Barriers to access to infertility care and assisted reproductive technology within the public health sector in Brazil.

BACKGROUND: In Brazil, access to infertility care, including assisted reproductive technologies (ARTs), is restricted. This is the third report of a study on access to infertility care and ARTs within the public sector, focusing on the barriers to these services. METHODS: The study was anchored on quantitative and qualitative methods. For the quantitative study interviews were conducted with health authorities in each of the 26 states, the Federal District, the state capitals and 16 cities with ≥ 500,000 inhabitants and directors of infertility referral centres within the public sector. Qualitative case studies-- were conducted in five ART centres. RESULTS: Overall, 63.5% of the authorities reported that complex infertility treatments were unavailable. Barriers identified consisted of "lack of political decision to implement them", and "lack of financial resources". In addition, 75% reported to have "no plans to implement them over the next 12 months". At the facilities offering ART, the barriers to these procedures were the high costs, long waiting times, complex scheduling processes and lack of initiative to implement low cost ARTs. CONCLUSIONS: Infertile couples' access to ART procedures is restricted due to the insufficient services and lack of political commitment to support existing and new services..

Physician-patient communication in the prevention of female reproductive tract infections: some limitations.

The objective of this study was to describe the information that women with tubal infertility recalled having received from physicians when they consulted for a reproductive tract infection (RTI) and the information physicians reported having provided to women consulting for RTIs. Interviews were conducted with 16 women presenting primary tubal infertility selected on the basis of purposeful sampling criteria. Also, 15 physicians working in the public health network in the city of Campinas, Brazil, were selected at random and interviewed. Analysis of the women's statements concerning previous RTI-related medical consultations showed that they did not recall having received any information on either prevention or the impact of RTI on their reproductive future. Analysis of interviews with physicians showed that the information they provided to women consulting for RTIs was incomplete and unclear. The information women recalled having received and that which physicians remembered having provided at the time of treating a patient with RTI was similar. In conclusion, these women lacked adequate or complete information and that it was probably not possible for them to adopt measures to avoid repetition of RTI and minimize risk of tubal infertility.

Impaired respiratory muscle function in chemical plant workers producing chlorfenvinphos.

All employees of a chemical plant division producing chlorfenvinphos were studied, i.e. 35 males aged 25-57 years (mean 42.1); their employment period ranged from 1-15 years (mean 9.0). Chronic bronchitis was diagnosed in 13 workers (37.1%). Mean air chlorfenvinphos concentrations in the work environment estimated with gas-liquid chromatography were from 0.0008-0.0018 mg/m3 (maximum allowable concentration according to Polish standards is 0. 01 mg/m3). The activity of erythrocyte acetylcholinesterase was similar to that observed in people who were not exposed to chemicals, however, a slightly lowered activity of plasma cholinesterase in the studied population was evidently the result of mild liver impairment. Spirometric investigations performed in the studied workers revealed slight alterations manifested by increased intrathoracic gas volume (ITGV) (the value of the index was 138.6% of the mean value, 24 workers with an abnormally high index), as well as by decreased specific airway conductance (sGaw); its mean value in the studied group was 58.5% of the mean standard (11 people showed an abnormal index). Substantial functional changes were found in the respiratory muscles. Maximal inspiratory pressures (MIP = 97. 2 +/- 28.3 cm H2O) as well as maximal expiratory pressures (MEP = 113.9 +/- 44.2 cm H2O) in the studied group were significantly lower (p < 0.01) as compared to those observed in the control group (MIP = 120.7 +/- 31.7; MEP = 154.4 +/- 40.2 cm H2O) of 22 males having similar cigarette smoking habit, without occupational exposure to chemicals. It was also found that the people who had worked for more than 10 years under conditions of exposure to chlorfenvinphos showed significantly lower (p < 0.05) values of maximal inspiratory pressure (87.2 +/- 28.06 cm H2O, n = 17) compared to the workers whose period of employment was shorter than 10 years (106.6 +/- 26.8 cm H2O, n = 18). The two groups were comparable with regard to age and smoking habits. The values of maximal expiratory pressures were similar in both groups. No essential disturbances in neuro-muscular transmission were observed; only in 3 workers (8.5%) the electrostimulating myasthenic test showed some disturbances in neuro-muscular transmission. It seems that respiratory muscles impairment in humans exposed to chlorfenvinphos results from changes in the metabolism and structure of muscles, and partly from lung hyperinflation.

Expanding contraceptive choice: findings from Brazil.

This article presents findings from a participatory action research project in a municipality in southern Brazil that models a new and holistic approach to broadening women's contraceptive choices. The project encourages a collaborative process between researchers, community members, and public health managers to diagnose service-delivery problems, to design and implement interventions, and to evaluate their effectiveness. Findings from the baseline evaluation revealed major constraints in availability of and access to family planning and reproductive health services for women, as well as severe deficiencies in quality of care. Interventions designed to address these weaknesses, bound by the limited resources of the public sector, focused on training, restructuring of providers' roles and service-delivery patterns, the management process, the creation of a referral center, and the introduction of injectables, vasectomy services, and a program for adolescents. Evaluation results show the project's considerable impact in broadening reproductive options, although not all issues, especially those related to sustainability, have been resolved.

[The place of galactography in the diagnosis of secreting mamma]. / Miejsce galaktografii w diagnostyce sutka wydzielajacego.

Examinations were carried out in 3,300 women, finding in 210 cases a spontaneous or provoked discharge from one or two breasts. Out of these women 115 patients came for galactographic examination. After the radiological examinations 37 patients were treated surgically including 28 cases with the diagnosis of intraductal hyperplasia, and in this group of patients histopathological examination demonstrated: nine cases of cancer, seven cases of papilloma, seven cases of fibroadenoma, seven cases of benign dysplasia with ductal epithelial hyperplasia, three cases of inflammatory lesions, and one case without pathological changes. The analysis carried out demonstrated that galactographic picture of secreting ducts may suggest a hyperplastic process but determination of its character is possible only in histopathological examination.

[Breast examination in women from the Paluk region]. / Badania sutków u kobiet z regionu Paluk.

Breast examination for early cancer detection in high risk patients are being performed even more frequently in our country and in other ones. Wide availability of mammosonography facilitates such management. X-ray mammography in view of irradiation is less frequently used. An attempt has been undertaken at carrying out breast examinations of a selected Paluski area. The analysis included 180 women who after carrying out comprehensive breast examination and obtaining of history data were qualified for the group of high risk for breast cancer.

[Value of mammography and sonomammography in the diagnosis of benign breast diseases coexisting with genital pathologic lesions]. / Wartosc mammografii i sonomammografii w rozpoznaniu lagodnych chorób sutka wspólistniejacych z patologia narzadu rodnego.

In the paper the relationship was analysed between certain gynaecological diseases and benign changes occurring within the breast. The study was carried out in 400 patients and 108 females were subjected to the analysis. In 42 patients in this group histopathological examination was also performed. On the basis of the studies carried out among women in the Bydgoszcz region, a relationship was found between benign changes in the breast and certain genital diseases.