Clinical Assessment of 3 Intrauterine Devices in Adolescent Girls: A Randomized Clinical Trial.

STUDY OBJECTIVE: To assess clinical performance, bleeding pattern, dysmenorrhea, and satisfaction up to 1 year after placement of 3 types of intrauterine devices (IUDs) (TCu380A, levonorgestrel 52 mg, and levonorgestrel 19.5 mg) in adolescents METHODS: The study was a randomized trial with 318 adolescents allocated to the 3 IUDs. We assessed reasons for removal, continuation, menstrual patterns, dysmenorrhea, and satisfaction. RESULTS: Participants aged (mean ± SD) 17.9 ± 1.4 years, with 80.8% being nulligravidae. After 1 year, 265 (83.3%) continued using the IUD; however, the continuation rate of TCu380A (75.4 ± 4.2) was lower than that of both the levonorgestrel 52-mg (88.6 ± 3.1) and 19.5-mg IUDs (86.8 ± 3.3), and bleeding/pain and expulsion were the main reasons for removal of the TCu380A IUD. The duration of menstruation was longer among the TCu380A IUD users (6.0 ± 2.0 days) than those using the levonorgestrel 52 mg (2.5 ± 3.9) and 19.5 mg (3.2 ± 3.2) devices, P < .001. Amenorrhea was reported by 49.5% and 37.8% users of the levonorgestrel 52-mg and 19.5-mg devices, respectively, P < .001. Dysmenorrhea was reported in 68.5% of all participants at the baseline; this was 67.9% of the TCu380A group and 33.3% and 36.0% of the levonorgestrel 52-mg and 19.5-mg IUD groups, respectively, P < .001. Satisfaction ranged from 80.7% in the TCu380A group to 97.8% in the levonorgestrel 52-mg group (P = .03). CONCLUSION: The 3 IUDs are suitable for adolescents, with high contraceptive efficacies and rates of continuation within 1 year of use and high degrees of satisfaction. Users of the hormonal IUDs reported lower expulsion rates, more favorable menstrual patterns, and less dysmenorrhea compared with the TCu380A IUD.

Pain and ease of insertion of three different intrauterine devices in Brazilian adolescents: A participant-blinded randomized trial.

OBJECTIVES: To compare pain and ease of insertion of the copper 380 mm2, levonorgestrel 52 mg, and levonorgestrel 19.5-mg intrauterine devices (IUDs) in Brazilian adolescents. STUDY DESIGN: We conducted a participant-blinded randomized trial at two clinics in Brazil. We enrolled 318 adolescents<19 years old in a 1:1:1 ratio from November 2021 to February 2022. We informed the adolescents about the IUD type inserted after they evaluated the pain associated with the IUD insertion using a Visual Analogue Scale and immediately after that the healthcare provider who placed the IUD evaluated the ease of the procedure. RESULTS: The VAS pain level was significantly higher after the levonorgestrel 52-mg IUD placement, median and [interquartile range, IQ] 8.0 [4.0] than the copper 380-mm2 IUD 7.0 [4.0], and the levonorgestrel 19.5-mg IUD 7.0 [6.0] (p = 0.001). The placement was easier after the copper 380-mm2 IUD (87/106, 82.1%) and the levonorgestrel 19.5-mg IUD (91/106, 85.8%) when compared with the levonorgestrel 52-mg IUD (75/105, 70.7%). After multiple logistic regression analyses, the higher VAS pain scores were associated with the levonorgestrel 52-mg IUD (OR = 2.90), low number of pregnancies (OR -0.48), and with a history of dysmenorrhea (OR = 2.67). CONCLUSIONS: The placement of the copper 380-mm2 IUD and the levonorgestrel 19.5-mg IUD was associated with lower pain according to the adolescent and was easier according to the provider when compared with the levonorgestrel 52-mg IUD. However, the small observed differences may not be clinically relevant. IMPLICATIONS: We found that the three types of IUDs were generally easy to place; however, mean pain scores were high during insertions. Our findings of high pain scores reinforce the need for interventions to reduce pain for adolescent IUD insertion.

Single-visit long-acting reversible contraception provision and pregnancy rates within 3 months.

OBJECTIVES: To assess the occurrence of pregnancy in a cohort of women who received a copper intrauterine device (IUD), hormonal IUDs or an etonogestrel (ENG) contraceptive implant at a single-visit practice. METHODS: Prospective study conducted at the University of Campinas, Campinas, São Paulo, Brazil. We obtained data from four ongoing studies including both the date of the device placement, the first day of the last menstrual period, and the occurrence of pregnancy up to 3 months after device placement. RESULTS: We included 2479 device placements (413 TCu380A IUDs, 1476 hormonal IUD and 590 ENG implants). Almost half of the device placements (1113/2479; 44.9%) were performed within the first 5 days of the menstrual cycle. We observed three pregnancies: one in an ENG implant user who received the implant within days 1-5 of the menstrual cycle; one in a woman who received a hormonal IUD during days 6-10 of the menstrual cycle; and one in a copper IUD user with placement during days 21-25 of menstrual cycle. CONCLUSIONS: Single-visit long-acting reversible contraception placements are a good strategy with overall very low pregnancy rates. This strategy has a potential to reduce unintended pregnancies and to reduce costs and barriers to both women and the healthcare system.

Consumo de processados e ultraprocessados por gestantes da atenção básica no tocantins / Consumption of processed and ultraprocessed by pregnant pregnant women in basic care in Tocantins / Consumo de procesados y ultraprocesados por mujeres embarazadas en cuidados básicos en Tocantins

Introdução:oconsumo frequente de alimentos industrializados, prontos para o consumo, é considerado um mau hábito alimentar em todas as fases do ciclo da vida e pode ser especialmente prejudicial aos grupos populacionais mais vulneráveis, como as mulheres grávidas.Noentanto, são preparações altamente palatáveis e práticas que, mesmo contraindicadas, continuam representando parcela importante no cardápio dos brasileiros.Objetivo:caracterizar o consumo de alimentos quanto ao grau de processamento, por gestantes adultas, atendidas na atenção básica de Palmas, Tocantins.Metodologia:o estudo investigou 60 mulheres em quatro dos sete territórios de saúde de Palmas, por meio de um recordatórioque investigou o consumo alimentar nas 24 horas anteriores à entrevista. Foram estimados pelo Dietbox, o consumo de energia, macronutrientes, ferro, cobalamina e ácido fólico totais e por grupo de alimentos, conformecategorização em quatro grupos:Grupo 1: alimentos in natura ou minimamente processados; Grupo 2: Ingredientes culinários processados; Grupo 3: Alimentos processados; Grupo 4: Alimentos ultraprocessados. Os dados foram analisados no programa Statistical Package for Social Sciences versão 23.0,por meio de estatísticas descritivas.Resultados:observou-se para o grupo de gestantes estudadas que a ingestão de micronutrientes, em sua maior parte, foi oriunda de alimentos in natura ou minimamente processados, reforçando a importância da ingestão desses tipos de alimentos para uma dieta saudável, sobretudo na gestação.No entanto, observou-se que os alimentos processados e ultraprocessados(vegetais em conservas, alguns pães, macarrão instantâneo, bolacha recheada, margarina, achocolatados, refrigerantese salsichas)ainda figuram expressivamente nas dietas das gestantes estudadas, tendo fornecido em média 28% da energia diária consumida, 83,2% dos carboidratos diários, 22% dos lipídeos totais e 15,25% das proteínas.Conclusão:processados e ultraprocessados ainda figuram na dieta das gestantes, fornecendo percentuais expressivos da energia e dos carboidratos ingeridos, porém não ofertando quantidades razoáveis de ferro, cobalamina ou ácido fólico (AU).

Introduction:the frequent consumption of industrialized, ready-to-eat foods is considereda bad eating habit at all stages of the life cycle and can be especially harmful to the most vulnerable population groups, such as pregnant women. However, they are highly palatable and practical preparations that, even contraindicated, continue to represent an important part of the Brazilian menu. Objective: to characterize food consumption according to the degree of processing, by adult pregnant women attended in primary care in Palmas, Tocantins.Methodology: the study investigated 60 women in four of the seven health territories in Palmas, through a recall that investigated food consumption in the 24 hours prior to the interview. The consumption of energy, macronutrients, iron, cobalamin and folic acid total and by food group were estimated by Dietbox, as categorized into four groups: Group 1: fresh or minimally processed foods; Group 2: Processed culinary ingredients; Group 3: Processed foods; Group 4: Ultra-processed foods. Data were analyzed using the Statistical Package for Social Sciences version 23.0 using descriptive statistics. Results:it was observed for the group of pregnant women studied that the intake of micronutrients, for the most part, came from fresh or minimally processed foods, reinforcing the importance of ingesting these types of foods for a healthy diet, especially during pregnancy. However, it was observed that processed and ultra-processed foods (canned vegetables, some breads, instant noodles, stuffed biscuits, margarine, chocolate drinks, soft drinks and sausages) still figure significantly in the diets of the pregnant women studied, providing an average of 28% of the daily energy consumed, 83.2% of daily carbohydrates, 22% of total lipids and 15.25% of proteins. Conclusion: processed and ultra-processed products still figure in the pregnant women's diet, providing significant percentages of energy and carbohydrates ingested, but not offering reasonable amounts of iron, cobalamin or folic acid (AU).

Introducción:elconsumo de alimentos industrializados se considera un mal hábito alimentario en todas las etapas del ciclo de vida,puede ser especialmente perjudicial para los grupos de población más vulnerables, como las mujeres embarazadas. Sin embargo, son preparaciones muy apetecibles y prácticas que, incluso contraindicadas, continúan representando una parte importante del menú brasileño.Objetivo: caracterizar el consumo de alimentos según el grado de procesamiento, por gestantes adultas atendidas en atención primaria en Palmas, Tocantins.Metodología: el estudio investigó 60 mujeres en cuatro de los siete territorios de salud en Palmas, mediante recordatorio del consumo de alimentos en las 24 horas previas a la entrevista. Dietbox estimó el consumo de energía, macronutrientes, hierro, cobalamina y ácido fólico total por grupo de alimentos, categorizados en cuatro grupos: Grupo 1: alimentos frescos o mínimamente procesados; Grupo 2: Ingredientes culinarios procesados; Grupo 3: Alimentos procesados; Grupo 4: Alimentos ultraprocesados. Los datos se analizaron utilizando el paquete estadístico Statistical Package for Social Sciences version 23.0 y estadística descriptiva.Resultados:para el grupo de gestantes estudiadasla ingesta de micronutrientes, en su mayor parte, provino de alimentos frescos o mínimamente procesados, lo que refuerza la importancia de ingerir este tipo de alimentos para una dieta saludable, especialmente durante el embarazo. Sin embargo, se observó que los alimentos procesados y ultraprocesados (vegetales enlatados, panes, fideos instantáneos, bizcochos rellenos, margarina, bebidas de chocolate, refrescos y embutidos) todavía figuran de manera significativa en las dietas de las embarazadas estudiadas, proporcionando un promedio del28% de la energía diaria, el 83,2% de los carbohidratos diarios, el 22% de los lípidos totales y el 15,25% de las proteínas.Conclusión: los productos procesados y ultraprocesados siguen figurando en la dieta de las embarazadas, aportando porcentajes importantes de energía y carbohidratos, pero sin ofrecer cantidades razonables de hierro, cobalamina o ácido fólico (AU).

Ingestão de nutrientes por gestantes da atenção básica no Tocantins / Nutrient intake by primary care pregnant women in Tocantins / Consumo de nutrientes por mujeres embarazadas de cuidado primario en Tocantins

Introdução:Em decorrência de alterações no comportamento alimentar materno durante os trimestres gestacionais, além das variações diárias e sazonais, podem ocorrer alterações na ingestão de nutrientes, que impactam diretamente no resultado obstétrico, sobretudo durante o primeiro trimestre de gestação. Objetivo:investigar o consumo de nutrientes por gestantes adultas, assistidas na atenção básica de Palmas,Tocantins, buscando identificar precocemente desvios evitáveis por meio de orientações dietéticas pré-natais.Metodologia:oestudo investigou 50 mulheres em quatro dos sete territórios de saúde de Palmas,Tocantins,por meio de umrecordatório que investigou o consumo alimentar nas 24 horas anteriores à entrevista. Foram estimadospelo Dietbox, a ingestão diária de energia, carboidratos, proteínas, lipídios totais, ferro, calciferol, folato e cobalamina sem considerar os nutrientes obtidos por meio da suplementação medicamentos.Os dados foram analisados no programa Statistical Package for Social Sciences versão 23.0por meio de estatísticas descritivas.Resultados:foram observados altos percentuais de inadequação da ingestão para todos os macros e micronutrientes estudados na população de gestantes. Destacaram-se 82% das gestantes com ingestões inadequadas de energia; 98% de inadequação para o ácido fólico e 94% para ferro e cobalamina. A ingestão diária de calciferol esteve inadequada em 100% das gestantes. Conclusão: ogrupo de gestantes estudado está ingerindo nutrientes aquém do recomendado, estando o binômio mãe-filho sujeitos a resultados obstétricos indesejáveis, caso nenhuma intervenção seja realizada (AU).

Introduction: Due to changes in maternal eating behavior during the gestational trimesters, in addition to daily and seasonal variations, changes in nutrient intake may occur, which directly impact obstetric outcome, especially during the first trimester of pregnancy.Objective: to investigate the consumption of nutrients by adult pregnant women, assisted in primary care in Palmas, Tocantins, seeking to early identify preventable deviations through prenatal dietary guidelines.Methodology: the study investigated 50 womenin four of the seven health territories in Palmas, through a recall that investigated food consumption in the 24 hours prior to the interview. The daily intake of energy, carbohydrates, proteins, total lipids, iron, calciferol, folate and cobalamin were estimated by Dietbox without considering the nutrients obtained through drug supplementation. Data were analyzed using the Statistical Package for Social Sciences version 23.0using descriptive statistics.Results: high percentages of inadequate intake wereobserved for all macro and micronutrients studied in the population of pregnant women. 82% of pregnant women with inadequate energy intake stood out; 98% unsuitable for folic acid and 94% for iron and cobalamin. The daily intake of calciferol was inadequate in 100% of the pregnant women.Conclusion: the group of pregnant women studied is ingesting less than recommended nutrients, and the mother-child binomial is subject to undesirable obstetric results, if no intervention is performed (AU).

Introducción: Debido a los cambios en la conducta alimentaria materna durante los trimestres gestacionales, además de las variaciones diarias y estacionales, pueden ocurrir cambios en la ingesta de nutrientes que impactan directamente en el resultado obstétrico, especialmente durante el primer trimestre del embarazo. Objetivo:investigar el consumo de nutrientes por parte de gestantes adultas, atendidas en atención primaria en Palmas, Tocantins, buscando identificar desviaciones precoces evitables a través de guías dietéticas prenatales. Metodología:el estudio investigó a 50 mujeres en cuatro de los siete territorios de salud en Palmas, a través de un recordatorio que investigó el consumo de alimentos en las 24 horas previas a la entrevista. Dietbox estimó la ingesta diaria de energía, carbohidratos, proteínas, lípidos totales, hierro, calciferol, folato y cobalamina sin considerar los nutrientes obtenidos a través de la suplementación farmacológica. Los datos se analizaron utilizando el paquete estadístico para ciencias sociales versión 23.0utilizando estadística descriptiva. Resultados:se observaron altos porcentajes de ingesta inadecuada para todos los macro y micronutrientes estudiados en la población de gestantes. Se destacó el 82% de las embarazadas con aporte energético inadecuado; 98% inadecuado para ácido fólico y 94% para hierro y cobalamina. La ingesta diaria de calciferol fue inadecuada en el 100% de las embarazadas. Conclusión: el grupo de gestantes estudiado está ingiriendo menos nutrientes de los recomendados, y el binomio madre-hijo está sujeto a resultados obstétricos indeseables, si no se realiza ninguna intervención (AU).

Heart rate recovery in asthmastic children and adolescents after clinical field test.

BACKGROUND: Inflammation caused by chronic lung disease in childhood may lead to delayed heart rate recovery (HRR) however, there is lack of evidence on HRR in this population. The aim was to assess HRR after functional capacity testing in asthmatic children and adolescents and to compare with severity and disease control. METHOD: This was a study secondary to a randomized control trial. The modified shuttle test (MST) was performed to assess functional capacity and HRR. This is an externally cadenced test in which the distance walked is the outcome. HRR was assessed after MST and was defined as HR at exercise peak minus HR in the second minute after the end of exercise. Asthma control was assessed by the Asthma Control Test (ACT). Data normality was tested by Shapiro Wilk and the comparison between groups was made by Student's t test or Mann Whitney test for numerical variables, and by Chi-square test for categorical variables. Statistical significance was considered when p < 0.05. SPSS version 20 was used in the analyzes. RESULTS: The sample included 77 patients diagnosed with asthma (asthma group - AG) who were regularly treated for asthma. Control group (CG) consisted of 44 volunteers considered healthy, matched in age and gender to AG. The median age of CG was 12 (10-14) years and in AG 11 (9-13 years) being classified as mild to moderate asthmatic, and 57% of the sample had controlled asthma by ACT. Distance walked in the CG was 952 ± 286 m and AG 799 ± 313 m, p = 0.001. HRR was more efficient in CG (79 ± 15 bpm) compared to AG (69 ± 12 bpm), p = 0.001. The mild (69 ± 12 beats) and severe (72 ± 15 beats) AG presented worse HRR compared to control group (79 ± 15 bpm), p < 0.05. CONCLUSIONS: Asthmatic children and adolescents have delayed HRR after modified Shuttle test compared to their peers, suggesting that asthma leads to autonomic nervous system imbalance. TRIAL REGISTRATION: Registered in Clinical Trials under number NCT02383069 and approved by the Universidade Nove de Julho - UNINOVE Research Ethics Committee, protocol number 738192/2014.

Associação do estado nutricional ao consumo de nutrientes em gestantes / Nutritional status associated with nutrient consumption in pregnant women

O objetivo do estudo foi avaliar o consumo de nutrientes entre gestantes, associando-o a inadequações do estado nutricional. Estudo transversal, com 96 gestantes do Tocantins, avaliando o perfil socioeconômico e da gestação atual. Dois recordatórios de 24 horas avaliaram a ingestão de nutrientes. A suplementação de nutrientes esteve inadequada em 77% das mulheres; 64% apresentaram excesso de peso pré-gestacional, sendo que 42% o mantiveram durante a gravidez. A inadequação de ganho de peso na gestação foi observada em 74% e as ingestões diárias de energia (p=0,019) e lipídeos (p=0,003) foram significativamente diferentes entre os estratos de estado nutricional pré-gestacional. Das gestantes com baixo peso, 60% ingeriram proteínas e 45% consumiram energia abaixo da recomendação. As ingestões diárias de macro e micronutrientes estavam inadequadas na população, influenciando negativamente o ganho de peso gestacional e o estado nutricional. A má nutrição traz consequências indesejáveis para o binômio, devendo ser precocemente detectada e corrigida.

Objective: to evaluate the consumption of nutrients among pregnant women, associating it with inadequate nutritional status. Method: it is a cross-sectional study with 96 pregnant women from Tocantins, with evaluation of the socioeconomic and current pregnancy profile. Two 24-hour recalls assessed nutrient intake. Results: nutrient supplementation was inadequate in 77% of women; 64% had pre-pregnancy excess weight, and 42% maintained it during pregnancy. The inadequacy of weight gain during pregnancy was observed in 74% and the daily intakes of energy (p = 0.019) and lipids (p = 0.003) were significantly different between the strata of pre-gestational nutritional status. Of the low weight pregnant women, 60% ingested proteins and 45% consumed energy below the recommendation. Daily macro and micronutrient intakes were inadequate in the population, what influenced negatively gestational weight gain and nutritional status. Conclusion: malnutrition has undesirable consequences for the binomial and should be detected and corrected early.