The use of portable video media vs standard verbal communication in the urological consent process: a multicentre, randomised controlled, crossover trial.

OBJECTIVES: To determine if portable video media (PVM) improves patient's knowledge and satisfaction acquired during the consent process for cystoscopy and insertion of a ureteric stent compared to standard verbal communication (SVC), as informed consent is a crucial component of patient care and PVM is an emerging technology that may help improve the consent process. PATIENTS AND METHODS: In this multi-centre randomised controlled crossover trial, patients requiring cystoscopy and stent insertion were recruited from two major teaching hospitals in Australia over a 15-month period (July 2014-December 2015). Patient information delivery was via PVM and SVC. The PVM consisted of an audio-visual presentation with cartoon animation presented on an iPad. Patient satisfaction was assessed using the validated Client Satisfaction Questionnaire 8 (CSQ-8; maximum score 32) and knowledge was tested using a true/false questionnaire (maximum score 28). Questionnaires were completed after first intervention and after crossover. Scores were analysed using the independent samples t-test and Wilcoxon signed-rank test for the crossover analysis. RESULTS: In all, 88 patients were recruited. A significant 3.1 point (15.5%) increase in understanding was demonstrable favouring the use of PVM (P < 0.001). There was no difference in patient satisfaction between the groups as judged by the CSQ-8. A significant 3.6 point (17.8%) increase in knowledge score was seen when the SVC group were crossed over to the PVM arm. A total of 80.7% of patients preferred PVM and 19.3% preferred SVC. Limitations include the lack of a validated questionnaire to test knowledge acquired from the interventions. CONCLUSIONS: This study demonstrates patients' preference towards PVM in the urological consent process of cystoscopy and ureteric stent insertion. PVM improves patient's understanding compared with SVC and is a more effective means of content delivery to patients in terms of overall preference and knowledge gained during the consent process.

Menarche among Brazilian women: memories of experiences.

OBJECTIVE: to present women's experiences of menarche and related memories. DESIGN: qualitative study using focus groups for data collection. SETTING: the city of Campinas, São Paulo state, Brazil. PARTICIPANTS: 64 women aged 21-51 years, experiencing menstrual periods, with former or current sexual activity and no perceived infertility. METHODS: eight focus groups were carried out using a semi-structured guideline. Discussions were recorded with participants' consent, and transcribed and revised. Thematic content analysis was carried out using gender relations as the theoretical framework. FINDINGS: menarche was experienced as a passage from childhood to womanhood, associated with belonging to a new group and acquiring a new status in the family. The experiences of menarche were not always welcomed or expected, but were recalled as associated with body changes and awareness of sexual issues. The mother's behaviour and attitudes towards menarche were clearly seen as generators of strong and everlasting impressions, either in a positive or negative way. Memories related to the experience of menarche extended through their life, interfering with their relation with their own body, including their reproductive health. KEY CONCLUSIONS: the way in which menarche is experienced may exert an impact on women's reproductive health, sexuality and lifestyle behaviours. IMPLICATIONS FOR PRACTICE: the acknowledgement of menarche experiences can be useful to guide health-care providers towards more effective education of girls on sexual and reproductive health issues and better attention to women's needs.

[Pelvic floor muscle training in female sexual dysfunctions]. / Treinamento dos músculos do assoalho pélvico nas disfunções sexuais femininas.

PURPOSE: To evaluate the effect of pelvic floor muscle training (PFMT) on female sexual dysfunctions. METHODS: Twenty-six women with a diagnosis of sexual dysfunction (sexual desire, arousal, orgasmic disorders and/or dyspareunia) were included in a clinical trial with a before/after approach . The assessment was carried out before, during (after five sessions) and at the end of the treatment (after ten sessions) by two-digit palpation (assessment of pelvic floor muscle, PFM, strength), intravaginal electromyography (EMG) (capture of PFM contraction amplitudes) and Female Sexual Function Index (FSFI, a questionnaire for the evaluation of sexual function). The women underwent PFMT in different positions for ten sessions (once or twice a week). For statistical analysis, absolute and relative frequencies were used for clinical characteristics and PFM strength. The Friedman test was used to compare the FSFI domain scores and EMG values, the Students t-test was used to determine the association between these values and the characteristics of the women, and the Wilcoxon test for percent modification of the EMG. The Mann-Whitney test permitted us to compare these values with clinical characteristics. The Spearman correlation test was used to correlate the EMG values with mean total score. Results were considered statistically significant if p<0.05. RESULTS: A significant improvement (p<0.0001) of FSFI scores was observed at the end of treatment compared to the values observed before and in the middle of treatment. Regarding the EMG, the amplitudes of tonic and phasic contractions increased significantly during treatment (p<0.0001). Pelvic floor strength increased, which 69% of the women presenting grade 4 or 5 at the end of treatment, with a total improvement of sexual complaints. CONCLUSIONS: The PFMT improved muscle strength and electromyography contraction amplitudes, with improved sexual function, indicating that this physiotherapy approach may be successfully used for the treatment of female sexual dysfunctions.

The effectiveness of connective tissue massage in the treatment of primary dysmenorrhea among young women / Efetividade da massagem do tecido conjuntivo no tratamento da dismenorréia primária em mulheres jovens

OBJECTIVE: to evaluate the possible effectiveness of connective tissue massage for the non-medical treatment of primary dysmenorrhea. METHODS: this was a pilot observational cohort study. SETTING: University clinics. PARTICIPANTS: Seventy two young women presenting primary dysmenorrhea. INTERVENTION: Physiotherapy students in their last year at university and physiotherapists were trained for 20 hours to apply the massage. All volunteers were submitted to lumbar connective tissue massage twice weekly, while they were not menstruating, during the three menstrual cycles that followed admission. The following regions were manipulated: sacral, lumbar, last thoracic vertebrae and subcostal. INDICATORS: Pain score, use of pain medication and other menstrual systemic symptoms over time (before treatment, after each of the three menstrual periods during treatment, and in the second and in the third month following treatment). RESULTS: after the first treatment month, the pain score decreased significantly (p<0.001). The percentage of women requiring pain medication and reporting systemic symptoms decreased over time, although there was no correlation between the number of massages and the pain score in the multiple regression analysis. CONCLUSIONS: connective tissue massage may cause a reduction in menstrual pain but the study design does leaves open the possibility of a placebo effect. The results justify performing a randomized clinical trial to confirm whether such an effect exists or not.

OBJETIVO: avaliar a possível efetividade da massagem do tecido conjuntivo para o tratamento não medicamentoso da dismenorréia primária. MÉTODOS: estudo piloto, do tipo observacional de coorte com setenta e duas mulheres jovens com dismenorréia primária em Clínica Universitária. Estudantes de fisioterapia e fisioterapeutas receberam treinamento de 20 horas para aplicar a massagem. Todas as voluntárias receberam massagem do tecido conjuntivo lombar duas vezes por semana, no período intermenstrual durante os três ciclos menstruais após a admissão. As regiões manipuladas foram: sacral, lombar, última vértebra torácica e sub-costal. Desfechos avaliados: Escore de dor, uso de medicamentos e ocorrência de outros sintomas sistêmicos ao longo do tempo (antes do tratamento, após cada ciclo menstrual durante o tratamento e nos dois meses após o tratamento). RESULTADOS: o escore de dor diminuiu significativamente após o primeiro mês de tratamento (p<0,001). A porcentagem de voluntárias que precisou de medicamentos para dor e que relatou sintomas sistêmicos diminuiu com o tempo de tratamento, mas não houve correlação entre o número de massagens e o escore de dor na análise multivariada. CONCLUSÃO: a massagem do tecido conjuntivo pode causar uma redução da dor menstrual, mas o tipo de estudo não permite excluir um efeito placebo. Os resultados justificam a realização de estudo clínico randomizado para confirmar ou não esse efeito.

Treinamento dos músculos do assoalho pélvico nas disfunções sexuais femininas / Pelvic floor muscle training in female sexual dysfunctions

OBJETIVO: avaliar o efeito do treinamento dos músculos do assoalho pélvico (TMAP) sobre as disfunções sexuais femininas. MÉTODOS: para esse ensaio clínico com abordagem antes e depois, foram incluídas 26 mulheres que apresentavam diagnóstico de disfunção sexual (transtorno de desejo sexual, de excitação, orgástico e/ou dispareunia). As participantes foram avaliadas antes, na metade (após cinco sessões) e ao final do tratamento (após dez sessões), por meio da palpação vaginal bidigital (avaliação da força dos músculos do assoalho pélvico-MAP), eletromiografia (EMG) intravaginal (captação das amplitudes de contração dos MAP) e Female Sexual Function Index (FSFI), questionário de avaliação da função sexual. As mulheres foram submetidas ao TMAP em diferentes posições, por dez sessões (uma ou duas vezes na semana). Para análise estatística, utilizou-se frequências absolutas e relativas para características clínicas e força dos MAP. Empregou-se teste de Friedman para comparação dos escores dos domínios do FSFI e valores da EMG, t de Student para associação entre esses valores e características das mulheres e Wilcoxon para modificação percentual da EMG. O teste Mann-Whitney permitiu comparar esses valores com características clínicas. Para correlacionar os valores da EMG com escore total médio, utilizou-se teste de correlação de Spearman. Adotou-se nível de significância de p<0,05. RESULTADOS: foi observada melhora significativa (p<0,0001) dos escores do FSFI ao final do tratamento quando comparado às avaliações inicial e intermediária. Em relação à EMG, as amplitudes das contrações fásicas e tônicas aumentaram significativamente (p<0,0001) ao longo do tratamento. Houve aumento na força do assoalho pélvico, com 69 por cento das mulheres apresentando grau 4 ou 5 na avaliação final e melhora total das queixas sexuais. CONCLUSÕES: o TMAP resultou na melhora da força muscular e amplitudes de contração pela EMG, com melhora na função sexual, o que indica que essa abordagem terapêutica pode ser utilizada com sucesso no tratamento das disfunções sexuais femininas.

PURPOSE: to evaluate the effect of pelvic floor muscle training (PFMT) on female sexual dysfunctions. METHODS: twenty-six women with a diagnosis of sexual dysfunction (sexual desire, arousal, orgasmic disorders and/or dyspareunia) were included in a clinical trial with a before/after approach . The assessment was carried out before, during (after five sessions) and at the end of the treatment (after ten sessions) by two-digit palpation (assessment of pelvic floor muscle, PFM, strength), intravaginal electromyography (EMG) (capture of PFM contraction amplitudes) and Female Sexual Function Index (FSFI, a questionnaire for the evaluation of sexual function). The women underwent PFMT in different positions for ten sessions (once or twice a week). For statistical analysis, absolute and relative frequencies were used for clinical characteristics and PFM strength. The Friedman test was used to compare the FSFI domain scores and EMG values, the Students t-test was used to determine the association between these values and the characteristics of the women, and the Wilcoxon test for percent modification of the EMG. The Mann-Whitney test permitted us to compare these values with clinical characteristics. The Spearman correlation test was used to correlate the EMG values with mean total score. Results were considered statistically significant if p<0.05. RESULTS: a significant improvement (p<0.0001) of FSFI scores was observed at the end of treatment compared to the values observed before and in the middle of treatment. Regarding the EMG, the amplitudes of tonic and phasic contractions increased significantly during treatment (p<0.0001). Pelvic floor strength increased, which 69 percent of the women presenting grade 4 or 5 at the end of treatment, with a total improvement of sexual complaints. CONCLUSIONS: the PFMT improved muscle strength and electromyography contraction amplitudes, with improved sexual function, indicating that this physiotherapy approach may be successfully used for the treatment of female sexual dysfunctions.

Association between operational indexes and the utilization rate of a general surgery center.

This is a prospective study that focused on the dynamics of operating rooms using operational indexes that measure optimization, resistance, overload and utilization of the surgical unit, and also identified the factors most associated with these indexes. A total of 1,908 surgeries were analyzed over a period of two months in 2007. The average rates of utilization, optimization and resistance indexes were 80.41%, 65.35% and 34.65% respectively. The difference between the positive and negative overload index was low (5.42%). Operating room rescheduling and delays were the variables that contributed the most to the increase in these indexes. In the linear regression statistical model, the utilization rate was found to be the first common variable selected in the overload, resistance and optimization indexes. It is essential to work on these operational indexes with a view to obtain satisfactory results in the management of the surgical center, with well-defined work processes and teamwork.

Association between characteristics of current menses and preference for induced amenorrhea.

BACKGROUND: Several studies suggest that many women would prefer to avoid menses altogether, but few studies have examined the social or clinical predictors of such preference. STUDY DESIGN: In total, 1224 healthy women of reproductive age were surveyed in Brazil, Germany and the United States regarding social, menstrual and reproductive characteristics and preferences for various dimensions of menstruation, including the ideal interval between menses. The extent to which a preference to never bleed was predicted by current experiences with menses was evaluated. RESULTS: Long menses, menstrual pain and a perceived high cost of pads and tampons were predictive of preferring amenorrhea over all other menstrual patterns after controlling for age, parity and education. Independent significant associations were also found with increasing degrees of life stress and ever use of injectable contraceptives. CONCLUSION: A negative experience with menstruation, a high ranking of life stress and ever use of injectable contraception were independently associated with a preference to avoid menses altogether.

Association between operational indexes and the utilization rate of a general surgery center / La asociación entre los índices operacionales y la tasa de ocupación de un centro quirúrgico general / Associação entre os índices operacionais e a taxa de ocupação de um centro cirúrgico geral

This is a prospective study that focused on the dynamics of operating rooms using operational indexes that measure optimization, resistance, overload and utilization of the surgical unit, and also identified the factors most associated with these indexes. A total of 1,908 surgeries were analyzed over a period of two months in 2007. The average rates of utilization, optimization and resistance indexes were 80.41 percent, 65.35 percent and 34.65 percent respectively. The difference between the positive and negative overload index was low (5.42 percent). Operating room rescheduling and delays were the variables that contributed the most to the increase in these indexes. In the linear regression statistical model, the utilization rate was found to be the first common variable selected in the overload, resistance and optimization indexes. It is essential to work on these operational indexes with a view to obtain satisfactory results in the management of the surgical center, with well-defined work processes and teamwork.

Se trata de un estudio prospectivo que analizó la dinámica de las salas quirúrgicas a través de índices operacionales que miden la optimización, resistencia, sobrecarga y ocupación del centro quirúrgico, y también identificó los factores que más se asociaron a esos índices. Fueron analizadas 1.908 cirugías, durante dos meses en el año de .2007. La tasa de ocupación y los índices de optimización y resistencia promedios encontrados fueron 80,41, 65,35 y 34,65 por ciento, respectivamente. La diferencia entre el índice de sobrecarga positivo y negativo fue bajo (5,42 por ciento). El cambio de sala y el atraso, respectivamente, fueron las variables que más contribuyeron para la elevación de esos índices. En la prueba estadística de regresión linear se observó que la tasa de ocupación fue la primera variable común seleccionada tanto en los índices de sobrecarga, resistencia y optimización. Es fundamental la actuación sobre eses índices operacionales para obtener resultados satisfactorios en la administración del centro quirúrgico, con procesos bien definidos y trabajo en equipo.

Estudo prospectivo que analisou a dinâmica das salas cirúrgicas através de índices operacionais que medem a otimização, resistência, sobrecarga e ocupação do centro cirúrgico, e também identificou os fatores que mais se associaram a esses índices. Foram analisadas 1908 cirurgias, durante dois meses de 2007. A taxa de ocupação e os índices de otimização e resistência médios encontrados foram 80,41, 65,35 e 34,65 por cento, respectivamente. A diferença entre o índice de sobrecarga positivo e negativo foi baixo (5,42 por cento). O remanejamento de sala e o atraso, respectivamente, foram as variáveis que mais contribuíram para a elevação desses índices. No teste estatístico de regressão linear observou-se que a taxa de ocupação foi a primeira variável comum selecionada tanto nos índices de sobrecarga, resistência como otimização. É fundamental a atuação sobre esses índices operacionais para se obter resultados satisfatórios no gerenciamento do centro cirúrgico, com processos bem definidos e trabalho em equipe.

Process for obtaining informed consent: women's opinions.

UNLABELLED: In Brazil, every study involving human beings is required to produce an informed consent form that must be signed by study participants: this is stated in Resolution 196/96.(1) Consent must be obtained through a specific structured process. OBJECTIVE: To present the opinions of women regarding how the process of obtaining informed consent should be conducted when women are invited to participate in studies on contraceptive methods. SUBJECTS AND METHODS: Eight focus groups were conducted, involving a total of 51 women living in the metropolitan region of Campinas. The women involved in the study were either participating in a clinical trial in the area of women's health or had participated in such a trial in the previous 12 months. A thematic guide was used to conduct the focus group discussions; the discussions were recorded, transcribed and a thematic analysis performed. RESULTS: In general, the person who invites a woman to participate in a study should be a member of the research team but not the principal investigator. Information relating to the study should be given orally and in writing, both individually and in the group setting. Study volunteers should be informed about, among other things, the risks, possible side effects and discomforts, including long-term effects. The use of audiovisual aids to provide information was suggested. CONCLUSION: The process for obtaining informed consent was seen as a means of establishing a relationship between the volunteers and the investigator/research team. The information that the study participants expected to be given coincides with the requirements established under Resolution 196/96. The use of audiovisual aids would improve understanding of the information provided.

Severe maternal morbidity (near miss) as a sentinel event of maternal death. An attempt to use routine data for surveillance.

BACKGROUND: To identify all the records within the Brazilian Hospital Information System (HIS) that contained information suggestive of severe maternal morbidity (near miss); to describe the diagnoses and procedures used; to identify variables associated with maternal death. METHODS: A descriptive population study with data from the HIS and Mortality Information System (MIS) files of records of women during pregnancy, delivery and in the postpartum period in all the capital cities of the Brazilian states in 2002. Initially, records of women between 10 and 49 years of age were selected; next, those records with at least one criterion suggestive of near miss were selected. For the linkage of HIS with MIS and HIS with itself, a blocking strategy consisting of three independent steps was established. In the data analysis, near miss ratios were calculated with corresponding 95% confidence interval and the diagnoses and procedures were described; a multiple logistic regression model was adjusted. Primary and secondary diagnoses and the requested and performed procedures during hospitalization were the main outcome measures. RESULTS: The overall maternal near miss ratio was 44.3/1,000 live births. Among the records indicating near miss, 154 maternal deaths were identified. The criteria of severity most frequently found were infection, preeclampsia and hemorrhage. Logistic regression analysis resulted in 12 variables, including four significant interactions. CONCLUSION: Although some limitations, the perspective of routinely using this information system for surveillance of near miss and implementing measures to avoid maternal death is promising.

[Probabilistic record linkage: an application to severe maternal morbidity (near miss) and maternal mortality]. / Relacionamento probabilístico de registros: uma aplicação na área de morbidade materna grave (near miss) e mortalidade materna.

This article presents an experience with record linkage from the Brazilian Hospital Information System (SIH) with the Mortality Information System (SIM), and the SIH with itself, applied to severe maternal morbidity (near miss) and maternal mortality. This was an empirical study using Brazilian data for the state capitals and Federal District in 2002. For the two linkages separately applied in each capital, a three simple step blocking strategy was established, plus related multiple steps and also two clerical review strategies. From the total number of true pairs found after the two linkages, simple steps failed to find fewer than 8%, while the multiple step strategy failed to find only 0.7%. This approach allowed exploring the issue of severe maternal morbidity and mortality in these databases. The number of pairs found and reviewed under the multiple steps strategy was lower than the sum of pairs obtained with the three simple steps, and fewer pairs were lost. However, for the record linkage of the SIH with itself, both strategies are suggested.

Relacionamento probabilístico de registros: uma aplicação na área de morbidade materna grave (near miss) e mortalidade materna / Probabilistic record linkage: an application to severe maternal morbidity (near miss) and maternal mortality

Apresentar uma experiência de relacionamento do Sistema de Informações Hospitalares (SIH) com o Sistema de Informações sobre Mortalidade (SIM), e do SIH com ele próprio, aplicados na área de morbidade materna grave (near miss) e mortalidade materna. Trata-se de um estudo empírico, utilizando-se dados brasileiros das capitais de estados e do Distrito Federal em 2002. Para os dois relacionamentos, aplicados separadamente em cada uma das capitais, estabeleceu-se estratégia de blocagem em três passos simples, bem como a de múltiplos passos relacionados, e duas de revisão manual. Do total de pares verdadeiros dos dois relacionamentos, menos de 8 por cento não puderam ser localizados pelos passos simples, enquanto que a estratégia de múltiplos passos deixou de localizar apenas 0,7 por cento. Foi possível explorar o assunto de mortalidade e morbidade materna grave nos bancos de dados. O número de pares formados e revisados sob a estratégia de múltiplos passos foi inferior à soma dos pares nos três passos simples e, além disso, menos pares foram perdidos. Porém, para o relacionamento do SIH com ele próprio, sugerem-se as duas estratégias.

This article presents an experience with record linkage from the Brazilian Hospital Information System (SIH) with the Mortality Information System (SIM), and the SIH with itself, applied to severe maternal morbidity (near miss) and maternal mortality. This was an empirical study using Brazilian data for the state capitals and Federal District in 2002. For the two linkages separately applied in each capital, a three simple step blocking strategy was established, plus related multiple steps and also two clerical review strategies. From the total number of true pairs found after the two linkages, simple steps failed to find fewer than 8 percent, while the multiple step strategy failed to find only 0.7 percent. This approach allowed exploring the issue of severe maternal morbidity and mortality in these databases. The number of pairs found and reviewed under the multiple steps strategy was lower than the sum of pairs obtained with the three simple steps, and fewer pairs were lost. However, for the record linkage of the SIH with itself, both strategies are suggested.

Vulnerabilidade de gênero para a paternidade em homens adolescentes / Gender vulnerability for parenthood among male adolescents

OBJETIVO: Analisar as relações de gênero vivenciadas por adolescentes do sexo masculino e como elas contribuem para torná-los vulneráveis à gravidez na adolescência. MÉTODOS: Estudo qualitativo realizado em Campo Grande, Mato Grosso do Sul, em 2003. Participaram 13 adolescentes masculinos com menos de 20 anos, com um único filho de até 11 meses, cuja mãe estava na mesma faixa etária do pai. Realizaram-se entrevistas semi-estruturadas gravadas. Após transcrição, procedeu-se à análise temática de conteúdo. RESULTADOS: Identificaram-se estereótipos de gênero em que se destacavam papéis de líder, provedor e ativo sexualmente, bem como a rejeição a ser cuidador. Esses papéis apareceram consolidados principalmente na perspectiva dos entrevistados acerca do trabalho como marcador de sua condição de homem e provedor da família. A liderança dos adolescentes prevaleceu no relacionamento com a mãe de seu filho, notadamente na iniciativa das relações sexuais e no uso de contraceptivos. A gravidez foi considerada por eles como "por acaso" e inesperada, mas a paternidade foi vivenciada como uma prova final de sua condição de homens adultos. CONCLUSÕES: Verificou-se a condição de vulnerabilidade dos adolescentes para a paternidade em virtude da socialização de gênero nos moldes tradicionais. Isso foi evidenciado com a ausência dos papéis relativos ao cuidado consigo próprio e com os outros, com a incorporação precoce de papéis de dominação sexual masculina e de trabalhador e pai, ou seja, deixar de ser criança e alcançar a condição de homem.

OBJECTIVE: To analyze gender relations perceived by male adolescents and how they contribute to making them more vulnerable to pregnancy during adolescence. METHODS: Qualitative study carried out in Campo Grande, Midwestern Brazil, in 2003. Subjects were 13 male adolescents under 20 years of age, fathers of an only child aged up to 11 months whose mother was in the same age group as them. Semi-structured interviews were carried out, tape recorded and transcribed. Thematic content analysis was carried out. RESULTS: Gender stereotypes were identified in which the role of leader, provider, and sexually active was stressed and the role of caregiver was rejected. These roles seemed consolidated especially in the subjects' perspective regarding paid employment as a marker of their male condition as well as of a family provider. Adolescents' leadership prevailed in the relationship with the mother of their child especially in taking initiative in sexual intercourse and the use of contraceptives. They considered that pregnancy was unexpected and happened "by chance". However, fatherhood was experienced as a definite evidence of their status as adult men. CONCLUSIONS: Male adolescents showed to be vulnerable to fatherhood due to gender socialization following traditional patterns. This was evidenced by the inexistence of roles related to self care and care for others, and early playing roles of male sexual dominance, of father and family provider in order to grow up and become a man.

Delivery of microbicides to the vagina: difficulties reported with the use of three devices, adherence to use and preferences.

PURPOSE: A crossover study was carried out in 405 couples to compare women's difficulties with three different devices that could be used to administer a microbicide and to evaluate adherence to use and preference for any one of the devices. METHODS: Couples used a single size diaphragm, a vaginal ring or disposable applicators for 1 month each in a randomly assigned order. RESULTS: Few women reported difficulty using the applicators or the ring; however, almost two-thirds reported difficulty using the diaphragm. Approximately 5%, 10% and 40% of the women and a similar but slightly lower percentage of their partners reported incorrect use of the applicator, vaginal ring and diaphragm, respectively. About half the women preferred the vaginal ring, while around half the men preferred the applicator. CONCLUSION: The release of microbicides from a vaginal ring is a lead worth pursuing. The diaphragm is the only one of the three devices that also offers mechanical protection, but it requires greater investment in patient education to ensure adherence to use.

Women's responses to menses and nonbleeding intervals in the USA, Brazil and Germany.

BACKGROUND: Studies from several countries suggest women differ in their preferred length of nonbleeding intervals, yet studies to date have not explored the social determinants of such preferences. METHOD: We report results from a menstrual preference and social survey of 1207 healthy women in three age groups (18-20, 25-34 and 45-49 years) and two educational strata (high and low educational attainment), from Campinas (Brazil), Heidelberg (Germany) and Ann Arbor (USA) ( approximately 400 women from each country). RESULTS: Women's preferred length of nonbleeding intervals differed significantly between countries. In Ann Arbor, only 15.5% of women preferred to bleed monthly, vs. 30.2% in Heidelberg. In both Ann Arbor and Campinas, approximately one-third of women preferred to "never" have menses, compared to 8.2% in Heidelberg. Multivariate analyses indicated that country, church attendance, stress and menstrual pain were significant predictors of women's preferences. CONCLUSION: The most common preference among women was to bleed once every 3 months, but preferences varied substantially by country groups. Preferences for nonbleeding intervals were, in part, explained by personal experiences of stress or menstrual pain, but unexplained cultural differences persist between country groups.

[Gender vulnerability for parenthood among male adolescents]. / Vulnerabilidade de gênero para a paternidade em homens adolescentes.

OBJECTIVE: To analyze gender relations perceived by male adolescents and how they contribute to making them more vulnerable to pregnancy during adolescence. METHODS: Qualitative study carried out in Campo Grande, Midwestern Brazil, in 2003. Subjects were 13 male adolescents under 20 years of age, fathers of an only child aged up to 11 months whose mother was in the same age group as them. Semi-structured interviews were carried out, tape recorded and transcribed. Thematic content analysis was carried out. RESULTS: Gender stereotypes were identified in which the role of leader, provider, and sexually active was stressed and the role of caregiver was rejected. These roles seemed consolidated especially in the subjects' perspective regarding paid employment as a marker of their male condition as well as of a family provider. Adolescents' leadership prevailed in the relationship with the mother of their child especially in taking initiative in sexual intercourse and the use of contraceptives. They considered that pregnancy was unexpected and happened "by chance". However, fatherhood was experienced as a definite evidence of their status as adult men. CONCLUSIONS: Male adolescents showed to be vulnerable to fatherhood due to gender socialization following traditional patterns. This was evidenced by the inexistence of roles related to self care and care for others, and early playing roles of male sexual dominance, of father and family provider in order to grow up and become a man.

Morte materna declarada e o relacionamento de sistemas de informações em saúde / Declared maternal death and the linkage between health information systems

Objetivo: Descrever as características da mortalidade materna segundo Sistema de Informação sobre Mortalidade em relação a dados correspondentes a esses registros em outros sistemas. Métodos: Estudo descritivo, com utilização dos dois sistemas de informações de dados vitais e do sistema hospitalar, para as 26 capitais estaduais e o Distrito Federal do Brasil, em 2002. Inicialmente foram calculadas as razões de mortalidade materna e obtidas informações das mortes maternas declaradas. A partir dessas mortes relacionou-se probabilisticamente os Sistema de Informação sobre Mortalidade com o Sistema de Informações sobre Nascidos Vivos e com o Sistema de Informações Hospitalares, utilizando-se o programa Reclink II, com estratégia de blocagem em múltiplos passos. Para os registros pareados, foram detalhados os diagnósticos e procedimentos hospitalares aproximados pelos critérios mais conhecidos de morbidade materna grave. Resultados: Foram registradas 339 mortes maternas em 2002, com razões de mortalidade materna oficial e ajustada, respectivamente, de 46,4 e 64,9 (mortes por 100.000 nascidos vivos). No relacionamento com os dados do sistema de nascidos vivos, foi possível localizar 46,5 por cento das mortes maternas e, com o de informações hospitalares, localizaram-se 55,2 por cento das mortes. O diagnóstico de internação mais frequente foi o de infecção 13,9 por cento, e o procedimento com maior percentagem 39,0 por cento foi o de admissão à UTI. Conclusões: foi baixa a percentagem de relacionamento entre os registros das três fontes estudadas. Nenhuma das possíveis falhas e ou impossibilidade de relacionamento apontadas, isoladamente ou em conjunto, podem explicar esse baixo percentual.

[Declared maternal death and the linkage between health information systems]. / Morte materna declarada e o relacionamento de sistemas de informações em saúde.

OBJECTIVE: To describe the characteristics of maternal mortality according to the Mortality Information System in relation to the data corresponding to these records that are in other systems. METHODS: This was a descriptive study using two information systems on vital data and another on the hospital system, for the 26 state capitals and the Federal District of Brazil, in 2002. Initially, the maternal mortality ratios were calculated and information on declared maternal deaths were obtained. From these data, the Mortality Information System was probabilistically linked with the Live Birth Information System and the Hospital Information System, using the "Reclink II" software, with a multiple-step blocking strategy. For paired records, the diagnoses and hospital procedures brought together by the best-known criteria for severe maternal morbidity were detailed. RESULTS: A total of 339 maternal deaths were recorded in 2002. The official and adjusted maternal mortality ratios were, respectively, 46.4 and 64.9 (deaths per 100,000 live births). By correlating with data from the live birth system, 46.5% of the maternal deaths could be located; and from the hospital information, 55.2%. The most frequent admission diagnosis was infection (13.9%) and the most frequent procedure was intensive care unit admission (39.0%). CONCLUSIONS: There were low percentage linkages between the records from the three sources studied. However, the possible failures and/or impossibilities in the linkages indicated may separately or jointly explain these low percentages.

Preferências de mulheres brasileiras quanto a mudanças na menstruação / Preference of Brazilian women regarding menstrual changes

OBJETIVO: avaliar a associação entre a experiência menstrual de mulheres e as mudanças preferidas na menstruação. MÉTODOS: estudo de corte transversal, no qual 420 mulheres foram entrevistadas, alocadas em três grupos de idade (18-20, 25-34 e 45-49 anos), e em dois grupos de escolaridade (<8 séries e >12 séries), que tinham menstruado nos três meses que antecederam a entrevista. As mulheres foram selecionadas em Campinas (SP), em nove serviços de saúde privados e em sete públicos. Para a coleta de dados, foi utilizado um questionário construído com base nos resultados de um estudo piloto prévio realizado com grupos focais. Um banco de dados foi preparado com as informações registradas nos questionários e os dados foram analisados com o software SAS versão 8.2. Para análise estatística, foram utilizados o teste do chi2 de Pearson e o teste exato de Fisher para avaliar a associação entre as variáveis estudadas (p<0,05). RESULTADOS: a maioria das mulheres preferia intervalos entre menstruações maiores que uma vez ao mês. Houve associação dos intervalos característicos da menstruação das mulheres, bem como do grau de interferência da menstruação nas atividades diárias, com o intervalo preferido entre menstruações, que é o maior que uma vez por mês (p=0,0248 e p=0,048, respectivamente). Não houve associação das características da dor: duração, intensidade e uso de medicação com o intervalo preferido pelas mulheres. CONCLUSÕES: os resultados sugerem que as mulheres gostariam de menstruar em intervalos maiores do que um mês ou até gostariam de nunca menstruar.

PURPOSE: to evaluate the association between women's menstrual experience and preferred changes in their menstrual cycles. METHODS: a cross-sectional study design was used. A total of 420 women were interviewed. Participants complied with the following criteria: age (18 to 20, 25 to 34 and 45 to 49 years); schooling (<8 years and >12 years); having menstruated during the three months previous to the study. Subjects were selected in the city of Campinas (SP), in nine private and seven public health services. For data collection, a questionnaire was prepared on the basis of the results of a previous pilot study that consisted of small groups. A data bank was prepared with the information registered in the questionnaires and the analysis was carried out with SAS, version 8.2. For the statistical analysis, the Pearson chi2 test and the Fisher exact test were used to evaluate the association between variables (p<0.05). RESULTS: most subjects preferred greater than once a month intervals between menstruations. There was an association of the typical menstrual intervals experienced by women (p=0.0248) and the degree of interference of menstruation with daily activities (p=0.048) with the preferred interval between menses. However, there was no association between preferred intervals by women and the following characteristics of pain: duration, intensity and use of medication. CONCLUSIONS: the results suggest that women would like intervals longer than one month or to never menstruate.

[Hysterosonography: evaluation of the uterine cavity in women with abnormal uterine bleeding]. / Histerossonografia: avaliação da cavidade uterina com sangramento anormal.

OBJECTIVE: To compare the diagnostic accuracy of sonohysterography with that of hysteroscopy and ultrasonography for the diagnosis of uterine alterations with abnormal uterine bleeding. METHODS: Fifty three patients scheduled for hysteroscopy at the Hysteroscopy Sector of the Women's Hospital (CAISM) at the "Universidade Estadual de Campinas" (Brazil) were included in the study. Sensitivity and specificity of the three propaedeutic methods were compared using histology as the gold standard. RESULTS: Sensitivity of sonohysterography and of hysteroscopy was 94% and that of ultrasonography 83%. The specificity of sonohysterography was 77%, of hysteroscopy 91% and of ultrasonography 69%. There were no significant differences between sensitivities of the three methods. However, a significant difference was found between the specificity of ultrasonography and hysteroscopy. Sonohysterography demonstrated a much greater capability than ultrasonography to identify endometrial polyps. CONCLUSION: Sonohysterography may be used to complement ultrasonography and to substitute hysteroscopy, for the diagnosis of alterations that result in abnormal uterine bleeding.