Measurement tools and intensity of nipple pain among women with or without damaged nipples: A quantitative systematic review.

AIMS: To describe and evaluate pain scales used to measure nipple pain in breastfeeding women and to identify nipple pain intensity in women with or without nipple damage. BACKGROUND: Nipple pain is one of the most common reasons given for premature cessation of breastfeeding. However, there are no agreed tools to measure pain and no previous reviews have provided summary estimates of pain scores. DESIGN: Systematic review. DATA SOURCES: Medline, CINAHL, Scopus, Web of Science, SciELO, and LILACS. REVIEW METHODS: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The guiding question was: How is nipple pain in breastfeeding women measured and how severe is it? We analysed articles published up to February 2018, excluded review articles and those that did not present the level of nipple pain or tools to estimate pain severity. RESULTS: A total of 1,023 articles were identified and 25 were included in the review after applying the exclusion criteria. The Numeric Rating Scale (nine studies) and Visual Analogue Scale (seven studies) were the most prevalent tools for measuring pain. Using a pain score between 0-10, women with nipple damage reported a weighted mean of 6.2 in the first week and 5.8 after that period; women without damage reported a weighted mean of 2.7. CONCLUSION: Women with nipple damage consistently reported a higher level of pain than women without damage. To prevent premature cessation of breastfeeding, it is important to help new mothers avoid nipple damage.

Non-pharmacological interventions during childbirth for pain relief, anxiety, and neuroendocrine stress parameters: A randomized controlled trial.

AIM: This study aimed to investigate the effect of warm shower hydrotherapy and perineal exercises with a ball on pain, anxiety, and neuroendocrine stress parameters during childbirth. METHODS: This randomized controlled trial was conducted with 128 women during childbirth, admitted for hospital birth in São Paulo, Brazil, from June 2013 to February 2014. The participants were randomly assigned into one of the following intervention groups: received warm shower hydrotherapy (GA); performed perineal exercises with a ball (GB); and combined intervention group, which received warm shower hydrotherapy and perineal exercises with a ball (GC) (n = 39). Pre-and post-intervention parameters were evaluated using visual analogue scales for pain and anxiety, and salivary samples were collected for the stress hormones analysis. RESULTS: Pain, anxiety, and epinephrine release decreased in the group performing perineal exercises with a ball (GB). ß-endorphin levels increased in this group (GB) after the intervention and showed significant difference in capacity to cause this effect (P = .007). However, no significant differences were observed in cortisol, epinephrine, and norepinephrine levels. CONCLUSIONS: Warm showers and perineal exercises could be considered as adjunct therapy for women suffering from pain, anxiety, and stress during childbirth. Clinical Trial Registry RBR-84xprt.

Contraceptive practices in women with sickle-cell disease.

This was a cross-sectional study of sexually active women with sickle-cell disease (SCD) managed at São Paulo Federal University during a one-year period. A total of 54 women were included. Mean age was 32.0 (11.2, standard deviation) years and almost 95% were black or of mixed racial ancestry. Almost 80% reported a history of multiple blood transfusions, 50% had kidney disease and 17% had a history of thrombosis. Over 80% of them had used some form of contraception, mostly combined hormonal contraceptive (52%) or progestin-only contraceptives (46%). Although most women had multiple comorbidities which would contraindicate the use of combined hormonal contraceptives, this was the most popular method used by them. We did not identify an association between the use of combined hormonal contraceptives and major complications. Larger, prospective studies are needed to evaluate the use and the effects of contraceptive methods in women with SCD.

Maternal and perinatal effects with the use of floral therapy in childbirth: randomized clinical trial.

OBJECTIVE: To evaluate the clinical, obstetric, maternal and perinatal effects of the use of flower essences in labor, against factors that enhance it. METHOD: Clinical trial, randomized, controlled, in 164 parturients divided into two groups, flower essences and placebo, respectively, evaluated before and after the intervention. Carried out in a vaginal delivery center, in the city of São Paulo, from May to October 2018. Data were analyzed using descriptive statistics, Student's t test, bilateral hypothesis, negative and positive observed critical t, Pearson's chi-square, exact test. Fisher. RESULTS: It was observed in the Experimental Group, moderate increase in systolic blood pressure (p=0.046), frequency (p=0.055) and intensity of contractions (p=0.031), as well as a reduction in time to birth (194 minutes), higher number of vaginal deliveries (p=0.038) and better pattern of fetal vitality. CONCLUSION: There was evidence of a positive action of the Floral Essence on the potentiating factors of labor, being effective in maternal clinical and obstetrical repercussions, as well as perinatal ones.

Effects of floral therapy on labor and birth: a randomized clinical trial.

OBJECTIVES: to assess the effects of floral therapy in the face of factors that boost pain in the parturition process and its results in the duration of labor. METHODS: this is a randomized, controlled and triple-blind clinical trial. We selected 164 pregnant women with gestational age ≥37 weeks, cervical dilation ≥4 cm, randomly divided into floral therapy and placebo group. RESULTS: the Five Flower floral essence proved to be effective, considering the factors that boost pain in labor. Experimental Group did not show an increase in contractions, unlike Control Group, which presented an increase of one contraction for mothers in active phase and amniorrhexis. The Five Flower essence proved to be effective in reducing labor time by 1:30h from the beginning of the intervention at birth. CONCLUSIONS: floral therapy proved to be effective in pain management, reflecting positively in its brevity, qualifying its outcome.

Actions for early detection of breast cancer in two municipalities in the Western Amazon.

OBJECTIVE: to assess the implementation of actions for early detection of breast cancer in Primary Care and to verify the adequacy of these actions with the Ministry of Health recommendations. METHOD: a cross-sectional study conducted from September 2017 to March 2018 with 736 women registered in Basic Health Units in two municipalities in Acre. For data collection, a validated questionnaire was used. In statistical analysis, the chi-square test or Fisher's exact test was applied. RESULTS: the frequency of mammography was 42%. Of the women at standard risk for breast cancer, only 5,8% underwent mammography properly. CONCLUSION: there was a low compliance of early detection actions to the Ministry of Health recommendations; thus, the need to adopt measures to increase professionals' adherence to government proposals is highlighted, as well as continuous actions assessments.

[Human Papillomavirus (HPV) and uterine cervical cancer]. / Vírus HPV e câncer de colo de útero.

This article refers to a review of literature about the HPV virus and the cervical neoplasia, aiming at raising aspects of the virus infection which influences in the natural development of the uterine cervical cancer such as: the type of virus, the duration and the persistence of the infection and also the association with the manifestations of the preceding lesions up to the evolution of the neoplasia. It was possible to notice the strong association of the infection with the evolution of the cervical neoplasia, however, studies to better elucidate certain aspects of the infection of the HPV virus that acts on the uterine cervix are still necessary so that the actions of prevention and fight against the disease will be more efficient.

Tracking of cellular atypes of the cut of uterus of women in Primary Care.

OBJECTIVES: to analyze the screening for cervical cell atypias in women assisted in Primary Care. METHODS: quantitative, retrospective and cross-sectional study, with analysis of 190 medical records of women who had atypical results from the cervical cytopathological exam collection from 2012 to 2014. RESULTS: the most frequent atypias found were possibly Non-neoplastic squamous (ASC-US, 57.4%) and Low-grade intraepithelial lesion (LSIL, 23.2%). The time elapsed between the exam and the result was 24 days. The professional's conduct after the result of the last cervical cytopathology was adequate for 51.1% of women. CONCLUSIONS: there is a need to improve the cervical cancer screening program and correctly target the atypia identified, aiming at the access of the target population for the diagnostic investigation and treatment of precursor lesions of cervical cancer.

Sleep quality in women who use different contraceptive methods.

BACKGROUND: Both menstrual cycle and hormone alterations influence sleep pattern. The aim of this study was to evaluate sleep quality in women who use different contraceptive methods. MATERIAL AND METHODS: This study was a descriptive, cross-sectional survey. Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality, and a questionnaire was used to obtain sociodemographic, clinical, lifestyle, and contraceptive use data. RESULTS: The study population comprised 235 women in reproductive age. Regarding lifestyle, 25.5% of the women were physically active, 12.3% were tobacco-smoking, and 70.6% drank coffee daily. Sleep quality was good in 34% of the studied population and poor in 66% of the population. The population was divided into two groups: hormonal (57.1%) and non-hormonal (42.9%) contraceptive users. Sleep quality in the users of non-hormonal contraceptive methods was similar to that in the users of hormonal methods (6.1±3.2 versus 5.9±2.9; p=0.5). Sleep efficiency was statistically higher among the users of non-hormonal contraceptive methods (94.7±17.7) than among the users of hormonal methods (90.0±15.3; p=0.03). The patients who had irregular or altered menstrual cycles reported poorer sleep quality. The absence of routine physical activity negatively influenced sleep quality (p=0.05). The women who snored reported worse sleep quality (p=0.002). CONCLUSIONS: Nearly half of the studied population was users of hormonal contraception, and most of these women reported poor sleep quality. Sleep efficiency was higher among the users of non-hormonal contraceptives. No differences in subgroups (hormonal contraceptive users) were observed.

Repercussions of using the birth plan in the parturition process. / Repercussões da utilização do plano de parto no processo de parturição.

OBJECTIVE: To analyze the repercussions of using the Birth Plan in the parturition process from the national and international scientific production. METHODS: Integrative literature review performed in the LILACS, PUBMED, CINAHL and SciELO, comprising 13 articles published in English, Spanish and Portuguese, in the period from 2008 through 2018. RESULTS: The construction of the Birth Plan during prenatal influences positively the process of parturition and maternal-fetal outcomes. Unrealistic expectations can cause dissatisfaction with the experience of childbirth. Care providers play a central role in supporting its planning and fulfillment. CONCLUSIONS: The analyzed publications justify the clinical implementation of the Birth Plan, once it represents an intensifying technology of humanized care and maternal satisfaction. There are still some challenges related to the use of this instrument concerning women's adherence and professional support to improve the fulfillment of the Birth Plans.

Complementary therapies in labor: randomized clinical trial. / Terapias complementares no trabalho de parto: ensaio clínico randomizado.

OBJECTIVE: To evaluate the effect of isolated and combined warm shower bath and perineal exercise with Swiss ball, on perception of pain, anxiety and labor progression. METHOD: Randomized, controlled clinical trial with 128 patients allocated into three groups of therapies: isolated and combined bath and ball. Pain and anxiety perception was evaluated before and thirty minutes after therapeutic intervention through visual analogic scales (VAS). RESULTS: Pain perception score increased, and anxiety decreased in all groups, mainly when using a shower bath. The cervical dilation increased in all groups (p<.001), as well as the number of uterine contractions increased, mainly in the group that used combined bath and ball and also showed shorter labor time. CONCLUSION: The studied therapies contribute to maternal adaptation and well-being and favor labor's evolution.

[An overview of the evaluation of nursing graduation courses]. / Um olhar sobre as avaliações de cursos de graduação em enfermagem.

This study aimed, starting from the index of adherence of the Pedagogical Projects of the Undergraduate Nursing Courses to the National Curriculum Rules for these Courses, to analyze qualitatively potentialities and weak points of the courses. It is a descriptive, comparative study, between the present data in the PP/UNC and the proposed in the NCR/UNC, having as basis the reports of the evaluation processes conducted by the INEP/MEC. The sample was composed by the reports used for approval and reapproval, conducted in the period from 2002 through 2006, concerning 12 undergraduate courses. One analyzed 8 courses located in the superior part and 4 in the inferior. The study revealed strong and weak points of the courses in the three dimensions of the evaluation reports, and shows needs in the colleges/courses to search for a better use of the epistemologic bases present in the NCR/UNC and proposed in the PP/UNC.

Monthly injectable contraceptive use by adolescents in Brazil: evaluation of clinical aspects.

PURPOSE: This prospective noncomparative observational study evaluated the clinical symptoms, body weight and blood pressure of 38 adolescents receiving a monthly injectable contraceptive containing estradiol valerate 5 mg and norethisterone 50 mg. METHODS: The volunteers, aged 16-19 years, were examined monthly during 1 year and asked about the following symptoms at baseline: dysmenorrhea, headache, breast tenderness, leg pain and irritability. RESULTS: There was a constant and gradual decline in each of the above symptoms over time, and there was a statistically significant difference between symptoms reported at the first visit and subsequent appointments. Body weight and blood pressure did not change significantly during the 1-year period. No pregnancies were observed. CONCLUSION: These findings suggest that monthly injectable contraception with estradiol valerate 5 mg/norethisterone 50 mg represents a highly effective and well-tolerated contraceptive for teens.

[Adherece of Nursing Graduation Courses to the National Curricular Guidelines]. / Aderência dos Cursos de Graduação em Enfermagem às Diretrizes Curriculares Nacionais.

The objective of this study was to evaluate the adherence of the Pedagogic Projects of Nursing Graduation Courses (PPC/ENF) to the National Guidelines for the Curriculum of Nursing Graduation Courses (DCN/ENF). It was a descriptive study that compared the information obtained from the reports of the PPC/ENF and the proposals of DCN/ENF, using data collected by INEP/MEC and made available for this study. The data base consisted of all reports from 110 nursing graduation courses that were seeking accreditation or renewal between 2002 and 2006. Sixty aspects of the evaluation were selected and 10. The study reports that the rate of adherence of the nursing courses to the DCN/ENF guidelines was low, 72%. These findings indicate there is a need for nursing courses/schools to adjust the epistemological bases of the DCN/ENF to the proposals of PPC/ENF.

Maternal and perinatal effects with the use of floral therapy in childbirth: randomized clinical trial / Efectos maternos y perinatales del uso de floral em el parto: ensayo clínico aleatorizado / Efeitos maternos e perinatais com utilização de floral no trabalho de parto: ensaio clínico randomizado

ABSTRACT Objective To evaluate the clinical, obstetric, maternal and perinatal effects of the use of flower essences in labor, against factors that enhance it. Method Clinical trial, randomized, controlled, in 164 parturients divided into two groups, flower essences and placebo, respectively, evaluated before and after the intervention. Carried out in a vaginal delivery center, in the city of São Paulo, from May to October 2018. Data were analyzed using descriptive statistics, Student's t test, bilateral hypothesis, negative and positive observed critical t, Pearson's chi-square, exact test. Fisher. Results It was observed in the Experimental Group, moderate increase in systolic blood pressure (p=0.046), frequency (p=0.055) and intensity of contractions (p=0.031), as well as a reduction in time to birth (194 minutes), higher number of vaginal deliveries (p=0.038) and better pattern of fetal vitality. Conclusion There was evidence of a positive action of the Floral Essence on the potentiating factors of labor, being effective in maternal clinical and obstetrical repercussions, as well as perinatal ones.

RESUMEN Objetivo Evaluar los efectos clínicos, obstétricos, maternos y perinatales del uso de esencias florales en el parto, frente a factores que lo potencian. Método Ensayo clínico, aleatorizado, controlado, en 164 parturientas divididas en dos grupos, esencias florales y placebo, respectivamente, evaluadas antes y después de la intervención. Realizado en un centro de parto vaginal, en la ciudad de São Paulo, de mayo a octubre de 2018. Los datos fueron analizados mediante estadística descriptiva, prueba t de Student, hipótesis bilateral, t crítica observada negativa y positiva, chi-cuadrado de Pearson, prueba exacta. Pescador. Resultados Se observó en el Grupo Experimental, aumento moderado de la presión arterial sistólica (p = 0,046), frecuencia (p = 0,055) e intensidad de las contracciones (p = 0,031), así como una reducción del tiempo hasta el nacimiento (194 minutos), mayor número de partos vaginales (p = 0,038) y mejor patrón de vitalidad fetal. Conclusión Se evidenció una acción positiva de la Esencia Floral sobre los factores potenciadores del parto, siendo efectiva en las repercusiones clínicas y obstétricas maternas, así como perinatales.

RESUMO Objetivo Avaliar os efeitos clínicos, obstétricos maternos e perinatais com o uso de essências florais no trabalho de parto, frente a fatores que o potencializam. Método Ensaio clínico, randomizado, controlado, em 164 parturientes divididas em dois grupos, essências florais e placebo, respectivamente, avaliadas pré e pós intervenção. Realizado em centro de parto normal, na cidade de São Paulo, de maio a outubro de 2018. Os dados foram analisados por estatística descritiva, teste t de Student hipótese bilateral, t crítico observado negativo e positivo, Qui-quadrado de Pearson, Exato de Fisher. Resultados Observou-se no Grupo Experimental, moderada elevação da pressão arterial sistólica (p=0,046) da frequência (p=0,055) e intensidade das contrações (p=0,031), assim como, redução do tempo ao nascimento (194 minutos), maior número de partos vaginais (p=0,038) e melhor padrão de vitalidade fetal. Conclusão Evidenciou-se ação positiva da Essência Floral perante os fatores potencializadores do trabalho de parto, sendo efetiva nas repercussões clínicas e obstétricas maternas, bem como perinatais.

Aplicabilidade de algoritmo de apoio à decisão na avaliação perineal para o parto / Aplicabilidad de algoritmo para respaldar la decisión en la evaluación perineal para el parto / Applicability of decision support algorithm in perineal assessment for childbirth

Resumo Objetivo Desenvolver um algoritmo para avaliação perineal na assistência ao parto e aferir sua aplicabilidade e acurácia utilizando um protótipo de sistema de suporte à decisão. Métodos Pesquisa aplicada de desenvolvimento tecnológico, constituída pela construção de algoritmo, avaliação por profissionais com expertise na área, criação de um protótipo de Sistema de Apoio à Decisão usando ferramentas on-line e avaliação de sua aplicabilidade e acurácia durante a assistência a 305 partos realizados por enfermeiros. Os dados foram analisados por estatística descritiva, teste Qui-quadrado e exato de Fisher além do coeficiente de Kappa para avaliar a concordância entre o procedimento indicado pelo sistema e o realizado pelo profissional. Resultados Houve concordância entre a sugestão do algoritmo e a decisão do profissional em 93,1% dos partos; em 6,9% o profissional decidiu caminhos opostos ao recomendado. Os profissionais que optaram por seguir a sugestão do algoritmo obtiveram como desfecho a integridade perineal ou a ocorrência de lacerações de 1°grau. Os que optaram por não seguir a recomendação houve ocorrência de lacerações de 2º ou 3º graus em 28,6% das parturientes. Já na análise de acurácia, o algoritmo sugeriu que a episiotomia deveria ser realizada em 45 dos 305 partos assistidos. Verificou-se associação entre divergências de conduta e número de eventos adversos (p=0,001). Conclusão O algoritmo mostrou-se ferramenta útil para a avaliação perineal na assistência ao parto.

Resumen Objetivo Desarrollar un algoritmo para la evaluación perineal en la asistencia al parto y determinar su aplicabilidad y precisión utilizando un prototipo de sistema para respaldar la decisión. Métodos Investigación aplicada de desarrollo tecnológico, constituida mediante la construcción del algoritmo, evaluación de profesionales con experiencia en el área, creación de un prototipo de Sistema para Respaldar la Decisión usando herramientas en línea y evaluación de su aplicabilidad y precisión durante la atención a 305 partos realizados por enfermeros. Los datos fueron analizados mediante estadística descriptiva, prueba χ2 de Pearson y prueba exacta de Fisher, además del coeficiente Kappa para evaluar la concordancia entre el procedimiento indicado por el sistema y el realizado por el profesional. Resultados Hubo concordancia entre la sugerencia del algoritmo y la decisión del profesional en el 93,1 % de los partos, en el 6,9 % el profesional decidió un camino opuesto al recomendado. Los profesionales que optaron por seguir la sugerencia del algoritmo obtuvieron como resultado la integridad perineal o episodios de desgarro de primer grado. Los que optaron por no seguir la recomendación, tuvieron episodios de desgarros de segundo y tercer grado en el 28,6 % de las parturientas. Por otro lado, en el análisis de precisión, el algoritmo sugirió que la episiotomía debería ser realizada en 45 de los 305 partos atendidos. Se verificó relación entre divergencias de conducta y número de eventos adversos (p=0,001). Conclusión El algoritmo demostró ser una herramienta útil para la evaluación perineal en la atención a partos.

Abstract Objective To develop an algorithm for perineal assessment in childbirth care and assess its applicability and accuracy using a decision support system prototype. Methods This is applied research of technological development, consisting of the construction of an algorithm, assessment by professionals with expertise in the area, creation of a Decision Support System prototype using online tools and assessment of its applicability and accuracy during care for 305 childbirths performed by nurses. Data were analyzed using descriptive statistics, chi-square and Fisher's exact tests, in addition to the Kappa coefficient to assess the agreement between the procedure indicated by the system and that performed by professionals. Results There was agreement between the algorithm's suggestion and professional decision in 93.1% of childbirths. In 6.9%, professionals decided opposite paths to the recommended one. The professionals who chose to follow the algorithm's suggestion had perineal integrity or the occurrence of first-degree tear as an outcome. Those who chose not to follow the recommendation had second- or third-degree tears in 28.6% of parturient women. In the accuracy analysis, the algorithm suggested that episiotomy should be performed in 45 of the 305 assisted childbirths. There was an association between divergences in conduct and the number of adverse events (p=0.001). Conclusion The algorithm proved to be a useful tool for perineal assessment in childbirth care.

Efetividade das essências florais no trabalho de parto e nascimento: avaliação dos parâmetros obstétricos e neuroendócrinos / Efectividad de las esencias florales en el trabajo de parto y nacimiento: evaluación de los parámetros obstétricos y neuroendócrinos / Effectiveness of flower essences in labor and birth: evaluation of obstetric and neuroendocrine parameters

Resumo Objetivo Avaliar a efetividade da terapia floral associados aos fatores que potencializam a dor e o estresse no processo de parturição por meio de parâmetros obstétricos e neuroendócrinos. Métodos Ensaio clínico randomizado, triplo cego, placebo controlado, realizado com 164 parturientes de risco obstétrico habitual, subdivididas entre dois grupos para as quais foram ministradas essência floral Five Flower e placebo, respectivamente. Avaliou-se aspectos obstétricos e neuroendócrinos por meio da análise bioquímica dos hormônios Beta-endorfina e Cortisol salivar antes e ao término da intervenção. Resultados A essência floral modulou os fatores que potencializam a dor no trabalho de parto, isto é, rotura das membranas amnióticas, fase ativa e indução do parto. Houve aumento dos níveis de Beta-endorfina juntamente com a diminuição de uma contração em mulheres com rotura das membranas ovulares e com indução. Em relação ao estresse, houve constância dos valores do Cortisol para o Grupo Experimental, não alterando seu valor na fase ativa, rotura das membranas ovulares ou indução. A Essência Five Flower mostrou-se eficaz na redução de uma hora e vinte e cinco minutos do tempo do trabalho de parto no Grupo Experimental. Conclusão A terapia floral realizada, mostrou-se eficaz no controle da dor e estresse durante o trabalho de parto, refletindo positivamente na sua brevidade e qualificando seu desfecho.

Resumen Objetivo Evaluar la efectividad de la terapia floral asociada a los factores que potencializan el dolor y el estrés en el proceso de parto por medio de parámetros obstétricos y neuroendócrinos. Métodos Ensayo clínico aleatorizado, triple ciego, placebo controlado, realizado con 164 parturientas de riesgo obstétrico normal, subdivididas en dos grupos en que se les administró esencia floral Five Flower y placebo. Se evaluaron aspectos obstétricos y neuroendócrinos por medio del análisis bioquímico de las hormonas betaendorfina y cortisol salival antes y al final de la intervención. Resultados La esencia floral reguló los factores que potencializan el dolor en el trabajo de parto, es decir, ruptura de las membranas amnióticas, fase activa e inducción del parto. Hubo aumento de los niveles de betaendorfina junto con la reducción de una contracción en mujeres con ruptura de las membranas ovulares y con inducción. Con relación al estrés, hubo constancia de los valores de cortisol en el grupo experimental, sin aumento de su valor en la fase activa, ruptura de las membranas ovulares o inducción. La esencia Five Flower demostró ser eficaz para la reducción de una hora y veinticinco minutos de tiempo de trabajo de parto en el grupo experimental. Conclusión La terapia floral realizada demostró ser eficaz en el control del dolor y del estrés durante el trabajo de parto, con un impacto positivo en su brevedad y en la cualificación de su desenlace.

Abstract Objective To evaluate the effectiveness of floral therapy associated with factors that strengthen pain and stress in the labor process through obstetric and neuroendocrine parameters. Methods Randomized, triple-blind, placebo-controlled clinical trial performed with 164 parturients at usual obstetric risk subdivided into two groups to which Five Flower floral essence and placebo were administered. Obstetric and neuroendocrine aspects were evaluated through biochemical analysis of the beta-endorphin and cortisol hormones through salivary samples before and after the intervention. Results The flower essence modulated the factors that strengthen pain in labor, that is, rupture of amniotic membranes, active phase and induction of labor. There was an increase in beta-endorphin levels along with one less contraction in women with ruptured ovular membranes and labor induction. Regarding stress, cortisol values were constant for the Experimental group, and did not change in the active phase, rupture of the ovular membranes or induction. The Five Flower essence proved to be effective in reducing labor time by 1 hour 25 minutes in the Experimental group. Conclusion The floral therapy used proved to be effective in controlling pain and stress during labor, and reflected positively on its agility and qualified its outcome.

Long-term evaluation of lipid profile and oral glucose tolerance test in Norplant users.

PURPOSE: This study reports the results of the lipid profile and oral glucose tolerance test (OGTT) in 46 normal patients tested before and after 5 years of Norplant use. RESULTS: After 5 years, there was a substantial decrease of 28.9% in high-density lipoprotein cholesterol levels and a similar but less pronounced fall of 7.1% in the total cholesterol levels. The Castelli 1 index did not vary, and the triglycerides and low-density lipoprotein cholesterol levels remained normal and unchanged throughout the study period. All the mean values of OGTT were significantly lower after 5 years, except for the 90-min glycemia. CONCLUSION: These findings indicate that long-term Norplant use does not increase cardiovascular risks.

Bleeding patterns of adolescents using a combination contraceptive injection for 1 year.

PURPOSE: This prospective observational study evaluated the bleeding patterns of adolescents receiving a monthly injectable contraceptive containing norethisterone enanthate 50 mg plus estradiol valerate 5 mg. MATERIALS AND METHODS: The study enrolled 73 volunteers aged between 14 and 19 years; of these patients, 38 (52%) recorded their menstrual cycles during 1 year. RESULTS: After 1 year of using the contraceptive, most of the 38 women (71.1%) had adequate menstrual patterns (two to four bleeding episodes; none lasting 10 days or longer; with a range of bleeding-free intervals not exceeding 17 days), 23.7% reported prolonged bleeding episodes, 2.6% had irregular bleeding and 2.6% had amenorrhea. Only 1 of the 38 teenagers is known to have discontinued the method due to bleeding. Among these 38 adolescents, dissatisfaction with bleeding patterns was not a frequent reason given for discontinuation of the monthly injectable contraceptive.

Nursing phenomena identified in family planning visits with ICNP - Beta version 2.

This descriptive, exploratory, retrospective survey, carried out at a family planning service, aimed to identify nursing phenomena during nursing visits according to the ICNP, Beta version 2. Data were collected based on 52 records of nursing visits, realized from October 2001 to December 2002. To conduct the cross-mapping process, all identified nursing phenomena were joined, organized and compared according to the ICNP's terms. Of the 51 identified nursing phenomena/diagnoses, 46 (90.2%) showed exact and partial concordance. The identified nursing phenomena can be used to assist nurses to provide care for clients in family planning services. The ICNP showed to be a comprehensive program, although some terms need to be reviewed and others enhanced. However, considering that it is an international classification applicable to several countries, the mapping process and cross-references were very satisfactory.