Legal abortion requests and outcomes for women when the law is restrictive - experience from a referral centre in south-eastern Brazil.

METHODS: Retrospective cohort study with review of medical records of women assisted between 2015 and 2020. The variables were socio-demographic and SV characteristics, gestational age, reactions towards pregnancy and outcome. We compared outcome groups using the chi-square test, Fisher's exact test and the Kruskal-Wallis test. The significance level was 5%. RESULTS: We evaluated the medical records of 235 women, of which 153(65%) had undergone to abortion; 17(7.2%) had a spontaneous abortion; 19(8%) remained pregnant; 25(10.6%) had an abortion denied; and 21(8.9%) had been lost to follow-up. Out of the total number of women, 44(18.7%) were adolescents, 152(65.2%) were white and 201(88.5%) had an education ≥9 years. Women who remained pregnant had a known aggressor, disclosed the pregnancy (p < 0.001) and were more ambivalent (p < 0.001) than the other groups. Gestational age was higher in the denied abortion group than in the performed abortion group (p < 0.001). CONCLUSION: Feelings related to decision-making about abortion affected all groups, with differences. It is important to give women space to be heard, so they can make their own decisions.

Abortion care is possible in places with restrictive laws; however, women with more vulnerable characteristics did not seek the service. Legal restrictions interfere with women's decision-making about abortion and can promote inequality in gaining access to health services.

Hippocampal Microglia Activation Induced by Acute Pancreatic Injury in Rats.

BACKGROUND: Acute pancreatitis is an inflammation of the pancreatic glandular parenchyma that causes injury with or without the destruction of pancreatic acini. Clinical and experimental evidence suggest that certain systemic proinflammatory mediators may be responsible for initiating the fundamental mechanisms involved in microglial reactivity. Here, we investigated the possible repercussions of acute pancreatitis (AP) on the production of inflammatory mediators in the brain parenchyma focusing on microglial activation in the hippocampus. METHODS: The acute pancreatic injury in rats was induced by a pancreas ligation surgical procedure (PLSP) on the splenic lobe, which corresponds to approximately 10% of total mass of the pancreas. Blood samples were collected via intracardiac puncture for the measurement of serum amylase. After euthanasia, frozen or paraffin-embedded brains and pancreas were analyzed using qRT-PCR or immunohistochemistry, respectively. RESULTS: Immunohistochemistry assays showed a large number of Iba1 and PU.1-positive cells in the CA1, CA3, and dentate gyrus (DG) regions of the hippocampus of the PLSP group. TNF-α mRNA expression was significantly higher in the brain from PLSP group. NLRP3 inflammasome expression was found to be significantly increased in the pancreas and brain of rats of the PLSP group. High levels of BNDF mRNA were found in the rat brain of PLSP group. In contrast, NGF mRNA levels were significantly higher in the control group versus PLSP group. CONCLUSION: Our findings suggest that AP has the potential to induce morphological changes in microglia consistent with an activated phenotype.

Adolescent Female Victims of Sexual Violence: Analysis of Loss of Follow-up after Emergency Care and Outpatient Follow-up.

OBJECTIVE: To assess the loss to follow-up after emergency care and during 6-months of outpatient follow-up, and the associated variables, among adolescent sexual violence survivors. METHODS: This is a retrospective study with review of the medical records of 521 females, aged 10 to 18 years, who received emergency care in a referral service in São Paulo, Brazil. The variables were sociodemographic; personal history; characteristics of abuse, disclosure, and reactions triggered after abuse (physical and mental disorders as well as social changes), psychotropic prescription needs, and moment of abandonment: after emergency care and before completing 6 months of outpatient follow-up. To compare groups of patients lost to follow-up at each time point, we used the Chi-square and Fisher exact tests followed by multiple logistic regression with stepwise criterion for selection of associated variables. We calculated the odds ratio with confidence interval (OR, CI 95%). The level of significance adopted was 5%. RESULTS: A total of 249/521 (47.7%) adolescents discontinued follow-up, 184 (35.3%) after emergency care and 65 (12.4%) before completing outpatient follow-up. The variables of living with a partner (OR = 5.94 [CI 95%; 2.49-14.20]); not having a religion (OR = 2.38 [CI 95%;1.29-4.38)]), having a Catholic religion [OR = 2.11 (CI 95%; 1.17-3.78)]; and not disclosing the abuse [OR = 2.07 (CI 95%; 1.25-3.44)] were associated with loss to follow-up after emergency care. Not needing mental disorder care (OR = 2.72 [CI 95%; 1.36-5.46]) or social support (OR = 2.33 [CI 95%; 1.09-4.99]) were directly associated with loss to outpatient follow-up. CONCLUSION: Measures to improve adherence to follow-up should be aimed at adolescents who live with a partner and those who do not tell anyone about the violence.

OBJETIVOS: Avaliar a perda de seguimento de adolescentes vítimas de violência sexual após o atendimento de emergência, durante o seguimento ambulatorial e as variáveis associadas. MéTODOS: Estudo retrospectivo com a revisão de prontuários de 521 mulheres de 10 a 18 anos, que buscaram atendimento de emergência em um serviço de referência em São Paulo, Brasil. As variáveis foram sociodemográficas; antecedentes pessoais; características do abuso, atitude de revelação e reações desencadeadas após o abuso (distúrbios físicos, mentais e mudanças sociais), necessidades de prescrição de psicotrópicos e momento do abandono: após atendimento de emergência e antes de completar 6 meses de seguimento ambulatorial. Para comparar os grupos de perda de seguimento em cada momento, foram utilizados os testes do qui-quadrado e exato de Fisher, seguidos de regressão logística múltipla com critério stepwise para seleção das variáveis associadas. Calculamos a razão de probabilidade com intervalo de confiança (RP, IC 95%). O nível de significância adotado foi de 5%. RESULTADOS: Um total de 249 (47,7%) das adolescentes descontinuaram o acompanhamento, 184 (35.3%) após o atendimento de emergência e 65 (12.4%) antes de completar o seguimento ambulatorial. As variáveis de viver com companheiro [RP = 5,94 (IC 95%; 2,49­14,20]; não ter religião [RP = 2,38 (IC 95%;1,29­4,38)], ter religião católica [RP = 2,11 (IC 95%; 1,17­3,78)] e não revelar o abuso [RP = 2,07 (IC 95%; 1,25­3,44)] foram associadas à perda de seguimento após o atendimento de emergência. Não necessitar de cuidados de saúde mental (RP = 2,72 [IC 95%; 1,36­5,46]) ou apoio social (RP = 2,33 [IC 95%; 1,09­4,99]) foram as variáveis associadas à perda do seguimento ambulatorial. CONCLUSãO: Medidas para melhorar a adesão ao seguimento devem ser direcionadas às adolescentes que vivem com parceiro e às que não revelam a violência sofrida.

Adolescent Female Victims of Sexual Violence: Analysis of Loss of Follow-up after Emergency Care and Outpatient Follow-up / Meninas adolescentes vítimas de violência sexual: Análise da falta de atendimento de emergência e seguimento ambulatorial

Abstract Objective To assess the loss to follow-up after emergency care and during 6-months of outpatient follow-up, and the associated variables, among adolescent sexual violence survivors. Methods This is a retrospective study with review of the medical records of 521 females, aged 10 to 18 years, who received emergency care in a referral service in São Paulo, Brazil. The variables were sociodemographic; personal history; characteristics of abuse, disclosure, and reactions triggered after abuse (physical and mental disorders as well as social changes), psychotropic prescription needs, and moment of abandonment: after emergency care and before completing 6 months of outpatient follow-up. To compare groups of patients lost to follow-up at each time point, we used the Chi-square and Fisher exact tests followed by multiple logistic regression with stepwise criterion for selection of associated variables. We calculated the odds ratio with confidence interval (OR, CI 95%). The level of significance adopted was 5%. Results A total of 249/521 (47.7%) adolescents discontinued follow-up, 184 (35.3%) after emergency care and 65 (12.4%) before completing outpatient follow-up. The variables of living with a partner (OR = 5.94 [CI 95%; 2.49-14.20]); not having a religion (OR = 2.38 [CI 95%;1.29-4.38)]), having a Catholic religion [OR = 2.11 (CI 95%; 1.17-3.78)]; and not disclosing the abuse [OR = 2.07 (CI 95%; 1.25-3.44)] were associated with loss to follow-up after emergency care. Not needing mental disorder care (OR = 2.72 [CI 95%; 1.36-5.46]) or social support (OR = 2.33 [CI 95%; 1.09-4.99]) were directly associated with loss to outpatient follow-up. Conclusion Measures to improve adherence to follow-up should be aimed at adolescents who live with a partner and those who do not tell anyone about the violence.

Resumo Objetivos Avaliar a perda de seguimento de adolescentes vítimas de violência sexual após o atendimento de emergência, durante o seguimento ambulatorial e as variáveis associadas. Métodos Estudo retrospectivo com a revisão de prontuários de 521 mulheres de 10 a 18 anos, que buscaram atendimento de emergência em um serviço de referência em São Paulo, Brasil. As variáveis foram sociodemográficas; antecedentes pessoais; características do abuso, atitude de revelação e reações desencadeadas após o abuso (distúrbios físicos, mentais e mudanças sociais), necessidades de prescrição de psicotrópicos e momento do abandono: após atendimento de emergência e antes de completar 6 meses de seguimento ambulatorial. Para comparar os grupos de perda de seguimento em cada momento, foram utilizados os testes do qui-quadrado e exato de Fisher, seguidos de regressão logística múltipla com critério stepwise para seleção das variáveis associadas. Calculamos a razão de probabilidade com intervalo de confiança (RP, IC 95%). O nível de significância adotado foi de 5%. Resultados Um total de 249 (47,7%) das adolescentes descontinuaram o acompanhamento, 184 (35.3%) após o atendimento de emergência e 65 (12.4%) antes de completar o seguimento ambulatorial. As variáveis de viver com companheiro [RP = 5,94 (IC 95%; 2,49-14,20]; não ter religião [RP = 2,38 (IC 95%;1,29-4,38)], ter religião católica [RP = 2,11 (IC 95%; 1,17-3,78)] e não revelar o abuso [RP = 2,07 (IC 95%; 1,25-3,44)] foram associadas à perda de seguimento após o atendimento de emergência. Não necessitar de cuidados de saúde mental (RP = 2,72 [IC 95%; 1,36-5,46]) ou apoio social (RP = 2,33 [IC 95%; 1,09-4,99]) foram as variáveis associadas à perda do seguimento ambulatorial. Conclusão Medidas para melhorar a adesão ao seguimento devem ser direcionadas às adolescentes que vivem com parceiro e às que não revelam a violência sofrida.

Sexual Violence Suffered by Women in Early and Late Adolescence: Care Provided and Follow-Up / Violência sexual sofrida por mulheres na adolescência precoce e tardia: Cuidado dispensado e seguimento

Abstract Objective To compare the sexual violence suffered by women in early and late adolescence, the reactions triggered after the aggression, and the care provided. Methods A retrospective study in which we reviewed the medical records of 521 female adolescents treated by a multidisciplinary team at a reference hospital in the city of Campinas, state of São Paulo, Brazil. We analyzed sociodemographic variables, and those pertainin to the characteristics of the episodes of violence, the emergency care, and the physical and psychological reactions observed during the follow-up. For the analysis, the sample was divided into groups of early (10 to 14 years) and late (15 to 18 years) adolescence. We used the Chi-squared/Fisher Exact, Mann-Whitney, and Kruskal-Wallis tests to compare the groups; the level of significance adopted was 5%. Results The early group (n= 242) contained more adolescents who were enrolled in school (p< 0.001), suffered more daytime aggressions (p= 0.031), in their residences (p< 0.001), by an aggressor with whom they were acquainted (p< 0.001), had greater need of legal protection (p= 0.001), and took longer to seek care (p= 0.048). Feelings of guilt, shame, and the perception of violence were similar between the groups. In the late group (n= 279), there was greater consumption of alcohol during the aggression (p= 0,005); they received significantly more prophylaxis treatments; reported more physical symptoms (p= 0.033), sleep disorders (p= 0.003), symptoms of anxiety (p= 0.045), and feelings of anguish (p= 0.011); and had more prescriptions of psychotropics (p= 0.005). Only 52% completed the 6-month follow-up, with no differences between the groups. Conclusion The age groups showed differences in the characteristics of the episodes of violence; early adolescents took longer to seek help, and the late group presented more intense symptoms and psychological worsening during the follow-up. Measures of prevention and specific care aimed at this population are needed.

Resumo Objetivo Comparar a violência sexual sofrida por vítimas no início e no final da adolescência, as reações desencadeadas após a agressão, e o cuidado de saúde dispensado. Métodos Estudo retrospectivo, em que foram revisados os prontuários de 521 mulheres adolescentes atendidas por equipe multiprofissional em hospital de referência em Campinas, São Paulo, Brasil. As variáveis foram sociodemográficas, e aquelas relativas às características da violência, ao atendimento de emergência, e às reações físicas e psicológicas observadas durante o seguimento nos grupos de adolescentes de idade precoce (10a 14 anos) e tardia (15 a 18 anos). Utilizamos os testes do Qui-quadrado/Exato de Fisher, Mann-Whitney e Kruskal-Wallis para comparar os grupos; adotamos o nível de significância de 5%. Resultados O grupo precoce (n= 242) continha maior número de estudantes (p< 0,001), que sofreram mais agressões diurnas (p= 0,031), em suas residências (p< 0,001), por agressor conhecido (p< 0,001), tiveram maior necessidade de proteção legal (p= 0,001), e demoraram mais a procurar atendimento (p= 0,048). Sentimentos de culpa, vergonha e a percepção da violência foram similares entre os grupos. No grupo tardio (n= 279) houve maior consumo de álcool durante a agressão (p= 0,005); as adolescentes receberam significativamente mais tratamentos de profilaxia; relataram mais sintomas físicos (p= 0,033), distúrbios do sono (p= 0,003), sintomas de ansiedade (p= 0,045), e sentimentos de angústia (p= 0,011); e receberam mais prescrições de psicotrópicos (p= 0,005). Apenas 52% completaram o seguimento de 6 meses, sem diferenças entre os grupos. Conclusão Os grupos apresentaram diferenças nas características da violência; as adolescentes precoces chegaram mais tardiamente ao serviço, e o grupo tardio apresentou maior sintomatologia e piora psicológica no seguimento. São necessárias medidas de prevenção e cuidados específicos voltados a essa população.

Sexual Violence Suffered by Women in Early and Late Adolescence: Care Provided and Follow-Up.

OBJECTIVE: To compare the sexual violence suffered by women in early and late adolescence, the reactions triggered after the aggression, and the care provided. METHODS: A retrospective study in which we reviewed the medical records of 521 female adolescents treated by a multidisciplinary team at a reference hospital in the city of Campinas, state of São Paulo, Brazil. We analyzed sociodemographic variables, and those pertainin to the characteristics of the episodes of violence, the emergency care, and the physical and psychological reactions observed during the follow-up. For the analysis, the sample was divided into groups of early (10 to 14 years) and late (15 to 18 years) adolescence. We used the Chi-squared/Fisher Exact, Mann-Whitney, and Kruskal-Wallis tests to compare the groups; the level of significance adopted was 5%. RESULTS: The early group (n = 242) contained more adolescents who were enrolled in school (p < 0.001), suffered more daytime aggressions (p = 0.031), in their residences (p < 0.001), by an aggressor with whom they were acquainted (p < 0.001), had greater need of legal protection (p = 0.001), and took longer to seek care (p = 0.048). Feelings of guilt, shame, and the perception of violence were similar between the groups. In the late group (n = 279), there was greater consumption of alcohol during the aggression (p = 0,005); they received significantly more prophylaxis treatments; reported more physical symptoms (p = 0.033), sleep disorders (p = 0.003), symptoms of anxiety (p = 0.045), and feelings of anguish (p = 0.011); and had more prescriptions of psychotropics (p = 0.005). Only 52% completed the 6-month follow-up, with no differences between the groups. CONCLUSION: The age groups showed differences in the characteristics of the episodes of violence; early adolescents took longer to seek help, and the late group presented more intense symptoms and psychological worsening during the follow-up. Measures of prevention and specific care aimed at this population are needed.

OBJETIVO: Comparar a violência sexual sofrida por vítimas no início e no final da adolescência, as reações desencadeadas após a agressão, e o cuidado de saúde dispensado. MéTODOS: Estudo retrospectivo, em que foram revisados os prontuários de 521 mulheres adolescentes atendidas por equipe multiprofissional em hospital de referência em Campinas, São Paulo, Brasil. As variáveis foram sociodemográficas, e aquelas relativas às características da violência, ao atendimento de emergência, e às reações físicas e psicológicas observadas durante o seguimento nos grupos de adolescentes de idade precoce (10a 14 anos) e tardia (15 a 18 anos). Utilizamos os testes do Qui-quadrado/Exato de Fisher, Mann-Whitney e Kruskal-Wallis para comparar os grupos; adotamos o nível de significância de 5%. RESULTADOS: O grupo precoce (n = 242) continha maior número de estudantes (p < 0,001), que sofreram mais agressões diurnas (p = 0,031), em suas residências (p < 0,001), por agressor conhecido (p < 0,001), tiveram maior necessidade de proteção legal (p = 0,001), e demoraram mais a procurar atendimento (p = 0,048). Sentimentos de culpa, vergonha e a percepção da violência foram similares entre os grupos. No grupo tardio (n = 279) houve maior consumo de álcool durante a agressão (p = 0,005); as adolescentes receberam significativamente mais tratamentos de profilaxia; relataram mais sintomas físicos (p = 0,033), distúrbios do sono (p = 0,003), sintomas de ansiedade (p = 0,045), e sentimentos de angústia (p = 0,011); e receberam mais prescrições de psicotrópicos (p = 0,005). Apenas 52% completaram o seguimento de 6 meses, sem diferenças entre os grupos. CONCLUSãO: Os grupos apresentaram diferenças nas características da violência; as adolescentes precoces chegaram mais tardiamente ao serviço, e o grupo tardio apresentou maior sintomatologia e piora psicológica no seguimento. São necessárias medidas de prevenção e cuidados específicos voltados a essa população.

Care to female adolescents victims of sexual violence at a referral service in Brazil from 2011 to 2018.

OBJECTIVE: To evaluate the characteristics of aggression, care, and follow-up of sexual violence in adolescent women at a university service in Campinas, São Paulo, Brazil. METHODS: In a retrospective cohort study from 2011 to 2018, we assessed sociodemographic characteristics, type and form of sexual violence perpetration, background and perception of the victim about violence, and characteristics of care and social/legal support during follow-up. RESULTS: Of 521 adolescents 242 (46.5%) were aged 10-14 years, 354 (68%) had not started sexual life, 465 (89%) perceived the violence and they had low prevalence of alcohol (71, 16%) and other psychoactive substance consumption (25, 6%), and 24 (4.6%) had an intellectual disability. Intimidation through physical force, acute abuse, vaginal penetration, acquaintance aggressor, being approached in a public place, and family/acquaintance residence were the most prevalent characteristics of aggression. In the 2017-2018 biennium, we observed a decrease in the prevalence of adolescents who were students (P < 0.001), an increase in the number of acquaintance aggressors (P = 0.008), and medical care after 72 hours (P < 0.033). CONCLUSION: Adolescents were victims of severe sexual violence. There was a decrease in prophylactic treatments and half of the adolescents did not complete outpatient follow-up. The economic worsening over the last decade may have contributed to these results.

Female body mass index and the selection of a long-acting reversible contraception for the first time.

OBJECTIVE: To evaluate Brazilian women with different body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) values who were switching from a short-acting reversible contraceptive (SARC) to a long-acting reversible contraceptive (LARC) method in relationship to the reasons reported for switching and the LARC method chosen. METHOD: We analyzed retrospective data from 1508 women aged 18-49 years who chose a LARC for the first time. The variables were sociodemographic, BMI, SARC in use, the reason given for switching, the chosen LARC (copper intrauterine device, levonorgestrel (52 mg) intrauterine system or ethyl norgestrel implant), and expectations of the LARC. We used χ2 , Mann-Whitney, and Kruskal-Wallis tests to compare BMI groups. The significance level adopted was 5%. RESULTS: The obesity group, 320 women (21.2%), reported weight gain (P < 0.000) and fear of pregnancy (P = 0.004) as the most frequent reasons for switching, whereas the normal weight group, 637 women (42.2%), reported more loss of libido (P < 0.000) and other personal complaints (P = 0.002). The IUD was chosen by 851 women (56.6%) and significantly by the largest number of obese women. CONCLUSION: Women in different BMI categories report different reasons for switching from SARC methods and elect different LARC methods for contraception.

Influence of a High-fat Diet in the Progression of Apical Periodontitis.

INTRODUCTION: This study evaluated the effects of a high-fat diet (HFD) on the progression of apical periodontitis (AP) in rats. METHODS: Eight-week old Wistar rats (N = 24) were included in this study. Half of the animals received an HFD and the other half a control diet (CD). AP lesions were induced 8 weeks later by creating pulp exposure of the mandibular left first molars. The animal's body mass was verified on a weekly basis. After 21 and 40 days, the animals were sacrificed. Blood was collected for biochemical tests, and the liver was removed for hepatic triglycerides analysis. The left hemimandibles were removed, radiographed, and then prepared for histologic evaluation. The right hemimandibles (region near molars) were removed for bone mineral density analysis by dual-energy X-ray absorptiometry. RESULTS: Radiographs showed that AP lesions were significantly larger in the HFD group compared with the CD group (P < .05). Histologic analysis confirmed that the AP lesions were larger and revealed a more severe inflammatory infiltrate in the HFD group. Bone mineral density was reduced in the HFD group compared with the CD groups (P < .05). The HFD resulted in a significant increase in body mass (P < .05), liver mass (P < .05), relative liver mass (P < .05), and hepatic triglycerides (P < .05). The levels of triglycerides and very-low-density lipoprotein were significantly higher in the 40-day HFD group compared with the 21-day HFD and 21- and 40-day CD groups (P < .05). CONCLUSIONS: Findings suggest that an HFD can influence the progression and severity of AP.

Role of Neuropeptide S on Behavioural and Neurochemical Changes of an Animal Model of Attention-Deficit/Hyperactivity Disorder.

Neuropeptide S (NPS) is a recently discovered peptide signalling through its receptor NPSR, which is expressed throughout the brain. Since NPSR activation increases dopaminergic transmission, we now tested if NPSR modulates behavioural and neurochemical alterations displayed by an animal model of attention-deficit/hyperactivity disorder (ADHD), Spontaneous Hypertensive Rats (SHR), compared to its control strain, Wistar Kyoto rats (WKY). NPS (0.1 and 1 nmol, intracerebroventricularly (icv)) did not modify the performance in the open field test in both strains; however, NPSR antagonism with [tBu-d-Gly5]NPS (3 nmol, icv) increased, per se, the total distance travelled by WKY. In the elevated plus-maze, NPS (1 nmol, icv) increased the percentage of entries in the open arms (%EO) only in WKY, an effect prevented by pretreatment with [tBu-d-Gly5]NPS (3 nmol, icv), which decreased per se the %EO in WKY and increased their number of entries in the closed arms. Immunoblotting of frontal cortical extracts showed no differences of NPSR density, although SHR had a lower NPS content than WKY. SHR showed higher activity of dopamine uptake than WKY, and NPS (1 nmol, icv) did not change this profile. Overall, the present work shows that the pattern of functioning of the NPS system is distinct in WKY and SHR, suggesting that this system may contribute to the pathophysiology of ADHD.

Safety and bleeding patterns of the levonorgestrel 52-mg intrauterine system among women with thrombosis or coagulopathy.

OBJECTIVE: To assess the safety of the levonorgestrel 52-mg intrauterine system (LNG-IUS) in women with a history of thrombosis or coagulopathy and to evaluate bleeding patterns. METHODS: A retrospective chart review was conducted of 117 women attending a clinic between 2007 and 2019. Their sociodemographic characteristics, hematologic status, reasons for using LNG-IUS, duration of use, use of oral anticoagulants, complications, and bleeding patterns were analyzed. RESULTS: Ninety-nine women had a history of thrombosis (71.7% in use of oral anticoagulants) and 18 had coagulopathies. No bleeding or any other complications occurred during placement of the LNG-IUS. Around two-thirds of the women reported amenorrhea or oligomenorrhea at 12, 24, and 54 months of follow-up, with no difference between the groups using the IUS for contraception or to treat heavy menstrual bleeding (HMB) (P=0.07), those with a history of thrombosis or coagulopathy (P=0.53), and users or non-users of oral anticoagulants (P=0.59). CONCLUSION: The LNG-IUS is safe for women with hematologic disorders. It was associated with amenorrhea or oligomenorrhea in a large proportion of users up to 54 months of follow-up regardless of use of oral anticoagulants, reason for use of LNG-IUS (contraception or HMB), or history of coagulopathy or thrombosis.

Consecutive Use of the 52 mg Levonorgestrel-releasing Intrauterine System: Variations in Bleeding Patterns.

OBJECTIVE: Changes in bleeding patterns could influence the decisions of healthcare professionals to change the levonorgestrel-releasing intrauterine system (LNG-IUS) before 7 years of use, the recommended period of extended use. We evaluated changes in the bleeding patterns of users of the 52 mg LNG-IUS at the end of use of the first (IUS-1) and during the second device (IUS-2) use. METHODS: We performed an audit of the medical records of all women who used two consecutive LNG-IUSs at the Family Planning clinic. We evaluated the sociodemographic/gynecological variables, the length of use, and the bleeding patterns reported in the reference periods of 90 days before removal of the IUS-1 and at the last return in use of IUS-2. We used the McNemar test to compare bleeding patterns. Statistical significance was established at p < 0.05. RESULTS: We evaluated 301 women aged (mean ± SD) 32 (±6.1) years, with lengths of use of 68.9 (±16.8) and 20.3 (±16.7) months for the IUS-1 and IUS-2, respectively. No pregnancies were reported. Bleeding patterns varied significantly among women who used the IUS-2 for ≥ 7 months to 6 years when compared the bleeding patterns reported in IUS-1 use. Eighty-nine out of 221 (40%) women maintained amenorrhea and infrequent bleeding; 66 (30%) evolved to bleeding patterns with light flow, and 66 (30%) maintained or evolved to heavy flow patterns (p = 0.012). No differences were observed among the 80 women with ≤ 6 months of use. CONCLUSION: Changes in bleeding patterns occur during the use of LNG-IUS and should not be decisive for the early replacement of the device.

OBJETIVO: Variações no padrão de sangramento podem afetar a decisão de troca do sistema intrauterino de levonorgestrel (SIU-LNG) antes do período de uso estendido recomendado de 7 anos. Nós avaliamos mudanças no padrão de sangramento de usuárias ao final do uso do primeiro SIU-LNG 52 mg (SIU-1) e durante o uso do segundo dispositivo (SIU-2). MéTODOS: Revisamos os prontuários de todas as mulheres que inseriram consecutivamente o SIU-LNG no ambulatório de Planejamento Familiar. Foram avaliadas as variáveis sociodemográficas/ginecológicas, o tempo de uso, e os padrões de sangramento relatados nos períodos de referência de 90 dias antes da remoção do SIU-1 e no último retorno em uso do SIU-2. Usamos o teste de McNemar para comparar os padrões de sangramento. A significância estatística foi estabelecida em p < 0,05. RESULTADOS: Analisamos os dados de 301 mulheres com idade (média ± desvio padrão [DP]) de 32 (±6,1) anos e tempo de uso de 68,9 (±16,8) e 20,3 (±16,7) meses para o SIU-1 e SIU-2, respectivamente. Nenhuma gravidez foi relatada. Os padrões de sangramento variaram significativamente durante o uso do SIU-2 (≥ 7 meses a 6 anos) em relação ao padrão relatado no SIU-1. Oitenta e nove das 221 (40%) mulheres mantiveram amenorreia e sangramento infrequente; 66 (30%) evoluíram para padrões de sangramento com fluxo leve e 66 (30%) mantiveram ou evoluíram para padrões de fluxo intenso (p = 0,012). Não foram observadas diferenças entre as 80 mulheres que utilizavam o SIU-2 há ≤ 6 meses. CONCLUSãO: Mudanças nos padrões de sangramento ocorrem durante o uso do LNG-IUS e não devem ser decisivas para a troca precoce do dispositivo.

Consecutive use of the 52 mg levonorgestrel-releasing intrauterine system: variations in bleeding patterns / Uso consecutivo do sistema intrauterino de levonorgestrel 52 mg: variações no padrão de sangramento

Abstract Objective Changes in bleeding patterns could influence the decisions of healthcare professionals to change the levonorgestrel-releasing intrauterine system (LNG-IUS) before 7 years of use, the recommended period of extended use. We evaluated changes in the bleeding patterns of users of the 52 mg LNG-IUS at the end of use of the first (IUS-1) and during the second device (IUS-2) use. Methods We performed an audit of the medical records of all women who used two consecutive LNG-IUSs at the Family Planning clinic. We evaluated the sociodemographic/gynecological variables, the length of use, and the bleeding patterns reported in the reference periods of 90 days before removal of the IUS-1 and at the last return in use of IUS-2. We used the McNemar test to compare bleeding patterns. Statistical significance was established at p < 0.05. Results We evaluated 301 women aged (mean ± SD) 32 (±6.1) years, with lengths of use of 68.9 (±16.8) and 20.3 (±16.7) months for the IUS-1 and IUS-2, respectively. No pregnancies were reported. Bleeding patterns varied significantly among women who used the IUS-2 for ≥ 7 months to 6 years when compared the bleeding patterns reported in IUS-1 use. Eighty-nine out of 221 (40%) women maintained amenorrhea and infrequent bleeding; 66 (30%) evolved to bleeding patterns with light flow, and 66 (30%) maintained or evolved to heavy flow patterns (p = 0.012). No differences were observed among the 80 women with ≤ 6 months of use. Conclusion Changes in bleeding patterns occur during the use of LNG-IUS and should not be decisive for the early replacement of the device.

Resumo Objetivo Variações no padrão de sangramento podem afetar a decisão de troca do sistema intrauterino de levonorgestrel (SIU-LNG) antes do período de uso estendido recomendado de 7 anos. Nós avaliamos mudanças no padrão de sangramento de usuárias ao final do uso do primeiro SIU-LNG 52 mg (SIU-1) e durante o uso do segundo dispositivo (SIU-2). Métodos Revisamos os prontuários de todas as mulheres que inseriram consecutivamente o SIU-LNG no ambulatório de Planejamento Familiar. Foram avaliadas as variáveis sociodemográficas/ginecológicas, o tempo de uso, e os padrões de sangramento relatados nos períodos de referência de 90 dias antes da remoção do SIU-1 e no último retorno em uso do SIU-2. Usamos o teste de McNemar para comparar os padrões de sangramento. A significância estatística foi estabelecida em p < 0,05. Resultados Analisamos os dados de 301 mulheres com idade (média ± desvio padrão [DP]) de 32 (±6,1) anos e tempo de uso de 68,9 (±16,8) e 20,3 (±16,7) meses para o SIU-1 e SIU-2, respectivamente. Nenhuma gravidez foi relatada. Os padrões de sangramento variaram significativamente durante o uso do SIU-2 (≥ 7 meses a 6 anos) em relação ao padrão relatado no SIU-1. Oitenta e nove das 221 (40%) mulheres mantiveram amenorreia e sangramento infrequente; 66 (30%) evoluíram para padrões de sangramento com fluxo leve e 66 (30%) mantiveram ou evoluíram para padrões de fluxo intenso (p = 0,012). Não foram observadas diferenças entre as 80 mulheres que utilizavam o SIU-2 há ≤ 6 meses. Conclusão Mudanças nos padrões de sangramento ocorrem durante o uso do LNG-IUS e não devem ser decisivas para a troca precoce do dispositivo.

Long-acting reversible contraceptive (LARCs) methods.

Unplanned pregnancy (UP) is a public health problem, which affects millions of women worldwide. Providing long-acting reversible contraceptive (LARC) methods is an excellent strategy to avoid or at least reduce UP, because the effectiveness of these methods is higher than other methods, and is indeed comparable to that of permanent contraception. As the initial introduction of the inert plastic intrauterine device (IUD) and of the six-rod implant, pharmaceutical companies have introduced a copper IUD (Cu-IUD), different models of levonorgestrel-releasing intrauterine system (LNG IUS), and one and two-rod implants, which certainly improved women's LARC options. The main characteristic of LARCs is that they provide high contraceptive effectiveness with a single intervention, and that they can be used for a long time. Emerging evidence from the last few years has demonstrated that it is possible to extend the use of the 52 mg LNG IUS and of the etonogestrel-implant beyond five- and three years, respectively, which adds new value to these LARCs.

Type 1 diabetes mellitus associated or not with primary hypothyroidism and women's fertility.

The aim of this study is to evaluate the prevalence of infertility and other reproductive parameters in women with type 1 diabetes mellitus (DM1) with and without primary hypothyroidism (PH). This is a cross-sectional study conducted at Division of Endocrinology. We evaluated 110 female, aged over 18 years, 79 had DM1 and 31 had DM1 plus PH. They were interviewed to obtain data on their gynecological and obstetric history; medical charts were reviewed to determine the characteristics of the diseases and to assess clinical/laboratory data. Infertility was defined as 12 months of unprotected sexual intercourse without conception. We used the chi-square and Mann-Whitney's tests, and logistic regression analysis. The prevalence of infertility in the total sample was 24.5%, no differences were found between groups regarding obstetric outcomes and gynecologic variables. Factors associated with infertility were microvascular complication (OR: 11.36; 95% CI: 2.488-52.632; p = .029), polycystic ovary syndrome (OR: 9.80; 95% CI: 2.247-43.478; p = .016), PH (OR: 3.38; 95% CI: 1.078-10.638; p = .047), and older age at onset of DM1 (OR: 1.12; 95% CI: 1.029-1.215; p = .019). The presence of PH in women with DM1 was a predictive factor for infertility. Women with DM1 showed poorer reproductive outcomes compared to the general population.

Changes in calcium metabolism and bone mineral density in new users of medroxyprogesterone acetate during the first year of use.

OBJECTIVE: To evaluate calcium metabolism and bone mineral density (BMD) in new users of depot medroxyprogesterone acetate (DMPA) in the first year of use. METHODS: This prospective, non-randomized study, conducted at the University of Campinas, São Paulo, Brazil, was carried out between February 2011 and February 2013. Women aged from 18 to 40 with a body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) <30 and with no known history of disease or medication use who chose to use DMPA were paired by age (±1 year) and BMI (±1) with women commencing the use of a copper intrauterine device (IUD). The primary outcomes were BMD measured by dual-energy X-ray absorptiometry and calcium metabolism markers; other variables were body composition and lifestyle habits. Repeated measures analysis of variance (ANOVA) and multiple regression analyses were used to evaluate associations. RESULTS: Twenty-seven women using DMPA and 24 using IUD were evaluated, with a mean age of 29.7 years and 28.6 years, respectively. The DMPA group presented with a 3.6% (P<0.001) loss of lumbar spine BMD, a 2.1% (P=0.100) loss of femoral neck BMD and higher phosphorus (P=0.014) concentrations at 12 months compared to the IUD group. The decreases in BMD were associated with the use of DMPA, while total mass and coffee intake were found to be protective factors. CONCLUSION: Changes in calcium metabolism and a decrease in BMD were found in the DMPA group at 12 months.

Disease activity and thromboembolic events in women with systemic lupus erythematosus with and without anti-phospholipid syndrome: users of the 52-mg levonorgestrel-releasing intrauterine system.

PURPOSE: The disease status and thromboembolic events in women with systemic lupus erythematosus (SLE), with and without anti-phospholipid syndrome (APS), were evaluated before and after placement of the 52-mg levonorgestrel-releasing intrauterine system (LNG-IUS). METHODS: A retrospective cohort study, with review of medical records of SLE women, who received an LNG-IUS placement between January 2007 and December 2016, carried out at the University of Campinas Medical School, Brazil. The outcomes included the disease activity (SLEDAI-2K) and damage index scores (SLICC/ACR-DI) presented for each year of device use, as well as venous/arterial thrombotic events, insertion up to a median of 5 years. The author's used χ2, Fisher's exact and the Mann-Whitney tests for analysis and generalized estimating equations for score comparison. RESULTS: The study evaluated 46 women with SLE, 18 with and 28 without APS; the mean age (± standard deviation [SD]) was 31.8 (SD ± 8.3) years old. The length of follow-up after LNG-IUS placement was 5.6 (SD ± 2.7) and 4.1 (SD ± 2.3) years for the groups with and without APS, respectively. Comparison of the groups found that the SLEDAI and SLICC mean scores were low for both at baseline, without variations through the follow-up. After LNG-IUS placement, two women presented three thrombotic arterial events, and one of them died from causes unrelated to LNG-IUS use. CONCLUSIONS: Our results, although restricted, provide information to policymakers and health professionals that the use of a 52 mg LNG-IUS over a 5-year median did not increase disease activity or damage index scores among women with SLE, with and without APS.

Sexual function and quality of life in a cohort of brazilian users of two kind of intrauterine contraceptives / Função sexual e qualidade de vida em uma amostra de brasileiras usuárias de dois tipos de contraceptivos intrauterinos

Abstract Objective To compare sexual function and quality of life (QOL) among intrauterine contraceptive (copper-intrauterine device [Cu-IUD] or the 52-mg 20 μg/day levonorgestrel- releasing intrauterine system [LNG-IUS]) users. Methods This was part of a cross-sectional study. Women aged between 18 and 49 years old, in a heterosexual relationship, reporting sexual intercourse in the previous 4 weeks, using Cu-IUD (Group 1) or LNG-IUS (Group 2) responded to a questionnaire with sociodemographic information, to the Female Sexual Function Index (FSFI), to the World Health Organization QOL Questionnaire Abbreviated Version (WHOQOL-BREF), and to a questionnaire about the contraceptive method used. The Student t-test, the Pearson χ2 test or the Fisher exact test, and the Mann-Whitney test were used for the analysis. For the adjusted comparison, we have used the analysis of covariance (ANCOVA). A multiple regression analyzing factors related to FSFI 26.55 was done. Significance was established at p < 0.05. Results A total of 347 women in Group 1 (mean age of 32.3 ± 7.5 years old) and of 298 in Group 2 (mean age of 32.7 ± 6.4 years old) completed the questionnaires.Most women had ≥ 8 years of schooling, were in amonogamous relationship, and had had ≤ 2 pregnancies. A total of 122 Cu-IUD and of 87 LNG-IUS users scored ≤ 26.55 on the FSFI. Significant lower scores in physical, environmental, and overall QOL domains in the WHOQOL-BREF questionnaire were found in Group 1. More women using the Cu- IUD were not satisfied with the method. Conclusion We did not find significant differences in sexual function; there was a lower score in some domains of QOL among women who used the Cu-IUD. It was not possible to ensure that those differences were related to the contraceptive method.

Resumo Objetivo Comparar a função sexual e a qualidade de vida (QV) entre usuárias de contraceptivos intrauterinos (dispositivo intrauterino com cobre [DIU-cobre] ou sistema intrauterino liberador de levonorgestrel [SIU-LNG 52 mg 20 μg/dia]. Métodos O presente estudo foi parte de um estudo de corte transversal. Mulheres com idades entre 18 e 49 anos, em relacionamento heterossexual, relatando relação sexual nas 4 semanas anteriores, utilizando DIU-cobre (Grupo 1) ou SIU-LNG (Grupo 2) responderam ao questionário com informações sociodemográficas, ao Índice de Função Sexual Feminino (IFSF), ao Questionário de QV da Organização Mundial de Saúde, versão abreviada (WHOQOL-BREF, na sigla eminglês), e a umquestionário sobre ométodo contraceptivo utilizado criado para o presente estudo. Os testes t de Student, o teste χ2 de Pearson, o teste exato de Fisher e o teste de Mann-Whitney foram utilizados. A análise de covariância (ANCOVA) foi utilizada para a comparação ajustada. Foi realizada a análise de regressão logística multivariada analisando fatores associados ao IFSF ≤ 26.55. O nível de significância foi p < 0.05. Resultados Um total de 347 mulheres no Grupo 1 (idade média 32,3 ± 7,5 anos) e de 298 no Grupo 2 (idade média 32,7 ± 6,4 anos) completaram os questionários. A maioria das mulheres relatou ≥ 8 anos de escolaridade, estava emrelaçãomonogâmica e teve ≤ 2 gestações. Um total de 122 e de 87 usuárias do DIU-cobre e do SIU-LNG, respectivamente, pontuaram ≤ 26,55 no IFSF. Pontuações significativamente menores nos domínios físico, meio-ambiente e QV geral no WHOQOL-BREF foram encontrados no Grupo 1. Mais mulheres do Grupo 1 estavam insatisfeitas com o método. Conclusão Não encontramos diferenças na função sexual, entretanto havia menores pontuações em certos domínios da QV entre as usuárias do DIU-cobre. Não foi possível afirmar relação dessas diferenças com os métodos.

Follow-up visits to check strings after intrauterine contraceptive placement cannot predict or prevent future expulsion.

OBJECTIVES: In some settings women are advised to return to the clinic after intrauterine contraceptive (IUC) placement, for a follow-up visit to check the strings and identify any expulsions. Our objective was to evaluate whether the number of follow-up visits to check the strings at the external cervical os after IUC placement predicts or prevents future expulsions. METHODS: This was a retrospective study conducted at the University of Campinas Medical School, Brazil. We reviewed the medical records of all women who used an IUC between January 1980 and December 2017, to identify women who had experienced IUC expulsion (N = 1974). We excluded women whose IUC was expelled more than once (n = 331) or after 10 years of use (n = 31). We fitted a generalised linear model of the time between IUC placement and expulsion, adjusting for several variables at expulsion. Significance was established at p < .05. RESULTS: Most expulsions (843/1612; 52.3%) occurred within the first 6 months after IUC placement and 691/1612 (42.9%) were within the first three months after placement. The adjusted model showed that the number of visits, the woman's age, and complaints of pain and bleeding during use were not significantly associated with and had no influence on expulsion. CONCLUSIONS: Our results indicate that after IUC insertion more than one follow-up visit within the first four to six months after placement is not necessary, as additional visits to check for IUC strings do not appear to reduce or predict future expulsion.

Sexual Function and Quality of Life in a Cohort of Brazilian Users of Two Kind of Intrauterine Contraceptives.

OBJECTIVE: To compare sexual function and quality of life (QOL) among intrauterine contraceptive (copper-intrauterine device [Cu-IUD] or the 52-mg 20 µg/day levonorgestrel-releasing intrauterine system [LNG-IUS]) users. METHODS: This was part of a cross-sectional study. Women aged between 18 and 49 years old, in a heterosexual relationship, reporting sexual intercourse in the previous 4 weeks, using Cu-IUD (Group 1) or LNG-IUS (Group 2) responded to a questionnaire with sociodemographic information, to the Female Sexual Function Index (FSFI), to the World Health Organization QOL Questionnaire Abbreviated Version (WHOQOL-BREF), and to a questionnaire about the contraceptive method used. The Student t-test, the Pearson χ2 test or the Fisher exact test, and the Mann-Whitney test were used for the analysis. For the adjusted comparison, we have used the analysis of covariance (ANCOVA). A multiple regression analyzing factors related to FSFI ≤ 26.55 was done. Significance was established at p < 0.05. RESULTS: A total of 347 women in Group 1 (mean age of 32.3 ± 7.5 years old) and of 298 in Group 2 (mean age of 32.7 ± 6.4 years old) completed the questionnaires. Most women had ≥ 8 years of schooling, were in a monogamous relationship, and had had ≤ 2 pregnancies. A total of 122 Cu-IUD and of 87 LNG-IUS users scored ≤ 26.55 on the FSFI. Significant lower scores in physical, environmental, and overall QOL domains in the WHOQOL-BREF questionnaire were found in Group 1. More women using the Cu-IUD were not satisfied with the method. CONCLUSION: We did not find significant differences in sexual function; there was a lower score in some domains of QOL among women who used the Cu-IUD. It was not possible to ensure that those differences were related to the contraceptive method.

OBJETIVO: Comparar a função sexual e a qualidade de vida (QV) entre usuárias de contraceptivos intrauterinos (dispositivo intrauterino com cobre [DIU-cobre] ou sistema intrauterino liberador de levonorgestrel [SIU-LNG 52 mg 20 µg/dia]. MéTODOS: O presente estudo foi parte de um estudo de corte transversal. Mulheres com idades entre 18 e 49 anos, em relacionamento heterossexual, relatando relação sexual nas 4 semanas anteriores, utilizando DIU-cobre (Grupo 1) ou SIU-LNG (Grupo 2) responderam ao questionário com informações sociodemográficas, ao Índice de Função Sexual Feminino (IFSF), ao Questionário de QV da Organização Mundial de Saúde, versão abreviada (WHOQOL-BREF, na sigla em inglês), e a um questionário sobre o método contraceptivo utilizado criado para o presente estudo. Os testes t de Student, o teste χ2 de Pearson, o teste exato de Fisher e o teste de Mann-Whitney foram utilizados. A análise de covariância (ANCOVA) foi utilizada para a comparação ajustada. Foi realizada a análise de regressão logística multivariada analisando fatores associados ao IFSF ≤ 26.55. O nível de significância foi p < 0.05. RESULTADOS: Um total de 347 mulheres no Grupo 1 (idade média 32,3 ± 7,5 anos) e de 298 no Grupo 2 (idade média 32,7 ± 6,4 anos) completaram os questionários. A maioria das mulheres relatou ≥ 8 anos de escolaridade, estava em relação monogâmica e teve ≤ 2 gestações. Um total de 122 e de 87 usuárias do DIU-cobre e do SIU-LNG, respectivamente, pontuaram ≤ 26,55 no IFSF. Pontuações significativamente menores nos domínios físico, meio-ambiente e QV geral no WHOQOL-BREF foram encontrados no Grupo 1. Mais mulheres do Grupo 1 estavam insatisfeitas com o método. CONCLUSãO: Não encontramos diferenças na função sexual, entretanto havia menores pontuações em certos domínios da QV entre as usuárias do DIU-cobre. Não foi possível afirmar relação dessas diferenças com os métodos.