Use of the etonogestrel-releasing implant is associated with hypoactivation of the coagulation cascade.

BACKGROUND: The role of progestogens in haemostasis is controversial. Our objective is to evaluate the haemostatic effects of an etonogestrel-releasing implant. METHODS: This open-label, self-controlled, longitudinal study involved 20 healthy women receiving subcutaneous etonogestrel-releasing implants. At baseline, 1, 3 and 6 months, we measured the following: activated partial thromboplastin time; prothrombin time; thrombin time; fibrinogen; coagulation factors II, V, VII, VIII, IX, X and XI; von Willebrand factor; activated protein C (APC); antithrombin; free protein S; plasminogen activator inhibitor type 1 (PAI-1); alpha2-antiplasmin; thrombin-antithrombin (TAT) complex; prothrombin fragment 1 + 2 (F1 + 2); D-dimers; APC resistance. Statistical analyses included the Friedman test and ANOVA. RESULTS: Levels of APC (P < 0.01), factor II (P = 0.02), factor VII (P = 0.006), factor X (P = 0.01) and F1 + 2 (P < 0.001) were reduced, whereas those of PAI-1 (P = 0.01) and factor XI (P = 0.006) were transitory increased. All of these values, however, remained within normal ranges. Surprisingly, TAT concentrations fell below the normal range (P < 0.001). CONCLUSIONS: Our findings suggest that the etonogestrel-releasing implant does not induce a prothrombotic pattern during the first six months of use, and that its use is associated with a reduction in thrombin generation.

Estudo dos aspectos psicológicos em mulheres inférteis / Psicological aspects in infertile women

PURPOSE: To assess the frequency of stress and anxiety levels in infertile women, and to correlate these aspects with risk factors, in order to obtain data for specific psychological guidance. METHODS: The case-control study included a total of 302 women, 152 being infertile (case group: 30.3 +/- 5.4 years), and 150 non-fertile (control group: 25.7 +/- 7.9 years). The quantitative approach involved the application of Lipp's Stress Symptoms Inventory and State-Trait Anxiety Inventory. Response variables considered were: stress frequency and anxiety scores (State and Trait). Statistical analysis was performed by using the Chi-squared and Mann-Whitney tests, and logistical regression to test associations between response variables and considered risk factors. Statistical significance was defined as p < 0.05. RESULTS: The stress was more frequent in the case group than the control group (61.8 and 36.0%, respectively), however, no significant differences were observed between groups in relation to stress phases and predominant symptoms. With respect to anxiety, there were no significant differences between case and control groups as to median state scores (39.5 and 41.0; respectively) and anxiety trait scores (44.0 and 42.0; respectively). Factors significantly associated with greater risk for high anxiety scores in the case group were: primary infertility, unawareness of the causal factor, diagnostic phase investigation, religion, lack of children from other marriages. CONCLUSIONS: It can be concluded that infertile women are more vulnerable to stress; however, they are capable of adapting to stressful events without serious physical or psychological compromising.

Analise da modulacao autonomica do coracao durante condicoes de repouso em homens de meia idade e mulheres pos-menopausa / Analysis of heart autonomic modulation during resting conditions in middle-aged men and postmenopausal women

O controle autonomico do coracao pode ser investigado a partir da analise da variabilidade da requencia cardiaca (VFC). Sabe-se que o aparecimento de doencas cardiovasculares (DCV) em mulheres aumenta com a idade, principalmente apos a menopausa, quando o risco torna-se similar ao observado em homens. Assim, o objetivo deste trabalho e analisar e comparar a VFC de homens de meia-idade e de mulheres pos-menopausa em condicoes de repouso. Foram estudados dois grupos saudaveis e sedentarios, sendo 10 homens de meia-idade (52,6 +- 2,63 anos) e 10 mulheres pos-menopausa (56,8+-5,09 anos) que nao faziam uso de terapia de reposicao hormonal. A frequencia cardiaca e os intervalos R-R (iR-R) foram obtidos a partir de eletrocardiograma em tempo real, batimento a batimento, durante 6 minutos em condicoes de repouso, nas posicoes supina(S) e sentada(SE). Para analise da VFC foram calculados os indices RMSM e RMSSD dos iR-R em milissegundo(ms). Nao foram observadas diferencas estatisticamente significativas nos valores dos indices RMSM e RMSSD entre os homens e as mulheres e entre as posicoes supina e sentada de ambos os grupos. A reducao da VFC observada em ambos os grupos estudados sugere similar decrescimo da modulacao parasimpatica sobre o coracao, fato que pode contribuir para o aumento do risco de DCV observado nessa faixa etaria em ambos os sexos

Effects of raloxifene therapy on the anticoagulant system in postmenopausal women.

BACKGROUND: Raloxifene therapy is associated with a three-fold increase in the risk for venous thromboembolism; however, its effects on the hemostatic system in postmenopausal women have not been well defined. OBJECTIVE: To determine the effects of raloxifene therapy on the levels of natural anticoagulant proteins in postmenopausal women. METHODS: Sixteen healthy postmenopausal women were enrolled in this prospective longitudinal study. The patients were treated with raloxifene hydrochloride (60 mg/day) for a period of 6 months. Antithrombin and protein C activities and protein S antigen levels were measured in all users at baseline, and after 1, 3 and 6 months of treatment. Statistical analysis included one-way analysis of variance (ANOVA) and the Bonferroni test for multiple comparisons among the study periods. RESULTS: Statistically significant 5.1% and 6.5% reductions of plasma antithrombin activity were observed at 3 and 6 months of therapy, respectively (p < 0.05). Compared with baseline, raloxifene did not significantly affect protein C activity or protein S level. CONCLUSIONS: The results of this prospective study show for the first time that raloxifene use is associated with a significant reduction in plasma antithrombin activity. This effect may contribute to a procoagulant state and partly explain the increased risk of venous thromboembolism in raloxifene users.

Heart rate variability under resting conditions in postmenopausal and young women.

The aim of the present study was to compare the modulation of heart rate in a group of postmenopausal women to that of a group of young women under resting conditions on the basis of R-R interval variability. Ten healthy postmenopausal women (mean +/- SD, 58.3 +/- 6.8 years) and 10 healthy young women (mean +/- SD, 21.6 +/- 0.82 years) were submitted to a control resting electrocardiogram (ECG) in the supine and sitting positions over a period of 6 min. The ECG was obtained from a one-channel heart monitor at the CM5 lead and processed and stored using an analog to digital converter connected to a microcomputer. R-R intervals were calculated on a beat-to-beat basis from the ECG recording in real time using a signal-processing software. Heart rate variability (HRV) was expressed as standard deviation (RMSM) and mean square root (RMSSD). In the supine position, the postmenopausal group showed significantly lower (P<0.05) median values of RMSM (34.9) and RMSSD (22.32) than the young group (RMSM: 62.11 and RMSSD: 49.1). The same occurred in the sitting position (RMSM: 33.0 and RMSSD: 18.9 compared to RMSM: 57.6 and RMSSD: 42.8 for the young group). These results indicate a decrease in parasympathetic modulation in postmenopausal women compared to young women which was possibly due both to the influence of age and hormonal factors. Thus, time domain HRV proved to be a noninvasive and sensitive method for the identification of changes in autonomic modulation of the sinus node in postmenopausal women.

Heart rate variability under resting conditions in postmenopausal and young women

The aim of the present study was to compare the modulation of heart rate in a group of postmenopausal women to that of a group of young women under resting conditions on the basis of R-R interval variability. Ten healthy postmenopausal women (mean Ý SD, 58.3 Ý 6.8 years) and 10 healthy young women (mean Ý SD, 21.6 Ý 0.82 years) were submitted to a control resting electrocardiogram (ECG) in the supine and sitting positions over a period of 6 min. The ECG was obtained from a one-channel heart monitor at the CM5 lead and processed and stored using an analog to digital converter connected to a microcomputer. R-R intervals were calculated on a beat-to-beat basis from the ECG recording in real time using a signal-processing software. Heart rate variability (HRV) was expressed as standard deviation (RMSM) and mean square root (RMSSD). In the supine position, the postmenopausal group showed significantly lower (P<0.05) median values of RMSM (34.9) and RMSSD (22.32) than the young group (RMSM: 62.11 and RMSSD: 49.1). The same occurred in the sitting position (RMSM: 33.0 and RMSSD: 18.9 compared to RMSM: 57.6 and RMSSD: 42.8 for the young group). These results indicate a decrease in parasympathetic modulation in postmenopausal women compared to young women which was possibly due both to the influence of age and hormonal factors. Thus, time domain HRV proved to be a noninvasive and sensitive method for the identification of changes in autonomic modulation of the sinus node in postmenopausal women

[Incidence of cesarean section regarding the financial support source for delivery care]. / Incidência de cesáreas segundo fonte de financiamento da assistência ao parto.

OBJECTIVE: To study the types of delivery according to the category of patient admission and the most frequently reported indications for cesarean sections. METHODS: In a retrospective survey of deliveries performed in the municipality of Ribeirão Preto, São Paulo, Brazil, from 1986 to 1995, the type of delivery, category of admission and recorded diagnoses were assessed. Data were obtained from the Center of Hospital Data Processing of the Department of Social Medicine in the University of São Paulo, Ribeirão Preto. RESULTS: A total of 86,120 deliveries were registered during the study period; 5.4% were allocated in the private category, 28.7% in the prepayment category, and 65.9% in the public health system (SUS). It was observed a decrease in the private and SUS categories and an increase in the prepayment category. During the study period, the percentage of cesarean deliveries increased from 68.3% to 81.8% in the private category and from 69.1% to 77.9% in the prepayment category, and decreased from 38.7% to 32.1% in the SUS category. The major indications for cesarean section were fetal distress, with the incidence of 9.5%, 10.9% and 9.0% in the private, prepayment and SUS categories, respectively; and cephalopelvic dystocia, at the rates of 5.8%, 6.5% and 3.9%, respectively. CONCLUSION: The incidence of cesarean section varied according to admission category, with a rising trend as the pregnant woman's social status increased, but without a correlation with the obstetrical risk.