[Factors associated with condom use and knowledge about STD/AIDS among teenagers in public and private schools in São Paulo, Brazil]. / Fatores associados ao uso de preservativo masculino e ao conhecimento sobre DST/AIDS em adolescentes de escolas públicas e privadas do Município de São Paulo, Brasil.

This study aimed to compare knowledge about STD/AIDS and identify the factors associated with adequate knowledge and consistent use of male condoms in teenagers from public and private schools in the city of São Paulo, Brazil. We selected 1,594 adolescents ranging 12 to 19 years of age in 13 public schools and 5 private schools to complete a questionnaire on knowledge of STD/AIDS and use of male condoms. Prevalence ratios were computed with a 95% confidence interval. The score on STD knowledge used a cutoff point corresponding to 50% of correct answers. Statistical tests were chi-square and Poisson multiple regression. Consistent use of male condoms was 60% in private and 57.1% in public schools (p > 0.05) and was associated with male gender and lower socioeconomic status. Female gender, higher schooling, enrollment in private school, Caucasian race, and being single were associated with higher knowledge of STDs. Teenagers from public and private schools have adequate knowledge of STD prevention, however this does not include the adoption of effective prevention. Educational programs and STD/AIDS awareness-raising should be expanded in order to minimize vulnerability.

Conhecimento sobre métodos anticoncepcionais por estudantes adolescentes / Knowledge of contraceptive methods among adolescent students

OBJETIVO: Comparar o conhecimento sobre métodos anticoncepcionais e identificar os fatores associados ao conhecimento adequado dos adolescentes de escolas públicas e privadas. MÉTODOS: Realizou-se estudo transversal, do qual participaram 1.594 adolescentes entre 12 e 19 anos, de 13 escolas públicas e cinco privadas do Município de São Paulo entre junho e dezembro de 2003. As escolas foram selecionadas aleatoriamente e os alunos responderam um questionário sobre características sociodemográficas, reprodutivas e métodos anticoncepcionais. As razões de prevalência foram calculadas com intervalo de confiança de 95 por cento para cada questão sobre conhecimento de métodos e o tipo de escola. Atribuiu-se meio ponto para cada questão correta sobre conhecimento de anticoncepcionais, o ponto de corte foi 50 por cento de acerto. Os testes estatísticos utilizados foram o qui-quadrado, o Wilcoxon-Gehan e a regressão múltipla de Poisson. RESULTADOS: Dentre os adolescentes, 61 por cento eram do sexo feminino nos dois grupos de escolas. Predominou nível socioeconômico baixo nas escolas públicas e alto nas privadas (p<0,001). Cerca de 18,6 por cento dos adolescentes nas escolas privadas e 28,6 por cento nas públicas tinham atividade sexual (p<0,002). Quanto ao conhecimento, 25,7 por cento dos adolescentes das escolas públicas e 40,8 por cento das privadas apresentaram escore superior ou igual a cinco. Os fatores associados ao maior conhecimento foram ser do sexo feminino, estudar em escola privada, estar no ensino médio, ter nível socioeconômico alto, ter relação sexual e ter maior idade. CONCLUSÕES: O nível de conhecimento adequado sobre métodos anticoncepcionais foi baixo para os adolescentes de ambos os tipos de escolas. Os resultados revelam que, assim como os mais desfavorecidos, os adolescentes de maior nível socioeconômico necessitam de informações adequadas sobre planejamento familiar, visando a melhorar esse conhecimento para mudança seu comportamento.

Fatores associados ao uso de preservativo masculino e ao conhecimento sobre DST/AIDS em adolescentes de escolas públicas e privadas do Município de São Paulo, Brasil / Factors associated with condom use and knowledge about STD/AIDS among teenagers in public and private schools in São Paulo, Brazil

Comparar o conhecimento sobre DST/AIDS e avaliar fatores associados ao conhecimento adequado e ao uso consistente do preservativo masculino, em adolescentes de escolas públicas e privadas do Município de São Paulo. Participaram 1.594 adolescentes entre 12 e 19 anos, de 13 escolas públicas e 5 privadas, que responderam um questionário sobre DST/AIDS e uso de preservativo. Calcularam-se as razões de prevalência com intervalo de confianca de 95 por cento. O escore de conhecimento sobre DST teve o ponto de corte equivalendo a 50 por cento de acerto. Os testes estatísticos foram qui-quadrado e Wilcoxon-Gehan. Realizou-se regressão múltipla de Poisson. O uso consistente de preservativo foi 60 por cento nas escolas privadas e 57,1 por cento nas públicas (p > 0,05) e esteve associado ao sexo masculino e menor nível sócio-econômico. O sexo feminino, maior escolaridade, escola privada, cor branca e estado marital solteiro associaram-se ao maior conhecimento sobre DST. Os adolescentes de escola pública e privada apresentam conhecimento adequado sobre prevencão de DST, entretanto esse conhecimento não determina adocão de atitudes efetivas de prevencão. Programas de conscientizacão sobre DST/AIDS devem ser ampliados visando minimizar as vulnerabilidades.

[Knowledge of contraceptive methods among adolescent students]. / Conhecimento sobre métodos anticoncepcionais por estudantes adolescentes.

OBJECTIVE: To compare the knowledge of contraceptive methods as well as to identify factors associated with adequate knowledge among public and private school adolescents. METHODS: A cross-sectional study comprising 1,594 adolescents aged between 12 and 19 years old from 13 public and five private schools in the city of São Paulo city, Brazil, was carried out from June to December 2003. Schools were randomly selected and students filled out a questionnaire about sociodemographic, reproductive and contraceptive methods. The prevalence ratios were estimated with a 95% confidence interval for each question on their knowledge of contraceptive methods and by school group. Each question correctly answered received a half score, and the cut-off value was 50% of correct answers. Statistical tests utilized were Chi-square and Wilcoxon-Gehan tests and Poisson multiple regression model. RESULTS: Of all respondents, 61% were of females in both school groups. Most students had low socioeconomic condition in public schools while they had mostly high socioeconomic condition in private schools (p<0.001). Nearly 18.6% private and 28.6% public school students were sexually active (p<0.002). In regard to their knowledge, 25.7% of public and 40.8% of private school students had a score equal to or above five. Factors associated with higher knowledge were: being female, at high school of a private school, having high socioeconomic condition, having had sexual intercourse and being older. CONCLUSIONS: Knowledge of contraceptive methods was low in both public and private school students. The study results show that both underprivileged as well as high socioeconomic adolescents need to have adequate information about family planning to improve their knowledge and change their behavior.

Uterine artery embolization for the treatment of symptomatic myomas in Brazilian women.

CONTEXT: Uterine myomas are benign tumors that mostly occur in women of reproductive age at a frequency ranging from 20 to 25%. The symptoms are increased menstrual flow, pain and compressive signs. New treatments have been proposed and uterine artery embolization is one of them. OBJECTIVE: To evaluate the effects of treatment by embolization of the uterine artery, in women with symptomatic myomas. Uterine and dominant myoma volumes and the major symptoms were evaluated before treatment and 12 weeks later. TYPE OF STUDY: Open clinical trial. SETTING: A tertiary-care women's hospital. PARTICIPANTS: The study was conducted on 32 women with symptomatic single or multiple myomas of the uterine body, seen at the outpatient unit from May 2000 to September 2001. MAIN MEASUREMENTS: The patients were submitted to gynecological examination and abdominal and endovaginal pelvic ultrasonography, and the examinations were repeated 12 weeks after the first procedure. Uterine artery embolization using PVA (polyvinyl alcohol) particles of 355-700 was performed by catheterization of the right femoral artery in 30 women and by bilateral catheterization in two. RESULTS: Before embolization, the mean uterine volume of the 32 women was 455 cm and the mean volume of the dominant myoma was 150 cm . Twelve weeks after embolization, the mean uterine volume was 256 cm and the mean volume of the dominant myoma was 91 cm , with p < 0.01 in both cases. Twelve weeks after the treatment, all the women answered a questionnaire, which showed that 71% had improvement in menstrual regularity, 90% decreased menstrual volume and 81% shortened menstrual duration. The most frequent immediate post-procedure symptoms, established as complications, were pain (100%) and fatigue (34%). One woman had myoma degeneration and was submitted to myomectomy. CONCLUSION: The significant reduction in uterine and dominant myoma volume confirms the validity of the treatment of symptomatic myomas by the technique of uterine artery embolization in Brazilian women. There was significant reduction in menstrual flow and duration, as well as better cycle regularity in the women studied. The few adverse effects observed in the sample studied mainly involved pain immediately after embolization.

Uterine artery embolization for the treatment of symptomatic myomas in Brazilian women

CONTEXT: Uterine myomas are benign tumors that mostly occur in women of reproductive age at a frequency ranging from 20 to 25 percent. The symptoms are increased menstrual flow, pain and compressive signs. New treatments have been proposed and uterine artery embolization is one of them. OBJECTIVE: To evaluate the effects of treatment by embolization of the uterine artery, in women with symptomatic myomas. Uterine and dominant myoma volumes and the major symptoms were evaluated before treatment and 12 weeks later. TYPE OF STUDY: Open clinical trial. SETTING: A tertiary-care women's hospital. PARTICIPANTS: The study was conducted on 32 women with symptomatic single or multiple myomas of the uterine body, seen at the outpatient unit from May 2000 to September 2001. MAIN MEASUREMENTS: The patients were submitted to gynecological examination and abdominal and endovaginal pelvic ultrasonography, and the examinations were repeated 12 weeks after the first procedure. Uterine artery embolization using PVA (polyvinyl alcohol) particles of 355-700 æ was performed by catheterization of the right femoral artery in 30 women and by bilateral catheterization in two. RESULTS: Before embolization, the mean uterine volume of the 32 women was 455 cm and the mean volume of the dominant myoma was 150 cm . Twelve weeks after embolization, the mean uterine volume was 256 cm and the mean volume of the dominant myoma was 91 cm , with p < 0.01 in both cases. Twelve weeks after the treatment, all the women answered a questionnaire, which showed that 71 percent had improvement in menstrual regularity, 90 percent decreased menstrual volume and 81 percent shortened menstrual duration. The most frequent immediate post-procedure symptoms, established as complications, were pain (100 percent) and fatigue (34 percent). One woman had myoma degeneration and was submitted to myomectomy. CONCLUSION: The significant reduction in uterine and dominant myoma volume confirms the validity of the treatment of symptomatic myomas by the technique of uterine artery embolization in Brazilian women. There was significant reduction in menstrual flow and duration, as well as better cycle regularity in the women studied. The few adverse effects observed in the sample studied mainly involved pain immediately after embolization

Macroplastique implantation system for the treatment of female stress urinary incontinence.

PURPOSE: We evaluated the 12-month followup outcome of the Macroplastique (Uroplasty, Minneapolis, Minnesota) implantation system for the treatment of stress urinary incontinence caused by intrinsic sphincter deficiency using objective and subjective measures, including quality of life impact. MATERIALS AND METHODS: A total of 21 consecutive women with a mean age of 47.4 years and a mean body mass index of 25.65 kg./m.2 in whom intrinsic sphincter deficiency was urodynamically diagnosed were enrolled in the study. Patients were preoperatively assessed by physical examination, quality of life questionnaire, Stamey grading of incontinence, pad use, pad weight test and urodynamic testing. Patients underwent periurethral injection under local anesthesia with the Macroplastique implantation system. The mean volume of silicone elastomers injected was 6.3 ml. RESULTS: As assessed by the King health questionnaire, patient quality of life improved in all domains and in most lower urinary tract symptoms. Patient satisfaction and subjective surgeon evaluation were assessed by Stamey incontinence grading. From patient point of view 12 (57.1%) considered themselves cured, 4 (19%) were improved and 5 (23.8%) had failure. According to subjective surgeon grading 8 patients (38.1%) were considered cured 6 (28.6%) were improved and 7 (33.3%) had failure. Pad use decreased from a mean of 4.38 to 1.29 units daily. According to the pad weight test 13 patients (62%) were dry, 4 (19%) were improved and 4 (19%) had failure. Urodynamic testing demonstrated that 8 patients (40%) were dry and 1 (5%) was improved. CONCLUSIONS: The Macroplastique implantation system proved to have an acceptable outcome for patient and surgeon. The procedure can be done with local anesthesia and without cystoscopic guidance.

Avaliação da resposta do câncer de mama à quimioterapia: papel da ultra-sonografia e da dopplerfluxometria / Evaluation of breast cancer response to chemotherapy: role of ultrasound and Doppler

Objetivo: comparar os tamanhos dos tumores mamários localmente avançados por meio de exame clínico, mamografia, ultra-sonografia e dopplervelocimetria associada à ultra-sonografia, avaliados antes e depois da quimioterapia primária. Métodos: estudo clínico prospectivo e descritivo. Foram incluídas dezoito mulheres com tumor primário clínico maior ou igual a 50 mm que foram submetidas à palpação, mamografia, ultra-sonografia e dopplervelocimetria, no momento do diagnóstico e após 3 ciclos de quimioterapia. A resposta foi considerada presente quando ocorreu diminuição clínica maior que 50 por cento e ultra-sonográfica maior que 25 por cento, e ausente quando a redução medida pela clínica fosse inferior 50 por cento e a ultra-sonográfica menor que 25 por cento. A análise estatística utilizada foi descritiva com teste de Wilcoxon na comparação dos métodos. Resultados: em relação ao tamanho dos tumores, o método cuja medida mais se aproximou do exame anatomopatológico foi o exame clínico na pós-quimioterapia, quando comparado com a ultra-sonografia e a mamografia. A mamografia permitiu avaliação em 44 por cento dos casos, antes da quimioterapia (8/18). Nos casos em que não houve resposta à quimioterapia, a dopplervelocimetria demonstrou aumento significativo do fluxo, com a diminuição dos índices de pulsatilidade e resistência. Nos casos em que houve resposta (9 casos), com redução do tamanho tumoral, a dopplervelocimetria não mostrou alterações significativas em relação aos parâmetros estudados. Conclusão: o exame clínico mostrou-se como melhor método de avaliação da redução do volume dos tumores tratados com quimioterapia neoadjuvante quando comparado com o exame de ultra-sonografia e a mamografia. A dopplervelocimetria demonstrou que houve aumento do fluxo nos casos com resposta ausente

Achados da inspeçäo visual com ácido acético para rastreamento de cåncer do colo uterino / Visual inspection for cervical cancer screening

Avaliaçäo dos resultados da aplicaçäo de ácido acético, como teste auxiliar no rastreamento de lesöes precursoras do cåncer do colo uterino, em mulheres que procuraram o atendimento primário de saúde do serviço público na zona leste da cidade de Säo Paulo. Método- corte transversal com 150 mulheres, de demanda espontånea. Foi realizada a coleta de material para Papanicolaou e em seguida foi aplicado soluçäo de ácido acético a 5 por cento no colo uterino, com imediata realizaçäo da inspeçäo visual com auxílio de låmpada comum. Os casos classificados como anormais foram encaminhados para o serviço de colposcopia, assim como os resultados normais porém com o Papanicolaou alterado