Calidad de vida relacionada con la salud de personas con hemofilia en el noreste de Brasil / Quality of life related to the health of people with hemophilia in Northeast Brazil

Introducción: La hemofilia se caracteriza por la ocurrencia de hemorragias frecuentes y afecciones del aparato locomotor graves en los pacientes que causan daños físicos, sociales y psicológicos y afecta directamente su calidad de vida relacionada con la salud. Objetivo: Evaluar la calidad de vida de personas con hemofilia en el noreste de Brasil. Métodos: Estudio epidemiológico transversal cuantitativo realizado con 13 personas con hemofilia de un Banco de Sangre en el noreste de Brasil. La recolección de datos se realizó mediante la aplicación de un cuestionario sociodemográfico y clínico y de Haem-A-Qol, utilizado para evaluar la calidad de vida de las personas con hemofilia. Los valores brutos y medios se calcularon en general para todos los dominios y luego para cada dominio para que pudieran mostrarse. Resultados: Se obtuvo un promedio total de 30,94 en relación a los diez dominios evaluados. Los dominios con los promedios más altos fueron "salud física" con 49,23 y "afrontamiento" con 35,89 y con el promedio más bajo fue "planificación familiar". Conclusiones: Los participantes de la investigación tienen una calidad de vida insatisfactoria en relación con la salud física y el afrontamiento y, satisfactoria en relación con las relaciones y la sexualidad(AU)

Introduction: Hemophilia is characterized by the occurrence of frequent bleeding and serious musculoskeletal conditions in patients that cause physical, social and psychological damage and directly affect their health-related quality of life. Objective: To evaluate the quality of life of people with hemophilia in the northeast of Brazil. Methods: Quantitative cross-sectional epidemiological study conducted with 13 people with hemophilia from a Blood Bank in northeastern Brazil. Data collection was performed by applying a sociodemographic and clinical questionnaire and Haem-A-Qol, used to assess the quality of life of people with hemophilia. Raw and mean values were calculated overall for all domains and then for each domain so that they could be displayed. Results: A total average of 30,94 was obtained in relation to the ten domains evaluated. The domains with the highest averages were "physical health" with 49,23 and "coping" with 35,89 and with the lowest average was "family planning". Conclusions: The research participants have an unsatisfactory quality of life in relation to physical health and coping, and satisfactory in relation to relationships and sexuality(AU)

Awareness, acceptability and barriers to the utilization of modern methods of family planning among women attending antenatal clinic in Bayero University, Kano

Background: Contraceptive prevalence rate (CPR) is generally very low in Nigeria, but particularly lowest in northern Nigeria. Barriers to access and utilization have been variously studied, but there is need to consider specific contexts. Objective: The aim of this study is to determine the level of awareness, acceptability, and barriers to the utilization of modern methods of family planning in Bayero University, Kano, North-west, Nigeria. Methodology: This was a cross-sectional study conducted at the antenatal section of BUK staff clinic, among 152 pregnant women between May and October 2013. Ethical approval and informed consent were obtained. Descriptive statistics was used to report categorical variables. Results: Awareness of modern methods of contraception was high (86.18%) and the majority (86.19%) knew at least one method of family planning. The commonest methods known by the respondents were: Oral contraceptive pills (39.47%), injectables (22.37%) and condom (14.47%). Out of the152 respondents, 77(50.66%) accepted the use of modern methods of family planning and 39(25.65%) out of these number had ever used at least one method, while 38(25.00%) did not. Fear of side effects (42.11%), desire for more children (15.79%), and lack of awareness (13.82%), religious prohibition (10.53%) and opposition by male partners (7.89%) constituted the major barriers to the utilization of modern methods of family planning. Conclusion: The level of awareness was found to be high but acceptability and utilization were low, this is due to the existing barriers to utilization of modern methods of family planning. Effort should be made to allay the fear of side effects and to educate women on the implication of frequent childbirth

Task sharing for family planning services, Burkina Faso

Problem: In Burkina Faso, the coverage of services for family planning is low due to shortage of qualified health staff and limited access to services.Approach:Following the launch of the Ouagadougou Partnership, an alliance to catalyse the expansion of family planning services, the health ministry created a consortium of family planning stakeholders in 2011. The consortium adopted a collaborative framework to implement a pilot project for task sharing in family planning at community and primary health-care centre levels in two rural districts. Stakeholders were responsible for their areas of expertise. These areas included advocacy; monitoring and evaluation; and capacity development of community health workers (CHWs) to offer oral and injectable contraceptives to new users and of auxiliary nurses and auxiliary midwives to provide implants and intrauterine devices. The health ministry implemented supportive supervision cascades involving relevant planning and service levels.Local setting In Burkina Faso, only 15% (2563/17 087) of married women used modern contraceptives in 2010.Relevant changes Adoption of new policies and clinical care standards expanded task sharing roles in family planning. The consortium trained a total of 79 CHWs and 124 auxiliary nurses and midwives. Between January 2017 and December 2018, CHWs provided injectables to 3698 new users, and auxiliary nurses or midwives provided 726 intrauterine devices and 2574 implants to new users. No safety issues were reported.Lessons learnt The pilot project was feasible and safe, however, financial constraints are hindering scale-up efforts. Supportive supervision cascades were critical in ensuring success

Contraception and family planning at the extreme of reproductive life-climacteric / Anticoncepção e planejamento familiar no extremo da vida reprodutiva-climatério

SUMMARY Menopause is an endocrine phenomenon characterized by gradual estrogen decline. This is a stage in a woman's life in which contraception is extremely important as the risks associated with pregnancy and childbirth increase, both maternal issues associated with higher incidence of comorbidities and issues related to fetal abnormalities, mitochondrial abnormalities, or genetic syndromes. On the other hand, there is a growing number of women who have postponed motherhood and need effective contraception, but without prolonging the return to fertility. Long-acting reversible contraceptives (LARCs), low-dose oral hormonal contraceptives and non-oral contraceptives are preferred. The levonorgestrel-releasing intrauterine system is a very good alternative that can maintain endometrial protection after menopause. Definitive methods such as tubal ligation and vasectomy are options for couples that already have their offspring. In this review, we present evidence for contraceptive indication and the effects of hormonal methods on climacteric including options for contraception, control of bleeding during perimenopause and of climacteric symptoms, as well as the transition from such methods to hormone therapy if indicated.

Resumo O climatério é um fenômeno endócrino caracterizado pelo gradativo declínio estrogênico. Esta é uma fase da vida da mulher em que a contracepção tem crescente importância, uma vez que crescem os riscos no ciclo gravídico-puerperal, seja por questões maternas, associadas à maior incidência de comorbidades, seja por questões ligadas a malformações fetais, anormalidades mitocondriais ou síndromes genéticas. Por outro lado, é cada vez maior o número de mulheres que tem postergado a maternidade, necessitando de contracepção eficiente; porém, que não prolongue o retorno à fertilidade. Dá-se preferência para métodos contraceptivos de longa duração (LARC), baixas doses hormonais orais e administradas por vias não orais. O sistema intrauterino liberador de levonorgestrel é ótima alternativa, podendo manter proteção endometrial na pós-menopausa. Os métodos definitivos, como laqueadura e vasectomia, são opções para o casal com prole constituída. Nesta revisão apresentamos evidências para indicação e efeitos dos métodos hormonais no climatério, como opções contraceptivas, para controle de sangramento perimenopausa e de sintomas climatéricos, bem como a transição destes para a terapia hormonal quando indicada.

Programa de Planificación Familiar y Riesgo Reproductivo sensible al género / Program for family planning and reproductive risk gender sensitive

Introducción: la escasa asistencia masculina a la consulta de planificación familiar es reconocida en las publicaciones científicas como una problemática que imposibilita, entre otros factores, el acceso equitativo a ese servicio, dificulta la distribución y manejo de recursos en función de necesidades de atención femeninas y masculinas. Los hombres se encuentran en desventaja con respecto a las mujeres en cuanto a: prestación de servicios de planificación familiar enfocados a ellos como población diana, beneficios de las acciones o estrategias de salud sexual y salud reproductiva plasmadas en planes, programas o políticas de salud y esto constituye, en términos de derechos reproductivos, una limitación al momento de garantizarlos a cada persona sin distinción alguna. Objetivo: identificar en el Programa de Planificación Familiar y Riesgo Reproductivo la contemplación de las necesidades de atención relativas a salud sexual y reproductiva de los hombres. Método: se realizó un análisis de contenido cualitativo de tipo temático al Programa de Planificación Familiar y Riesgo Reproductivo por el que se guían los servicios de planificación familiar en Cuba. Resultados: el Programa de Planificación familiar y Riesgo reproductivo carece de propuestas concretas para lograr la identificación y satisfacción de las necesidades de los hombres; situación que repercute en la escasa participación masculina en el servicio de Planificación Familiar. Conclusiones: el Programa de Planificación familiar y Riesgo reproductivo solo responde de manera explícita a una única necesidad de atención masculina: la falta de orientación y educación sexual de los hombres(AU)

Introduction: the low male attendance to family planning consultation is recognized in the scientific literature as a problem which precludes, inter alia, equal access to that service, it makes the distribution and management of resources according to needs of female and maleassistance. Men are at a disadvantage with respect to women regarding: provision of family planning services aimed at them as a target population benefits of actions or strategies of sexual and reproductive health reflected in plans, programs and policies on health and this is, in terms of reproductive rights, a limitation on the time of guaranteeing to every person without distinction. Objective: Identify care needs on sexual and reproductive health of men in the Program for Family Planning and Reproductive Risk. Method: A qualitative analysis was made on thematic content of theProgram for Family Planning and Reproductive Risk by which family planning services are guided in Cuba. Results: Program for Family Planning and Reproductive Risk lacks concrete proposals for identifying and meeting the needs of men, which affects the low male participation in family planning service. Conclusions: Family Planning Program and reproductive risk only responds to a sole need for male assistance: the lack of guidance and sex education for men(AU)

Nutritional aspects of children and adolescents with epidermolysis bullosa: literature review

Epidermolysis Bullosa is a genetic disorder that affects mainly the skin, however, all others systems are influenced. The nutritional care of children and adolescents with Epidermolysis Bullosa is a key treatment strategy, since the energy needs are increased due to the disease's metabolism, burdening the immune system and cicatrization process, symptoms caused by the disease hinder the intake and adequate absorption of nutrients, which may result in inadequate growth and development. Because this is a rare disease, there are few professionals who know the characteristics of both the clinical evolution and nutritional and dietary treatments. This literature review discusses the latest knowledge on energy and specific nutrient requirements to the dietary treatment and monitoring of children and adolescents with Epidermolysis Bullosa.

Clinical and psychological repercussions of videolaparoscopic tubal ligation: observational, single cohort, retrospective study / Repercussões clínicas e psíquicas da ligadura tubária videolaparoscópica: estudo observacional de coorte única, retrospectivo

CONTEXT AND OBJECTIVE: Tubal ligation is one of the most commonly used contraceptive methods worldwide. Since the controversy over the potential effects of tubal sterilization still continues, this study aimed to evaluate the clinical and psychological repercussions of videolaparoscopic tubal ligation. DESIGN AND SETTING: Observational, single cohort, retrospective study, conducted in a tertiary public hospital. METHODS: A questionnaire was applied to 130 women aged 21-46 years who underwent videolaparoscopic tubal ligation by means of tubal ring insertion or bipolar electrocoagulation and sectioning, between January 1999 and December 2007. Menstrual cycle interval, intensity and duration of bleeding, premenstrual symptoms, dysmenorrhea, dyspareunia, noncyclic pelvic pain and degree of sexual satisfaction were assessed in this questionnaire. Each woman served as her own control, and comparisons were made between before and after the surgical procedure and between the two techniques used. RESULTS: The clinical and psychological repercussions were significant, with increases in bleeding (P = 0.001), premenstrual symptoms (P < 0.001), dysmenorrhea (P = 0.019) and noncyclic pelvic pain (P = 0.001); and reductions in the number of sexual intercourse occurrences per week (P = 0.001) and in libido (P = 0.001). Women aged ≤ 35 years at the time of sterilization were more likely to develop menstrual abnormalities. The bipolar electrocoagulation method showed greater clinical and psychological repercussions. CONCLUSION: Regardless of the technique used, videolaparoscopic tubal ligation had repercussions consisting of increased menstrual flow and premenstrual symptoms, especially in women aged ≤ 35 years, and also had a negative influence on sexual activity. .

CONTEXTO E OBJETIVO: A ligadura tubária é um dos métodos contraceptivos mais utilizados em todo o mundo. Como a controvérsia sobre seus possíveis efeitos ainda continua, o objetivo deste estudo foi avaliar as repercussões clínicas e psíquicas da laqueadura videolaparoscópica. TIPO DE ESTUDO E LOCAL: Estudo observacional de coorte único, retrospectivo, conduzido em hospital público terciário. MÉTODOS: Foi aplicado um questionário a 130 mulheres, entre 21-46 anos, submetidas à ligadura tubária videolaparoscópica, pelas técnicas de eletrocoagulação bipolar/secção ou inserção do anel tubário, entre janeiro de 1999 e dezembro de 2007. Nesse questionário avaliou-se: intervalo do ciclo menstrual, intensidade e duração do sangramento, sintomas pré-menstruais, dismenorreia, dispareunia, dor pélvica não cíclica e grau de satisfação sexual. Cada mulher serviu como seu próprio controle, foi realizada análise comparativa entre os períodos pré- e pós-cirúrgico e entre as duas técnicas utilizadas. RESULTADOS: As repercussões clínicas e psicológicas mostraram-se significativas, com aumento de sangramento (P = 0,001), de sintomas pré-menstruais (P < 0,001), dismenorreia (P = 0,019), dor pélvica não cíclica (P = 0,001), e redução no número de relações sexuais por semana (P = 0,001) e na libido (P = 0,001). Mulheres com idade ≤ 35 anos, no momento da laqueadura, mostraram-se mais propensas a desenvolverem alterações menstruais. A técnica de eletrocoagulação bipolar mostrou maiores repercussões clínicas e psíquicas. CONCLUSÃO: A ligadura tubária videolaparoscópica, independentemente da técnica, repercutiu com ...

Guía nacional de planificación familiar / National Family Planning Guide

Esta guía, es una actualización de la edición del 2010, y es el resultado de una compilación de información basada en evidencia científica sobre los métodos anticonceptivos y el proceso de planificación familiar. Está dirigida a proveedores de salud en general y contiene lineamientos técnico normativos y científicos que deben tomarse en cuenta para la consejería balanceada en métodos de planificación familiar. Incluye una descripción detallada de métodos y dispositivos anticonceptivos.

Achievements of the Iranian family planning programmes 1956-2006

Family planning programmes initiated in the Islamic Republic of Iran from 1966 met with limited success. Following the 1986 census family planning was considered a priority and was supported by the country's leaders. Appropriate strategies based on the principles of health promotion led to an increase in the contraceptive prevalence rate among married women from 49.0% in 1989 to 73.8% in 2006. This paper reviews the family planning programmes in the Islamic Republic of Iran and their achievements during the last 4 decades and discusses the principles of health promotion and theories of behaviour change which may explain these achievements. Successful strategies included: creation of a supportive environment, reorientation of family planning services, expanding of coverage of family planning services, training skilled personnel, providing free contraceptives as well as vasectomy and tubectomy services, involvement of volunteers and nongovernmental organizations and promotion of male participation

Levonorgestrel-releasing IUD versus coper IUD in control of dysmenorrhea, satisfaction and quality of life in women using IUD

The levonorgestrel-releasing IUD can help the treatment of dysmenorrheal by reducing the synthesis of endometrial prostaglandins as a conventional treatment. This study was performed to assess the frequency of dysmenorrheal, satisfaction and quality of life in women using Mirena IUDs as compared to those using copper IUDs. This double-blind randomized clinical trial was performed between 2006 and 2007 on 160 women aged between 20 to 35 years who attended Shahid Ayat Health Center of Tehran, and they were clients using IUDs for contraception. 80 individuals in group A received Mirena IUD and 80 individuals in group B received copper [380-A] IUD. Demographic data, assessment of dysmenorrheal, and follow-up 1, 3 and 6 months after IUD replacement were recorded in questionnaires designed for this purpose. To assess the quality of life, SF36 questionnaire was answered by the attending groups, and to assess satisfaction, a test with 3 questions was answered by clients. Dysmenorrheal significantly was decreased in both groups six months after IUD insertion as compared to the first month [p<0.001]. However, statistically, Mirena reduced dysmenorrheal faster and earlier compared to cupper IUD [<0.003]. There isn't any significant difference between these two groups in satisfaction and quality of life outcomes. There is no difference between these two groups in terms of the satisfaction and quality of life, therefore the usage of Mirena IUD is not a preferred contraception method

Breves consideraciones históricas, jurídicas y actuales acerca del aborto y la regulación menstrual / Brief historical, legal, and current considerations on abortion and menstrual regulation

El aborto en Cuba no ha sido determinante principal en la fecundidad actual; hay moderada tendencia a la disminución de los eventos aborto y regulación menstrual, pero no es homogéneo para todas las provincias y aún no se conoce con exactitud la morbilidad por este proceder, por no uniformidad en la vigilancia epidemiológica del proceder. En los primeros años que siguieron al triunfo revolucionario se promovió y estableció la institucionalización hospitalaria de la práctica del aborto voluntario, a nivel hospitalario, como medida encaminada a la disminución de las complicaciones y muertes maternas y en pleno ejercicio de la igualdad entre los géneros, basados en el libre derecho de decidir sobre la reproducción. Las orientaciones del Ministerio de Salud Pública se fundamentaban en el criterio de que toda mujer que no pudiera o no quisiera llevar a término su embarazo, corría grave peligro si la interrupción deseada de este no era realizada por personal especializado en condiciones apropiadas. Las complicaciones más frecuentes, entonces, eran la infección por restos ovulares, las lesiones traumáticas (perforación uterina) y las hemorrágicas. Hoy se considera que el volumen de abortos voluntarios es elevado, que el propósito principal de las políticas de planificación familiar es disminuir esta práctica al mínimo indispensable. Se considera el proceder como riesgoso y, por ende, constituye aún una de las causas frecuentes de morbilidad y mortalidad materna y perinatal.

Abortion in Cuba has not been a main determinant in current fertility behavior. A discreet trend according to the decrease of abortion and menstrual regulation events is observed. It is not homogenous for all provinces, and morbidity of these procedures is precisely still unknown due to non-uniformity on the epidemiological surveillance. During the first years after the triumph of the Revolution, hospital institutionalization of voluntary abortion practice was promoted and established as a way of decreasing maternal complications and deaths and of equalling both sexes, based on the free right to make decisions on reproduction. The orientations of Public Health Ministry were supported by the criterion stating that every woman who could not or does not want to carry her pregnancy to term would be at a high risk in case the pregnancy interruption would not be carried out by trained medical staff under appropriate conditions. Infection due to ovary remains, traumatic injuries (uterine perforation), and hemorrhages were the most frequent complications. Nowadays, the amount of voluntary abortions is considered high but the main goal of Familiar Planning policies is to reduce this method up to a minimum rate. This procedure was considered as risky and, thus, it still constitutes one of the common causes of maternal and perinatal morbidity and mortality.

Consejería en anticoncepción para adolescentes y jóvenes / Adolescent and youth contraconceptive couselling

La adhesión por parte de las mujeres adultas y peor aún, de los adolescentes a regular su fertilidad para tener los hijos deseados en momentos oportunos es todavía baja y altos los índices de embarazos inoportunos. Una de las causas es la inadecuada consulta por anticoncepción especialmente hacia los adolescentes por no estar debidamente preparados para una verdadera consejería.

Contraceptive attitude and behaviour among university men: a study from Punjab, Pakistan

The men's attitudes towards family planning and on the use of family planning method may affect not only their wives intention to use contraception but also the choice of a particular family planning method. This focus of this study is to assess the educated men's role, belief, practice and their participation in family planning. A cross-sectional data on 150 university male employees was taken. The logistic regression in connection with stepwise procedures is used to find the most significant variables that influence the men's current use of contraception status. About 42 percent of the married male employees were users of family planning methods. Among family planning methods, condom was the most used method [about 71%] followed by traditional methods [14%]. The mean age at first marriage of the respondents was 23 years and for the spouses it was 19 years. The knowledge of men in family planning methods is quite universal and general; but the attitude on the use of contraceptives and the family planning method is much different between the employees who had the awareness of contraception and those who had no awareness

Emergency contraception: knowledge and attitude among females

To assess women's knowledge of emergency contraception. Descriptive study. Gynaecology Unit IV, Lyari General Hospital Karachi, In January 2009. Women aged between 18 to 45 years visiting Gynaecology OPD at Lyari General Hospital Karachi were interviewed and responses entered in a specially designed questionnaire of knowledge and attitude about emergency contraception. Of the 300 respondents, 129[43%] had practiced contraception while 9[3%] admitted to having an induced abortion. Only 144[48%] had heard of emergency contraception [EC]. 123[41%] knew only about hormonal method of EC. Only 6[2%] knew the correct timing of EC. Six requested for EC previously. Many women were uninformed about the action and timing of EC. Health facilitator should educate masses about EC, emphasizing available methods and correct timing of use

Perceptions of women about menstrual regulation services: qualitative interviews from selected urban areas of Dhaka.

Menstrual regulation (MR) programmes were introduced in Bangladesh in 1974 to reduce morbidity and mortality due to unsafe abortions. About 468,000 MR procedures are performed annually, and its potential is not fully used. To develop MR programmes, the voices of women could add important aspects to its acceptability. This qualitative interview study aimed to explore and describe the perceptions about MR in a sample of women from Dhaka, Bangladesh. The most prominent perception was that, despite the moral dilemma inherent in terminating pregnancies, MR was highly valued as a solution in problematic life situations. However, unprofessional attitudes and misconduct among MR providers were revealed, and there was also a lack of knowledge and openness in families. To improve the quality of MR services, professional ethics needs to be highlighted in training and supervision of providers. To improve the acceptability of MR, education on the benefits of MR has to be made available to the whole population.

Aspectos bioéticos relacionados con el aborto / Bioethic aspects related to abortion

La historia de los métodos de regulación de la fertilidad han transitados por diferentes etapas durante varios siglos, evolucionando paralelamente al desarrollo de los derechos civiles de la mujer. A pesar de este progreso, en la actualidad no se ha podido eliminar la práctica del aborto y ha aumentado su incidencia en los países donde la información y los servicios de planificación familiar son débiles. En el mundo mueren anualmente cientos de miles de mujeres por causas relacionadas con la práctica del aborto en condiciones no seguras. El uso de anticonceptivos eficaces y los servicios de planificación familiar puede disminuir la incidencia de los abortos inducidos, y por tanto, se reducen los problemas de salud relacionados con el aborto, mediante la disminución de los embarazos no deseados. En este trabajo se propuso valorar los riesgos y aspectos bioéticos relacionados con el aborto inducido. Se realizó un estudio de revisión bibliográfica que abordó diversos aspectos relacionados con el aborto inducido, donde se describe la historia de los métodos anticonceptivos, las leyes y posturas que a lo largo de la historia ha tenido relación con el aborto(AU)

The history of the fertility regulation methods has passed through different stages for several centuries, and it has evolved parallely to the development of women's civil rights. In spite of this progress, it has not been possible to eradicate the practice of abortion until now, and its incidence has increased in those countries where information and family planning services are deficient. Hundreds of thousands of women die every year in the world due to causes related to abortion performed under unsafe conditions. The use of efficient contraceptives and of family planning services may decrease the incidence of induced abortions and also the health problems connected with it, on reducing the undesired pregnancies. The risks and bioethic aspects associated with induced abortion were assessed in this paper. A bibliographic review of the different aspects related to induced abortion was made. The history of the contraceptive methods, and the laws and positions that have been related to abortion in the course of history were also described(AU)

Nonoxynol-9 vaginal pessary: a preliminary Indian experience.

BACKGROUND: Barrier methods of contraception do not have systemic effects and allow the user complete control over their use. For women, the ease of use of a contraceptive is often more important than its efficacy. Hence, barrier methods could be offered as a useful alternative method of contraception. Nonoxynol-9 (a spermicide) is a locally acting, non-hormonal method free from systemic side-efforts. It is a woman-controlled, reversible method which is to be used before intercourse. There are little data available on its efficacy, side-effects and acceptability among Indian women. METHODS: The vaginal pessary nonoxynol-9 was offered as a contraceptive option to 3200 women attending the Family Planning clinics at 31 Human Reproduction Research Centres (HRRCs) of the Indian Council of Medical Research. The other contraceptives offered included an intrauterine device, oral pills, condoms, Norplant, tubal sterilization and vasectomy using the cafeteria approach. Those who accepted nonoxynol-9 were followed up to assess the rates of continuation, failure and side-effects. RESULTS: The nonoxynol-9 pessary was accepted by 541 women who were followed up for 3470 woman-months of use. The reasons given for acceptance were that it was user-controlled and/or they did not wish to use other methods because of the side-effects or contraindications of these methods. The overall continuation rates were 41.2% and 33% at 9 and 12 months of use, respectively. Most women (31.3%) discontinued its use due to personal reasons such as husband dissatisfaction, desire for further pregnancy, irregular use of pessary and difficulty in insertion. Twenty-nine women became pregnant during the study period (15 due to method failure and 14 due to user failure) giving a use-effectiveness of 8.8% at 12 months. The method failure rate was 4.3% at 12 months of use. The failure rates were lower compared with the reported failure rates of barrier contraceptives (1%-30% at 1 year of use) and the side-effects were minimal. CONCLUSION: Nonoxynol-9 had low acceptability (16.9%) and overall continuation rates--41.2% and 33% at 9 and 12 months of use. It could be offered to women looking for a short term, user-controlled contraceptive.

District-level religious composition and adoption of sterilization in India.

This paper examined the influence of religion on the adoption of female sterilization, using data from the 1992/93 Indian National Family Health Survey. The influence of religion at both individual and district levels was examined, and a multi-level modelling methodology was used for assessing community variations in the influence of religion on the adoption of sterilization. Individual religion was a strong predictor of the decision to adopt sterilization, and residence in a district in which more than 20% of the people were Muslims significantly lowered the odds of adoption of sterilization. There was more variation in the adoption of sterilization between districts for Muslim women and women from minority religious groups. The results demonstrate the influence of community conservatism on the choice of contraceptive methods and point to the mediating effects that community characteristics can have on access to sterilization services for women from religious minority sub-groups.

Norma Nacional de Atención Prenantal / National standard of prenatal care

Trata sobre las normas para las actividades de atención prenatal

Atención de enfermería a gestantes ingresadas en el hogar materno del municipio de Contramaestre / Nursing care to pregnant women admitted in the maternal home of the Contramaestre municipality

El análisis de los indicadores que valoran la eficiencia en el desarrollo del Programa Materno Infantil indican que el Sistema Nacional de Salud cubano ha puesto a disposición del pueblo instituciones sociales, recursos materiales y humanos suficientes para lograr los propósitos en la salud materno infantil. Se realizó un estudio descriptivo en el hogar materno del municipio de Contramaestre a las 662 gestantes ingresadas para valorar la atención de enfermería en el período enero-diciembre del año 2002 mediante diferentes indicadores como: el promedio de estadía, índice ocupacional, aplicación del Proceso de Atención de Enfermería, enseñanza del Programa de Maternidad y Paternidad Responsable y el estado de satisfacción de las gestantes. Se revisaron los registros controles, ingresos , egresos, control de asistencia y las historias clínicas y se aplicó una encuesta para conocer el grado de satisfacción de las gestantes en torno a la calidad de la alimentación, condiciones para el sueño y el confort, trato recibido y retorno a la institución, si fuera necesario. Se comprobó que hubo mayor índice ocupacional en el segundo semestre a expensas del incremento de ingresos por situaciones geográficas, la mayoría de las expectativas fueron cumplidas y las gestantes, en el 99,2 por ciento, se sintieron satisfechas con el servicio recibido, por lo que se puede concluir que sobre la base de los indicadores valorados, la atención de enfermería en el hogar materno de Contramaestre fue buena en el período estudiado(AU)

The analysis of the indicators that value the efficiency in the development of the Infantile Maternal Program indicates that the Cuban National System of Health has put to disposition of the town social institutions, enough material and human resources to achieve the purposes in the infantile maternal health. He/she was carried out a descriptive study in the maternal home from the municipality of Boatswain to the 662 gestantes entered to value the infirmary attention in the period January-December of the year 2002 by means of different indicators as: the demurrage average, occupational index, application of the Process of Attention of Infirmary, teaching of the Program of Maternity and Responsible Paternity and the state of satisfaction of the gestantes. The registrations controls were revised, revenues, expenditures, control of attendance and the clinical histories and a survey was applied to know the degree of satisfaction of the gestantes around the quality of the feeding, conditions for the dream and the comfort, received treatment and I return to the institution, if it was necessary. He/she was proven that there was bigger occupational index in the second semester to expense of the increment of revenues for geographical situations, most of the expectations were completed and the gestantes, by 99,2 percent, felt satisfied with the received service, for what you can conclude that it has more than enough the base of the valued indicators, the infirmary attention in Boatswain's maternal home it was good in the studied period(AU)