Effect of transcranial direct current stimulation combined with pelvic muscle training in women: Randomized, controlled, double-blind, and clinical trial.

BACKGROUND: Pelvic floor muscle training (PFMT) is widely used for pelvic floor muscle (PFM) weakness in women; however, it has no prolonged effects. OBJECTIVE: To evaluate the effect of Transcranial Direct Current Stimulation (tDCS) associated with PFMT on PFM contraction, sexual function and quality of life (QoL) in healthy women. STUDY DESIGN: 32 nulliparous women, aged 22.7 ± 0.42 years, were randomized into two groups: G1 (active tDCS combined with PFMT) and G2 (sham tDCS combined with PFMT). The treatment was performed three times a week for 4 weeks, totaling 12 sessions. PFM function was assessed using the PERFECT scheme (P = power, E = endurance, R = repetitions, F = rapid contractions, ECT = each timed contraction) and the perineometer (cmH2O). Sexual function was assessed by The Female Sexual Function Index, and QoL by the SF-36 questionnaire. These assessments were performed before and after the 12nd treatment session and after 30-day follow-up. RESULTS: There was a significant increase (p = 0.037) in the power of G2 compared to G1; repetitions and fast contraction increased in the G1 group, and the resistance increased in both groups, however, without statistical difference between the groups. ECT increased in the G1 group (p = 0.0). CONCLUSION: Active tDCS combined with PFMT did not potentiate the effect of the PFMT to increase the PFM function, QoL, and sexual function in healthy women. However, adjunctive tDCS to PFMT improved the time of contractions, maintaining it during follow-up.

The Brazilian Portuguese version of the Pregnancy Mobility Index: Cross-cultural adaptation and psychometric evaluation - a validation study

ABSTRACT BACKGROUND: The Pregnancy Mobility Index (PMI) was developed to assess mobility in pregnant women in the Netherlands. At present, no similar questionnaire is available in Brazil. OBJECTIVE: The present study aimed to translate, cross-culturally adapt, and evaluate the psychometric properties of a Brazilian PMI. DESIGN AND SETTING: The present study was a validation study conducted at the Universidade Federal do Paraná and a public maternity ward in Curitiba, Brazil. METHODS: Text translation and cross-cultural adaptation followed international guidelines. Construct validity, internal consistency, and inter- and intra-rater reliability tests included 97 women. The Pelvic Girdle Questionnaire, Multidimensional Pain Evaluation Scale, Schober's test, and lumbar spine range of motion assessment were administered on the first day. Intra-rater reliability (n = 19) was measured after 15 days. Exploratory factor analysis was performed, and the correlation matrix was analyzed using Pearson's coefficient. RESULTS: Pregnant women (88%) understood the cultural adaptation process. The internal consistency was high (Cronbach's alpha > 0.90), construct validity was moderate, with significant correlation between lumbar spine range of motion (r = 0.283-0.369) and Schober's test (r = -0.314), and high correlation between the Multidimensional Pain Evaluation Scale (r = -0.650 and -0.499) and Pelvic Girdle Questionnaire (r = -0.737). Intra- and inter-rater reliabilities were excellent (intraclass correlation coefficient = 0.932 and 0.990, respectively). CONCLUSION: The Brazilian version of the PMI was successfully translated with excellent reliability and moderate-to-high construct validity. It is an important tool for assessing mobility in pregnant women. CLINICAL TRIAL: RBR-789tps (Validation study), https://ensaiosclinicos.gov.br/rg/RBR-789tps.

Access to maternal reproductive health care services in remote hinterland regions of Guyana / Acesso à serviços de saúde maternal e reprodutiva nas regiões remotas da Guiana

Access to reproductive health care services is critical to the life of a woman, her family, and the society as a whole. Women who live in remote hinterland Regions of Guyana experience many challenges relative to their access to reproductive health care services. This has resulted in higher rates of home deliveries, high maternal mortality rates, and higher teenage pregnancies rates than their counterparts who live in coastal settings. There is still a paucity of literature in Guyana that scientifically explored the critical issues affecting "access of reproductive health care services from the perspective of Indigenous women who live in remote hinterland regions". Aim: To identify the challenges to access to Reproductive Health care services from the prospective of women, ages 18 to 49 years who live in remote hinterland regions of Guyana. Methodo: This study was based on a sample of 85 Indigenous women, age 18 - 49 years who resided in three remote hinterland regions of Guyana. Data was collected by means of an interview schedule. Simple quantitative study analysis - Frequency distribution; Univariate and bivariate analysis; Correlation analysis - Pearson's r correlation (r) was used to determine the challenges in a wide variety of reproductive health care services. Results: Some reproductive health services were accessed on a sporadic basis by women who live in remote hinterland regions of Guyana. These include: cervical cancer screening (34%) and 91% never had a breast examination; 60% had no access to family planning and contraceptives within the last 12 months of the study. Further, 92% of respondents had obtained prenatal care at a health facility during their last pregnancy, while only 52% of reported having delivered at the health facilities where they first sought health care services from, and 28% did not have prenatal appointments at a government public health facility. Some of the challenges to access to these reproductive health services (as identified by women) including: Inadequate health facilities to allow for easy access to reproductive health care; Inadequate competent providers to provide skilled midwifery care; Unavailability or lack of consistent supply of equipment and supplies to provide for clinical and laboratory tests; Lack of consistent supply of contraceptives; Poor referral system to allow for the receipt of test results not done in the regions and for timely interventions; and lack of information and counselling services, among others. Conclusion: Many challenges exist in relation to access to a number of reproductive health care services in remote hinterland regions of Guyana. The identification of these challenges can help to validate what obtains in hinterland regions - relevant to reproductive health care services, and help to form the basis to better inform the provision and strengthening of specific and targeted interventions, policies, and services that are of high quality, and that meets the needs of women who live in remote hinterland regions of the country.

O acesso aos serviços de saúde reprodutiva é fundamental para a vida das mulher, sua família e a sociedade como um todo. As mulheres que vivem em regiões remotas do interior da Guiana enfrentam muitos desafios em relação ao acesso a serviços de saúde reprodutiva. Isso resultou em taxas mais altas de partos domiciliares, altas taxas de mortalidade materna e taxas mais altas de gravidez na adolescência do que entre aquelas que vivem em áreas costeiras. Ainda há uma escassez de literatura na Guiana que explorou cientificamente as questões críticas que afetam o "acesso a serviços de saúde reprodutiva a partir da perspectiva de mulheres indígenas que vivem em regiões remotas do interior". Objetivo: Identificar os desafios para o acesso aos serviços de saúde reprodutiva na perspectiva de mulheres de 18 a 49 anos que vivem em regiões remotas do interior da Guiana. Método: Este estudo foi baseado em uma amostra de 85 mulheres indígenas, com idades entre 18 e 49 anos, que residiam em três regiões remotas do interior da Guiana. Os dados foram coletados por meio de um roteiro estruturado. Análise de estudo quantitativo simples - Distribuição de frequência; Análise univariada e bivariada; Análise de correlação - A correlação r de Pearson (r) foi usada para determinar os desafios em uma ampla variedade de serviços de saúde reprodutiva. Resultados: Alguns serviços de saúde reprodutiva foram acessados esporadicamente por mulheres que vivem em regiões remotas do interior da Guiana. Estes incluem: rastreio do cancer do colo do útero (34%) e 91% nunca fizeram um exame de mama; 60% não tiveram acesso a planejamento familiar e contraceptivos nos últimos 12 meses anteriores ao estudo. Além disso, 92% das entrevistadas obtiveram atendimento pré-natal em uma unidade de saúde durante a última gravidez, enquanto apenas 52% relataram ter feito o parto nas unidades de saúde onde procuraram pela primeira vez e 28% não tiveram consultas de pré-natal em unidade de saúde pública. Alguns dos desafios para o acesso a esses serviços de saúde reprodutiva (conforme identificados pelas mulheres) incluem: instalações de saúde inadequadas para facilitar o acesso aos cuidados de saúde reprodutiva; provedores competentes inadequados para fornecer cuidados obstétricos qualificados; indisponibilidade ou falta de fornecimento consistente de equipamentos e insumos para realização de exames clínicos e laboratoriais; falta de fornecimento consistente de contraceptivos; sistema de encaminhamento deficiente para permitir o recebimento de resultados de exames não realizados nas regiões e para intervenções oportunas; e falta de serviços de informação e aconselhamento, entre outros. Conclusão: Existem muitos desafios em relação ao acesso a vários serviços de saúde reprodutiva em regiões remotas do interior da Guiana. A identificação desses desafios pode ajudar a validar o que se obtém nas regiões do interior, relevantes para os serviços de saúde reprodutiva, além de ajudar a formar a base para melhorar o fornecimento de informações e o fortalecimento de intervenções, de políticas e serviços específicos, e que atendam às necessidades de mulheres que vivem em regiões remotas do interior do país.

The 12 women who won the Nobel Prize in Medicine or Physiology: [errata] / As 12 mulheres laureadas com o Prêmio Nobel de Medicina ou Fisiologia: [errata]

Introduction: the Nobel Prize is one of the highest academic honors in the world. Since its first edition, in 1901, until 2021, there have been hundreds of winners. In the Medicine or Physiology category, chosen by the Karolinska Institute in Stockholm, Sweden, 112 awards have been given to 224 laureates, among them, only 12 (5.4%) women. Aims and source of data: with the aim of reviewing the biographies, characteristics, and peculiarities of each woman awarded the Nobel Prize for Medicine or Physiology. Data were analyzed from the following sources: the Award page, websites of the institutions to which some of them have been or are affiliated, books with biographies of Nobel laureates in Medicine or Physiology, and articles in the PubMed database. Summary of findings: the average age when receiving the award was 63.4 years. The most recurrent country of origin was the United States of America, also responsible for the largest number of institutions to which the laureates were affiliated at the time of the award. The academic training of the laureates was quite diverse, ranging among medicine, chemistry, physics, biology, pharmacy, psychology and natural sciences. Five of the 12 laureates did not have children. Comments: the origins and trajectories, although plural, have points in common, such as a fascination with science since childhood and the need to overcome additional barriers throughout their education, because of their sex. Conclusion: investments on a global scale are necessary to increase equity between sexes.

Introdução: o prêmio Nobel é uma das maiores honrarias acadêmicas do mundo. Desde a sua primeira edição, em 1901, até 2021, já foram centenas de vencedores. Na categoria Medicina ou Fisiologia, escolhido pelo Instituto Karolinska em Estocolmo, na Suécia, foram entregues 111 prêmios para 224 laureados, dentre eles, apenas 12 (5,4%) mulheres. Objetivos e métodos: com o objetivo rever as biografias, características e peculiaridades, de cada mulher laureada com o prêmio Nobel de Medicina ou Fisiologia, foram analisados dados provenientes da página do prêmio; de sites das instituições às quais algumas delas foram ou são afiliadas; em livros com biografias dos laureados com o prêmio Nobel de Medicina ou Fisiologia; e artigos na base de dados PubMed. Síntese dos dados: a média de idade ao receber o prêmio foi de 63,4 anos. O país de origem mais recorrente foi os Estados Unidos da América; também é o local que abriga o maior número de instituições às quais as laureadas estavam filiadas no momento da premiação. A formação acadêmica das laureadas foi bastante diversa, variando entre: medicina, química, física, biologia, farmácia, psicologia e ciências naturais. Cinco das 12 laureadas não tiveram filhos. Conclusão: fazem-se necessários investimentos em escala global para aumentar a equidade entre os gêneros.

Gestação: implicações na vida da gestante / Pregnancy: implications for the pregnant woman's life / Embarazo: implicaciones para la vida de la embarazada

Objetivo: analisar a gestação e suas implicações na vida da gestante. Método: revisão bibliográfica integrativa seguindo os pressupostos de Ludke e André, e abordagem qualitativa. Resultados: No presente estudo, foram analisados 16 (dezesseis) artigos científicos, que atenderam aos critérios de inclusão previamente estabelecidos, onde foram encontrados 8 (oito) na base de dados SCIELO, 2 (dois) artigos na BVS e outros 6 (seis) em Revistas de Enfermagem, a seguir, apresenta-se um panorama geral dos artigos analisados. Conclusão: cada mulher externaliza seus sentimentos de descoberta de gravidez de forma diferente, algumas ficam animadas e sentem prazer, outras ficam tristes e receosas com o que está por vir. É importante instigar a enfermagem a interagir e auxiliar a parturiente de forma abrangente.

Objective: to analyze the management and its conclusions in the pregnant woman's life. Method: integrative literature review following the assumptions of Ludke and André, and a qualitative approach. Results: In this study, 16 (sixteen) scientific articles were formed, which met the advanced inclusion criteria, where 8 (eight) were found in the SCIELO database, 2 (two) articles in the VHL and another 6 (six) in Nursing Journals, below, presents an overview of the distribution articles. Conclusion: each woman externalizes her feelings of pregnancy discovery differently, some are excited and feel pleasure, others are sad and afraid of what is to come. It is important to encourage nursing to interact and assist the parturient in a comprehensive way.

Objetivo: analizar el manejo y sus conclusiones en la vida de la gestante. Método: revisión integradora de la literatura siguiendo los supuestos de Ludke y André, y un enfoque cualitativo. Resultados: En este estudio se conformaron 16 (dieciséis) artículos científicos, los cuales cumplieron con los criterios de inclusión avanzada, donde se encontraron 8 (ocho) en la base de datos SCIELO, 2 (dos) artículos en la BVS y otros 6 (seis) en Enfermería. Revistas, a continuación, presenta una descripción general de los artículos de distribución. Conclusión: cada mujer exterioriza sus sentimientos de descubrimiento del embarazo de manera diferente, algunas están emocionadas y sienten placer, otras están tristes y temerosas de lo que está por venir. Es importante fomentar que la enfermería interactúe y asista al parturient de manera integra.

The 12 women who won the Nobel Prize in Medicine or Physiology / As 12 mulheres laureadas com o Prêmio Nobel de Medicina ou Fisiologia

Introduction: the Nobel Prize is one of the highest academic honors in the world. Since its first edition, in 1901, until 2021, there have been hundreds of winners. In the Medicine or Physiology category, chosen by the Karolinska Institute in Stockholm, Sweden, 112 awards have been given to 224 laureates, among them, only 12 (5.4%) women. Aims and source of data: with the aim of reviewing the biographies, characteristics, and peculiarities of each woman awarded the Nobel Prize for Medicine or Physiology. Data were analyzed from the following sources: the Award page, websites of the institutions to which some of them have been or are affiliated, books with biographies of Nobel laureates in Medicine or Physiology, and articles in the PubMed database. Summary of findings: the average age when receiving the award was 63.4 years. The most recurrent country of origin was the United States of America, also responsible for the largest number of institutions to which the laureates were affiliated at the time of the award. The academic training of the laureates was quite diverse, ranging among medicine, chemistry, physics, biology, pharmacy, psychology and natural sciences. Five of the 12 laureates did not have children. Comments: the origins and trajectories, although plural, have points in common, such as a fascination with science since childhood and the need to overcome additional barriers throughout their education, because of their sex. Conclusion: investments on a global scale are necessary to increase equity between sexes.

Introdução: o prêmio Nobel é uma das maiores honrarias acadêmicas do mundo. Desde a sua primeira edição, em 1901, até 2021, já foram centenas de vencedores. Na categoria Medicina ou Fisiologia, escolhido pelo Instituto Karolinska em Estocolmo, na Suécia, foram entregues 111 prêmios para 224 laureados, dentre eles, apenas 12 (5,4%) mulheres. Objetivos e métodos: com o objetivo rever as biografias, características e peculiaridades, de cada mulher laureada com o prêmio Nobel de Medicina ou Fisiologia, foram analisados dados provenientes da página do prêmio; de sites das instituições às quais algumas delas foram ou são afiliadas; em livros com biografias dos laureados com o prêmio Nobel de Medicina ou Fisiologia; e artigos na base de dados PubMed. Síntese dos dados: a média de idade ao receber o prêmio foi de 63,4 anos. O país de origem mais recorrente foi os Estados Unidos da América; também é o local que abriga o maior número de instituições às quais as laureadas estavam filiadas no momento da premiação. A formação acadêmica das laureadas foi bastante diversa, variando entre: medicina, química, física, biologia, farmácia, psicologia e ciências naturais. Cinco das 12 laureadas não tiveram filhos. Conclusão: fazem-se necessários investimentos em escala global para aumentar a equidade entre os gêneros.

Multimorbilidad crónica en mujeres con diagnóstico de fibromialgia en Chile / Chronic multimorbidity in women diagnosed with fibromyalgia in Chile

Objetivo: posicionar a la población diagnosticada de fibromialgia en la categoría de multimórbida y describir algunas de sus características. Lo anterior mediante el análisis de la prevalencia de comorbilidades, el uso de recursos clínicos y el uso de fármacos de la población estudiada. Materiales y métodos: estudio descriptivo, transversal con una muestra de 546 mujeres diagnosticadas de fibromialgia. Aplicación de un cuestionario autoadministrado en modalidad on line. Uso de estadística descriptiva e inferencial (bivariada) para el análisis de datos. Resultados: un 94,7% de las pacientes estudiadas padece al menos una enfermedad diagnosticada además de la fibromialgia; 11,4% padece cinco o más afecciones. Las comorbilidades más frecuentes son trastornos de salud mental, siendo la depresión la principal (70%) seguida de colon irritable (52,8%) y cefalea (50,3%). Un 51,1% presenta alta frecuencia de consulta médica. Un 77,3% utiliza más de un tipo de fármaco. La media de uso farmacológico es de 2,8 tipos. Un 80,3% afirma haberse automedicado alguna vez, siendo en promedio 1,6 la cantidad de fármacos automedicados. Conclusiones: la población con fibromialgia es altamente multimórbida y en plena edad laboral y reproductiva, presenta alto riesgo de morbimortalidad debido a la presencia de polifarmacia y automedicación, además proyecta multimorbilidad crítica a futuro, envejecimiento patológico y alto consumo de recursos clínicos..(AU)

Objective: to situate the population diagnosed with fibromyalgia in the multimorbid category and describe some of its characteristics by analyzing the prevalence of comorbidities, the use of clinical resources and the use of drugs in the studied population. Materials and methods: descriptive, cross-sectional study with a sample of 546 women diagnosed with fibromyalgia. Application of an online self-administered questionnaire. Use of descriptive and inferential statistics for data analysis. Results: was found that 94.7% of the studied women suffer from at least one diagnosed disease in addition to fibromyalgia and 11.4% have five or more conditions. The most frequent comorbidities are mental health disorders, with depression being the main one (70%), followed by irritable bowel syndrome (52.8%) and headache (50.3%), 51.1% have a high frequency of medical consultation and 77.3% use more than one type of drug. The average of pharmacological use is 2.8 types. Among them, 80.3% was self-medicated at some point being 1.6 the average of self-medicated drugs. Conclusions: the population with fibromyalgia is young and highly multimorbid. This group presents a high risk of morbidity and mortality due to the presence of polypharmacy and self-medication behavior, it also projects future critical multimorbidity, pathological aging and high consumption of clinical resources..(AU)

Conhecimento sobre triagem neonatal: discursos de mães e pais de recémnascidos / Knowledge about neonatal screening: discourses of newborns' mothers and fathers

Objetivo: descrever o discurso de pais e mães sobre as concepções e o conhecimento sobre triagem neonatal. Método: Estudo descritivo, qualitativo, realizado com 18 mães e dois pais em três Unidades de Saúde da Família (USF), do município de São Felipe, Bahia. Participaram do estudo, 18 mães e 02 pais de recém-nascidos acompanhados no Programa de Crescimento e Desenvolvimento da Criança e do Adolescente. Realizou-se entrevista individual em profundidade, e a análise dos dados por meio método do Discurso do Sujeito Coletivo. Resultados: As mães e pais compreendem a finalidade do teste do pezinho, tiveram acesso ao conhecimento sobre triagem neonatal, evidenciando potencialidades no processo de aprendizagem e educação para a saúde, mediante a variadas fontes, com destaque para a atuação profissional da enfermeira na atenção ao pré-natal e fragilidades quanto às doenças detectadas na triagem. Conclusão: O conhecimento de mães e pais sobre a triagem neonatal está direcionado à finalidade, procedimento, potencializado pela assistência pré-natal, amigos e pela mídia, em espaços como a Atenção Básica, hospitalar e ao convívio social no direcionamento ao processo educativo e cuidativo desse público alvo

Objective: To describe the discourse of fathers and mothers about the conceptions and knowledge about neonatal screening. Method: Descriptive, qualitative study, conducted with 18 mothers and two fathers in three Family Health Units (FHU), in the municipality of São Felipe, Bahia. Eighteen mothers and two fathers of newborns followed in the Child and Adolescent Growth and Development Program participated in the study. In-depth individual interviews were conducted and data were analyzed using the Collective Subject Discourse method. Results: Mothers and fathers understand the purpose of the foot test, had access to knowledge about neonatal screening, highlighting potentialities in the process of learning and health education, through various sources, highlighting the professional performance of nurses in the care of the child. Pre-natal care and weaknesses regarding the diseases detected in the screening. Conclusion: The knowledge of mothers and fathers about newborn screening is directed to the purpose, procedure, enhanced by prenatal care, friends and the media, in spaces such as Primary Care, hospital and social life in the direction of the educational and care process. this target audience.

Woman-warrior, woman-man: recognition of the work and its meanings in the perception of female recycling workers / Mujer-guerrera, mujer-hombre: reconocimiento del trabajo y sus sentidos en la percepción de mujeres recicladoras / Mulher-guerreira, mulher-homem: reconhecimento do trabalho e seus sentidos na percepção de mulheres recicladoras

ABSTRACT The study aimed to reveal the recognition of the work and of its meanings in the perception of female recycling workers of a recycling cooperative. It is a qualitative, exploratory-descriptive study, undertaken with female recycling workers in a recycling cooperative in a municipality of the central region of the State of Rio Grande do Sul, Brazil. The data were produced through participant observation, semistructured interviews (held with seven women) and focus groups (with six women), between July and August 2013; the data were analyzed using content analysis. The results show that the dynamic of the recognition is complex and involves situations of valorization and of prejudice. The female workers elaborate individual and collective meanings for the work which they undertake, represented, principally, by the self image of "Woman-warrior" and "Woman-man". It is concluded that recognition and meanings of the work correlate with how the female recycling workers experience and understand their work.

RESUMEN El objetivo del estudio fue revelar el reconocimiento del trabajo y sus sentidos en la percepción de mujeres recicladoras de una cooperativa de reciclaje. Estudio cualitativo, exploratorio, descriptivo, realizado con recicladoras de una cooperativa de una ciudad de la región central del Rio Grande do Sul, Brasil. Los datos fueron recolectados por medio de observación participante, entrevista semiestructurada (realizada con siete mujeres) y grupos focales (con seis mujeres), entre julio y agosto de 2013, y analizados por medio de análisis de contenido. Los resultados muestran que la dinámica del reconocimiento es complexa y envuelve situaciones de valorización y de preconcepto. Las trabajadoras elaboran sentidos individuales y colectivos para el trabajo que desempeñan, representado, principalmente, por la auto-imagen de "mujer-guerrera" y "mujer-hombre". Se concluye que reconocimiento y sentidos del trabajo se correlacionan en el modo como las recicladoras vivencian y comprenden su trabajo.

RESUMO O objetivo do estudo foi revelar o reconhecimento do trabalho e seus sentidos na percepção de mulheres recicladoras de uma cooperativa de reciclagem. Estudo qualitativo, exploratório-descritivo, realizado com recicladoras em uma cooperativa de reciclagem de município da região central do Rio Grande do Sul, Brasil. Os dados foram produzidos por meio da observação participante, entrevista semiestruturada (realizada com sete mulheres) e grupos focais (com seis mulheres), entre julho e agosto de 2013, e analisados por meio da análise de conteúdo. Os resultados mostram que a dinâmica do reconhecimento é complexa e envolve situações de valorização e de preconceito. As trabalhadoras elaboram sentidos individuais e coletivos para o trabalho que desempenham, representados, principalmente, pela autoimagem da "mulher-guerreira" e "mulher-homem". Concluiu-se que reconhecimento e sentidos do trabalho se correlacionam no modo como as recicladoras vivenciam e compreendem seu trabalho.

Adesão ao rastreamento para câncer do colo do útero entre mulheres de comunidades assistidas pela Estratégia Saúde da Família da Baixada Fluminense, Rio de Janeiro, Brasil / Adherence to cervical cancer screening among woman from communities assisted by the Family Health Strategy at the Baixada Fluminense, Rio de Janeiro State, Brazil

OBJETIVOS : Avaliar a adesão ao rastreamento para câncer do colo do útero em população assistida pela Estratégia Saúde da Família (ESF) e identificar as causas referidas da não adesão. MÉTODOS: Estudo de prevalência seletiva sobre rastreamento para câncer do colo do útero entre mulheres assistidas pela ESF dos municípios de Duque de Caxias e Nova Iguaçu, nove anos após a participação em estudo conduzido pelo Instituto Nacional de Câncer. Foram elegíveis apenas as mulheres que não tiveram diagnóstico de NIC II ou lesão mais grave na avaliação histopatológica, não se submeteram à histerectomia no período e ainda residiam nas comunidades. Foram identificados os locais, os resultados e os intervalos dos exames, as características socioeconômicas e demográficas, e as causas referidas de não adesão. Os resultados foram coletados por meio de entrevista e consulta a prontuários. Foi calculada a prevalência de adesão ao rastreamento e o teste qui-quadrado foi utilizado para comparar as proporções das variáveis estudadas e sua relação com os motivos referidos de atraso na realização dos exames. RESULTADOS: Foram entrevistadas 764 mulheres, das quais 70,7% estavam com os exames atualizados. As causas referidas para não adesão à coleta dos exames foram: não percepção de risco (44,6%), barreiras sociais (26,3%), barreiras percebidas à ação (22,3%) e barreiras institucionais (21,4%). Estas foram proporcionalmente mais frequentes entre residentes de Nova Iguaçu do que de Duque de Caxias (p<0,01), exceto quanto às barreiras institucionais (p=0,19). CONCLUSÕES: Apesar das dificuldades e barreiras apontadas pelas mulheres, observou-se boa adesão ao rastreamento ...

PURPOSE: To assess the adherence to a cervical cancer screening program and to identify reported reasons for inadequate screening in women receiving care as part of the Family Health Strategy. METHODS: A selective prevalence study on cervical cancer screening in women receiving care as part of the Family Health Strategy in the cities of Duque de Caxias and Nova Iguaçu in the state of Rio de Janeiro, southeastern Brazil, nine years after they participated in a previous study of the Brazilian National Cancer Institute. Only those women who were not diagnosed with CIN II or more severe lesions by histopathology, did not undergo hysterectomy during the study period and still resided in the communities were eligible to participate in the study. Information on exam sites, test results and schedules, sociodemographic characteristics and reported reasons of non-adherence was obtained. Data were collected through interviews and medical record review. The prevalence of adherence to screening was estimated, and the chi-square test was used to compare proportions between the variables studied and their relationship with the reported reasons of non-adherence to screening. RESULTS: A total of 764 women were interviewed, 70.7% of whom received adequate cervical cancer screening. The reported reasons for inadequate screening included: no risk perception (44.6%), social barriers (26.3%), perceived barriers to action (22.3%) and institutional barriers (21.4%). These reasons were proportionately higher among residents of Nova Iguaçu than among residents of Duque de Caxias (p<0.01), except for institutional barriers (p=0.19). CONCLUSIONS: Although difficulties and barriers were reported, there was good adherence to cervical cancer screening among the women studied. Health providers should receive proper training for complying with the Brazilian Ministry of Health guidelines of regular testing and to facilitate access to screening. .

Uma experiência de empoderamento de mulheres na Atenção Primária à Saúde / An experience of women's empowerment in Primary Health Care / Una experiencia de empoderamiento de mujeres en la Atención Primaria de la Salud

Este artigo apresenta a análise de uma prática de estágio realizada em um Centro de Saúde, localizado no Distrito Sanitário Norte de Belo Horizonte. O objetivo central da prática era promover iniciativas de mobilização e discussões políticas entre mulheres moradoras da região abrangida pelo centro de saúde. No decorrer dos encontros foram produzidas discussões, tendo como pano de fundo relações de gênero, abordando-se temas como violência, saúde da mulher, divisão de trabalho, valorização das mulheres, construção de papéis sociais e direitos humanos. A prática foi nomeada como "Movimento de Mulheres" pelas próprias integrantes, em um dos encontros iniciais. O trabalho é inspirado em metodologias participativas e na compreensão de grupo como dispositivo, sobretudo no que diz respeito à coconstrução das ações em saúde. Os conceitos de gênero e empoderamento foram norteadores das reflexões e ações. Os encontros ocorreram quinzenalmente, com duração média de uma hora e meia cada. Havia aproximadamente 12 mulheres por encontro entre usuárias, estagiárias e agentes comunitárias de saúde. Como tentativa de articulação, em dois dos encontros esteve presente uma conselheira municipal de saúde, quando se discutiu o papel das mulheres na mobilização social. A prática se revelou como um importante dispositivo de integração, uma vez que aproxima e corresponsabiliza universidade, serviço e comunidade na construção das ações.

This paper presents the analysis of a training practice developed in a Health Center located in the North Sanitary District of Belo Horizonte. The central aim of the practice was to promote initiatives of mobilization and political discussions among women who live in the region covered by the health center. During the meetings, discussions were produced through the background of gender relations, approaching themes as violence, women's health, work division, women's valorization, construction of social roles, and human rights. The practice was named as "Women's Movement" by the women involved in one of the first meetings. The work is inspired in participant methodologies and in the comprehension of group as a device, especially when it comes to the co-construction of actions in the health field. The concepts of gender and empowerment were guidelines of the reflections and actions. The meetings took place every other week, with average duration of one and a half hour each. There were approximately 12 women in each meeting between users, psychology students, and health communitarian agents. As an articulation attempt, in two meetings a Municipal Health Counselor was present, discussing women's role in social mobilization. The practice has been revealed as an important device of integrations, since it puts closer and produces accountability between university, health services, and community in the construction of health actions.

En este artículo se presenta el análisis de una práctica realizada en un centro de salud ubicado en el Distrito Sanitario Norte de Belo Horizonte. El objetivo principal de la práctica era promover iniciativas de movilización y discusiones políticas entre las mujeres que viven en la región cubierta por el centro de salud. Durante las reuniones fueran producidas discusiones teniendo como telón de fondo las relaciones de género, ocupándonos de temas como la violencia, la salud de las mujeres, la división del trabajo, lo empoderamiento de las mujeres, la construcción de los roles sociales y los derechos humanos. La práctica fue llamada "Movimiento de Mujeres" por sus propios miembros en una de las reuniones iniciales. El trabajo se hay inspirado en las metodologías participativas y en la comprensión del grupo como dispositivo, especialmente con respecto a la co-construcción de las acciones de salud. Los conceptos de género y empoderamiento fueran organizadores de las reflexiones y de las acciones. Las reuniones se realizaron cada dos semanas, con un promedio de una hora y media. Había alrededor de 12 mujeres por encuentro, incluso usuarias, estudiantes y agentes comunitarias de salud. En un intento de articular la práctica con otros espacios, en dos reuniones asistió una consejera municipal de salud, cuando se discutió el papel de la mujer en la movilización social. La práctica se reveló como un importante dispositivo de integración, medida que se acerca y llama la responsabilidad de la universidad, servicio y comunidad en la construcción de las acciones.

Endangering women's health for profit: health and safety in Mexico's maquiladoras.

PIP: This article focuses on the situation of women in Mexico's maquiladoras (assembly plants). There are approximately 1 million Mexicans working in over 4000 maquiladoras in which violations of worker's human, labor, and health rights exist. The specific dangers of work in maquiladoras and the double burden of domestic and factory work that women already bear all contribute to a wide range of health hazards for women. These workplace hazards include toxic chemicals, unsafe equipment, poor workstation design, and excessive heat or cold, poor ventilation and lighting, harmful noise levels, and dangerously high production quotas. Since most maquiladoras illegally dump hazardous waste and spew contaminants into the surrounding environment, residents of maquiladora communities are exposed to additional health hazards simply because they live near the plants. In response to this problem, workers have organized themselves into community-based groups and democratic unions. The need for worker-controlled organizations was emphasized because workers who are organized have greater possibilities of addressing their concerns about health, safety, wages, and job security than those who are not.^ieng

Indoor biofuel air pollution and respiratory health: the role of confounding factors among women in highland Guatemala.

BACKGROUND: A number of studies have reported associations between indoor biofuel air pollution in developing countries and chronic obstructive lung disease (COLD) in adults and acute lower respiratory infection (ALRI) in children. Most of these studies have used indirect measures of exposure and generally dealt inadequately with confounding. More reliable, quantified information about this presumed effect is an important pre-requisite for prevention, not least because of the technical, economic and cultural barriers to achieving substantial exposure reductions in the world's poorest households, where ambient pollution levels are typically between ten and a hundred times higher than recommended standards. This study was carried out as part of a programme of research designed to inform the development of intervention studies capable of providing quantified estimates of health benefits. METHODS: The association between respiratory symptoms and the use of open fires and chimney woodstoves ('planchas'), and the distribution of confounding factors, were examined in a cross-sectional study of 340 women aged 15-45 years, living in a poor rural area in the western highlands of Guatemala. RESULTS: The prevalence of reported cough and phlegm was significantly higher for three of six symptom measures among women using open fires. Although this finding is consistent with a number of other studies, none has systematically examined the extent to which strong associations with confounding variables in these settings limit the ability of observational studies to define the effect of indoor air pollution adequately. Very strong associations (P < 0.0001) were found between the type of fire and a number of household and socioeconomic factors including the arrangement of rooms, floor type, and possession of a radio and television. The spouse's economic activity type was also significantly associated (P < 0.05). Thus, while 82% of open fire users had dirt floors and only 18% cement or tile floors, the situation was reversed for plancha users, only 16% of whom had dirt floors. CONCLUSIONS: Confounding presents a substantial problem for observational studies of indoor air pollution and health, although there is a reasonable case for believing that the observed association is causal. Intervention studies are required for stronger evidence of this association, and more importantly, to determine the size of health benefit achievable through feasible exposure reductions.

PIP: The authors investigated the association between respiratory symptoms and the use of open fires and chimney woodstoves, as well as the distribution of confounding factors, in a cross-sectional study of 340 women aged 15-45 years living in a poor rural area in the western highlands of Guatemala, and found a significantly higher prevalence of reported cough and phlegm for 3 of 6 symptom measures among women using open fires. When considering confounding factors, very strong associations were found between the type of fire and a number of household and socioeconomic factors including the arrangement of rooms, floor type, and possession of a radio and television. The spouse's economic activity type was also significantly associated. 82% of open fire users had dirt floors, with the remaining 18% having cement or tile floors, while only 16% of chimney woodstove users had dirt floors.

Fighting for human rights: women, war and social change in Zimbabwe.

PIP: This article considers whether women's importance to the success of the Zimbabwean liberation struggle that took place from 1966-80 resulted in the fulfillment of the promises of the male resistance leadership to replace traditional patriarchal subjugation with equality. The introduction notes that the answer to this is complex because actions taken that were beneficial to women were taken for gender-neutral reasons and, therefore, left the patriarchy intact. Women have also gained because their participation in the struggle helped them learn to question assumptions and understand basic human rights, but the goals of the liberation struggle have not been realized for women. The article continues to apply a human rights perspective to an examination of Zimbabwean women's legal status, representation in government, empowerment through education, economic participation, and access to health and welfare. The conclusion of the article points out that not only have women not achieved full human rights in Zimbabwe, there have also been disturbing examples of a backlash against female emancipation including 1) the government-authorized arrests of women who happened to be walking around at night in September 1983, 2) calls for the repeal of laws beneficial to women, and 3) incidences when female university students were publicly stripped of their modern garb (this led to a 1998 protest by more than 100 women).^ieng

Family planning is reducing abortions.

PIP: This news brief presents the US President's wife's statement on the association between use of family planning and a decline in abortions worldwide. Hillary Rodham Clinton attended the Sixth Conference of Wives of Heads of State and Government of the Americas held in La Paz, Bolivia. The conference was suitably located in Bolivia, a country with the highest rates of maternal mortality in South America. Bolivia has responded by launching a national family planning campaign coordinated between government, nongovernmental, and medical organizations. Half of Bolivian women experience pregnancy and childbirth without the support of trained medical staff. Mortality from abortion complications account for about half of all maternal deaths in Bolivia. Voluntary family planning workers teach women about the benefits of child spacing, breast feeding, nutrition, prenatal and postpartum care, and safe deliveries. Bolivia has succeeded in increasing its contraceptive use rates and decreasing the number of safe and unsafe abortions. Bolivia's program effort was supported by USAID. USAID provided technical assistance and funds for the establishment of a network of primary health care clinics. Mrs. Clinton visited one such clinic in a poor neighborhood in La Paz, which in its first six months of operation provided 2200 consultations, delivered 200 babies, registered 700 new family planning users, and immunized 2500 children. Clinics such as this one will be affected by the US Congress's harsh cuts in aid, which reduce funding by 35% and delay program funding by 9 months. These US government cuts in foreign aid are expected to result in an additional 1.6 million abortions, over 8000 maternal deaths, and 134,000 infant deaths in developing countries. An investment in population assistance represents a sensible, cost-effective, and long-term strategy for improving women's health, strengthening families, and reducing abortion.^ieng

Workshop on screening for cancer of the uterine cervix in Central America.

PIP: This article describes the objectives and content of a workshop held in Managua, Nicaragua, during November 1995, on screening for cervical cancer. The aims were to discuss cost-effective models of screening in countries with a high incidence of cervical cancer and to reach a consensus on principles for screening that is balanced with a country's resources. The workshop aimed to develop a planning framework and to identify program strengths and weaknesses by country. In 1990 there were 25,000 deaths due to cervical cancer in Central America; even so, most countries attach a low priority to cervical cancer screening. Workshop plenary sessions were devoted to discussions about the natural history of cancer of the cervix and the implications for screening, the high costs of human papillomavirus (HPV) tests, approaches to national registries of cervical cancer, screening issues in Central America, downstaging, laboratory quality control issues, treatment of abnormalities, recruitment of women, and IEC. This report includes individual country program reports for Nicaragua, Panama, Haiti, the Dominican Republic, Guatemala, Honduras, and St. Vincent and the Grenadines. Participants concluded that priority should be placed on education about cancer and cancer of the cervix and education of primary health care professionals. It was agreed that all participating countries should begin pilot programs adapted to resource availability, with the idea of a later nationwide expansion. Health care professionals who treat women during the prime reproductive years should use the opportunity to identify women at high risk of invasive cancer. There is overcoverage of women aged under 35 years and insufficient coverage of women aged 35-64 years. Health programs need to enlist the help of women's groups in creating a need and demand in communities. Cytology laboratories need to provide quality services.^ieng

Mental health of the mothers of malnourished children.

BACKGROUND: The objective of this study is to measure the association between protein-energy malnutrition (PEM) in children and their mothers' mental health, in a low income area in the city of Embú, São Paulo, Brazil. METHODS: A case-control study was performed. Cases were 60 moderately and severely malnourished children (Gomez criteria) selected from two primary health care units. Controls consisted of 45 eutrophic children attending the same units. The main outcome measure was for the mothers to present a mental health score > 6 according with the 'Adult Psychiatric Morbidity Questionnaire' (QMPA), a psychiatric screening instrument. RESULTS: Of mothers of children with PEM, 63% and 38% of mothers in the control group were QMPA positive: odds ratio (OR) = 2.8 (95% confidence interval [CI]: 1.2-6.9). Of PEM children, 27% had low birthweight (LBW = < 2500 g) and 6% of the control group had LBW. Interactions were found between: mothers' mental health and number of children (with > or = 4 children: OR = 20.0 [95% CI: 2.1-274.2], with < or = 3 children: OR = 1.6 [95% CI: 0.6-4.5), as well as mothers' mental health and maternal age (in women > 30: OR = 12.5 [95% CI: 2.0-93.4], in women < or = 30: OR = 1.5 [95% CI: 0.5-4.4]. CONCLUSIONS: Mothers of children with PEM showed a higher rate of mental disturbances than mothers of eutrophic children. Unlike LBW, maternal age and number of children interact with mothers' mental health, increasing the association. Management of poor mental health may lead to mothers being better caretakers of their children and this may have a positive impact on PEM.

Voices of impoverished Brazilian women: health implications of roles and resources.

This qualitative study was based on individual interviews with 75 Brazilian women in an impoverished peri-urban squatter community (favela) in southeastern Brazil. The purposes of the study were to describe women's role involvement in domestic and employment contexts; identify stresses and satisfactions of maternal, spousal, and employment roles; and assess personal and environmental role constraints and resources from the perspective of women's health. The analytic approach to the interview data was qualitative content analysis, through which thematic categories of maternal, spousal, and employment role satisfactions and stresses were identified by the researchers. Women's unrelenting work in the face of harsh social and economic environments was a broad theme woven throughout the women's descriptions of their lives. The confluence of role constraints affecting the participants' lives included poverty, marginalization, abuse, and lack of support and recognition by partners and society. In order to overcome great adversity and meet heavy role demands, these women relied on self, faith in God, family, and health resources. Implications for women's health promotion are discussed.

PIP: This article describes a qualitative study of women's role in an impoverished peri-urban squatter community in Brazil. The convenience sample included 75 women, comprised of Roman Catholics (51%), Protestants (17%), Spiritists (17%), and unreligiously-affiliated (11%). 26 women were illiterate. 49 had some primary school education. 59% had income that was below the poverty line. 92% reported their income as inadequate. 17 households did not have piped water, and 5 households did not have electricity. None had telephones. Only 28 had refrigerators. Interviews were conducted at the local health post among a sample that was largely unexposed to the questionnaire survey process, which sometimes posed difficulties. Attempts were made to seek out divergent cases or experiences and alternative explanations. Findings indicate that all the women identified themselves as the member of the household responsible for domestic housekeeping, and all saw that role as their most time- and energy-consuming. Most had at least 1 child. 72% were married, and 16% lived with a male partner. 12% were single, widowed, or divorced. Most were dependent upon spouses for economic support. 29 women had some employment outside the home. Women reported the lack of child care as a major reason for not being employed. There were other barriers. The women valued their role as mothers, but work and worries were dominant themes. Women complained about their partner's alcohol and drug misuse, domestic violence, and a lack of appreciation or affection. Working women reported socioeconomic satisfaction and work overload. Women's living conditions were harsh. Women showed considerable inner strength and creativity in dealing with demands and stresses.

Let's talk reproductive health -- young people's voices.

PIP: This article presents extracts from comments made by young people in various parts of the world about the meaning of the term "safe motherhood." A Ghanian woman noted that young girls, who often bear a heavier workload than boys but receive less food, need to be given the same diet as boys. A young Senegalese mother relayed that she found out she was pregnant when she went to a hospital with stomach pains shortly before her 14th birthday. Until then she had no idea that sexual intercourse led to pregnancy. A Mexican youth cited the problems that accompany adolescent pregnancy and motherhood, and a young woman in India called for delivery of proper medical care to all young mothers and presentation of health education about safe motherhood in schools. An Egyptian youth extolled the benefits of a project that involved young people from rural youth organizations in safe motherhood IEC (information, education, and communication) activities. Previously, adolescents had not received any special attention. Finally, a youth working in a family planning educational booth in Botswana stated that many youth who engage in sexual intercourse at an early age have no idea of the consequences of their actions.^ieng

Gender relations, the gendered division of labour and health: the case of the women factory workers of Rio Tinto, northeast Brazil, 1924-91.

PIP: This article examines gendered work-health relationships among female factory workers in Rio Tinto, a textile factory town in Brazil. The author draws on her own and her parents' experiences as factory workers and as residents of Rio Tinto. In addition, she gathered research during 1982-86 and 1988-93, interviewing 30 female and 12 male workers. Findings from 1924-58 and 1959-91 indicate that the family structure and work process were interlinked. Self-images are construed to be the intersection of social relations of sex and class, psychopathology, and the concept of work positions. Gendered relations are a social construction, and awareness of these relations is based on a hierarchy and form of power based on a gendered division of labor. Gendered relations arise out of a specific historical context. Social practices reflect the relationship between sexual division of labor and gendered social relations, their modalities, shape, and periodization. The work-health relationship is expressed in the gendered technical organization of work, the gendered socialization of work, and domestic labor. The period of 1917-58 reflects the capitalist influences. When women became wage earners, their management of household tasks was changed. Men took over the heavy tasks, and women performed tasks that required skill and patience. Work-related health impacts, such as deformed knees or severed fingers, and accidents varied with the task. Women adapted to work conditions. During the 1940s, female workers refused to join the collective protests of men for better wages and conditions. The dream of progress faded by 1964. After 1959, new gendered relations of production and reproduction emerged. Labor laws were passed; new machines were introduced. During 1965-70, the health issues were headaches, irritability, and anxiety. 1970-91 brought a hollowness of spirit and the search for an explanation for the violence they had experienced.^ieng