A pílula da oportunidade: discursos sobre as pílulas anticoncepcionais em A Gazeta da Farmácia, 1960-1981 / The opportunity pill: discourses about the birth control pill in A Gazeta da Farmácia, 1960-1981

Resumo O artigo analisa matérias sobre pílulas anticoncepcionais publicadas em A Gazeta da Farmácia, entre 1960 e 1980, examinando aspectos pouco conhecidos da biografia desses medicamentos e da constituição do seu mercado. Para os profissionais de farmácia, os anticoncepcionais orais se apresentaram como "as pílulas da oportunidade", seja no sentido dos lucros, seja no sentido de resgatar seu prestígio no campo científico, clínico-terapêutico e político. As trajetórias das pílulas anticoncepcionais e do mundo da farmácia se interseccionaram, quando ambos buscavam tecer sua biografia, apadrinhados pela indústria. Farmacêuticos e pílulas se coconstituíram, um sendo importante ponto de passagem para outro.

Abstract The pharmacy world was a mandatory crossing point and active player in the establishment of hormonal contraception in Brazil. Through an analysis of articles published in A Gazeta da Farmácia from 1960 to 1981, the study explores little-known aspects of the birth control pill's biography and the construction of its Brazilian market. For pharmacy professionals, oral contraceptives were "opportunity pills" in two senses: they provided profits and they restored the prestige of these professionals within the scientific, clinical-therapeutic, and political realms. The pathways of the pill and the pharmacy world intersected as both wove their biographies under the patronage of industry. Pharmacists and the pill were co-constructed, and each was an important crossing point for the other.

Female sexual dysfunction with combined oral contraceptive use

Combined oral contraceptive pills (COCs) remain one of the most popular forms of contraception to prevent unwanted pregnancy in women. While it is known that COCs can cause sexual dysfunction in women, there is currently no recommendation to screen for sexual function before and after initiation of COCs. We propose that, based on the evidence available, assessment of sexual function should be done at initiation of COCs, as well as at regular intervals thereafter. This would allow COC-related sexual dysfunction to be managed early, such as by switching the patient to newer-generation COCs or other forms of contraception.

Aspectos clínico-epidemiológicos del aborto en un hospital de Upata. Estado Bolívar-Venezuela / Clinical and epidemiological aspects of abortion in a hospital of Upata. State Bolivar Venezuela

Resumen Introducción. El aborto se ha convertido en un problema de salud pública. Una las causas que podría estar influyendo para su aumento es la falta de información sobre el control prenatal, por lo anterior, este es un tema que no escapa de la realidad y de la práctica médica. Objetivo. Caracterizar clínica y epidemiológicamente el aborto. Materiales y Métodos. Estudio observacional, descriptivo, retrospectivo, realizado en el Hospital "Gervasio Vera Custodio" Upata-Estado Bolívar, Venezuela, durante el periodo comprendido de enero a diciembre de 2013. Se recolecto datos de 207 historias clínicas de mujeres con diagnóstico de aborto. En el análisis estadístico se aplicó la prueba chi2 de Pearson. Resultados. Se encontró que la edad prevalente de aborto fue de 21 a 30 años con 42%. La edad gestacional más frecuente de las pacientes fue de 1 a 8 semanas con 50%. De estas 93,5% no cumplieron control prenatal. El tipo de aborto más frecuente fue espontáneo con 98,5%. Se realizó legrado uterino a 97%, de las cuales, 8,5% presentaron complicaciones. Se encontraron diferencias estadísticamente significativas al relacionar la edad materna con la edad gestacional. Conclusiones. Existió alta prevalencia de aborto espontáneo en el grupo de 21 a 30 años de edad, presentados entre las semanas 1 a 8 de gestación. La técnica más segura fue el legrado uterino. Finalmente, se encontró bajo cumplimiento del control prenatal.

Abstract Introduction. The abortion has become a public health problem may be due to the lack of information about prenatal care, so that this is an issue which does not escape reality and everyday medical practice. Objective. Characterize the abortion clinic and epidemiologically. Materials and Methods. An observational, descriptive, retrospective study at the Hospital "Gervasio Vera Custodio" Upata-Ciudad Bolivar, Venezuela was performed from January to December 2013. Data from 207 women with diagnosed a diagnosis of abortion were collected from medical records. Pearson chi-square test was applied for the statistical analysis. Results. It was found that abortion was prevalent among 21-30 years old with a 42%. The most common gestational age of abortion was 1 to 8 weeks in the 50% and 93.5% of them did not meet prenatal care. The most frequent abortion was spontaneous in 98.5% ot the patients. Curettage was performed in 97%, of which 8.5% had complications. Statistically significant differences were found to maternal age related to gestational age. Conclusion. There was high prevalence of abortion in the group of 21-30 years of age with 1 to 8 weeks of gestation. The safest practice was the uterine curettage. Finally, the mayority of the cases had no prenatal care.

Effects of a Customized Birth Control Program for Married Immigrant Postpartum Mothers

PURPOSE: This study was conducted to develop a customized birth control program and identify its effects on attitude, subjective norm, behavioral control, intention, and behavior of contraception among immigrant postpartum mothers. METHODS: In this experimental study, Vietnamese, Filipino or Cambodian married immigrant postpartum mothers were recruited. They were assigned to the experiment group (n=21) or control group (n=21). The customized birth control program was provided to the experimental group for 4 weeks. RESULTS: The experimental group showed a significant increase in the score of attitude, subjective norm, behavioral control, intention, and behavior of contraception. CONCLUSION: Findings in this study indicate that the customized postpartum birth control program, a systematic and integrative intervention program composed of customized health education, counseling and telephone monitoring, is able to provide effective planning for postpartum health promotion and birth control behavior practice in married immigrant women.

Retiro temprano del implante subdérmico con etonogestrel en usuarias de un programa de anticoncepción de Tunja - Boyacá, Colombia / Early removal of subdermal implant containing Etonogestrel in users of a contraceptive program from Tunja - Boyacá, Colombia

Introducción: Los implantes subdérmicos proveen alta efectividad anticonceptiva reversible; no obstante, con su empleo ocurren algunos efectos colaterales. Se ha demostrado que algunas mujeres son menos tolerantes a ellos y solicitan tempranamente el retiro. Objetivo: Evaluar factores relacionados con el retiro del implante subdérmico Implanon®, en mujeres usuarias del programa ambulatorio de Planificación Familiar de una institución de Salud ubicada en Tunja. Materiales y métodos: Estudio observacional, de corte transversal analítico. Se revisaron las historias clínicas de 184 usuarias que solicitaron el retiro del implante en el período comprendido entre 2009 y 2012; se registraron las razones aducidas por las pacientes para solicitar el retiro del implante subdérmico, excluyendo el deseo de una nueva gestación y el tiempo de empleo. Resultados: La media de edad fue de 27,8 años; el tiempo mínimo de uso fue 2 meses, con media de 2,7 años (SD=1,7), la principal razón fue cambios en el patrón de sangrado genital (74,5%), seguida de cefalea (71,7%), cambios en el estado de ánimo (57,6%), dolor pélvico 57,1% y dolor de origen venoso 42,9%; la mayoría de efectos se presentan al inicio de la inserción y tienden a desaparecer en el curso de los primeros meses, con excepción de la cefalea y los cambios de peso. Conclusiones: El implante subdérmico es un método anticonceptivo altamente eficaz; es recomendable realizar intervenciones de educación en salud previo a la inserción.

Introduction: Subdermal implants provide high reversible contraceptive effectiveness; however, some side effects occur with their use. It has been shown that some women are less tolerant to them so they ask for an early retirement. Objective: To assess factors related to the removal of the subdermal implant Implanon ® in women who are users of the ambulatory family planning program of a health institution located in Tunja. Materials and methods: An observational, analytical cross-sectional study was made where the medical histories of 184 users who requested the removal of the implant between 2009 and 2012 were reviewed. The reasons given by patients to request the removal of the subdermal implant were registered, excluding the desire for a new pregnancy and the time use. Results: It was found that the average age was of 27,8 years; the minimum time of use was 2 months with average of 2.7 years (SD = 1, 7). The main reason to request the procedure was due to the changes in their period (74.5%), followed by headache (71.7%), changes in mood (57.6%), pelvic pain (57.1%) and pain of venous origin (42.9%). Most effects occur at the beginning of the inclusion and tend to disappear in the course of the first months, except for the headache and weight changes. Conclusions: The subdermal implant is a highly effective method of birth control. It is recommended to make effective health education interventions prior to insertion.

The clinical effect comparison of three types of intrauterine devices / 中国基层医药

Objective To compare the clinical effect of three types of intrauterine devices and their adverse events.Methods From June 2012 to June 2013,683 women of reproductive age underwent the insertion of Gyne Fix-IN IUD,Mcu IUD and HCu280 IUD in Family -Planning Service Outlet of Yi -shan District in Zaozhuang City were collected in this study.The patients were followed up for 1year.The clinical effect and adverse events of three types of intrauterine devices were compared.Results The expulsion rate of Gyne FixIN IUD (0.88%)group was lower than those in the Mcu IUD (3.95%)and HCu280 IUD (4.41%)group (χ2 =4.565,5.514,all P 0.05).Conclusion The three kinds of IUDs could be used as the first menstrual period returns after vaginal delivery.HCu280 IUD has good clinical effect.The effective contraception rate is high while adverse events are low.It is worthy of clinical use.

Contexto social del debate sobre el control natal en Colombia en las décadas de 1960 y 1970: política, medicina y sociedad / The social context of the birth control debate in Colombia in the 1960s and 1970s: politics, medicine and society

El artículo busca presentar el contexto y aproximación preliminares necesarios para comprender y abordar el debate sobre el control natal en Colombia en las décadas de 1960 y 1970. Recoge las principales posturas en conflicto en dicho período, y los discursos y lógicas que permearon la llegada de los programas de planificación norteamericanos a América Latina como forma de control político de los movimientos revolucionarios.

The article seeks to present the necessary context and a preliminary approach to understanding and addressing the birth control debate in Colombia in the 1960s and 1970s. It covers the main conflicting positions during that period and the discourses and logics permeating the arrival of North American family planning programs to Latin America as a form of political control of revolutionary movements.

Ovarian Cancer among Women of Lahore Metropolitan; a Survey.

The symptoms, causes and different risk factors related to ovarian cancer (OC) in Lahore Metropolitan are studied. Information was collected from 52 patients (having mean age 45±10 years) referred to the Institute of Nuclear Medicine and Oncology Lahore (INMOL), Pakistan. The risk was found relevant in the patients having positive family history of any cancer other than OC and that’s why 21.1% patients faced this dilemma. Marital status was not found a cause of OC as unmarried and married patients both were affected. Birth control pills were not a cause of OC as 96.6% patients in Lahore did not used them. High parity and Brest feeding were the cause of OC as 59.6% patients have high parity and 78.8% have breast fed their children for more than one year. Fallopian tube tide (94.2%), hysterectomy (86.5%) and smoking (98.1%) were not the cause of OC. Irregularity in menstrual cycle (30.8%), eating disorders (38.5%), abdominal pain or bloating (90.4%) and natural menopause (50%) were the symptoms of OC. Hormone replacement therapy (HRT) is not found a cause of OC in Lahore as all the selected patients under study never used HRT.

Análisis de aspectos familiares, socioeconómicos y ginecológicos como factores de riesgo para el embarazo en la adolescencia / Famliar, social,, economic, and gyncologic aspects analysis as rissk factors for teenage pregnancy

INTRODUCCIÓN: El embarazo en la adolescencia es un tema de gran importancia por su impacto en salud, economía y dentro de la sociedad. OBJETIVO: Analizar los aspectos familiares, socioeconómicos y ginecológicos como factores de riesgo implicados en el embarazo en adolescentes. MATERIALES Y MÉTODOS: Diseño metodológico: Casos y controles Estudio comparativo de adolescentes embarazadas de la comunidad Santa Ana la Nueva con adolescentes nuligestas del mismo núcleo, entre abril a junio del 2012. Se confeccionó una encuesta basada en la aglutinación de instrumentos previamente seleccionados. Cálculo de tamaño de muestra: 22 casos y 22 controles. RESULTADOS: La edad promedio fue 16.13 años (DS: ± 1.641) para controles y para los casos fue 17.7 años (DS: ± 1.445). De los casos, 10 (45.45%) eran solteras, 10 (45.45%) concubinas y 2 (9.09%) casadas; para los controles 20 (90.1%) fueron solteras. En los casos 16 (72.73%) se dedicaban a los labores de casa, 5 (22.73%) eran estudiantes y 1 (4.55%) dedicada al comercio. Para los casos, el 40.91% tuvieron un nivel de educación igual a primaria o menor comparado con el total de los controles que cursaban secundaria. 19 mujeres de los casos (86.36%) tuvo madre cuyo primer hijo nació antes de los 20 años, comparado con 12 (54.55%) de los controles (p=0.045) (OR: 5.27, IC 95% 1.02 - 34.58). La funcionalidad familiar y el tipo familiar no representaron diferencia cuando se compararon ambos grupos. En relación al nivel socioeconómico, 100% de los casos provenían de un nivel bajo comparado con el 95.45% de los controles. En este grupo poblacional el consumo de tabaco, alcohol y drogas no tuvo relación con el embarazo en la adolescencia. El inicio de vida sexual activa ≤ 15 años en el grupo de casos no representó un factor para el embarazo en adolescentes comparado con el grupo control, donde 16 (72.73%) no iniciaron vida sexual (p=0.08). Todas las mujeres del grupo control tenían conocimiento de métodos anticonceptivos, comparado con sólo 12 (45.45%) de los casos (p<0.001).18 de los casos (81.82%) no utiliza anticonceptivos actualmente (OR:15.3, IC 95% 2.93 - 87.71) y 9 (41.01%) tuvieron más de una pareja sexual (OR: 6.92, IC 95% 1.11 - 72.63). CONCLUSION: Haber tenido una madre cuyo hijo haya nacido en la adolescencia, el conocimiento de métodos anticonceptivos, la falta de uso de los mismos y tener más de una pareja sexual en esta etapa son factores relacionados con un incremento de la probabilidad de embarazo en la adolescencia.

INTRODUCTION: Pregnancy in adolescence is topic of great importance for the impact in public health, economy and society. OBJETIVE: To analyze familiar, social, economic and gynecologic aspects as risks factors involved in teen pregnancy. MATERIAL AND MÉTHODS: Design: Case-control study. Comparative study of adolescents with previous or current pregnancy from the community Santa Ana la Nueva - Tarija, with nulliparous adolescents from the same area, between april and june, 2012. A questionnaire was made based on different chosen instruments. Sample size: 22 cases and 22 controls RESULTS: Mean age was 16.13 years (SD: ± 1.641) for controls and for the cases was 17.7 years old (SD: ± 1.445). Of cases, 10 (45.45%) were single, 10 (45.45%) lived with couple and 2 (9.09%) were married. 20 controls were single (90.1%). Among the cases 16 (72.73%) were households and 5 (22.73%) were students, 1 (4.55%) worked in business. From this cases, 40.91% had a primary education, uncompleted or complete, compared to the total of controls who were enrolled in secondary education (p<0.001), 19 (86.36%) of the cases had a mother who had her first born before 20 years, compared to 12 (54.55%) of the controls (p=0.045) (OR: 5.27 95% IC 1.02 - 34.58). Type of family and familiar dysfunctionality did not represent differences when comparing both groups. About the socioeconomical status, 100% of cases came from a low status, compared to 95.45% of controls. In this studied group nor tabacco, alcohol or drug consumption had relation with pregnancy. Starting sexual intercourse at the age of ≤ 15 years did not represent a risk factor for pregnancy, compared to the control group where 16 (72.73%) did not initiated intercourse (p=0.08) . All women from the control group had knowledge about contraception, compared to only 12 (45.45%) of cases (p<0.001). 18 (81.82%) cases do not use contraception actually (OR:15.3, 95% IC 2.93 - 87.71) and 9 (41.01%) had more than 1 sexual couple (OR: 6.92, 95% IC 1.11 - 72.63). CONCLUSION: Having a mother whose first child was born in her adolescence, lack of knowledge in contraception, and its use, and having more than one sexual couple in this period are risk factors related with a major probability for pregnancy in adolescence.

Práticas de saúde sexual e contraceptivas em universitárias: um estudo descritivo / Prácticas de salud sexual y contraceptivas en universitarias: un estudio descriptivo / Sexual and birth control health practices among female undergraduates: a descriptive study

Aim: To describe the sexual and birth control health practices of Brazilian female undergraduates and compare them according to family income. Method: This is a descriptive study of a sample of eighty female public university students, using the chi-square test, with a significance level of p<0.05, and modified contingency coefficient. Results: Female undergraduates with lower incomes initiated their sex lives between the ages of 14 and 16 years (53.3%), used protection in their first sexual experience (80%) and used public health services (66.7%). Those with higher incomes started their sex lives at the age of 17 years old or more (64.7%), their first sexual intercourse was unprotected (35.3%), and they used the private health network (88.2%). Discussion: The level of family income does not influence access to sexual and reproductive health in the investigated sample. Conclusion: There are differences in the type of service provider used between those with different family incomes.

Objetivos: Descrever as práticas de saúde sexual e contraceptivas das jovens universitárias e comparar as similaridades e diferenças destas práticas segundo a renda familiar. Método: Pesquisa descritiva. A amostra investigada foi de oitenta jovens de uma universidade pública. Foi aplicado o teste qui-quadrado, nível de significância p<0,05, e o coeficiente de contingência modificado. Resultados: As universitárias com menor renda iniciaram a prática sexual entre os 14 e 16 anos (53,3%), utilizaram o preservativo na primeira relação sexual (80%) e são usuárias de serviços públicos de saúde (66,7%). As jovens com maior rendimento começaram a vida sexual com 17 anos ou mais (64,7%), a primeira relação sexual foi mais desprotegida (35,3%) e são atendidas na rede suplementar (88,2%). Discussão: O nível de renda familiar não influencia no acesso à saúde sexual e reprodutiva da amostra investigada. Conclusão: Houve diferença para o tipo de prestador de serviço de saúde segundo a renda.

Objetivos: Describir las prácticas de salud sexual y contraceptivas de las jóvenes universitarias y comparar las similaridades y diferencias de estas prácticas según la renta familiar. Método: Pesquisa descriptiva. La muestra investigada fue de ochenta jóvenes de una universidad pública. Fue aplicado el test qui-cuadrado, nivel de significancia p<0,05, y el coheficiente de contingencia modificado. Resultados: Las universitarias con menor renta iniciaron la práctica sexual entre los 14 y16 años (53,3%), utilizaron el preservativo en la primera relación sexual (80%) y son usuarias de servicios públicos de salud (66,7%). Las jóvenes con mayor rendimiento comezaron la vida sexual con 17 años o más (64,7%), la primera relación sexual fue más desprotegida (35,3%) y son atendidas en la red suplementar (88,2%). Discusión: El nivel de renta familiar no influencia en el acceso a la salud sexual y reproductiva de la muestra investigada. Conclusión: Hubo diferencia para el tipo de proveedor del servicio de la salud según la renta.

Comportamiento sexual y conocimiento sobre infecciones de transmisión sexual en estudiantes venezolanos de un liceo del municipio de Miranda / Sexual behavior and knowledge of sexually transmitted infections in Venezuelan students from a high school in municipality of Miranda

Se realizó un estudio descriptivo y comparativo, de corte longitudinal, de 201 estudiantes entre 11-17 años (de un universo de 220), de un liceo público de la localidad de Quisiro, del municipio de Miranda, en la República Bolivariana de Venezuela, con vistas a evaluar el comportamiento sexual y el conocimiento de infecciones de transmisión sexual, previo consentimiento informado de los padres y de la muestra en cuestión. El análisis de los datos se efectuó con el paquete estadístico SAS R, versión 9.3.1. En los integrantes de la serie, la actividad sexual era bastante común, con predominio de los que la iniciaron activamente entre los 14 y 15 años, poco uso de métodos anticonceptivos, mayor número de parejas sexuales en los varones, así como un mejor conocimiento acerca de las infecciones de transmisión sexual en el caso de las chicas.

A descriptive and longitudinal controlled study in 201 students aged 11-17 years (from a total of 220) of a public high school in Quisiro town, Miranda municipality in the Bolivarian Republic of Venezuela was conducted to evaluate sexual behavior and knowledge of sexually transmitted infections, with previous informed consent of the parents and of the sample in question. Data were analyzed using the SAS R statistical package, version 9.3.1. In the members of the series the sexual activity was quite common, with predominance of those that actively started it between 14 and 15 years, little use of birth-control methods, higher number of sexual partners for boys and a better knowledge of sexually transmitted infections for girls.

A Study on the Discourse and Reality of Abortion in Korea: 1920s~1930s / 의사학

This paper tried to collect, classify and analyse the discourse about abortion in 1920~1930. In Korea, modern medical abortion operation started in 1920~30s. At that time abortion was prohibited by the Japanese Government-General of Korea, because the Japanese Government-General of Korea needed large population which was used for labor and exploitation. Hence, the Empire of Japan de-penalized Japanese criminal law related to birth control but Korean law was not revised between 1910~1945. Nevertheless, there were quite a few women who wanted abortion when they had children born in sin or they were too poor to raise their children, so they had abortion secretly. At that time the women generally had abortion through toxic drugs or foods and violence (dropping from a high place or beating their stomach). But high class women did it by medical operation. In 1920s, there was few Korean (modern) medical doctors who could operate for abortion, instead Japanese immigrant medical doctors did it--as the newspaper of that time showed(there were many pieces of news that Japanese doctor who helped abortion was arrested by the police). As time went by Korean doctors got their say about the technique and various knowledge of abortion in newspapers, magazines, and academic Journals; this was especially the case starting in 1930. It is worth noting that they were sometimes arrested for illegal abortion operations. Furthermore, from the late 1920s the insist that abortion should be permitted for women and poor people, appeared. This insist was affected by Japan, the Soviet Union and other countries which was generous with abortion.

Seria a pílula anticoncepcional uma droga de "estilo de vida"?: ensaio sobre o atual processo de medicalização da sexualidade / La píldora anticonceptiva, ¿una droga de "estilo de vida"?: Ensayo sobre el proceso actual de medicalización de la sexualidad / The birth control pill as a 'lifestyle drug': on the medicalization of sexuality

Este artigo discute o processo de medicalização da sexualidade, refletindo sobre a pílula anticoncepcional hormonal e sua relação com o conceito de drogas de estilo de vida (entendido como medicamentos utilizados não necessariamente para tratar uma doença, mas para aprimorar a vida das pessoas). A pílula anticoncepcional, lançada em 1957 nos Estados Unidos, foi desde a sua criação destinada à utilização no dia a dia de mulheres saudáveis, e tornou-se um importante símbolo cultural, revolucionando a vida das mulheres e da sociedade em geral. Refletiremos, assim, sobre o surgimento da pílula anticoncepcional e suas transformações. Analisaremos também o atual marketing dos laboratórios farmacêuticos, cujo foco tem sido não tanto no efeito original de controle de natalidade, e mais nos efeitos secundários desejáveis que as novas pílulas poderiam proporcionar - como redução da acne e tratamento de "problemas de humor" relacionados à menstruação - "adequando-se", assim, ao estilo de vida da "mulher moderna".

Este artículo discute el proceso de medicalización de la sexualidad, reflexionando sobre la píldora anticonceptiva hormonal y su relación con el concepto de drogas de estilo de vida (entendido como medicamentos no necesariamente utilizados para tratar una afección, sino para mejorar la vida de las personas). La píldora anticonceptiva, lanzada en Estados Unidos en 1957, desde su creación estuvo destinada al uso cotidiano de mujeres saludables, y se convirtió en un importante símbolo cultural, revolucionando sus vidas y la de la sociedad en su conjunto. En ese sentido, se reflexiona acerca del surgimiento de la píldora anticonceptiva y sus transformaciones. Se analiza también el marketing de los laboratorios farmacéuticos, que ha puesto el foco no tanto en el efecto original de control de la natalidad, sino más bien en los efectos secundarios deseables que las nuevas píldoras podrían proporcionar -como reducción del acné y tratamiento de "problemas de humor" relacionados a la menstruación- "adecuándose" de este modo al estilo de vida de la "mujer moderna".

This article discusses the process of medicalization of sexuality, by focusing on the hormonal birth control pill as a 'lifestyle drug,' i.e., medications that are used to improve people's quality of life, instead of treating illness. The birth control pill, released in the US in 1957, has been destined to everyday use by healthy women since its creation. It has revolutionized their lives and society as a whole, becoming an important cultural symbol. This article addresses the emergence of hormonal contraception and its transformations. The marketing of the pill by pharmaceutical companies has been focused less on birth control than on its desirable side-effects-such as acne reduction and the treatment of 'mood problems' related to menstruation- in a search of greater adequacy to a 'modern woman's' lifestyle.

Profile of the free distribution of emergency contraception for adolescents in São Paulo's counties

Descreve-se a postura adotada por municípios do estado de São Paulo que receberam lotes de contracepção de emergência do Ministério da Saúde em 2005 e 2006, com relação à entrega para adolescentes. Utilizando levantamento quantitativo, realizado com questionários semi-estruturados enviados por e-mail às secretarias municipais de saúde, foram examinados: fluxos, serviços e profissionais de saúde envolvidos e critérios de dispensa. Do total, 91,0 por cento responderam à pesquisa, demonstrando que 85,4 por cento iniciaram a oferta do método para adolescentes menores de 18 anos, principalmente em prontos socorros (69,1 por cento). Em unidades básicas tradicionais e de saúde da família houve menor integração, 65,3 por cento e 37,6 por cento, respectivamente, e em serviços especiais de atenção a adolescentes, apenas 31,9 por cento municípios ofertam (percentagens não excludentes). A entrega, geralmente, é feita por médicos e/ou enfermeiros, porém 30 por cento sub-utiliza o potencial da enfermagem. Atende-se, fundamentalmente, os casos de violência sexual e, excluído-se esse evento, há queda de 10 a 30 pontos percentuais no fornecimento em casos de falha ou não uso de contraceptivo regular. Conclui-se que há seletividade na dispensa método, baixa oferta na Atenção Básica, não facilitando acesso de adolescentes nas situações de risco gravídico mais recorrentes em seu cotidiano, contrariando orientações do Ministério da Saúde. Essa postura está ligada à falta de atualização sobre legislações e normas federais vigentes quanto à Saúde Sexual e Reprodutiva deste público, pelo desconhecimento do mecanismo de ação do método (por vezes, identificado como perigoso ou abortivo) e por preconceitos quanto à prática sexual adolescente, provocando a aquisição em farmácias e usos errôneos.

Historia sobre el papel de las hormonas y los anticonceptivos en el lupus / History on the role of hormones and contraceptives in lupus

En este artículo presentamos los diferentes eventos que llevaron a conocer a profundidad la interrelación que existe entre las hormonas y el lupus, así como los autores que participaron en estas investigaciones. Revisamos los artículos publicados sobre el tema desde los inicios del siglo XX. Hacemos un recuento especial sobre la píldora anticonceptiva, cómo se gesto su descubrimiento y cómo se interrelaciona ésta con el lupus, al igual que las demás hormonas. Finalmente hacemos un recuento de las principales investigaciones que se realizan entre las hormonas y el lupus.

In this paper we present the diverse events leading up to know in depth the relationship between hormones and lupus, and the authors who participated in this research. We reviewed published articles on the subject since the early twentieth century. We especially count on the birth control pill, how it was discovered and how this interacts with lupus, as well as other hormones. Finally we review the major research being conducted between hormones and lupus.

The German Social Democratic Party(SPD) and the Debate on the Fertility Decline in the German Empire (1870~1918) / 의사학

This paper aimed to examine the debate over the fertility decline in the German Empire, focusing on the role of the SPD. During the German Empire, the fertility rate dramatically declined and the growing awareness of a continuous decline in the birth rate prompted a massive debate among politicians, doctors, sociologists, and feminist activists. The fertility decline was negatively evaluated and generated consciousness of crisis. However, it was not the only way to face this new phenomenon. Indeed, the use of birth control among the upper class was interpreted as a part of a modernizing process. As the same phenomenon reached the working class, it suddenly became a social problem and was attributed to the SPD. The debate over the fertility decline in imperial German society ridden with a fierce class conflict was developed into a weapon against the SPD. Contrary to the assumption of conservative politicians, the SPD had no clear-cut position on this issue. Except for a few politicians like Kautsky and the doctors who came into frequent contact with the workers, the "birth strike" was not listed as the main interest of the SPD. Even Clara Zetkin, the leader of the Social Democratic women's organization viewed it as a concern of the individual person which could not be incorporated in the party program. The women's organization of the SPD put priority on class conflict rather than issues specific to women. As a result, the debate over the birth rate decline within the SPD was not led by the women themselves. There could have been various means to stimulate the birth rate. Improvement in the welfare system, such as tax relief for large families, better housing conditions, and substantial maternity protection, could have been feasible solutions to the demographic crisis. However, Germany chose to respond to this crisis by imposing legal sanctions against birth control. In addition to paragraphs 218-220 of the German criminal law enacted in 1872 which prescribed penal servitude for anyone who had an abortion or people who helped to practice it, Paragraph 184.3 of the civil code was enacted in order to outlaw the advertising, display, and publicizing of contraceptives with an 'indecent' intention, although selling or manufacturing contraceptives was not forbidden. Such a punitive approach was especially preferred by the government and conservative parties because it was easy to implement and "cheap" in comparison with the comprehensive social welfare program. What made the SPD different from other conservative parties was the fact that the SPD opposed the government's attempt to prohibit contraception by means of strengthening a penal code. According to the SPD, it was not only morally unacceptable, but also technically impossible for the government to intervene in family limitation. Moreover, politicians from the SPD criticized that such a punitive policy targeted the working class because the upper echelon of the society could easily evade the ban on contraceptives. However, the SPD did not proceed to draft comprehensive social welfare measures in order to fight the fertility decline. The miserable condition of working class women remained as an invisible social phenomenon even within the SPD. The German women who could not find the proper means to practice contraception were driven to have abortions. Annually, hundreds of the women were accused of practicing abortion and imprisoned. In sum, German society ran about in confusion and did not know how to properly respond to the unprecedented decline in fertility. By defining the fertility decline just as a social disease due to moral decay and influence of socialism, German society lost a chance to rationalize itself. Given that women, the main actors, had no way to take part in the debate over this issue, it is not surprising that German society fought against the symptom of the disease, not against its root.

Eugenics Discourse and Racial Improvement in Republican China (1911-1949) / 의사학

This paper aimed to examine the advent of eugenics and its characteristics in republican China. Although eugenics was introduced into China as a discourse to preserve and improve race by the 1898 reformers such as Yan Fu (1854-1921) and Yi Nai (1875-?) in the late imperial period, it was not until the republican period that eugenics discourse started to combine with the discourse and movement related to social reform. The May 4th intellectuals put forward criticisms of Confucian patriarchy, propagating science and democracy. They pointed out that the large family system was a source of every social evil, and argued the need for a small family system based on monogamy. The aim of the small family system was to improve both the race and the environment. Such thinkers argued that freedom of love and the liberation of individuality were necessary for this end. Zhou Jianren (1888-1984), Lu Xun's youngest brother and representative eugenicist in the May 4th period, combined eugenics with freedom of love and the liberation of individuality. Pan Guangdan (1899-1967) and Zhou Jianren debated the eugenics controversy in the 1920s. They raised the freedom of love and the liberation of individuality as central issues related to the eugenics controversy. The eugenics debate was developed into the controversy between biological determinism and environmentalism in the late 1920s. However, these issues did not continue to be brought up in the 1930s. The main issues concerning the eugenics controversy in the 1930s were cultural identity and the population problem. Particularly in the 1930s, the scope of birth control as the solution to the population problem was extended from the individual person and family to nation and race. For eugenicists like Pan Guangdan, birth control violated the aim of eugenics and brought about the degeneration of the race. However, such theorists did not deny the value of birth control itself. The supporters of birth control thought that selecting superior descendents and eliminating inferior descendents fit with the ideals of eugenics. They thought that the propagation of contraception could suppress the increase of inferior and weak descendents, and result in the improvement of the race. Physicians suggested the necessity of birth control and organized birth control clinic, Chinese society did not pay attention to their arguments and activities in 1920s. After birth control made at issue from the 1930s, physicians started to discuss eugenics and play the important role in the medical practice. Chinese physicians passed a resolution of birth control for mothers and children's happiness and health and public health in 1930s.As a result, Chinese intellectuals supported eugenics and supported the proposition that eugenics could improve the race. On the basis of this situation, the Guomindang government legislated eugenic laws related to contraception, eugenic marriage, and sterilization and the isolation of hereditary defaulters in 1945.

Utilization of contraceptives and ANC services in 30 communes in Can tho province ( 2003):

The study was conducted in 534 mothers of reproductive age at 30 communes in 3 districts of Can Tho province. The study addressed the usage of contraceptive methods, antenatal care and related factors. The results showed that the proportion of women using contraceptive methods was 65.9%, among them 82.7% used modern methods. Acceptance of family planning between women with different educational and economical status varied. The acceptance was lower in poorer and less educated groups. The rate of contraceptive failure was 6.9%. The proportion of women who had ever had natural abortion was 14%. There were no significant differences of these rates by education levels and household economical status. The proportions of the better education and the wealthy women giving birth in hospitals were higher than the poorly and less educated women who had birth delivery at CHSs and midwife houses (54.2% vs. 42.5% and 55.1% vs. 12%, respectively).

Perfil lipídico y alteraciones menstruales en mujeres que usan el anticonceptivo inyectable combinado mesigyna / Lipid profile and menstrual disorders in women using contraceptive injection combined Mesigyne

La anticoncepción hormonal con inyectables hormonales de acción prolongada representa una alternativa ya bastante establecida. Nos propusimos conocer las alteraciones que sobre el metabolismo lipídico y sobre el patrón menstrual provocaba la utilización del anticonceptivo inyectable combinado mensual (AICs) Mesigyna schering AG. Se incluyó en el estudio a 75 mujeres no embarazadas que deseaban controlar su fertilidad. Se hicieron determinaciones de coleterol total, c- HDL, c- LDL, triglicéridos, Lpa. Como resultados obtuvimos que el c-HDL tuvo una ligera tendencia al aumento a partir del segundo año de uso del AICs Mesigyna, la Lpa estuvo elevada en el 16% del total de pacientes. En cuanto al patrón menstrual la regularidad del ciclo se presentó en el 81.3% del total de mujeres al finalizar el estudio. Concluimos que la aplicación del AICs Mesigyna produce alteraciones del ciclo menstrual invariablemente así como se demuestra su papel antiaterogénico por sus efectos metabólicos sobre el perfil lipídico.

Hormonal contraception with long-acting hormonal injections represrnt an established alternative. This study was aimed at knowing the disturbances that mently-birth control injection combined with mesigyna scherring AG provoked over lipid metabolism and menstrual pattern, to investigate it, 75 non-pregnant women who wished to control their fertility were included in the study. Total cholesterol, C-HDL, C-LDL, triglycerides and Ipa were determined showing that C-HDL had a slightly increase-trend from the second year of the use of AICs Mesigyna, the Lpa increased in the 16% of the total of patients. Menstrual pattern had regularity in its cycle-81.3 % of the total of women at the end of the study- concluding that the use of AICs Mesigyna produces disturbances on menstrual cycle invariably, demonstrating its antiatherogenic role due to its metabolic effects over lipid profile.

Birth control in married women : Study in postpartum women at Siriraj Hospital.

The study interviewed 494 postpartum women at Siriraj Hospital. Of These 44.9 percent were women with first para and 55.1 percent were those with at least one child. Among women with first para, 37.4 percent were 19 years old or less, which is not an appropriate age for having children. Among the group on non-contraceptive use, 45.3 percent were adolescents who were 19 years old or less. 40.9 percent of the women with first para and 52.4 percent of the women in the other group who stopped using contraception gave the reason that they wanted to have a child. In addition, 14.2 percent of the women with first para and 9.2 percent of women with at lest one child stated that they stopped using the contraceptive method was 19.7 percent among women with first para and 20.1 percent among women with at least one child. Therefore, counseling before and after the method use is essential for client to select the appropriate method and to prolong the use of the method.