A cosmopolítica da gestação, do parto e do pós-parto: autoatenção e medicalização entre os índios Munduruku / The cosmopolitics of pregnancy, childbirth and postpartum: self-attention and medicalization among Munduruku Indians

A pesquisadora Raquel Paiva Dias-Scopel, do Instituto Leônidas e Maria Deane (ILMD/Fiocruz Amazônia), levanta questões sobre a valorização e respeito à diversidade étnica e cultural dos povos indígenas e a difícil interface com o processos de medicalização e do direito ao acesso aos serviços de saúde biomédicos. O livro é parte da Coleção Saúde dos Povos Indígenas, da Editora Fiocruz e partiu da tese de doutorado defendida em 2014 no Programa de Pós-Graduação em Antropologia Social da Universidade Federal de Santa Catarina (UFSC). Foi publicado pela primeira vez em 2015 pela Associação Brasileira de Antropologia com o título A Cosmopolítica da Gestação, Parto e Pós-Parto: práticas de autoatenção e processo de medicalização entre os índios Munduruku. No prefácio da primeira edição, sua orientadora, a doutora em antropologia e professora titular da UFSC, Esther Jean Langdon, ressalta que o conceito fundamental deste livro é da autoatenção, que aponta para o reconhecimento da autonomia e da criatividade da coletividade, principalmente da família, como núcleo que articula os diferentes modelos de atenção ou cuidado da saúde.

Edad de menarquia y ascendencia indígena: Un estudio poblacional en Chile / Age at menarche and indigenous ancestry: A population study in Chile

Background: The age at menarche may influence decisively health and disease in women. It also indicates the beginning of the reproductive period and, as a consequence, the possibility of biological continuity for the human species. Genetic and environmental determinants define the age of menarche and can explain differences found among different populations. Aim: To determine the age at menarche among adolescents with different levels of indigenous descent (parental indigenous surnames), considering the effect of socioeconomic and demographic factors. Material and Methods: An observational study of historic cohorts of8.624 girls from the Arauca-nía Region (central-southern Chile) was carried out. Data were collected by health professionals using a previously validated questionnaire. Occurrence of menarche was estimated through survival analysis and compared between groups (according to indigenous parental surnames) adjusted for parents' income and educational level and provenance (rural/urban). Results: Estimated median age of menarche was 151 months (95% Cl: 150-151). In female with four indigenous surnames, menarche occurred two months later than girls without indigenous surnames and with two indigenous surnames (p < 0,001). In girls whose parents had lowest level of schooling, the difference increased to eight months later (p < 0,005). Conclusions: Age at menarche in the group with higher indigenous descent is later even if socio-economic conditions remain stable. Genetic factors might play an important role, however conditions of vulnerability can influence and further delay the onset of reproductive competency.

Socioeconomic status and age at menarche in indigenous and non-indigenous Chilean adolescents / Nivel socioeconómico y edad de la menarquia en adolescentes chilenas indígenas y no indígenas

The objective was to analyze the relationship between socioeconomic status and age at menarche among indigenous and non-indigenous girls in the Araucanía Region of Chile, controlling for nutritional status and mother's age at menarche. A total of 8,624 randomly selected girls from 168 schools were screened, resulting in the selection of 207 indigenous and 200 non-indigenous girls who had recently experienced menarche. Age at menarche was 149.6±10.7 months in the indigenous group and 146.6±10.8 months in the non-indigenous group. Among the non-indigenous, the analysis showed no significant association between age at menarche and socioeconomic status. In the indigenous group, age at menarche among girls with low socioeconomic status was 5.4 months later than among those with higher socioeconomic status. There were no differences in nutritional status according to socioeconomic level. Obesity was associated with earlier menarche. Menarche occurred earlier than in previous generations. An inverse relationship between socioeconomic status and age at menarche was seen in the indigenous group only; low socioeconomic status was associated with delayed menarche, regardless of nutritional status or mother's age at menarche.

El objetivo fue analizar la relación entre nivel socioeconómico y edad de menarquia en adolescentes indígenas y no indígenas de la Región de la Araucanía, Chile, controlando el efecto del estado nutricional, y la edad de menarquia de las madres. Se estudiaron 8.624 niñas de 168 escuelas elegidas aleatoriamente, seleccionando 207 indígenas y 200 no indígenas que habían tenido recientemente la menarquia. La edad de menarquia ocurrió a los 149,6±10,7 meses en indígenas y a los 146,6±10,8 meses en no indígenas. En el grupo no indígena, hubo una relación significativa entre edad de menarquia y nivel socioeconómico. En el grupo indígena, edad de menarquia del nivel socioeconómico bajo fue de 5,4 meses más tarde que el nivel socioeconómico más alto. No se observaron diferencias de estado nutricional por nivel socioeconómico. La obesidad adelantó la menarquia y la edad de menarquia ocurrió antes que la de sus madres. Existe una relación inversa entre nivel socioeconómico y edad de menarquia sólo en el grupo indígena; en los niveles socioeconómicos más bajos la edad de menarquia se retrasa independiente del estado nutricional y de la edad de menarquia de la madre.

Age at menarche and related factors in girlsof urban areas of Markazi (Central) province of Iran / Edad de la menarquia y factores relacionados en las niñas de zonas urbanas de la provincia Markazi (Central) de Irán

The age at menarche is an indicator of racial, geographical and nutritional patterns of different societies. This cross-sectional study conducted on 1223 girls aged 14-20 in the Markazi (Central) Province, Iran in 2010. In this research, the age at menarche, as the main variable, was determined for each city and compared between different cities. The statistical analyses included c2 test for determining statistically significant differences, variance analysis for determining the difference between groups, and Pearson correlation coefficient for determining the relationship between variables. The average age of first menstruation was 13.21+/-1.33 years in the Markazi Province, with no significant difference among the cities of the province. This age is inversely related to body mass index (BMI), nutritional status and weight. The pattern of distribution of BMI is similar for all the cities in the province. Although, the average age at menarche in the Markazi (central) Province, a cold area, is higher compared to warmer regions in Iran, it may be more influenced by race than by the climate. Considering the lower age at menarche in Markazi Province compared to previous similar studies, it may be stated that social well-being and nutritional standards have improved in the province.

La edad de la menarquia es un indicador de patrones raciales, geográficos y nutricionales de distintas sociedades. Este estudio transversal fue realizado el 2010 en 1223 niñas entre 14 y 20 años en la Provincia Markazi (Central), Irán. En esta investigación, la edad de la menarquia, como la variable principal, se determinaron para cada ciudad y en comparación entre las diferentes ciudades. Los análisis estadísticos incluyeron la prueba c2 para determinar diferencias estadísticamente significativas, el análisis de varianza para determinar la diferencia entre los grupos, y el coeficiente de correlación de Pearson para determinar la relación entre las variables. El promedio de edad de la primera menstruación fue 13,21+/-1,33 años en la provincia de Markazi, sin diferencias significativas entre las ciudades de la provincia. Esta edad es inversamente proporcional al índice de masa corporal (IMC), el estado nutricional y el peso. El patrón de distribución del IMC es similar para todas las ciudades de la provincia. Aunque la edad media de la menarquia en la Provincia Markazi (central), una zona de clima frío, es mayor en comparación con las regiones más cálidas en Irán, puede estar más influenciadas por la raza que por el clima. Teniendo en cuenta la baja edad de menarquia en la Provincia Markazi en comparación con estudios similares anteriores, se puede afirmar que el bienestar social y los niveles de nutrición han mejorado en la provincia.

Original research paper age at menarche and affecting bio-social factors among the girls of Lucknow, Uttar Pradesh.

The age at which first menstrual bleeding occurs in female, i.e menarche is viewed as an excellent physiological marker of adolescent maturation. The aim of this study is to determine the mean age at menarche among adolescent girls and to assess the influence of some Bio-social parameters affecting it.This study was conducted among 150 adolescent girls in the age group of 10 to 19 years, randomly selected from urban & rural government schools of Lucknow. 75 girls from each school were selected from November 2009 to March 2010. This was a cross sectional descriptive study. Girls were studied about their socioeconomic status, weight, height, place of residence. Out of 150 cases studied 108 cases were having menstruation, most frequent age of menarche being 13 years when 32 cases (29.63%) had its onset. The lowest age was 8 years and highest was 15 year. Mean age at menarche was found to be 12.43 ± 1.49. There seems to be definite association of various factors which modify the age at menarche like socio-economic status, body mass index, place of residence.

Eating attitudes and body image in ethnic Japanese and Caucasian adolescent girls in the city of São Paulo, Brazil / Atitudes alimentares e imagem corporal em meninas adolescentes de ascendência nipônica e caucasiana em São Paulo (SP)

OBJETIVO: Há muita controvérsia nos estudos que analisam a relação entre etnia e transtornos alimentares a despeito do rápido aumento desses distúrbios em diversos grupos étnicos. O objetivo do presente estudo foi verificar as atitudes alimentares em adolescentes de ascendência nipônica e caucasiana no Brasil. A influência do índice de massa corporal (IMC), da menarca e das relações socioafetivas no desenvolvimento dos transtornos alimentares também foi discutida. MÉTODOS: Questionários sobre atitudes alimentares e influências socioafetivas foram aplicados a 544 adolescentes de origem nipo-brasileira e caucasiana: adolescentes pré-menarca de 10 e 11 anos nipo-brasileiras (n = 122) e caucasianas (n = 176) e adolescentes pós-menarca de 16 e 17 anos nipo-brasileiras (n = 71) e caucasianas (n = 175). RESULTADOS: Adolescentes caucasianas apresentaram maiores escores no Teste de Atitudes Alimentares (EAT-26), mostraram maior insatisfação com suas imagens corporais, faziam mais dieta e tinham mais modelos de dietas representados pelas mães e pares do que as adolescentes nipo-brasileiras. CONCLUSÃO: As adolescentes caucasianas, de um modo geral, parecem sentir mais as pressões culturais e estéticas sobre a imagem corporal do que as nipônicas. A frequência alta de meninas caucasianas pré-menarca com escore acima de 20 no EAT-26 mostra que a preocupação com a imagem corporal vem ocorrendo cada vez mais cedo. A análise de regressão múltipla revelou muitas associações entre a interação das adolescentes com suas mães e o desenvolvimento de atitudes alimentares inadequadas.

OBJECTIVE: Despite investigations into the rapid increase in eating disorders across diverse ethnic groups, conclusions concerning ethnicity and eating disorders are contradictory. The objective of the present study was to investigate eating attitudes in ethnic Japanese and Caucasian adolescents in Brazil. The influence of body mass index (BMI), menarche and social-affective relationships on the development of eating disorders was also assessed. METHODS: Questionnaires evaluating the incidence of eating disorders and the influence of social-affective relationships were applied to 544 Japanese-Brazilian and Caucasian adolescent girls: 10 to 11-year-old Japanese-Brazilian (n = 122) and Caucasian (n = 176) pre-menarcheal adolescents, and 16 to 17-year-old Japanese-Brazilian (n = 71) and Caucasian (n = 175) post-menarcheal adolescents. RESULTS: Caucasian girls obtained higher scores on the Eating Attitudes Test (EAT-26), showed greater body image dissatisfaction, dieted more often and had more diet models introduced by their mothers and peers than the Japanese-Brazilian girls. CONCLUSION: The Caucasian adolescents overall appeared to be more sensitive to aesthetic and social pressures regarding body image than the Japanese adolescents. The high incidence of EAT-26 scores above 20 in the Caucasian pre-menarcheal group indicates that individual body image concerns are developing at an earlier age. Multiple logistic regression revealed several associations between mother-teen interactions and the development of abnormal eating attitudes.

Características reproductivas de las mujeres consultantes en servicios de urgencia general de la VIII Región / Reproductive history of women consulting in emergency services in a southern region of Chile

Background: The occurrence and timing of menstrual and reproductive events such as menarche, regularity of menses, births, maternal breastfeeding and menopause play an important role in a woman's life. Aim: To study the variability of reproductive live from menarche to menopause in different age groups in Chilean Caucasian and Mapuche aborigine females in a southern location of Chile. Subjects and Methods: A questionnaire about reproductive history was answered by 502 women consulting in six general emergency rooms of different public hospitals of the 8th region of Chile, between May and September 2002. Results: The median age at menarche was 12.8 years among adolescents and 13.7 years among older women (p <0.001). Fecundity rate was 5.2, 3.9 and 1.8 among older women, adults and young adults, respectively. Forty seven percent of adolescent had at least one child. The median age for natural menopause was 47 years. Eighty one percent of older women and 65% of adult women had given breastfeeding for more than six months. No statistical differences in reproductive characteristics were observed between Chilean Caucasians and Mapuche aborigines. Conclusions: Among these women, the age of menarche in younger women is similar to that of women from industrialized countries. Fecundity has been progressively decreasing. Menopause tends to occur sooner than in other geographical regions, probably due to the high number of surgical sterilizations in our population. Adolescent pregnancy still is a problem.

Idade da manarca em adolescentes de Londrina - PR / Menarche age in adolescents of Londrina - PR

O objetivo do estudo foi estabeler a idade da menarca e com que freqüência ela ocorre em escolares pertencentes a uma escola de nível sócio-econömico elevado do município de Londrina - Pr. Fizeram parte da amostra 160 moças com idades entre 6 e 17 anos. O método escolhido para determinaçäo da menarca foi o "status quo", e em seguida o método retrospectivo foi utilizadopara determinaçäo da idade da sua ocorrência. Para tratamento estatístico dos dados, recorreu-se à estatística descritiva à distribuiçäo de freqüência. Dentro o grupo total de moças, 75 já apresentavam a menarca,sendo médi da idade da menarca de 12,09ñ1,07 anos. A idade de início da ocorrência foi de 10 anos (12 porcento), na idade de 11 anos atingiu-se a maior freqüência (40 porcento) sguido de 12 anos (30,6 porcento). Ao final dos 12 anos, estima-se uma freqüência de 85 porcento das moças com menarca. Os resultados indicaram ainda um avanço maturacional entre as escolares de Londrina, indicando uma tendência secular positiva comparada a estudo anterior na mesma populaçäo

Ritmo anual de la menarquia en Medellín, Colombia / Anual rythm of menarche in Medellín, Colombia

Hypotheses on seasonal, phylogenetic and ontogenic factors or imprinting that may produce menarcheal rhythm were tested in a sample of school girls from Medellín, Colombia. The questionnaire included a net of important religious or national feasts and periods of vacation or study to prevent memory biases. Europeanb, Asian and Chilean samples showed peaks of menarche in december and january, but a few samples showed a second in june, july and august. The winter short photoperiod and low temperature were assumed to be the cause of the winter peak in most european samples. However, this seasonal hypothesis was refuted when a chilean sample also showed a peak in december, january and february (summer). In the present study performed in a sample from a tropical country we found 2 peaks of menarche, one in july and the other in november, december and january; thus, the seasonal hypothesis can be hardly supported. Moreover, this sample showed a high coincidence between the month of menarche and the month of birth, and a different pattern of menarche when menarches are distributed according to their coincidence with the gestational development. Both facts affirm the ontogenetic hypothesis, because they were also found in several samples. Since this population is different from those already studied and its monthly distribution of menarches and births is also different from those ones, the hypothetical phylogenetic factors find additional support. The possible influence of school stress and other environmental factors in the menarcheal rhythm are discussed

Variation in menarcheal age of Assamese girls.

The onset of menarche of 571 Assamese girls was investigated and the study sample included individuals from the population of various Assamese castes (brahmin, kalita, kaibarta), the Muslims and from the 2 Mongoloid populations, ie, the ahoms and the sonowals of Assam. Attempt was made to ascertain inter-group differences among themselves. The study revealed that there was insignificant statistical variation among the populations under consideration. Finally, the present findings were compared to that of the mean menarcheal age obtained on the same population by the earlier researchers which revealed good deal of variation among them. Secular trend in the age at menarche among these populations are discussed. Evidence of steady fall of menarcheal age in several populations has been noted in the present study.

New evidence of non seasonal factors in the menarche rhythm

The phylogenetic, ontogenetic and seasonal hypotheses on the annual periodicity of menarche were tested. Data from European, Asian (Caucasian, Mongolian and Caucaso-Mongolian people from the northern hemisphere) and Chilean (Caucaso-Amerindian from the southern hemisphere) populations were compared with data from Hungary (Caucaso-Mongolian Europeans from a northern temperature zone) and Madras, India (a complex ethnically originated people from a tropical northern area). Chileans were compared with those Caucaso-Mongolian people because Amerindians belong also to the Mongolian group. Hungarian girls showed peaks of menarche in the month of January (winter), June, July and August (summer), in contradiction with most European Caucasians who showed peaks only in winter months; and in agreement with Finns who showed both peaks. Indian girls had peaks in April, May and June (summer) and more extreme peaks and troughs than the Finnish girls (from a temperature arctic zone). These findings do not agree with the seasonal hypothesis, but they do with the phylogenetic hypothesis. Indian girls had a peak of menarche in the same month of birth and the arrangement of data according to the gestational-menarche coincidence showed a significant heterogeneity for the monthly peaks of menarche; thus, the ontogenetic hypothesis was also supported

Edad de menarquia y características menstruales de la mujer atleta puertorriqueña / Age of menarche and menstruation characteristics of Puerto Rican women athletes

El propósito de esta investigación fue determinar y describir la edad cronológica, edad de iniciación deportiva (EID), edade deportiva (ED), edad de menarquia (EM), características menstruales, uso de anticonceptivos orales, orden de nacimiento (ON), número de hermanos (NH), estado civil, número de hijos, y especialidad deportiva de las atletas puertorriqueñas que participaron en los XV Juegos Centro Americanos y del Caribe. La muestra (n=55) incluyó representantes de 9 deportes (atletismo n=6, baloncesto n=7, gimnasia n=5, nado sincronizado n=9, natación n=5, softbol n=4, tenis n=4 [tenis de campo n=2, tenis de mesa n=2], y vóleibol n=5) Los datos fueron obtenidos mediante una entrevista. El grupo demostró los siguientes valores promedio (Mñde)Ñ edad=21.0ñ5.3 años, EID=11.4ñ4.3 años, ED=9.6ñ4.4 años, EM=13.2ñ1.6 años, ON=2.87ñ1.3, y NH=3.7ñ1.9. Cinco por ciento de la población estudiada (gimnasia n=2 y natación n=1) reportó no haber alcanzado la menarquia. La prevalencia de irregularidad menstrual y dismenorrea fue 44.2 y 40.4%, respectivamente. El grupo demostró que 61.5% estaba muy seguro, 25% seguro y 13.5% poco seguro de los datos reportados con relación a su menarquia. La prevalencia del uso de anticonceptivos orales fue 7.3%. Los resultados obtenidos comparan favorablemente con aquellos demonstrados por poblaciones de atletas olímpicas

Menarca e estágios do desenvolvimento somático em escolares de Salvador-Bahia / Menarche and period of somatic evolution of students in Salvador-Bahia

Quatro mil e três escolares de Salvador, no período de 1980-1982, 2.003 matriculados em nove escolas particulares e 2.000 em catorze escolas públicas, na faixa etária de 9 a 17 anos, foram investigadas pelo método "status quo" para determinaçäo da média de idade da menarca. Estágios do desenvolvimento físico, composiçäo racial e distribuiçäo da menarca em funçäo dos meses do ano, foram também averiguados. As duas amostras apresentaram-se homogêneas quanto à distribuiçäo das escolares por idade: X82= 11,51; p= 0,174; mas, diferiram significativamente quanto à composiçäo racial; X4.2 = 1616,21; p < 0,00001. Nas escolas particulares, 88,7 por cento das meninas foram brancas e mulatasclaras; 1,14 por cento foram pretas. Nas escolas públicas foi consideravelmente menor o número de escolares que haviam tido menarca até a data da entrevista; X 12 = 12,57; p < 0,001. Quanto aos estágios do desenvolvimento somático, observou-se maior frequência de meninas pre-púberes e menor frequência de escolares classificadas como adolescentes, nas escolas públicas; X23 = 17,0; p < 0,001. As medidas estimadas para a menarca por probitos: Escolas Públicas 12,79 mais ou menos 0,05 anos SE; 1,10 anos SD; Escolas Particulares 12,27 mais ou menos 0,05 anos SE e 1,10 anos SD. As equaçöes de regressäo estabelecidas foram: Escolas Públicas y = 23,42 + 25,68 x Escolas Particulares y = 22,01 + 24,82 x; sendo: x = log de determinada idade; y = probito encontrado para x, o qual corresponde a por cento de meninas menstruando (tabela de transformaçäo de probitos em por cento) , (78). Para a populaçäo de 4.003 escolares, a qual foi considerada representativa da populaçäo de escolares de 9 a 17 anos em Salvador, a média foi 12,51 mais ou menos 0,04 SE, 1,10 anos SD. A equaçäo estabelecida foi y = - 21,66 + 24,30 x. Segundo os resultados dos testes de comparaçäo dos coeficientes de regressäo linear simples, observamos que nas escolas públicas somente os indivíduos classificados como grupo racial médio (os mulatos médios), apresentam a menarca em idade significativamente mais baixa que os claros (brancos e mulatos claros) e escuros (mulatos escuros e pretos), 12,75 mais ou menos 1,10 SD, 12,78 mais ou menos 1,10 anos SD, 12,79 mais ou menos 1,10 SD, respectivamente.