Nursing care of women who suffered sexual violence.

The aim of this study was to characterize the nursing care, provided to women who suffered sexual violence, treated at The Women's Hospital-CAISM/UNICAMP. A retrospective, descriptive study performed using 146 nursing care records of women attended from June 2006 to May 2007. The results showed that the majority of attendances occurred during the day period, that there was consistency between the interventions and the nursing diagnoses identified, and that women reported having received guidance in accordance with the protocol of the program. The nursing consultation time was greater at night (p=0.0227) and the women frequently understood the health risks resulting from sexual violence (p=0.0072), the use of antiretrovirals according to their daily activities (p=0.0397) and they were more focused on the purpose of the serology (p=0.0351). We concluded that the care provided was shown to be appropriate and of a better quality in the nightshift period.

Factors associated with bone density in young women with karyotypically normal spontaneous premature ovarian failure.

OBJECTIVE: To evaluate bone density and associated factors in women with premature ovarian failure (POF) compared to age-matched women with normal ovarian function. METHODS: A cross-sectional study of 50 patients with POF undergoing bone mineral densitometry was conducted, compared to 50 women paired by age who menstruated regularly. RESULTS: In women with POF, the mean bone mineral density measured was 1.22 g/cm(2) at the spine and 0.92 g/cm(2) at the femur, values which were significantly lower than in the control group (P < 0.0001). Factors directly associated with bone density of the lumbar spine were age and with bone density of the femur were BMI and reproductive age. CONCLUSION: Young women with POF have a decrease in lumbar spine and femoral bone density. Age, reproductive age and BMI were the factors associated with BMD. These women need early investigation and treatment to prevent bone loss and minimize fracture risk in the future.

[Comprehensive healthcare for female victims of sexual violence: the experience of the Women's Comprehensive Healthcare Center, State University in Campinas, Brazil]. / Atendimento integral às mulheres vítimas de violência sexual: Centro de Assistência Integral à Saúde da Mulher, Universidade Estadual de Campinas.

The Women's Comprehensive Healthcare Center (CAISM) has provided care for women who have suffered sexual violence since 1986. Since 1998, a special multidisciplinary team has been in charge of emergency and long-term care for victims of sexual violence. From August 1998 to May 2006, 1,174 women were treated, with an average of 150 per year in the last five years. During the same period, 71/109 women who became pregnant after rape had their pregnancies terminated, 23/109 continued the pregnancy to term, and 15/109 did not undergo abortion due to gestational age greater than 20 weeks. In Brazil, there are not enough public services to treat female victims of sexual violence who require legal abortion. Nationwide implementation of new services should be encouraged, in addition to all measures known to reduce the problem such as sex education in schools and widespread information and easy access to effective contraception.

Prevalence of uterine synechia after abortion evacuation curettage.

CONTEXT AND OBJECTIVE: Intrauterine adhesion (IUA) is a possible complication of uterine curettage following abortion. Because IUA is an important cause of infertility, some investigators have been advocating its inclusion in the routine investigational workup after every abortion curettage procedure. The aim of this study was to evaluate the uterine cavity of patients subjected to abortion curettage, in order to ascertain the prevalence of IUA and its association with social and clinical factors. DESIGN AND SETTING: This was a cross-sectional study at the Human Reproduction Unit, Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (Unicamp). METHODS: A total of 109 women were enrolled. The investigators searched the records of Unicamp's hospital for patients who had been subjected to uterine curettage following abortion. The hysteroscopy was performed 3 to 12 months after the curettage. The correlations between patients' characteristics and the prevalence of IUA were assessed by means of chi-squared and Fisher's exact test calculations. RESULTS: The prevalence of IUA was 37.6%. The number of previous abortions and curettage procedures did not correlate with the presence of IUA. Most of the women (56.1%) presented IUA grade I. CONCLUSIONS: In the present study, 37.6% of the women subjected to curettage following abortion had IUA, which was mostly mucous and grade I. None of the demographic and clinic characteristics evaluated were found to be associated with IUA. From this study, there is no firm evidence to justify carrying out routine diagnostic hysteroscopy following abortion evacuation.

[Characteristics related to the first and last cesarean delivery among women from a Campinas University Hospital]. / Características relacionadas ao primeiro e último parto por cesárea.

OBJECTIVE: To study the association between first and last caesarian sections with tubal sterilization; to determine length of reproductive life after the first delivery. METHODS: From February to October 2001 in a university hospital, interviews were carried out with 653 women having had at least two pregnancies. Of these women, 172 had a first caesarian section; 294 had a last caesarian section. Variables were social demographic characteristics, obstetric history and characteristics of the first and last deliveries and tubal sterilization. Bivariate analysis was performed, followed by multiple regression analysis calculating the adjusted odds ratio. Women who had undergone tubal sterilization were divided into age groups of 25 to 44 and >45 years in a percentile distribution. The Wilcoxon test was used to analyze age at tubal sterilization and length of reproductive life after the last delivery. The study was approved by the Ethics Committee. RESULTS: Of these women, 89% completed<8 years of school education and 78% were Caucasian. On multiple regression analysis, there was an association between the first and last caesarian section (OR=15.28, 95%CI 8.54 to 27.36), having a partner (OR=3.87, CI95% 1.63 to 9.17) and giving birth in the '70s, '80s or '90s (OR=4.43, 95%CI 1.37 to 14.27), (OR=6.11, 95%CI 1.47 to 25.47) and (OR=6.67, 95%CI 1.21 to 40.26), respectively. The last caesarian section was associated with intrapartum tubal sterilization (OR=14.09, 95%CI 7.37 to 26.97), giving birth in the '70s, '80s or '90s (OR=1.81, 95%CI 1.06 to 3.09), (OR=5.53, 95%CI 3.18 to 9.61) and (OR=5.90, 95%CI 3.03 to 11.48), respectively, family income of >5 minimum wages (OR=2.41, 95%CI 1.42 to 4.08) and age at first delivery>25 years (OR=1.80, 95%CI 1.01 to 3.22). Mean age at sterilization was 29.0 and 33.2 years in women aged 25 to 44 years and >45 years, respectively (p<0.001). The duration of the reproductive period after the first delivery was 9.0 and 11.4 years for the same groups (p<0.001). CONCLUSION: The first caesarian section was associated with the last caesarian section. The last caesarian section was associated with intrapartum tubal sterilization. Age at sterilization was lower and the reproductive period was shorter among younger women.

[Intrapartum and interval tubal sterilization]. / Laqueadura intraparto e de intervalo.

BACKGROUND: Brazil is a country with a high prevalence of tubal ligation, which is frequently performed at the time of delivery. In recent years, an increase in tubal reversal has been noticed, primarily among young women. OBJECTIVES: To study characteristics correlated with the procedure, determine frequency of intrapartum tubal ligation, measure patient satisfaction rates and tubal sterilization regret, in a sample of post-tubal patients. METHODS: Three hundred and thirty-five women underwent tubal ligation. The variables studied were related to the procedure: age at tubal ligation, whether ligation was performed intrapartum (vaginal or cesarean section) or after an interval (other than the intrapartum and puerperal period), health service performing the sterilization, medical expenses paid for the procedure, reason stated for choosing the method and causes related to satisfaction/regret: desire to become pregnant after sterilization, search for treatment and performance of tubal ligation reversal. The women were divided into two groups, a group undergoing ligation in the intrapartum period and a second group ligated after an interval, to evaluate the association between variables by using Fisher's exact test and chi-squared calculation with Yates' correction. The study was approved by the Ethics Committee of the institution. RESULTS: There was a predominance of Caucasian women over 35 years of age, married, and with a low level of education of which 43.5% had undergone sterilization before 30 years of age. Two hundred and forty-five women underwent intrapartum tubal ligation, 91.2% of them had cesarean delivery and 44.6% vaginal delivery. In both groups undergoing intrapartum tubal ligation and ligation after an interval, 82.0% and 80.8% reported satisfaction with the method. Although 14.6% expressed a desire to become pregnant at some time after sterilization, consultation regarding sterility occurred in 3.4% and 2.3%, respectively, and one woman underwent tubal reversal. The most frequent reasons for choosing the method were satisfaction with the number of offspring (35.5% and 46.7%) and medical indication (41.6% and 32.2%), respectively. CONCLUSION: The incidence of intrapartum tubal ligation was higher when the last delivery had been a cesarean section. No difference was detected among the groups regarding rates of satisfaction and regret after performance of the sterilization procedure.

[Endometrial evaluation in menopausal women after six months of isoflavones]. / Avaliação do endométrio em menopausadas após uso de isoflavonas.

OBJECTIVE: To evaluate the endometrium of menopausal women before and after six months use of total isoflavone. METHODS: A non-controlled clinical, type "before and after" trial was carried out with 32 post-menopause women, between 40 and 60 years of age. They received 80 mg/day of total isoflavones obtained from Trifolium pratense (Climadilâ) during six months. They were evaluated at the beginning and end of treatment by transvaginal pelvic ecography, hysteroscopy and endometrial biopsy. DATA ANALYSIS: Data collected were registered by means of the Epi info, version 6.04 b software, data analysis was made using the SAS version 8.2 statistics program, considering a significance level (alpha) of 0.05 and a 0.80 power (1-beta). In order to study the average variation of endometrial thickness and variation of the hysteroscopic and hystologic findings the t Student test for paired data was used. RESULTS: Among the 32 participant women, six presented vaginal bleeding and three presented endometrial alteration when compared to the initial exams. Two of the women developed endometrial cell proliferation and one of them endometrial hyperplasia. There were no significant alterations in relation to endometrial thickness. CONCLUSION: In this study, three women who used isoflavones during the six month period presented endometrial activity.

Evaluation of serum androgen levels in women with premature ovarian failure.

Women with premature ovarian failure (POF) did not show the same androgen profile as postmenopausal women. We observed that serum DHEA and DHEAS levels are significantly higher in women with POF than in postmenopausal women.

[Emergency care for women following sexual assault: characteristics of women and six-month post-aggression follow-up]. / Atendimento de emergência a mulheres que sofreram violência sexual: características das mulheres e resultados até seis meses pós-agressão.

This study evaluated the process and results of treatment for women at a university hospital after sexual violence. A prospective study of 166 women (> or = 12 years of age) treated from October 1999 to February 2002 included six months follow-up after aggression. Half of the women were under 20 years of age, two were illiterate, 70.0% unmarried, 20.0% used contraceptives, and 80.0% received treatment within the first 24 hours post-aggression. Nearly 80.0% of aggressors were unknown to victims and 95.0% of the cases involved vaginal penetration. Emergency contraception was administered to 76.0%, antibiotics to 98.0%, hepatitis B immunoglobulin to 95.0%, and HIV anti-retroviral prophylaxis to 90.0%. The first follow-up consultation (at 14 days) was attended by 137 women, whereas 37.0% dropped out before the 45-day visit and only 29.0% complied with the six-month follow-up. During follow-up, hepatitis B and HPV were identified in 2.6%, pelvic inflammatory disease and Trichomonas vaginalis in 2.1%, and syphilis in 1.3%. Three pregnancies were observed among 127 women who received emergency contraception (2.6%). No cases of HIV seroconversion were observed. Emergency care for victims of sexual assault is effective in reducing unwanted pregnancies and infections.

[The significance of the removal of the uterus for women: a qualitative study]. / O significado da retirada do útero para as mulheres: um estudo qualitativo.

OBJECTIVE: To identify the myths accepted by women about to undergo hysterectomy regarding the consequences that removal of their uterus might have on their lives. METHODS: A sample of 10 hospitalized women with surgical indication for hysterectomy was used to perform a qualitative study, with semi-structured interviews carried out during the preoperative period. A profile questionnaire was used with questions about personal features and semi-structured inquiries to facilitate deeper questioning. With authorization of the subjects, interviews were recorded and transcribed to perform a thematic analysis of the content. RESULTS: The myths most often mentioned during the interviews were: loss of femininity, frigidity, change in personality, possible change in body appearance (since they would be "hollow", "empty", "have a hole inside their belly"), interference in the affective and sexual life and the belief that their companion might change in relation to them (assuming that they would be hollow, cold, and with no sexual attraction). CONCLUSION: The interviewed women accepted a number of myths about the consequences that removal of their uterus would have on their lives. These myths are related to the social identity of the gender and to a lack of knowledge about their body its organs and functions.

Factors associated with the reduction of bone density in patients with gonadal dysgenesis.

OBJECTIVE: To correlate bone mineral density (BMD) in women with primary hypoestrogenism caused by 46,XX pure gonadal dysgenesis or Turner's syndrome with age, age at estrogen therapy initiation, length of estrogen use, and body mass index (BMI). DESIGN: Cross-sectional study. SETTING: Academic tertiary-care hospital. PATIENT(S): Thirty-eight women, aged 16 to 35 years (mean, 24.6 years), affected by these genetic disorders. INTERVENTION(S): Measurement of lumbar spine and femoral neck BMD using double x-ray absorptiometry. The results were correlated with the control variables by using Pearson's coefficient of correlation. Variables associated with BMD were evaluated by multiple linear regression analysis. MAIN OUTCOME MEASURE(S): Bone mineral density. RESULT(S): Bone mineral density of the lumbar spine showed that 90% of the women presented osteopenia or osteoporosis. The femoral neck was affected in 55% of these women. The length of estrogen therapy and the BMI showed a positive association with BMD at the lumbar spine and femoral neck, respectively. CONCLUSION(S): Women affected by pure gonadal dysgenesis or Turner's syndrome presented a marked decrease in BMD of the lumbar spine and femoral neck. Medical attention for their diagnosis and early hormone replacement therapy are advised.

Twin gestation two years after the diagnosis of premature ovarian failure in a woman on hormone replacement therapy. A case report.

BACKGROUND: Premature ovarian failure (POF) is a condition causing amenorrhea, hypoestrogenism and elevated gonadotropins before the age of 40 years and affects around 10% of patients seeking evaluation for secondary amenorrhea. Although it is a rare event, pregnancy has occurred in this group of patients. CASE: A successful twin pregnancy occurred in a 30-year-old woman two years after the diagnosis of POF. Cyclic hormone replacement therapy was initiated after the diagnosis. Twenty-one months later, ultrasound revealed an 8-week twin pregnancy. Two healthy infants, a boy and a girl, were delivered at 36 gestational weeks. CONCLUSION: There are no clinical or laboratory features that unequivocally establish the diagnosis of POF. Neither high levels of gonadotropins nor an ovarian biopsy with rare follicles excludes the possibility of pregnancy. Even though pregnancy in patients with POF is very unlikely, patients should be informed of this possibility, and a contraceptive method should be considered if pregnancy is not desired.

Perception of intimate partner violence among women seeking care in the primary healthcare network in São Paulo state, Brazil.

OBJECTIVE: To evaluate the prevalence and perception of intimate partner violence (IPV) among women in the primary healthcare network in the state of São Paulo, Brazil. METHODS: In a cross-sectional descriptive study conducted between August 2008 and May 2009 in São Paulo state, Brazil, sociodemographic variables (age, education, ethnicity, paid employment, religion, marital status, economic stratum), experiences of IPV (physical, sexual, psychological), and women's perception of violence were compared among 2379 women attending primary healthcare units. Statistical analysis was performed via χ(2) test, Student t test, and multiple logistic regression (odds ratios with 95% confidence intervals) to determine interrelations between the type and perception of violence. RESULTS: The overall prevalence of IPV was 55.7%, whereas that of psychological, physical, and sexual violence was 53.8%, 32.2%, and 12.4%, respectively; however, only 48.7% of women who experienced IPV had perceived this violence. The perception of IPV was highest for sexual violence (76.3%), followed by physical (64.7%) and psychological (49.7%) violence. CONCLUSION: The results showed that, among women within the primary healthcare network in the state of São Paulo, a high percentage had experienced some form of IPV during their lifetime but the rate of self-perception of IPV was low.

[Prevalence of violence by intimate male partner among women in primary health units in São Paulo State]. / Prevalência da violência praticada por parceiro masculino entre mulheres usuárias da rede primária de saúde do Estado de São Paulo.

PURPOSE: To evaluate the prevalence and factors associated with intimate partner violence (IPV) among women users of Basic Health Units (BHU) in the State of São Paulo. METHODS: This was a cross-sectional descriptive study based on secondary data analysis of women users' interviews at 75 BHU in the State of São Paulo, from August/2008 to May/2009. We used a questionnaire based on the Abuse Assessment Screen and the Conflict Tactics Scales modified by the Violence Against Women Study (VAW), structured and pre-tested. The variables studied were the types of IPV (psychological, physical and sexual) and sociodemographic variables (age, education, race, paid work, religion, marital status and economic class). We interviewed 2,379 women aged 18 to 60 years. RESULTS: The prevalence of lifetime IPV was 55.7%, and the prevalences of psychological, physical and sexual IPV were 53.8, 32.2 and 12.4%, respectively. Women without a partner but previously married, with schooling <8 years and belonging to the lower economic class had a higher risk for all types of IPV, and other factors were also associated with psychological and sexual IPV. CONCLUSIONS: The prevalence of IPV is high. Healthcare professionals in primary care should make an attempt to detect IPV.

Experiences of nurses in health care for female victims of sexual violence.

OBJECTIVE: To understand experiences of nurses caring for women who have suffered sexual violence. METHODOLOGICAL PROCEDURES: Qualitative-clinical study in which six nurses from a health care service for women who had suffered sexual violence were interviewed in the city of Campinas, Southeastern Brazil, between April and May 2007. Semi-guided interview technique with open questions was used. Data were analyzed following the content analysis technique, based on a psychodynamic framework. The following analytical categories were produced: what they think about, how they feel, how they act and how they react to the work with sexual violence victims. ANALYSIS OF RESULTS: Interviewees indicated receptiveness as key to provide humanized health care and form a bond with clients. Feelings such as fear, insecurity, impotence, ambivalence, anguish and anxiety were reported, causing behavioral changes and interfering with one's personal life, in addition to feelings of professional achievement and satisfaction. Technical qualification and activities aimed at providing psychological support were mentioned as strategies to help this type of care. CONCLUSIONS: Although dealing with feelings such as impotence, fear and indignation, the nurses' perception of relief when fulfilling their job tasks and the personal satisfaction felt when helping these women seem to surpass other feelings, as a form of gratification. The desire to 'run away' from the health care service and the willingness to do one's best occur simultaneously and are used as inner mechanisms in the sense of minimizing pain and suffering.

Prevalência da violência praticada por parceiro masculino entre mulheres usuárias da rede primária de saúde do Estado de São Paulo / Prevalence of violence by intimate male partner among women in primary health units in São Paulo State

OBJETIVOS: Avaliar a prevalência e fatores associados à violência praticada por parceiro íntimo (VPI), entre mulheres usuárias das Unidades Básicas de Saúde (UBS) do Estado de São Paulo. MÉTODOS: Foi realizado um estudo descritivo de corte transversal, a partir da análise secundária de dados de entrevista a mulheres usuárias de 75 UBS de 15 Departamentos Regionais do Estado de São Paulo, no período de Agosto/2008 a Maio/2009. Foi utilizado questionário baseado no Abuse Assessment Screen e o Conflict Tactics Scales modificado pelo Violence Against Women Study (VAW), estruturado e pré-testado. As variáveis estudadas foram os tipos de VPI (psicológica, física e sexual) e variáveis sociodemográficas (idade, escolaridade, cor da pele, trabalho remunerado, religião, estado marital e classe econômica). Foram entrevistadas 2.379 mulheres de 18 a 60 anos. RESULTADOS: A prevalência de VPI durante a vida foi de 55,7%, sendo a psicológica, física e sexual de 53,8, 32,2 e 12,4%, respectivamente. As mulheres sem companheiro, mas com casamento anterior, com escolaridade <8 anos e da classe econômica mais baixa tiveram maior risco para todos os tipos de VPI, outros fatores ainda foram associados à VIP psicológica e sexual. CONCLUSÕES: A prevalência de VPI nas UBS do Estado de São Paulo é alta. Os profissionais de saúde da atenção primária devem atentar para a detecção da VPI.

PURPOSE: To evaluate the prevalence and factors associated with intimate partner violence (IPV) among women users of Basic Health Units (BHU) in the State of São Paulo. METHODS: This was a cross-sectional descriptive study based on secondary data analysis of women users' interviews at 75 BHU in the State of São Paulo, from August/2008 to May/2009. We used a questionnaire based on the Abuse Assessment Screen and the Conflict Tactics Scales modified by the Violence Against Women Study (VAW), structured and pre-tested. The variables studied were the types of IPV (psychological, physical and sexual) and sociodemographic variables (age, education, race, paid work, religion, marital status and economic class). We interviewed 2,379 women aged 18 to 60 years. RESULTS: The prevalence of lifetime IPV was 55.7%, and the prevalences of psychological, physical and sexual IPV were 53.8, 32.2 and 12.4%, respectively. Women without a partner but previously married, with schooling <8 years and belonging to the lower economic class had a higher risk for all types of IPV, and other factors were also associated with psychological and sexual IPV. CONCLUSIONS: The prevalence of IPV is high. Healthcare professionals in primary care should make an attempt to detect IPV.

17-Hydroxyprogesterone deficiency as a cause of sexual infantilism and arterial hypertension: laboratory and molecular diagnosis--a case report.

The differential diagnosis of hypertension associated with hypokalemia in infancy and adolescence should necessarily include deficiency of the 17alpha-hydroxylase enzyme, a rare form of congenital adrenal hyperplasia (CAH). In addition to hypertension, the classic syndrome caused by this deficiency is characterized by suppressed production of sex hormones and consequently sexual infantilism. Although rare (1% of all forms of CAH), there appears to be a higher incidence of this syndrome in some population groups. This is a case report on two sisters followed up at the Department of Obstetrics and Gynecology, School of Medicine, Universidade Estadual de Campinas (UNICAMP), who were both found to have the 46,XY genotype with homozygosis for W406R, exon 7 of the CYP17 gene (OMIM 202110). The condition was diagnosed only at puberty when hypergonadotropic hypogonadism resulted in sexual infantilism; however, arterial hypertension had been present since infancy and late diagnosis and lack of timely adequate treatment resulted in complications.

Nursing Care of Women Who Suffered Sexual Violence / Atendimento de enfermagem às mulheres que sofrem violência sexual / Atención de enfermería a mujeres que sufren violencia sexual

The aim of this study was to characterize the nursing care, provided to women who suffered sexual violence, treated at The Women's Hospital-CAISM/UNICAMP. A retrospective, descriptive study performed using 146 nursing care records of women attended from June 2006 to May 2007. The results showed that the majority of attendances occurred during the day period, that there was consistency between the interventions and the nursing diagnoses identified, and that women reported having received guidance in accordance with the protocol of the program. The nursing consultation time was greater at night (p=0.0227) and the women frequently understood the health risks resulting from sexual violence (p=0.0072), the use of antiretrovirals according to their daily activities (p=0.0397) and they were more focused on the purpose of the serology (p=0.0351). We concluded that the care provided was shown to be appropriate and of a better quality in the nightshift period.

O objetivo deste estudo foi caracterizar a assistência de enfermagem prestada pelo enfermeiro às mulheres que sofreram violência sexual, atendidas no Hospital da Mulher -CAISM/Unicamp. Foi realizado estudo retrospectivo e descritivo com 146 fichas de atendimento de enfermagem a mulheres, entre junho de 2006 a maio de 2007. Os resultados mostraram que a maioria dos atendimentos ocorreu durante o período diurno, houve coerência entre as intervenções e os diagnósticos de enfermagem identificados, e as mulheres relataram que receberam orientações de acordo com o protocolo do programa. O tempo da consulta de enfermagem foi maior no período noturno (p=0,0227) e essas mulheres mais frequentemente conheciam os riscos de saúde, decorrentes da violência sexual (p=0,0072), adequaram os horários do antirretrovirais, de acordo com suas atividades diárias (p=0,0397), e estavam mais orientadas quanto à finalidade das sorologias (p=0,0351). Conclui-se que o atendimento prestado mostrou-se adequado e com melhor qualidade no plantão noturno.

Nuestro objetivo fue caracterizar la asistencia prestada por los enfermeros a las mujeres que sufrieron violencia sexual atendidas en el Hospital de la Mujer-CAISM (UNICAMP). Fue realizado un estudio retrospectivo y descriptivo con 146 fichas de atención de enfermería de mujeres atendidas entre junio de 2006 a mayo de 2007. Los resultados mostraron que la mayoría de las atenciones ocurrieron durante el período diurno, hubo coherencia entre las intervenciones y los diagnósticos de enfermería identificados y las mujeres relataron que recibieron orientaciones de acuerdo con el protocolo del programa. El tiempo de consulta de enfermería fue mayor en el período nocturno (p=0,0227) y se constató que esas mujeres frecuentemente conocían los riesgos de salud provenientes de la violencia sexual (p=0,0072), adecuaban los horarios de los antirretrovirales de acuerdo con sus actividades diarias (p=0,0397) y estaban más orientadas en cuanto a la finalidad de las serologías (p=0,0351). Concluimos que la atención prestada se mostró adecuada y con mejor calidad en el plantón nocturno.

Vivências de enfermeiros na assistência à mulher vítima de violência sexual / Experiences of nurses in health care for female victims of sexual violence

Objetivo: Compreender as vivências de enfermeiros no atendimento a mulheres que sofreram violência sexual. Prodedimentos metodológicos: Estudo clínico-qualitativo em que foram entrevistados seis enfermeiros de um serviço de assistência a mulheres vítimas de violência sexual em Campinas, SP, no período de abril a maio de 2007. Utilizou-se a técnica da entrevista semidirigida de questões abertas. Os dados foram analisados pela técnica de análise de conteúdo com base no referencial psicodinâmico. Foram produzidas categorias analíticas: o que pensam, o que sentem, como agem e como reagem ao trabalho com vítimas de violência sexual. Análise dos Resultados: Os entrevistados indicaram o acolhimento como fundamental na assistência humanizada e no estabelecimento de vínculo com a cliente. Foram relatados sentimentos como medo, insegurança, impotência, ambivalência, angústia e ansiedade, que acarretam alterações de comportamento e interferem na vida pessoal, como também sentimentos de satisfação e realização profissionais. A capacitação técnica e atividades que visam o apoio psicológico foram citadas como estratégias que podem ajudar nesse tipo de atendimento. Conclusões: Mesmo diante de sentimentos como impotência, medo e revolta, a percepção de alívio pelo dever cumprido e a satisfação pessoal dos enfermeiros em ter ajudado essas mulheres parecem se sobrepor aos demais sentimentos, como forma de gratificação. O desejo de "fugir" do atendimento e a vontade de dar o melhor de si ocorrem simultaneamente e são utilizados mecanismos internos no sentido de minimizar a dor e o sofrimento.

Aborto provocado: redução da frequência e gravidade das complicações. Consequência do uso de misoprostol / Artificial abortion: is reduction in the frequency and severity of complications a result of the use of misoprostol

OBJECTIVES: to ascertain the frequency and severity of complications resulting from artificial abortions and their possible association with the use of misoprostol. METHODS: a cross-sectional study was carried out. For ten months, a checklist (of World Health Organization criteria) was applied to all 543 women admitted to hospital for abortion at two hospitals in the city of Campinas, in the State of São Paulo, Brazil. Those classified as having a possibly, pro-bably or certainly artificial abortion were asked to fill in the questionnaire. RESULTS: of all the women admitted to hospital, 259 (48 percent) were classified as possibly, probably or certainly having an induced abortion and these filled in the questionnaire; 25 women stated that they had induced the abortion and, of these, nine mentioned the use of misoprostol. Infections and hemorrhaging were complications in 10 percent and 13 percent of the 259 women. Those who used misoprostol had fewer complications than those who used other methods, although this difference was not statistically significant, perhaps for reason of the low frequency for complications. CONCLUSIONS: the data show a reduction in the frequency and severity of complications arising from abortion, although it is not possible to point to the use of misoprosol as being responsible for this.

OBJETIVOS: verificar a frequência e a gravidade das complicações por abortos provocados e suas possíveis associações com o uso de misoprostol. MÉTODOS: estudo de corte transversal. Durante dez meses aplicou-se uma lista de verificação (critérios da World Health Organization) a todas as 543 mulheres internadas por aborto em dois hospitais na cidade de Campinas, São Paulo. Àquelas classificadas como aborto possível, provável ou certamente provocado foi aplicado também um questionário. RESULTADOS: dentre todas as mulheres internadas, 259 (48 por cento) foram classificadas como aborto possível, provável ou certamente induzido e responderam ao questionário; 25 mulheres declararam a indução do aborto e, destas, nove referiram uso de misoprostol. Complicações infecciosas e hemorrágicas ocorreram respectivamente em 10 por cento e 13 por cento das 259 mulheres. As que usaram misoprostol se complicaram menos que as que usaram outros métodos, porém essa diferença não foi estatisticamente significativa, talvez pela baixa freqüência de complicações. CONCLUSÕES: os dados mostram redução da freqüência e da gravidade das complicações do aborto, mas não permitem avaliar o papel do misoprostol.