-post study of 273 patients with chronic hepatitis C virus infection treated with DAAs from March 2018 to December 2019. Glycidic metabolism was evaluated through homeostasis model assessment (HOMA) - insulin resistance (IR) and HOMA-β indices and assessments of insulinemia and HbA1c levels. These parameters were analyzed with a T test by paired comparison of the means of the variables and Wilcoxon's test paired for the median; in the variables with an abnormal distribution, the Z score was generated for the mean in both the pretreatment and SVR periods. Statistical significance was considered at p ≤ 0.05. Results: Among 273 participants, 125 (45.8%) had prediabetes, and 50 (18.3%) had diabetes. In SVR, there was a significant increase in platelets, albumin, alkaline phosphatase, cholesterol and triglycerides and a significant decrease in aspartate aminotransferase, alanine aminotransferase, gamma GT and bilirubin. The HOMA-IR and HOMA-β indices increased in SVR from 1.95 to 2.29 (p = 0.087) and 71.20 to 82.60 (p = 0.001), respectively. Insulinemia increased from 7.60 μU/mL to 8.90 μU/mL (p = 0.011). HbA1c decreased from 5.6 to 5.4 (p < 0.001). Among patients with prediabetes and those with diabetes, the reduction in HbA1c values was significant (p = 0.006 and p = 0.026, respectively). Conclusion: SVR significantly impacts and leads to improvement in glucose metabolism in patients with chronic liver disease induced by hepatitis C virus.

Effects of hepatitis C virus genotypes and viral load on glucose and lipid metabolism after sustained virological response with direct-acting antivirals

SUMMARY OBJECTIVE: The objective of this study, carried out at the university hospital of the Federal University of Rio Grande, was to assess whether the treatment of chronic hepatitis C with direct-acting antivirals and the sustained virological response will affect the metabolic influences of the hepatitis C virus and whether these effects will vary according to genotypes and virus load. METHODS: This is an intervention pre-post study, carried out from March 2018 to December 2019, evaluating 273 hepatitis C virus patients treated with direct-acting antivirals. Inclusion criteria included being monoinfected with hepatitis C virus and achieving sustained virological response . Exclusion criteria included the presence of decompensated cirrhosis or co-infected with hepatitis B virus or human immunodeficiency virus. Genotypes, genotype 1 subtypes, and hepatitis C virus viral load were analyzed. Glucose metabolism was evaluated by the Homeostasis Model Assessment-insulin resistance indices: Homeostasis Model Assessment-β, TyG, and HbA1c, measured at the beginning of treatment and in sustained virological response. Statistical analysis with a T test by paired comparison of the means of the variables in the pretreatment and in the sustained virological response. RESULTS: Homeostasis Model Assessment-insulin resistance analysis: there were no significant differences between pretreatment and sustained virological response. Homeostasis Model Assessment-β analysis: significant increase in genotype 1 patients (p<0.028). TyG index analysis: significant increase in genotype 1b (p<0.017), genotype 3 (p<0.024), and genotype non-1 with low viral load (p<0.039). HbA1c analysis: significant decrease in genotype 3 (p<0.001) and genotype non-1 patients with low viral load (p<0.005). CONCLUSION: We detected significant metabolic influences after sustained virological response: impairment in lipid profile and improvements in the glucose metabolism. We found significant differences in genotype dependence, genotype 1 subtypes, and viral load.

Vaccination coverage against human papillomavirus (HPV) and associated factors in female academics from a university in southwestern Goiás, Brazil / Cobertura vacinal contra o papiloma vírus humano (HPV) e fatores associados em acadêmicas de uma universidade do sudoeste goiano

ABSTRACT OBJECTIVE To check the coverage of the HPV vaccine in women enrolled in health courses at a university in southwest Goiás, Brazil, and the factors associated with vaccination. METHODS This is a cross-sectional study, including female university students of health courses, aged 18 years or more. A standardized and self-applying questionnaire was used. Participants who received two or more doses of the vaccine were considered immunized. Multiple analysis was performed using multinomial logistic regression. RESULT We observed that, of the 1510 participants, 473 (31.3%) had two or more doses of HPV vaccine, 167 (11.0%) one dose and 870 (57.6%) were unvaccinated. Participants under 21 years of age and in socioeconomic stratum A were 2 times more likely to have received two or more doses of the vaccine (Prevalence Ratio = 1.95; 95%CI 1.40-2.70 and Prevalence Ratio = 2.09; 95%CI 1.39-3.13, respectively). CONCLUSIONS The research revealed extensive possibility for interventions with the aim of achieving greater vaccination coverage among female university students. Even women with more knowledge and high economic stratum showed low vaccination coverage, suggesting that results of higher vaccine coverage can be obtained with vaccination carried out in a school environment.

RESUMO OBJETIVO Verificar a cobertura da vacina contra o HPV em mulheres matriculadas em cursos da área de saúde de uma universidade do sudoeste do Estado de Goiás e os fatores associados à vacinação. MÉTODOS Trata-se de estudo transversal, incluindo universitárias dos cursos da área de saúde, com 18 anos ou mais. Foi utilizado questionário padronizado e autoaplicável. As participantes que receberam duas ou mais doses da vacina foram consideradas como imunizadas. A análise múltipla foi realizada por meio de regressão logística multinomial. RESULTADOS Observou-se que, das 1510 participantes, 473 (31,3%) com duas ou mais doses de vacina contra o HPV, 167 (11,0%) com uma dose e 870 (57,6%) não vacinadas. As participantes com menos de 21 anos e inseridas no estrato socioeconômico A tinham 2 vezes mais chance de terem recebido duas doses ou mais da vacina (Razão de Prevalência = 1,95; IC95% 1,40-2,70 e Razão de Prevalência = 2,09; IC95% 1.39-3,13, respectivamente). CONCLUSÕES A pesquisa revelou extensa possibilidade para intervenções com o objetivo de atingir maior cobertura vacinal entre as universitárias. Mesmo mulheres com mais conhecimento e de estrato econômico elevado apresentaram baixa cobertura vacinal, sugerindo que resultados de cobertura vacinal maior podem ser obtidos com a vacinação realizada em ambiente escolar.

Prevalence and associated factors with depression and anxiety in prisoners in South of Brazil

Abstract Background Brazil has the third largest prison population in the world. Research in the world has confirmed a high prevalence of mental disorders in this population. Objective To identify prevalence and associated factors with depression and anxiety in prisoners of the closed prison system. Methods This is a cross-sectional study with 643 prisoners were interviewed in six prisons in Rio Grande do Sul, Brazil. To evaluate depression and anxiety, the Mini International Neuropsychiatric Interview 5.0 (MINI) was used and sociodemographic, inprisonment and lifestyle habits variables were also collected. Results The prevalence of depression found in the study was 20.6% (95% CI: 17.5-23.8) and of anxiety was 19.9% (95% CI: 16.8-23.0). The following were identified as risk factors for depression: being female, having a history of mental illness, non-white skin color, having a religion, not receiving visits, smoking, using drugs and not performing physical activities. Risk factors for anxiety were: being female, having a history of mental illness, a family history of mental illness, smoking and using drugs. Discussion The study confirmed the high rates of depression and anxiety in the population deprived of liberty. In addition, women were twice as likely to have both disorders compared to men.

Avaliação Psicométrica da versão brasileira do "Questionário sobre Conhecimento de Doenças Sexualmente Transmissíveis" / Psychometric Evaluation of the Brazilian Version of the "Sexually Transmitted Disease Knowledge Questionnaire"

Resumo Este estudo analisou as propriedades psicométricas da versão brasileira do Questionário sobre Conhecimento de Doenças Sexualmente Transmissíveis (STD-KQ). Participou uma amostra de conveniência de 429 estudantes de uma universidade pública brasileira. A análise fatorial exploratória sugere uma estrutura com um fator (variância explicada = 61,1%; eigenvalue = 7,2), sendo corroborada pela análise confirmatória (Root Mean Square Error of Approximation = 0,04; Comparative Fit Index = 0,91; Tucker-Lewis Index = 0,90; Standardized Root Mean Square Residual = 0,05). Cinco itens apresentaram carga menor que 0,30 e por isso foram excluídos. O instrumento demonstrou consistência interna (confiabilidade composta = 0,97; alfa de Cronbach = 0,83) e estabilidade temporal (correlação de Pearson = 0, 86; kappa = 0,16) para um curto período. O conhecimento significativamente variou conforme a idade, o sexo e o curso. Concluindo, o presente estudo destaca as satisfatórias propriedades psicométricas da versão brasileira do STD-KQ em estudantes universitários.

Abstract This study evaluated the psychometric properties of the Brazilian version of the Sexually Transmitted Disease Knowledge Questionnaire (STD-KQ). A convenience sample of 429 students of a Brazilian public university participated in the study. Exploratory Factor Analysis suggested one factor solution (variance explained = 61.1%, eigenvalue = 7.2), confirmed by the confirmatory analysis (Root Mean Square Error of Approximation = 0.04; Comparative Fit Index = 0.91; Tucker-Lewis Index = 0.90; Standardized Root Mean Square Residual = 0.05). Five items feature charges less than 0.30 and wer eliminated. The instrument demonstrated internal consistency (Composite reliability = 0.97; Cronbach's alpha = 0.83) and temporal stability (Pearson correlation = 0.86; kappa = 0.16) over a brief period. The knowledge significantly varies by age, sex and course of study. In conclusion, this study highlights the satisfactory psychometric proprieties of the Brazilian version of STD-KQ in university students.

Frequency and associated factors with failure to perform the puerperal consultation in a cohort study / Frequência e fatores associados à não realização da consulta puerperal em um estudo de coorte

Abstract Objectives: to identify the frequency and factors associated with the non-realization of puerperal consultations in women resident of a medium-sized municipality in Brazil. Methods: a prospective cohort study based on data collected in two time points, the first 48h and after the 42nd day post-childbirth. In order to analyze data, proportions were compared using the chi-square test, and the adjusted analysis was performed using Poisson regression, according to a predetermined hierarchical model. Significance level was set at 5%. Results: of the 572 women included in the study, 24.8% did not perform puerperal consul-tations. The factors associated with the non-realization of puerperal consultations were: lower income (1 st tercile PR= 2.01; CI95%= 1.21-3.33 - 2 nd tercile PR= 1.94; CI95%=1.17-3.20) and schooling (≤ 8 years PR= 2.00; CI95%= 1.24-3.24), comorbidities during preg-nancy (PR= 1.45; CI95%= 1.01-2.09), realization of antenatal care in the public service (PR= 1.74; CI95%= 1.18-2.58) and non-use of contraceptive methods (PR= 3.10; CI95%=1.86-5.16). Conclusions: puerperal revision does not seem to be valued in the antenatal care, mainly in the public health system. An important inequality was identified in the provision of this service, since women more prone to recurring pregnancy and with lower income and schooling were the ones that least returned to the puerperal consultation.

Resumo Objetivos: identificar a frequência da não realização das consultas de puerpério e fatores associados em mulheres residentes de um município de médio porte no Brasil. Métodos: estudo de coorte prospectiva através da coleta de dados em dois momentos, nas primeiras 48h e após o 42º dia pós-parto. Para a análise dos dados, utilizou-se o teste qui-quadrado para comparar proporções e, para a análise ajustada, Regressão de Poisson obedecendo ao modelo hierárquico pré-determinado. O nível de significância adotado foi de 5%. Resultados: das 572 mulheres incluídas no estudo, 24,8% não realizaram consulta de puerpério. Os fatores associados a não realização da consulta de puerpério foram: menor renda (1º tercil RP= 2,01 IC95%= 1,21-3,33 - 2º tercil RP= 1,94 IC95%= 1,17-3,20), escolaridade (≤ 8 anos RP= 2,00 IC95%= 1,24-3,24); mulheres que apresentaram alguma comorbidade durante a gestação (RP 1,45; IC95%= 1,01-2,09), realizaram o pré-natal em serviço público (RP= 1,74; IC95%= 1,18-2,58) e que não usaram método anticoncepcional (RP= 3,10; IC95%= 1,86-5,16). Conclusões: a revisão puerperal não parece estar sendo valorizada no pré-natal, principalmente no sistema público de saúde. Foi identificada uma importante iniquidade na prestação desse serviço, pois as mulheres de menor renda, escolaridade e mais expostas a uma gravidez recorrente foram as que menos retornaram à consulta puerperal.

Tendência temporal e distribuição espacial da sífilis congênita no estado do Rio Grande do Sul entre 2001 e 2012 / Temporal trend and spatial distribution of congenital syphilis in the state of Rio Grande do Sul between 2001 and 2012

Resumo Objetivou-se avaliar a tendência temporal e a distribuição espacial da Sífilis Congênita (SC) no estado do Rio Grande do Sul. Todos os casos notificados pelo Sistema Nacional de Agravos de Notificação entre 2001 e 2012 foram incluídos. Os números de nascidos vivos foram obtidos do SINASC/DATASUS. As taxas de incidência de SC foram agrupados conforme as microrregiões do IBGE e analisados para todo o período e em triênios. A correlação espacial foi analisada pelo índice de Moran global (I) e local. Foram notificados 3.613 casos. Entre 2007 e 2012 morreram 89 neonatos (3,6%). As taxas de SC variaram de 1,03 em 2001 a 5,1 casos por 1.000 nascidos vivos em 2012, com um incremento anual de 0,84 casos por 1.000 nascidos vivos (p < 0,01) e 93,88% da variação explicada. As microrregiões foram espacialmente independentes (I = 0,06; p = 0,25), tendo Porto Alegre a maior incidência (4,19 casos/1.000 nascidos vivos) e Jaguarão a menor (0,23 casos/1.000 nascidos vivos). Observaram-se microrregiões com dependência espacial local significativa. O aumento dos casos de SC salienta um déficit na qualidade do pré-natal. A identificação das microrregiões com maior incidência é essencial para focalizar as políticas públicas sobre esse tema.

Abstract The scope of the study was to evaluate the temporal trend and spatial distribution of congenital syphilis (CS) in the state of Rio Grande do Sul. All cases reported by the SINASC/DATASUS between 2001 and 2012 were included. The number of live births was obtained from DATASUS. Incidence rates of CS were grouped according to micro-regions of IBGE and analyzed for the entire period and for triennia. The spatial correlation was analyzed by the global Moran index (I) and the local index. 3,613 cases were reported. Between 2007 and 2012 89 neonates (3.6%) died. Rates varied from to 1.03 in 2001 to 5.1 cases per 1000 live births in 2012, with an annual increase of 0.84 cases per 1000 live births (p < 0.01) and 93.88% of explained variance. The micro-regions were spatially independent (I = 0.06; p = 0.25), with Porto Alegre having the highest incidence (4.19 cases / 1000 live births) and Jaguarão the lowest (0.23 cases / 1000 live births). Micro-regions with significant local spatial dependence were observed. The increase in cases of CS highlights poor prenatal quality care. Identification of the micro-regions with the highest incidence is essential to focus public policy on this health problem.

O conhecimento de mulheres sobre os métodos para prevenção secundária do câncer de mama / Women's knowledge of methods for secondary prevention of breast cancer

Resumo Objetivou-se avaliar o conhecimento das mulheres sobre métodos de rastreamento do câncer de mama. Estudo de base populacional com mulheres de 18 anos ou mais em Rio Grande, entre abril e novembro de 2011. Entrevistadoras aplicavam questionário pré-codificado em todas as mulheres do domicílio selecionado. Construiuse um modelo para cada forma de rastreamento (autoexame das mamas, mamografia e exame clínico), analisados por regressão de Poisson. Das 1596 mulheres entrevistadas, 1355 referiram o autoexame, 456, a mamografia e, apenas 191, o exame clínico da mama, realizado por um profissional de saúde, como importantes para a prevenção do câncer de mama. As mulheres brancas, e com 11 anos ou mais de escolaridade, tiveram maior probabilidade de referirem a mamografia e o exame clínico como métodos de rastreamento. Para esses dois desfechos, também se observou uma tendência linear, sendo que a probabilidade de referir uma dessas formas de rastreamento se incrementou na medida em que aumentaram os quartis de renda. O estudo aponta para a necessidade de maior esclarecimento da população sobre os métodos de prevenção, evitando, assim, o diagnóstico tardio. Evidenciou-se que as mulheres não brancas e as de baixa escolaridade e renda, demonstraram menos conhecimentos sobre os métodos de exame clínico e mamografia.

Abstract The objective of this study was to evaluate women's knowledge of methods for screening breast cancer. The study was done on a population of women aged 18 or over in the city of Rio Grande between April and November 2011. Interviewers used questionnaires on all of the women at selected households. Models were developed for every type of screening (self-examination of breasts, mammography, and clinical exams) that were analyzed through the use of Poisson regression. Out of the 1596 women interviewed, 1355 reported self-examination, 456, mammography, and only 191, clinical examination of the breast, performed by a health professional, as important for the prevention of breast cancer. White women with 11 years or more worth of schooling had a greater probability of having mammography exams and clinical examinations as methods for screening. We noted, linked to the aforementioned, that there was a linear tendency whereby there was a greater probability for those with high incomes to undergo one of the above interventions. The study noted that there was a need for more detailed information aimed at the population on prevention methods in order to avoid late diagnosis. We noted that non-white women with little education and on low incomes showed less knowledge of clinical examination methods and mammographies.

Pregnancy recurrence in adolescents in Southern Brazil / Recorrência de gestação em adolescentes do extremo sul do Brasil

Summary Objective: To determine the pregnancy recurrence among adolescents and young people in a city located in the extreme south of Brazil and to identify associated factors. Method: One hundred and twelve (112) women participated, having delivered their children in 2010, while adolescents. The sample was stratified in two stages, being the first a census of the whole population of the city and the second a convenience sample. For statistical analysis, Pearson Chi-square test was used, with a significance level of 5%. Results: The recurrence rate was 53.6%, with an average of 28.6 months. At the time of delivery, in 2010, recurrence was significantly associated with level of education (p=0.044) as well as not being in school (p=0.036). In 2014, the factors associated were level of education (p<0.001), transcript of grades (p=0.030) and income (p=0.030). Conclusion: Recurrence of teenage pregnancy represents a lack of importance given to formal education, a fact that mitigates the opportunities and hinders insertion in the labor market, creating a cycle of social inequality. Multidisciplinary efforts involving schools, health services and the youth in educational activities are thus vital, aiming at critical thinking to transform reality.

Resumo Objetivo: Determinar a recorrência de gravidez em adolescentes de um município no extremo sul do Brasil e identificar os fatores associados. Método: Participaram 112 mulheres que tiveram filho em 2010, quando eram adolescentes. A amostra foi estudada em dois estágios, sendo no primeiro por meio de um censo do município e no segundo por uma seleção de conveniência. Para análise estatística, foi utilizado o teste Qui-quadrado de Pearson com nível de significância de 5%. Resultados: A taxa de recorrência de gravidez encontrada foi de 53,6% com tempo médio de 28,6 meses. No momento do parto, em 2010, estiveram significativamente associados à recorrência a escolaridade (p=0,044) e o fato de não estar estudando (p=0,036). Em 2014, foram a escolaridade (p<0,001), o histórico escolar (p=0,030) e a renda (p=0,030). Conclusão: A recorrência de gravidez na adolescência representa a pouca valorização da educação formal, o que mitiga a vivência de oportunidades e dificulta a inserção no mercado de trabalho, criando um ciclo de desigualdade social. É imprescindível unir esforços multidisciplinares nas escolas e nos serviços de saúde, em conjunto com os jovens, em ações educativas que visem a uma relação crítica reflexiva transformadora da realidade.

Prevalence of Candida spp. in cervical-vaginal samples and the in vitro susceptibility of isolates

Abstract Vulvovaginal candidiasis (VVC) is an infection of the genital mucosa caused by different species of the genus Candida. Considering the lack of data on this topic in the south of Brazil, this study aimed to assess the prevalence of Candida spp. in the cervical-vaginal mucosa of patients treated at a university hospital in southern Rio Grande do Sul, as well as the etiology and the susceptibility of the isolates against fluconazole, itraconazole, miconazole and nystatin. Samples were collected at the gynecology clinic of the Federal Hospital of the University of Rio Grande, and the isolates were identified using phenotypic and biochemical tests. The susceptibility analysis was performed according to the CLSI M27-A2 protocol. Of the 263 patients included, Candida spp. was isolated in 27%, corresponding to a prevalence of approximately 15% for both VVC and colonization. More than 60% of the isolates were identified as Candida albicans; C. non-albicans was isolated at a rate of 8.6% in symptomatic patients and 14.3% in asymptomatic patients. The prevalence of resistance against fluconazole and itraconazole was 42% and 48%, respectively; the minimal inhibitory concentration of miconazole ranged from 0.031 to 8 µg/mL, and that of nystatin ranged from 2 to >16 µg/mL. The high rate of resistance to triazoles observed in our study suggests the necessity of the association of laboratory exams to clinical diagnosis to minimize the practice of empirical treatments that can contribute to the development of resistance in the isolates.

Healthy gestational weight gain prevalence and associated risk factors: A population-based study in the far South of Brazil / Prevalência e fatores associados ao ganho de peso adequado na gestação: um estudo de base populacional no extremo sul do Brasil

ABSTRACT Objective To measure and identify the factors associated with healthy weight gain during pregnancy in the municipality of Rio Grande, Rio Grande do Sul, Brazil. Methods This was a population-based, cross-sectional study that included all parturient women from the municipality who gave birth at its maternity hospitals in 2013. Information was collected by interview with the mothers in the first 48 hours following parturition and from the prenatal care cards. Healthy weight gain was evaluated according to the Institute of Medicine guidelines. Data analysis used Poisson regression with robust variance using previous hierarchical model. Results Among the 1,784 pregnant participants, 89% attended at least six prenatal care visits, and 32% had healthy weight gain during pregnancy. Higher education level and fewer children resulted in a higher prevalence ratio for healthy weight gain (p=0.003 and p=0.029, respectively). Underweight women at conception had a higher proportion of healthy weight gain (p<0.001). Despite extensive coverage, prenatal care did not affect healthy weight gain during pregnancy (p=0.104). Conclusion The low proportion of women with healthy gestational weight gain suggests a need of better prenatal care services. Women who are overweight, have lower education levels, and had had multiple pregnancies at conception need special attention.

RESUMO Objetivo Medir a prevalência e identificar fatores associados ao ganho de peso adequado no período gestacional no município de Rio Grande, Rio Grande do Sul. Métodos Trata-se de um estudo transversal de base populacional do qual fizeram parte todas as parturientes residentes no município em questão e que tiveram filhos em maternidades ao longo do ano de 2013. As informações foram coletadas por entrevista nas primeiras 48 horas após o parto e também pelo Cartão da Gestante, usado nas consultas de pré-natal. O ganho de peso adequado foi avaliado conforme critérios do Institute of Medicine. Na análise dos dados, utilizou-se regressão de Poisson com ajuste robusto da variância e obedecendo modelo hierárquico prévio. Resultados Dentre as 1.784 gestantes incluídas no estudo, 89% realizaram pelo menos seis consultas de pré-natal e 32% apresentaram ganho de peso adequado na gestação. Quanto maior a escolaridade e menor o número de filhos, maior a razão de prevalência para ganho de peso adequado (p=0,003 e p=0,029; respectivamente). As mulheres que iniciaram a gestação com baixo peso tiveram a maior proporção de ganho de peso adequado (p<0,001). Apesar de ampla cobertura, o pré-natal não se mostrou capaz de influenciar o ganho de peso na gestação (p=0,104). Conclusão A reduzida proporção de mulheres as quais apresentaram ganho de peso adequado na gestação sugere a necessidade de melhoria dos cuidados oferecidos durante o pré-natal. Atenção especial deve ser dada àquelas que iniciam a gestação acima do peso, com níveis mais baixos de educação e de múltiplas gestações.

Maternidade na adolescência: ressignificando a vida? / Teenage maternity: life's new meaning?

OBJECTIVE: To identify transformations arising from teen pregnancy from the perspective of young women. METHODS: Study of qualitative and descriptive approach with 34 young women of low socio-economic strata that gave birth in the year 2010 as teenagers. The data have been collected through semi-structured interviews with questions about life before and after maternity, explored through content analysis. RESULTS: The life of the teenagers before pregnancy is heterogeneous in social, work and schooling aspects. After maternity, the freedom of being is re-configured, bringing losses related to the abandonment of studies, to the reduction in social life and to the stigma of teenage maternity; the gains from resignification of lifestyle, the abandonment of illegal and criminal conduct, increased self-confidence the reduction of exposure to violence inside the family, accompanied by new responsibilities, from the reconciliation of study and work or the abandonment of one of these activities. CONCLUSION: Maternity generates a feeling of satisfaction brought about by the experience of being a mother, with a new social identity.

OBJETIVO: Identificar as transformações oriundas da maternidade na adolescência na perspectiva de jovens mulheres. MÉTODO: Estudo de abordagem qualitativa descritiva com 34 jovens de estrato socioeconômico baixo que tiveram parto no ano de 2010 enquanto adolescentes. Os dados foram coletados quatro anos após o parto por meio de entrevista semiestruturada com questões sobre a vida antes e após a maternidade e explorados por meio da Análise de Conteúdo. RESULTADOS: A vida das adolescentes antes da gravidez é heterogênea nos aspectos sociais, laborais e estudantis. Após a maternidade, reconfigura-se a liberdade de ser, trazendo perdas relacionadas ao abandono dos estudos, a privação da vida social e ao estigma da maternidade compreendida como precoce; e ganhos oriundos da ressignificação do modo de vida, abandono de condutas ilegais e criminosas, aquisição de autoconfiança e da redução da exposição à violência intrafamiliar, acompanhado de novas responsabilidades, da conciliação do estudo e trabalho ou do abandono de uma destas atividades. CONCLUSÃO: A maternidade acarreta um sentimento de plenitude trazido pela experiência de ser mãe, com uma nova identidade social.

Avaliação dos fatores associados à transmissão vertical de HIV-1 / Evaluation of factors associated with vertical HIV-1 transmission

Resumo Objetivo Comparar a prevalência e os fatores associados à transmissão vertical de HIV-1 entre grávidas tratadas de 1998-2004 e de 2005-2011 em um serviço de referência de cuidado de pacientes com HIV no sul do Brasil. Métodos Estudo descritivo e analítico que usou as bases de dados de laboratórios da Rede Nacional de Laboratórios de CD4 e Carga Viral de DST/Aids do Ministério da Saúde. As grávidas com HIV-1 foram selecionadas em uma pesquisa ativa de informações clínicas e dados obstétricos e neonatais em seus prontuários médicos entre 1998-2011. Resultados Foram analisadas 102 grávidas entre 1998 e 2004 e 251 entre 2005-2011, no total 353 crianças nascidas de grávidas com HIV-1. Observou-se que a transmissão vertical foi de 11,8% entre 1998 e 2004 e de 3,2% entre 2005-2011 (p < 0,001). O maior uso de medicamentos antirretrovirais (p = 0,02), a redução na carga viral (p < 0,001) e o tempo de ruptura de membranas menor do que quatro horas (p < 0,001) foram associados à redução nos fatores de transmissão vertical quando os dois períodos são comparados. Conclusão Observou-se uma redução na taxa de transmissão vertical nos últimos anos. De acordo com as variáveis estudadas, sugere-se que os fatores de risco de transmissão vertical de HIV-1 foram ausência de terapia antirretroviral, alta carga viral das grávidas e tempo de ruptura maior do que quatro horas.

Abstract Objective To compare the prevalence and factors associated with vertical transmission of human immunodeficiency virus 1 (HIV-1) among pregnant women treated in the periods of 1998-2004 and 2005-2011 in a reference service for the care of HIV-infected patients in southern Brazil. Methods This was a descriptive and analytical study that used the databases of laboratories from the CD4 and STDs/AIDS Viral Load National Laboratory Network of the Brazilian Ministry of Health. HIV-1-infected pregnant women were selected after an active search for clinical information and obstetric and neonatal data from their medical records between the years of 1998 and 2011. Results 102 pregnant women were analyzed between 1998 and 2004 and 251 in the period between 2005 and 2011, totaling 353 children born to pregnant women with HIV-1. It was observed that the vertical transmission rate was 11.8% between 1998 and 2004 and 3.2% between 2005 and 2011 (p < 0.001). The increased use of antiretroviral drugs (p = 0.02), the decrease in viral load (p < 0.001), and time of membrane rupture lower than 4 h (p < 0.001) were associated with the decrease of vertical transmission factors when comparing the two periods. Conclusion It was observed a decrease in the rate of vertical transmission in recent years. According to the studied variables, is suggested that the risk factors for vertical transmission of HIV-1 were absence of antiretroviral therapy, high viral load in the pregnant women, and membrane rupture time >4 h.

Frequência do Papilomavírus Humano na placenta, no colostro e no sangue do cordão umbilical / Frequency of Human Papillomavirus in the placenta, in the colostrum and in the umbilical cord blood

OBJETIVO: Determinar a frequência do Papilomavírus Humano (HPV) na placenta, no colostro e no sangue do cordão umbilical de parturientes e seus neonatos atendidos no Ambulatório de Ginecologia e Obstetrícia do Hospital Universitário de Rio Grande (RS), Brasil. MÉTODOS: Foram coletadas biópsias de 150 placentas do lado materno, 150 do lado fetal, 138 amostras do sangue do cordão umbilical e 118 amostras de colostro. As biópsias de placenta foram coletadas da porção central e periférica. O DNA foi extraído segundo protocolo do fabricante e conforme referência encontrada na literatura. O HPV foi detectado pela técnica da reação em cadeia da polimerase aninhada (PCR-Nested) com os primers MY09/11 e GP5/GP6. A genotipagem foi por sequenciamento direto. As participantes responderam a um questionário autoaplicado com dados demográficos e clínicos, a fim de caracterizar a amostra. RESULTADOS: O HPV foi detectado em 4% (6/150) do lado materno das placentas, 3,3% (5/150) do lado fetal; 2,2% (3/138) no sangue do cordão e 0,8% (1/118) no colostro. A taxa de transmissão vertical foi de 50%. O genótipo de baixo risco oncogênico encontrado foi o HPV-6 (60%) e de alto risco, os HPV-16 e HPV-18 (20% cada). CONCLUSÕES: Esses resultados sugerem que o HPV pode infectar a placenta, o colostro e o sangue do cordão umbilical. .

PURPOSE: To determine the frequency of Human Papillomavirus (HPV) in the placenta, in the colostrum and in the umbilical cord blood of parturient women and their newborns assisted at the Clinic of Gynecology and Obstetrics of the University Hospital of Rio Grande (RS), Brazil. METHODS: Biopsies were collected from 150 placentas on the maternal side, 150 on the fetal side, 138 samples of umbilical cord blood and 118 of the colostrum. The placenta biopsies were collected from the central and peripheral portions. DNA was extracted according to the manufacturer's protocol and to a reference found in the literature. HPV was detected by the nested polymerase chain reaction (PCR-Nested) using primers MY09/11 and GP5/GP6. Genotyping was performed by direct sequencing. The participants responded to a self-applied questionnaire with demographic and clinical data, in order to characterize the sample. RESULTS: HPV was detected in 4% (6/150) of cases on the mother's side of the placentas, in 3.3% (5/150) on the fetal side, in 2.2% (3/138) in umbilical cord blood and in 0.84% (1/118) in colostrum samples. The vertical transmission rate was 50%. HPV-6 was the low-risk genotype found (60%) and the high-risk genotypes were HPV-16 and HPV-18 (20% each). CONCLUSIONS: These results suggest that HPV can infect the placenta, the colostrum and the umbilical cord blood. .

Knowledge about laboratorial routine requested by professionals in Basic Care: a descriptive study / Conocimiento de la rutina de laboratorio por los profesionales de la atención básica: estudio descriptivo / Conhecimento da rotina laboratorial por profissionais da atenção básica: estudo descritivo

Aim: To evaluate the knowledge and interpretation of laboratorial routine requests by professionals working in pre-natal care in the basic health network. Method: This is an evaluative study performed between September 2010 and February 2011, based on interviews with 15 doctors and 14 nurses. Result: 100% of the professionals understood which laboratorial exams should be requested. On the other hand, the interpretation of these exams was not satisfactory in relation to: incorrect standards for glycemia and hemoglobin levels; erroneous interpretation and conduct regarding Rh negative and positivity in VDRL, anti-HIV, HBsAg and toxoplasmosis. Discussion: The findings of this study are disturbing; excellence in pre-natal assistance depends on both the request for exams and the quality of consultations, enabling opportunistic interventions, to improve the pregnancy outcome. Conclusion: The interpretation of basic exams of the Program in Humanization of Pre-natal and Birth is an important point of fragility and rupture in pre-natal care in the municipality of Rio Grande, Brazil.

Objetivo: Evaluar el conocimiento y la interpretación de la rutina de laboratorio por los pre-natalistas de la red básica de salud. Método: Estudio evaluativo realizado entre septiembre de 2010 y febrero de 2011, por medio de entrevistas, con 15 médicos y 14 enfermeras. Resultado: 100% de los profesionales presentaban conocimiento sobre los exámenes de laboratorio que deben ser solicitados. En contrapartida, la interpretación de esos exámenes no fue satisfactoria, siendo referidos: valores incorrectos de glucemia y hemoglobina; interpretación y conductas erróneas frente al Rh negativo y la positividad del VDRL, anti-HIV, HBsAg y toxoplasmosis. Discusión: Los hallazgos de este estudio son preocupantes, ya que la excelencia de la asistencia pre-natal depende tanto de la solicitud de los exámenes, como de la calidad de las consultas, lo que posibilita intervenciones oportunas, para adecuar el final del embarazo. Conclusión: La interpretación de los exámenes básicos del Programa de Humanización en el Pre-natal y en el Nacimiento constituye un importante punto de fragilidad en la asistencia prenatal del municipio Rio Grande, RS.

Objetivo: Avaliar o conhecimento e interpretação da rotina laboratorial pelos pré-natalistas da rede básica de saúde. Método: Estudo avaliativo realizado entre setembro de 2010 e fevereiro de 2011, por meio de entrevistas com 15 médicos e 14 enfermeiras. Resultado: 100% dos profissionais apresentavam conhecimento sobre quais exames laboratoriais devem ser solicitados. Em contrapartida, a interpretação desses exames não foi satisfatória, sendo referidos: valores incorretos de glicemia e hemoglobina; interpretação e condutas errôneas frente ao Rh negativo e a positividade do VDRL, anti-HIV, HBsAg e toxoplasmose. Discussão: Os achados deste estudo são preocupantes, uma vez que a excelência da assistência pré-natal depende tanto da solicitação dos exames, quanto da qualidade das consultas, possibilitando intervenções oportunas, para adequação do desfecho gestacional. Conclusão: A interpretação dos exames básicos do Programa de Humanização no Pré-natal e Nascimento constitui um importante ponto de fragilidade da assistência pré-natal no município do Rio Grande, RS.

Prevalence of hrrpes simplex virus type 2 and rsk factors associated with thiss infection in women in southern Brazil / Prevalencia do herpes virus tipo 2 e fatores de risco associados a sua infeccao em mulheres do sul do Brasil

SUMMARY The herpes simplex virus type 2 (HVS-2) is the most prevalent infection worldwide. It is a cofactor in the acquisition of human immunodeficiency virus (HIV) and the persistence of human papillomavirus (HPV). This study evaluated the prevalence of HSV-2, using the polymerase chain reaction (PCR), and associated factors in patients treated at the Federal University of Rio Grande (FURG) and Basic Health Units (BHU) in Rio Grande, Brazil. The observed prevalence of HSV-2 was 15.6%. Among the 302 women studied, 158 had received assistance in BHU and 144 were treated at FURG. The prevalence of HSV-2 in these groups was 10.8% and 20.8%, respectively, RR 1.9 and p = 0.012. Knowledge about the Pap smear, and the presence of lesions showed no association with HSV-2 infection. Multivariate analysis showed that the variable that most influenced the risk of HSV-2 infection was the presence of HIV infection, with a relative risk of 1.9 and p = 0.04. Discussion: Genital ulcers are an important entry point for HIV, and condom use is an important strategy to reduce transmission of HIV and HSV-2. .

RESUMO O vírus herpes simplex tipo 2 (HVS-2) é uma das infecções mais prevalentes em todo o mundo. Considera-se um co-factor na aquisição do vírus da imunodeficiência humana (HIV) e na persistência do papilomavirus humano (HPV). Este estudo tem como objetivo avaliar a prevalência de HSV-2 usando a reação em cadeia da polimerase (PCR) e fatores associados em pacientes atendidos na Universidade Federal do Rio Grande e em Unidades Básicas de Saúde (UBS) do Rio Grande, Brasil. A prevalência de HSV-2 encontrada neste estudo foi de 15,6%. Entre as 302 mulheres estudadas, 158 haviam recebido assistência na UBS e 144 foram atendidos na FURG. A prevalência de HSV-2 nestes grupos foi de 10,8 e 20,8%, respectivamente, com RR: 1,9 e p = 0,012. Conhecer o exame de Papanicolaou, e presença de lesão não teve associação com infecção HSV-2. A análise multivariada mostrou que a variável que influencia no risco de infecção HSV-2 foi o paciente ter HIV, com risco relativo 1,9 e p = 0,04. Discussão: As úlceras genitais são importante porta de entrada para o vírus HIV e o uso do preservativo é estratégia importante para reduzir a transmissão do HIV e do HSV-2. .

Prevalência de Chlamydia trachomatis e fatores de risco associados à infecção detectada em amostra endocervical / Prevalence of Chlamydia trachomatis and risk factors associated with infection detected in endocervical sample

OBJETIVO: Foi avaliar a prevalência de Chlamydia trachomatis e os fatores de risco associados à infecção em amostras endocervicais de mulheres atendidas em ambulatório de Ginecologia e Obstetrícia. MÉTODOS: Amostras de secreção endocervical de 200 mulheres atendidas em Hospital Universitário foram avaliadas para diagnosticar C. trachomatis com uso da reação em cadeia da polimerase (PCR) utilizando primers CT05/CT06 que amplificam 281 pares de bases da principal proteína de membrana externa de C. trachomatis. Todas as participantes responderam a um questionário pré-codificado e autoaplicável. Os dados foram analisados no programa do software SPSS 17.0; para a análise multivariada foi utilizada a regressão de Poisson. RESULTADOS: Das 200 mulheres que foram incluídas no estudo, a prevalência de infecção por C. trachomatis foi de 11% (22 pacientes) e destas 55 (27,5%) foram positivas para o HPV. Os fatores de risco associados à infecção por C. trachomatis foram: ter 8 anos ou menos de escolaridade (p<0,001), renda familiar de até 1 salário mínimo (p=0,005), primeira relação sexual com 15 anos ou menos (p=0,04) e ser portadora do vírus HIV (p<0,001). Após a análise multivariada, apenas as variáveis escolaridade igual ou inferior a oito anos (RP 6,0; IC95% 1,26 - 29,0; p=0,02) e presença do HIV (RP 14,1; IC95% 3,4 - 57,5; p<0,001) permaneceram significantes. CONCLUSÕES: A prevalência de C. trachomatis em amostras endocervicais pelo método de PCR foi de 11%. Os fatores associados à maior infecção por C. trachomatis foram menor escolaridade e ser portar o vírus HIV.

PURPOSE: It was to determine the prevalence of Chlamydia trachomatis and the risk factors associated with infection in endocervical specimens from women seen in outpatient Obstetrics and Gynecology. METHODS: Samples of endocervical secretion of 200 women treated at the University Hospital of the Federal University of Rio Grande were analyzed for the presence of C. trachomatis by polymerase chain reaction (PCR) using primers that amplify CT05/CT06 281 base pairs of the main outer membrane protein of C. trachomatis. All participants completed a pre-coded and self-report questionnaire. Data were analyzed with the SPSS 17.0 software; for multivariate analysis it was used Poisson regression. RESULTS: Of the 200 women who were included in the study, the prevalence of infection with C. trachomatis was 11% (22 patients) and these 55 (27.5%) were positive for HPV. Risk factors associated with infection by C. trachomatis were: 8 years or less of schooling (p<0.001), family income below the poverty level (p=0.005), first intercourse at age 15 or less (p=0.04) and being a carrier of the virus HIV (p<0.001). After multivariate analysis, only the variables of schooling or less than eight years (PR 6.0; 95%CI 1.26 - 29.0; p=0.02) and presence of HIV (RP 14.1; 95%CI 3.4 - 57.5; p<0.001) remained statistically significant. CONCLUSIONS: The prevalence of C. trachomatis in endocervical specimens by PCR was 11%. The factors associated with a higher infection by C. trachomatis were lower education and being HIV positive.

Concordância entre informações do Cartão da Gestante e do recordatório materno entre puérperas de uma cidade brasileira de médio porte / Agreement between data from prenatal care cards and maternal recall in a medium-sized Brazilian city / Correspondencia entre la información de la cartilla de gestante y el diario materno entre puérperas de una ciudad media brasileña

Prenatal care is a key indicator of the quality of health services. The current study aimed to evaluate the correlation between data from prenatal care cards and maternal recall in the city of Rio Grande, Rio Grande do Sul State, Brazil. The cross-sectional study included all mothers from 2010 who had received prenatal care. Interviews were conducted with a pre-coded questionnaire in the maternity hospital. Of the 2,288 mothers interviewed, 1,228 (53.7%) had the prenatal care card with them and thus comprised the group for comparison. The analysis used kappa correlation and confidence interval. The variables six or more prenatal visits, clinical breast and gynecological examination, two blood tests, VDRL, HIV serology, urine test, and tetanus vaccination showed statistically significant differences between annotated and maternal recall data (p≤ 0.001). Adequacy of prenatal care based on the guidelines of the Program for Humanization of Prenatal Care (PHPN) was 23.9% according to information provided by the patients and 4.4% according to information recorded on the prenatal cards (p ≤ 0.001). The prenatal care card showed underreporting, which limited the quality assessment of prenatal care.

A assistência pré-natal é um indicativo da qualidade dos serviços de saúde. Esse estudo objetivou avaliar a concordância entre os dados do pré-natal da memória materna e do cartão da gestante no Município do Rio Grande, Rio Grande do Sul, Brasil. Estudo transversal incluindo todas puérperas do ano de 2010 que realizaram pré-natal. As entrevistas e a coleta dos dados do cartão ocorreram nas maternidades. Das 2.288 puérperas entrevistadas, 1.228 (53,7%) portavam o cartão da gestante, sendo a comparação realizada nesse grupo. A análise foi feita utilizando-se o teste de concordância kappa e o intervalo de confiança. A realização de seis ou mais consultas de pré-natal, exame das mamas e ginecológico, dois exames de sangue, VDRL, anti-HIV, urina e a vacinação antitetânica demonstraram diferença estatística entre os dados referidos e anotados (p ≤ 0,001). A adequação do pré-natal pelo índice do Programa de Humanização do Pré-Natal (PHPN) nos dados referidos foi de 23,9% e de 4,4% nos dados anotados (p ≤ 0,001). Observamos um sub-registro no cartão da gestante, o qual influenciou negativamente na avaliação da qualidade do pré-natal.

La asistencia prenatal es un indicativo de la calidad de los servicios de salud. Este estudio tuvo por objetivo evaluar la correspondencia entre los datos prenatales del diario materno y de la cartilla de gestante en el municipio de Río Grande, Rio Grande do Sul, Brasil. Es un estudio transversal incluyendo a todas las puérperas del año 2010 que recibieron asistencia prenatal. Las entrevistas y la recogida de los datos de la cartilla se produjeron en las maternidades. De las 2.288 puérperas entrevistadas, 1.228 (53,7%) llevaban la cartilla de gestante, realizándose la comparación en ese grupo. El análisis se ejecutó utilizándose el test de concordancia kappa y el intervalo de confianza. La realización de seis o más consultas de prenatal, examen de mamas y ginecológico, de los exámenes de sangre, VDRL, anti-VIH, orina y la vacunación antitetánica demostraron una diferencia estadística entre los datos proporcionados y los anotados (p ≤ 0,001). La adecuación del servicio prenatal por el índice del Programa de Humanización de Prenatal (PHPN) en los datos recogidos fue de un 23,9% y de un 4,4% en los datos anotados (p ≤ 0,001). Observamos un subregistro en la cartilla de la gestante, el cual influenció negativamente en la evaluación de la calidad de prenatal.

Índice de massa corporal e ganho de peso gestacional como fatores preditores de complicações e do desfecho da gravidez / Body mass index and gestational weight gain as factors predicting complications and pregnancy outcome

OBJETIVO: Avaliar o impacto do índice de massa corporal (IMC) no início da gestação e do ganho de peso no desfecho gestacional, para que esta medida possa ser implantada e valorizada pelos serviços de saúde de pré-natal. MÉTODO: Estudo transversal de base populacional. Na pesquisa, foram incluídos todos os nascimentos ocorridos nas duas únicas maternidades do município do Rio Grande (RS), em 2007. Dentre as 2.557 puérperas entrevistadas, o cálculo do IMC só pôde ser realizado em 1.117 puérperas. A análise foi realizada no programa Stata 11. Nos desfechos hipertensão, diabetes mellitus, trabalho de parto prematuro e cesárea foi realizada regressão logística. No caso do peso ao nascer, o ajuste ocorreu pela regressão logística multinomial, tendo como categoria base o grupo de 2.500 a 4.000 g. Em todas as análises foi adotado valor p<0,05 de um teste bicaudal. RESULTADOS: Não foi observado aumento do risco de hipertensão e diabetes nas pacientes dos diferentes grupos de IMC e ganho de peso. O risco de parto pré-termo foi evidenciado no grupo com ganho de peso ≤8 kg (p<0,05). Em relação via de parto, observa-se uma tendência, quanto maiores o IMC no início da gestação e o ganho de peso durante a gestação, maior o risco de parto cirúrgico, chegando 11% no grupo de obesas (p=0,004) e a 12% no grupo com ganho ≥17 kg (p=0,001). O peso do recém-nascido foi influenciado pelo IMC e pelo ganho de peso, sendo que quanto maiores o IMC no início da gestação e o ganho de peso gestacional, maior o risco de macrossomia. CONCLUSÕES: O monitoramento do IMC e o ganho ponderal durante a gestação é procedimento de baixo custo e de grande utilidade para o estabelecimento de intervenções nutricionais visando redução de riscos maternos e fetais.

PURPOSE: To evaluate the impact of body mass index (BMI) at the beginning of pregnancy and weight gain on pregnancy outcome so that this measure can be implemented and valued by prenatal care health services. METHOD: Cross-sectional population-based study of all births in the only two hospitals in Rio Grande city (Brazil), in 2007. Among the 2,557 mothers interviewed, it was possible to calculate BMI in only 1,117. The Stata 11 software was used for data analysis. Logist regression was applied to the outomes involving diabetes mellitus, premature labor and cesarean section. Regarding birth weight, data were adjusted by multinomial logistic regression using as base category the group of 2,500 to 4,000 g. The level of significance was set at p-value <0.05 in a two-tailed test. RESULTS: There was no increased risk of hypertension or diabetes in patients in the different groups of BMI and weight gain. The risk of preterm delivery was evident in the group with a weight gain ≤8 kg (p<0.05). Regarding the route of delivery, it was observed that the higher the BMI in early pregnancy (p=0.001) and the greater the weight gain during pregnancy (p=0.004), the greater the risk of surgical delivery, which reached 11% in the group of obese mothers (p=0.004) and 12% in the group with a weight gain ≥17 kg (p=0.001). The weight of the newborns was influenced by BMI and weight gain, and the higher the BMI in early pregnancy and the gestational weight gain, the greater the risk of macrosomia. CONCLUSION: The monitoring of BMI and weight gain during pregnancy is a low cost and useful procedure for the establishment of nutritional interventions aimed at reducing maternal and fetal risks.

Co-infections associated with human immunodeficiency virus type 1 in pregnant women from southern Brazil: high rate of intraepithelial cervical lesions

Human immunodeficiency virus type 1 (HIV-positive) pregnant women require specific prophylactic and therapeutic approaches. The efficacy of established approaches is further challenged by co-infection with other sexually transmitted diseases (STDs). The objective of this study was to determine the prevalence of co-infections in pregnant women infected with different HIV-1 subtypes and to relate these findings, together with additional demographic and clinical parameters, to maternal and infant outcomes. Blood samples from pregnant women were collected and tested for syphilis, hepatitis B virus (HBV) and hepatitis C virus (HCV). Human papillomavirus (HPV) diagnosis was evaluated by the presence of alterations in the cervical epithelium detected through a cytopathological exam. Medical charts provided patient data for the mothers and children. Statistical analyses were conducted with STATA 9.0. We found a prevalence of 10.8 percent for HCV, 2.3 percent for chronic HBV, 3.1 percent for syphilis and 40.8 percent for HPV. Of those co-infected with HPV, 52.9 percent presented high-grade intraepithelial lesions or in situ carcinoma. Prematurity, birth weight, Apgar 1' and 5' and Capurro scores were similar between co-infected and non-co-infected women. The presence of other STDs did not impact maternal and concept outcomes. More than half of the patients presenting cervical cytology abnormalities suggestive of HPV had high-grade squamous intraepithelial lesions or cervical cancer, evidencing an alarming rate of these lesions.