Practical training of health care providers in insertion of contraceptive implants: findings from two Brazilian centres.

BACKGROUND AND OBJECTIVES: Lack of information and myths or inadequate training of health care providers in the guidance and management of contraceptives could negatively affect choice and eventually continuation rates. Our objectives were to evaluate the impact of clinical and theoretical training of health care professionals on insertion and removal of etonogestrel (ENG)-implant regarding this contraceptive, including pre- and post-training knowledge about insertion and removal techniques, clinical characteristics, side effects and outcomes. MATERIAL AND METHODS: We conducted a cross-sectional study in which a questionnaire was sent to health care providers after they received clinical training in the management of ENG-implant. RESULTS: After training, 78.2% of the 139 participants initiated to offer and inserted up to 5 implants/month and 17.6% between 6 to 10/month. None of the interviewees reported having difficulty with insertions after training, and 87.9% reported feeling very confident for removal. CONCLUSION: Theoretical and practical training appeared important to prepare health care professionals, clarify doubts and promote higher rates of use of contraceptive implants in Brazil, contributing to reduce the rates of unintended pregnancies.

Contagem bacteriana total do leite em diferentes sistemas de ordenha e de resfriamento / Total bacterial count of milk in different systems of milking and cooling

Este trabalho teve por objetivo avaliar o efeito dos sistemas de ordenha e de resfriamento na contagem bacteriana total (CBT) e na quantidade de leite com CBT ≤ 105, que representa leite de alta qualidade. Um total de 12.221 registros de CBT do leite foi obtido de uma indústria láctea da região Oeste do Paraná, no período de janeiro a outubro de 2006. Após as coletas, a qualidade do leite foi analisada em laboratório pelo método de citometria de fluxo. Os dados de CBT foram classificados por sistema de ordenha, tipo de resfriador e intervalos da CBT, segundo critério da Instrução Normativa 62, e submetidos à análise de independência de Qui-Quadrado. As proporçõesde CBT do leite entre tipos de resfriadores, em cada sistema de ordenha, foram comparadas utilizando-se a estatística calculada Z. Observou-se menor (p < 0,01) valor de CBT do leite de vacas submetidas à ordenha canalizada e do leite resfriado a granel. A proporção das amostras de leite avaliadas nos três níveis de CBT resfriadas por sistema de imersão não diferiu (p = 0,1549) do leite resfriado a granel, quando o leite foi obtido de rebanhos ordenhados por ordenha canalizada. A alta qualidade microbiológica do leite da região Oeste do Paraná é obtida quando os produtores utilizam em suas propriedades rurais a ordenha canalizada e o sistema de resfriamento a granel.

Total bacterial count of milk in different systems of milking and cooling. This study aimed to evaluate the effect of milking systems and cooling on total bacterial count (TBC), and the amount of milk samples with TBC ≤ 105, which represents high-quality milk. A total of 12,221 records of milk TBC were obtained from a dairy industry in the western region of Paraná State, Brazil, from January to October 2006. After the sampling was conducted, the milk quality was analyzed in the laboratory by the method of flow cytometry. The TBC data wereclassified by milking system, type of coolers and intervals of the TBC, in accordance with Normative Instruction 62, and submitted to the chi-square test for independence. The proportions of milk TBC among types of coolers at each milking system were compared using the calculated statistic Z. A lower TBC value (p < 0.01) was observed in milk obtained from cows milked using a piped system and from bulk cooled milk. The proportion of milk samples evaluated at three levels of TBC cooled by the immersion system did not differ (p = 0.1549) from bulk cooled milk when the milk was obtained from herds milked with a piped system. The best microbiological quality of milk in the western region of Paraná was achieved with a piped milking system and bulk cooling.