Reproductive function and behaviors: an update on the role of neural estrogen receptors alpha and beta.

Infertility is becoming a major public health problem, with increasing frequency due to medical, environmental and societal causes. The increasingly late age of childbearing, growing exposure to endocrine disruptors and other reprotoxic products, and increasing number of medical reproductive dysfunctions (endometriosis, polycystic ovary syndrome, etc.) are among the most common causes. Fertility relies on fine-tuned control of both neuroendocrine function and reproductive behaviors, those are critically regulated by sex steroid hormones. Testosterone and estradiol exert organizational and activational effects throughout life to establish and activate the neural circuits underlying reproductive function. This regulation is mediated through estrogen receptors (ERs) and androgen receptor (AR). Estradiol acts mainly via nuclear estrogen receptors ERα and ERß. The aim of this review is to summarize the genetic studies that have been undertaken to comprehend the specific contribution of ERα and ERß in the neural circuits underlying the regulation of the hypothalamic-pituitary-gonadal axis and the expression of reproductive behaviors, including sexual and parental behavior. Particular emphasis will be placed on the neural role of these receptors and the underlying sex differences.

Sexual risk behavior and knowledge about sexually transmitted infections in a university population in Sorocaba, Brazil / Comportamento sexual de risco e conhecimento sobre infecções sexualmente transmissíveis em uma população universitária na cidade de Sorocaba/SP

INTRODUCTION: Sexually transmitted infections (STIs) are a major public health problem to which young people are highly exposed and knowledge about vulnerabilities that affect them is needed. OBJECTIVE: To evaluate the knowledge about STIs and sexual behavior of a university population in the city of Sorocaba/SP. METHODS: A descriptive, cross-sectional study was conducted with data collection realized by an online application with qualitative and quantitative characteristics. RESULTS: Four hundred and seventy-seven (477) university students from different areas of knowledge were analyzed. The majority pointed to the beginning of sexual life between 15 and 18 years old. Information about sex education was obtained mainly through parents and/ or guardians, while little additional knowledge was obtained after entering higher education. Biological and Health Sciences students achieved a higher score on the knowledge questionnaire and were less likely (0.391) to contract STIs when compared to Applied Social Sciences or Engineering students (2.8 and 2.9 more likely, respectively). CONCLUSION: Students who demonstrated greater knowledge about STIs and acquired more information on the subject during graduation were less likely to become infected, suggesting that campaigns aimed at the university public are essential for the prevention and control of these pathogens.

INTRODUÇÃO: As infecções sexualmente transmissíveis (IST) são um grande problema de saúde pública, ao qual os jovens apresentam alta exposição, sendo necessário um maior conhecimento sobre as vulnerabilidades que os acometem. OBJETIVO: Avaliar o conhecimento sobre as IST e o comportamento sexual de uma população universitária na cidade de Sorocaba/SP. MÉTODOS: Realizou-se um estudo descritivo, de corte transversal, com a coleta de dados realizada por meio de aplicação online de questionário com características qualitativas e quantitativas. RESULTADOS: Quatrocentos e setenta e sete (477) universitários de diferentes áreas de conhecimento foram avaliados. A maioria dos relatos apontou para o início da vida sexual entre 15 e 18 anos. As informações sobre educação sexual foram obtidas principalmente por intermédio dos pais e/ou responsáveis, enquanto pouco conhecimento adicional foi obtido após o ingresso no Ensino Superior. Estudantes de Ciências Biológicas e da Saúde alcançaram o maior score no questionário sobre conhecimento e apresentaram chances menores (0,391) de contrair IST, quando comparados aos estudantes de Ciências Sociais Aplicadas ou Engenharias (2,8 e 2,9 mais chances, respectivamente). CONCLUSÃO: Os estudantes que demonstraram maior conhecimento sobre as IST e que adquiriram mais informações sobre o tema durante a graduação apresentaram chances menores de se infectar, o que sugere que campanhas destinadas ao público universitário são essenciais para a prevenção e o controle desses patógenos.

Factores de riesgo en la edad reproductiva / Risk Factors in the Reproductive Age

Por medio de la presente y motivados por la lectura y análisis del artículo Características clínicas y microbiológicas de la infección de vías urinarias bajas en población ambulatoria,1 quisiéramos llamar la atención sobre un tema que últimamente tiene poca visibilidad en las publicaciones. Se trata de los factores de riesgo presentes en la edad reproductiva y que inciden negativamente en futuros embarazos, lo que se conoce como factores de riesgo preconcepcional. Al revisar lo publicado en los últimos cinco años apenas se aborda directamente el tema, que por demás mantiene vigencia capital cuando de salud materno infantil se trata. En el trabajo que motiva el análisis, se expresa la frecuencia de aparición de las infecciones urinarias bajas en ambos sexos, más frecuentes en mujeres...(AU)

Perfil reprodutivo de uma população de alta vulnerabilidade / Reproductive profile of a high vulnerability population

Introdução: padrões sexuais e reprodutivos são influenciados por fatores biopsicossociais. Dentre esses fatores, há a vulnerabilidade, conceito amplo, complexo e que determina maior atenção das políticas públicas. Objetivo: conhecer o perfil reprodutivo das mulheres que residem em uma área de alta vulnerabilidade na cidade de Curitiba-PR. Metodologia: descritivo, documental de caráter analítico observacional transversal. Coleta e análise de dados das Declarações de Nascidos Vivos (DNV) na Unidade de Saúde do Capanema e análise de dados públicos fornecidos pelo IBGE. Resultados: foram analisados 1199 DNVs, sendo 1011 mulheres com idades entre 13 e 49 anos, compreendidos entre os anos de 2003 a 2018. Foi possível a análise da Taxa de Fecundidade Total (TFT), via de parto, estado civil e escolaridade das parturientes. Discussão: a menor TFT foi apresentada na faixa etária de 13 a 15 anos (1,05 filhos/mulher) e a maior entre 36 a 49 anos (4,47 filhos/mulher). A via de parto vaginal correspondeu a 64% dos partos, enquanto que a via cirúrgica por cesárea aconteceu em 36% dos casos. Em relação à escolaridade, 3% apresentaram-se como analfabetas; 48% possuíam nível fundamental; 40% nível médio completo e 9% possuíam nível superior completo ou incompleto. Houve 0,5% de omissão da que escolaridade no momento do preenchimento dos dados. Os dados coletados sobre o estado civil foram considerados inconclusivos. Conclusão: Conclui-se que a Taxa de Fecundidade da população estudada está acima da Taxa de Fecundidade Total projetada para 2015 no Brasil nas faixas etárias acima de 19 anos e da taxa de fecundidade ideal para que haja uma reposição da população segundo o DATASUS (2021). Tais dados podem estar relacionados com a vulnerabilidade da comunidade em questão, corroborando com estudos que relatam maiores taxas de fecundidade relacionada a menor renda e menor escolaridade.

Introduction: sexual and reproductive patterns are influenced by biopsychosocial factors. Among these factors, there is vulnerability, a broad and complex concept that requires greater attention from public policies. Objective: to know the reproductive profile of women who live in an area of high vulnerability in the city of Curitiba-PR. Methodology: descriptive, documental, cross-sectional observational analysis. Collection and analysis of data from the Birth Certificates (BC) at the Capanema Health Unit and analysis of public data provided by the IBGE. Results: 1199 BCs were analysed, with 1011 women aged between 13 and 49 years old, between the years 2003 and 2018. It was possible to analyse the Total Fertility Rate (TFR), mode of delivery, marital status and level of education of the parturients. Discussion: the lowest TFR was observed in the age group from 13 to 15 years old (1.05 children/woman) and the highest between 36 to 49 years old (4.47 children/woman). Vaginal delivery corresponded to 64% of deliveries, while surgical caesarean section occurred in 36% of cases. Regarding schooling, 3% were illiterate; 48% had a fundamental level; 40% completed high school and 9% had completed or incomplete higher education. There was 0.5% omission of schooling attainment at the time of filling in the data. Data collected on marital status were considered inconclusive. Conclusion: it is concluded that the Fertility Rate of the studied population is above the Total Fertility Rate projected for 2015 in Brazil in the age groups above 19 years and the ideal fertility rate so that there is a replacement of the population according to DATASUS (2021). Such data may be related to the vulnerability of the community in question, corroborating with studies that report higher fertility rates related to lower income and lower education.

The effect of estrogen and progesterone on melanin-concentrating hormone producing-neurons in brain areas related to reproductive behavior in lactating dams.

The hypothalamus plays a role in reproductive cycle control, and it is a site of action of steroid hormones. Throughout the production of melanin-concentrating hormone (MCH), the hypothalamus shows adaptive changes during lactation. Therefore, in this work, we aimed to test the effects of estrogen and progesterone manipulation on MCH-immunoreactive (ir) neurons in hypothalamic brain areas related to reproductive behavior and on the MCH serum concentration. Our results show that the removal of steroid hormones by ovariectomy increases the number of MCH-ir neurons in the medial preoptic area (MPOA) and incerto-hypothalamic area (IHy) but not in the anterior part of the paraventricular nucleus of the hypothalamus (PVHa). The MCH in the serum levels also increases. In accordance, the injection of estradiol alone or estradiol and progesterone decreased the number of MCH-ir neurons in the MPOA and IHy, as well as its serum levels. The MPOA and IHy are the brain areas targeted by the steroid hormone inhibitory effect of the MCH system during lactation. This effect is also reflected in the MCH serum levels.

Reproductive Planning and the Choice of Long-acting Reversible Contraceptive Primary to Health: A Cross-Sectional Study / Planejamento reprodutivo e a escolha do contraceptivo de longa permanência na atenção primária à saúde: um estudo transversal

Abstract Objective Evaluate the different perspectives that involve the choice of long-acting reversible contraceptives (LARCs), the issues related to this process and the consequences of deciding one method in the women's in the primary health care (PHC) center in Sousas, a district in Campinas, SP (Brazil). Methods This is an analytical cross-sectional study, it was performed at the PHC in Sousas. Data were collected through the analysis of medical records and interviews with women who live in Sousas and had the insertion of the copper intrauterine device (IUD) (D) from April 2021 to April 2022 or the etonogestrel implant (I) from May to December 2022. The study was approved by the Research Ethics Committee of the Medical Science School at the State University of Campinas (UNICAMP). Results Reason for choosing this LARC: medical (D: 52%; I: 100%), easy adhesion (D: 71%; I: 67%), effectiveness (D: 55%; I: 100%). Indication by health professionals (D: 65%; I: 100%). And improvement of clinical characteristics: mood (D: 77%; I: 67%), body mass index (BMI; D: 52%; I: 33%), and libido (D: 84%; I: 67%). Conclusion It is suggested that women tend to decide between LARCs when guided by their doctor or PHC health professionals, and they select LARCs because of the ease of use and low failure rates. Therefore, this study highlights how LARCs can positively interfere in the aspects that pervade contraception, such as BMI, libido, and mood.

Resumo Objetivo Avaliar as diversas perspectivas que envolvem a escolha dos LARCs, as problemáticas relacionadas a esse processo e as consequências da escolha do método na vida das mulheres no centro de Atenção Primária à Saúde (APS) em Sousas, distrito de Campinas, SP. Métodos Trata-se de um estudo transversal analítico, realizado no Centro de Saúde de Sousas. Os dados foram coletados através da análise de prontuários e de entrevistas das mulheres residentes em Sousas, que inseriram o dispositivo intrauterino (DIU) de cobre (D) entre abril de 2021 a abril de 2022 ou o implante de etonogestrel (I) de maio a dezembro de 2022. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Ciência Médicas da Universidade Estadual de Campinas (UNICAMP). Resultados O motivo da escolha: por indicação médica (D: 52%; I: 100%), pela facilidade (D: 71%; I: 67%) e pela eficácia (D: 55%; I: 100%). Da indicação por profissionais de saúde (D: 65%; I: 100%). E melhora das características clínicas: humor (D: 77%; I: 67%), índice de massa corporal (IMC; D: 52%; I: 33%) e libido (D: 84%; I: 67%). Conclusão Sugere-se que as mulheres tendem a escolher LARCs quando orientadas pelo seu médico ou por profissionais de saúde da APS e optam pelos LARCs pela facilidade do uso e baixa taxa de falhas. Destaca-se como os LARC's podem interferir positivamente em aspectos que perpassam a contracepção, como o IMC, libido e estado de humor.

Estudiantes universitarias nuligestas en edad fértil y su postura acerca de posibles vías del parto / Nuligest university students of childbearing age and their position about possible ways of delivery

Resumen Introducción: Tanto a nivel sudamericano como mundial, el incremento de la tasa de cesáreas electivas ha sido abrumante. Esto se considera un problema de salud pública, ya que el parto vaginal es la vía más fisiológica para el nacimiento y trae beneficios de salud para la madre y el recién nacido, tanto inmediatos como a futuro. Objetivo: Evaluar la postura de mujeres nuligestas en edad fértil acerca de las vías del parto a través de sus conocimientos, percepciones y preferencias. Método: Estudio de corte transversal. Se aplicó una encuesta a estudiantes universitarias para la recopilación de datos mediante SPSS, y análisis con prueba de diferencias de proporciones y de χ2. Resultados: 210 mujeres encuestadas. Un 80% de ellas desconoce la menor morbilidad infantil asociada a un parto vaginal, más de la mitad estima una ventaja de la cesárea que evite el dolor y un gran porcentaje desconoce los riesgos médicos asociados a la cesárea. Conclusiones: Existe un alto nivel de desconocimiento respecto a beneficios, riesgos y consecuencias de las diferentes vías del parto.

Abstract Introduction: Both in South America and worldwide, the increase in the rate of elective caesarean sections has been overwhelming. This is considered a public health problem, since vaginal delivery is the most physiological route for birth and brings health benefits for the mother and the newborn, immediately and in the future. Objective: To evaluate the position of nulliparous women of childbearing age regarding the delivery pathways through their knowledge, perceptions, and preferences. Method: Cross-sectional study with an analytical component. A survey was applied to university students for data collection through SPSS, and analysis was made with the difference of proportions and χ2 test. Results: 210 women surveyed; 80% of them are unaware of the lower infant morbidity associated with a vaginal delivery, more than a half estimate an advantage of a cesarean section that it avoids pain, and a large percentage are unaware of the medical risks associated with cesarean sections. Conclusions: There is a high level of ignorance regarding the benefits, risks and consequences of the different delivery routes.

A Novel Decision Aid Improves Quality of Reproductive Decision-Making and Pregnancy Knowledge for Women with Inflammatory Bowel Disease.

BACKGROUND: Women with inflammatory bowel disease (IBD) with poor IBD-specific reproductive knowledge experience more childlessness and fear of IBD medications in pregnancy. The Pregnancy in IBD Decision Aid (PIDA), developed by an international multidisciplinary team, offers personalized online decision support regarding pregnancy in IBD. AIMS: Assess the impact of PIDA on quality of reproductive decision-making and pregnancy-related knowledge among preconception (PC) and pregnant patients with IBD, and evaluate acceptability to patients and clinicians. METHODS: PC and pregnant patients with IBD aged 18-45 completed questionnaires pre- and post-PIDA to assess quality of decision-making (Decisional Conflict Scale (DCS); Decision Self-Efficacy Scale (DSES) and IBD-in-pregnancy knowledge (Crohn's and Colitis Pregnancy Knowledge Score (CCPKnow)). Paired t test assessed for differences pre- and post-PIDA. Patients and clinicians completed acceptability surveys. RESULTS: DCS and DSES were completed by 74 patients (42 Crohn's disease, 32 ulcerative colitis); 41 PC and 33 pregnant. DCS improved significantly post-PIDA in PC patients regarding pregnancy planning (t(40) = 4.83, p < 0.0001, Cohen's dz = 0.75) and in pregnant patients regarding medication management (t(32) = 2.37, p = 0.0242, dz = 0.41). DSES for PC patients improved significantly post-PIDA (t(40) = -3.56, p = 0.001, dz = -0.56). CCPKnow improved significantly post-PIDA in PC (t(42) = 4.93, p < 0.0001, dz = -0.75) and pregnant patients (t(32) = 5.1, p < 0.0001, dz = -0.89). PIDA was deemed optimal for length, readability, and content amount and considered highly useful by patients (n = 73) and clinicians (n = 14). CONCLUSIONS: Patients using PIDA developed an improved quality of reproductive decision-making and IBD-in-pregnancy knowledge. PIDA is an accessible tool that can empower women with IBD to make values-congruent, evidence-based decisions regarding pregnancy and may reduce voluntary childlessness.

Suppression of reproductive behaviour and gonadal function in female horses-An update.

The behaviour of mares is often detrimental to their performance resulting in frequent demand for methods to suppress gonadal function. In addition, prevention of unintended reproduction especially in feral horse populations may require methods for suppression of gonadal function. Surgical ovariectomy is a safe method but not an acceptable approach in feral mares and undesired in mares where future breeding is considered. There are different approaches for artificial prolongation of the luteal phase resulting in transient inhibition of oestrus and ovulation. Among those, treatment with natural or synthetic progestogens is considered the most common and successful method. Whereas application of intrauterine devices may result in prolongation of luteal function in non-pregnant mares, intrauterine insertion of glass balls is no longer recommended because of complications in individual mares. There are several safer alternatives that may be of interest, especially for population control in free-roaming horses. Treatment with long-acting deslorelin implants inhibited ovulation and oestrus behaviour in mares for limited and variable time intervals in a dose-dependent manner. The effect of GnRH vaccines varies considerably among individual mares, is age dependent, and oestrus-like behaviour may still occur. Contraception via immunization against native porcine or recombinant zona pellucida antigen is successful, but immunocontraception is as much a result of ovarian inactivity as an antibody-based block to sperm-oocyte binding. In conclusion, several treatments for suppression of gonadal function in mares are available, but there are advantages and disadvantages associated that have to be considered. The treatment of choice will thus differ with regard to the demands.

Effects of early life adversity on male reproductive behavior and the medial preoptic area transcriptome.

Early life adversity can alter reproductive development in humans, changing the timing of pubertal onset and sexual activity. One common form of early adversity is limited access to resources. This adversity can be modeled in rats using the limited bedding/nesting model (LBN), in which dams and pups are placed in a low resource environment from pups' postnatal days 2-9. Our laboratory previously found that adult male rats raised in LBN conditions have elevated levels of plasma estradiol compared to control males. In females, LBN had no effect on plasma hormone levels, pubertal timing, or estrous cycle duration. Estradiol mediates male reproductive behaviors. Thus, here we compared reproductive behaviors in adult males exposed to LBN vs. control housing. LBN males acquired the suite of reproductive behaviors (mounts, intromissions, and ejaculations) more quickly than their control counterparts over 3 weeks of testing. However, there was no effect of LBN in males on puberty onset or masculinization of certain brain regions, suggesting LBN effects on estradiol and reproductive behaviors manifest after puberty. In male and female rats, we next used RNA sequencing to characterize LBN-induced transcriptional changes in the medial preoptic area (mPOA), which underlies male reproductive behaviors. LBN produced sex-specific alterations in gene expression, with many transcripts showing changes in opposite directions. Numerous transcripts altered by LBN in males are regulated by estradiol, linking hormonal changes to molecular changes in the mPOA. Pathway analysis revealed that LBN induced changes in neurosignaling and immune signaling in males and females, respectively. Collectively, these studies reveal novel neurobiological mechanisms by which early life adversity can alter reproductive strategies.

Evidências e fatores associados ao fenômeno de adiamento da maternidade no Brasil / Evidence and factors associated with the maternity postponement phenomenon in Brazil / Evidencia y factores asociados al fenómeno de aplazamiento de la maternidad en Brasil

Este trabalho tem como objetivo contribuir com a literatura sobre o fenômeno do adiamento da maternidade no Brasil, bem como analisar seus principais fatores associados. A pesquisa aborda o período de 1992 a 2015, considerando as informações da Pesquisa Nacional por Amostra de Domicílios (PNAD), do IBGE, e a análise de sobrevivência que possibilita caracterizar aquelas mulheres com nascimentos de primeira ordem. Os resultados constatam uma tendência crescente da postergação da maternidade no Brasil e que aquelas com mais chances de adiar a maternidade são brancas, solteiras, residentes em áreas urbanas, metropolitanas e na região Sudeste. Ademais, foi possível identificar que, entre os principais fatores que contribuem para essa tendência, estão o investimento em capital humano e a participação no mercado de trabalho, preponderantes para o adiamento da maternidade.

This paper aims to contribute to the literature on the phenomenon of postponement of motherhood in Brazil, as well as to analyze its main associated factors. The research analyzes the period from 1992 to 2015, considering information from the National Household Sample Survey and the survival analysis that makes it possible to characterize those women who are surviving without children or postponing their first child. The results show a growing tendency in maternity postponement in Brazil and that those most likely to postpone motherhood are white, single, living in urban, metropolitan areas and in the Southeast region. In addition, it was possible to identify that among the main factors that contribute to this trend is investment in human capital and participation in the labor market, which are preponderant for the postponement of motherhood.

Este trabajo tiene como objetivo contribuir a la literatura sobre el fenómeno del aplazamiento de la maternidad en Brasil, así como analizar sus principales factores asociados. La investigación analiza el período 1992-2015, considerando la información de la Encuesta Nacional de Muestras de Hogares y el análisis de supervivencia que permite caracterizar a las mujeres que sobreviven sin hijos o posponen a su primer hijo. Los resultados muestran una tendencia creciente de posponer la maternidad en Brasil y que quienes tienen más probabilidades de posponer la maternidad son blancas y solteras, y viven en áreas urbanas, metropolitanas y en el sudeste. Además, fue posible identificar que entre los principales factores que contribuyen a esta tendencia se encuentra la inversión en capital humano y la participación en el mercado laboral, que son preponderantes para el aplazamiento de la maternidad.

Intergenerational transmission between quilombola mothers and daughters: reproductive autonomy and intervening factors / Transmisión intergeracional entre madres e hijas quilombolas: autonomía reproductiva y factores intervinientes / Transmissão intergeracional entre mães e filhas quilombolas: autonomia reprodutiva e fatores intervenientes

ABSTRACT Objective: to analyze reproductive autonomy in quilombola women and the intervening factors of intergenerational transmission between mothers and daughters. Method: a cross-sectional and analytical study developed with 160 women, mothers and daughters from quilombola communities in the municipality of Vitória da Conquista, Bahia. The National Health Survey questionnaire was used to verify sociodemographic characteristics and intervening factors; and the Reproductive Autonomy Scale was also employed. The Chi-square, Mann-Whitney and Wilcoxon tests were applied. The data were analyzed by means of simple and multiple linear regression. Results: the group of mothers presented higher frequency of women that are married or live with a partner (66.2%), who worked (51.2%) and who had higher incomes (358.00 ± 663.00). The daughters presented more years of study (10.50 ± 5.00). Reproductive autonomy and intergenerational transmission between mothers and daughters mainly occur in the Absence of coercion (ICC=0.70; p=0368) and Communication (ICC=0.69; p=0694) domains. The mother's age (ß-adjusted=-0.027; p=0.039) and the daughter's skin color/race (ß-adjusted=0.423; p=0.049) were intervening factors in intergenerational transmission related to Decision-making, associated with the mother's age and with the daughter's self-recognition as black-skinned. Conclusion: the daughters do not follow the same choice as their mothers, which can be understood due to greater accessibility to reproductive planning services and increased schooling levels. Intergenerational transmission among quilombolas presents important specificities for reproductive decisions and enables a better understanding of the information and qualification of the health professionals' assistance in the care provided to these women.

RESUMEN Objetivo: analizar la autonomía reproductiva en mujeres quilombolas y los factores intergeneracionales de transmisión entre madres e hijas. Método: estudio transversal y analítico desarrollado con 160 mujeres, madres e hijas de comunidades quilombolas de la ciudad de Vitória da Conquista, Bahía. Se utilizó el cuestionario de la Pesquisa Nacional de Saúde para verificar las características sociodemográficas y los factores intervinientes; y la Escala de Autonomía Reproductiva. Se aplicaron las pruebas de Chi-cuadrado, Mann-Whitney y Wilcoxon. Los datos se analizaron mediante regresión lineal simple y múltiple. Resultados: el grupo de madres presentó mayor frecuencia de mujeres casadas o con pareja (66,2%), que trabajaban (51,2%) y tenían mayores ingresos (358,00 ± 663,00). Las hijas presentaron más años de escolaridad (10,50 ± 5,00). La autonomía reproductiva y la transmisión intergeneracional entre madres e hijas ocurren especialmente en los dominios Ausencia de Coerción (CCI=0,70; p=0368) y Comunicación (CCI=0,69; p=0694). La edad de la madre (ß-ajustada=-0.027; p=0.039) y la etnia / raza de la hija (ß-ajustada=0.423; p=0.049) fueron factores que intervinieron en la transmisión intergeneracional relacionada con la Toma de Decisiones, asociada a una menor edad de la madre y al autorreconocimiento de la hija como negra. Conclusión: las hijas no siguen la misma opción que sus madres, lo que puede explicarse debido a la mayor accesibilidad a los servicios de planificación reproductiva y mayores niveles de educación. La transmisión intergeneracional entre quilombolas presenta importantes especificidades para las decisiones reproductivas y permite una mejor comprensión de la información y la calificación de la asistencia de los profesionales de la salud en el cuidado de estas mujeres.

RESUMO Objetivo: analisar a autonomia reprodutiva em mulheres quilombolas e os fatores intervenientes da transmissão intergeracional entre mães e filhas. Método: estudo transversal e analítico desenvolvido com 160 mulheres, mães e filhas de comunidades quilombolas do município de Vitória da Conquista, Bahia. Utilizou-se o questionário da Pesquisa Nacional de Saúde para verificar características sociodemográficas e fatores intervenientes; e a Escala de Autonomia Reprodutiva. Foram aplicados testes qui-quadrado, Mann-Whitney e Wilcoxon. Os dados foram analisados através de regressão linear simples e múltipla. Resultados: o grupo das mães apresentou maior frequência de mulheres casadas ou com companheiro (66,2%), que trabalhavam (51,2%) e maior renda (358,00 ± 663,00). As filhas apresentaram mais anos de estudo (10,50 ± 5,00). A autonomia reprodutiva e a transmissão intergeracional entre mães e filhas ocorrem, sobretudo, nos domínios Ausência de Coerção (CCI=0,70; p=0368) e Comunicação (CCI=0,69; p=0694). A idade da mãe (ß-ajustado=-0,027; p=0,039) e cor/raça da filha (ß-ajustado=0,423; p=0,049) foram fatores intervenientes na transmissão intergeracional relacionada a Tomada de Decisão, associados a menor idade da mãe e ao autorreconhecimento da filha como negra. Conclusão: as filhas não acompanham a mesma escolha das mães, o que pode ser entendido por uma maior acessibilidade aos serviços de planejamento reprodutivo e aumento nos níveis de escolaridade. A transmissão intergeracional entre quilombolas apresenta especificidades importantes para decisões reprodutivas e possibilita melhor entendimento das informações e qualificação da assistência dos profissionais de saúde no cuidado com essas mulheres.

Association of reproductive risk factors and comorbidities among molecular subtypes of Breast cancer in a Tertiary care Hospital

The reasons for the recently observed increase in the incidence of breast cancer in the Indian population are not clearly understood, but thought to be largely explained by westernization of lifestyles and changes in reproductive behavior, which characterize exposure to hormones. Our aim is to review the reproductive risk factors and comorbidities and evaluate the association between molecular subtypes of breast cancer. A hospital-based analytical case-control study was conducted among the breast cancer cases with controls in a multispecialty teaching hospital for a period of one year. Totally, 130 subjects were recruited and an interview was conducted using a structured questionnaire to obtain demographic and risk factor data, including tissue marker status (ER, PR and HER-2) obtained from case files. Data were analyzed with SPSS-20 version. Results: The highest age group reported in this study was 51- 60 years which has a 3.8 times increased risk compared to other age and the age group of 31- 40 have a decrease risk of 0.33. In this study, the percentage of post menopause (68%) and mothers not breastfeeding (10%) was higher in cases compared to controls and a noted increase in the risk of breast cancer with odds ratio (OR) of 2.745 (p= <0.0001) and 9.08 (p=0.01) respectively. Duration of breastfeeding showed significantly (p=<0.0001)) moderate positive correlation (r=0.549, 0.457, 0.418 and 0.636) for luminal A, luminal B, HER+, and triple negative respectively. This study found that all the reproductive risk factors do not have correlation with a molecular subtype of breast cancer except breastfeeding. Post menopause and breastfeeding were common factors associated with all people and could be modifiable to prevent the occurrence of breast cancer through lifestyle change

Breeding and reproductive behaviour of the neo-tropical opossum, Didelphis marsupialis insularis, Allen 1902 under captive conditions / Reprodução e comportamento reprodutivo do gambá neotropical, Didelphis marsupialis insularis, Allen 1902, em condições de cativeiro

Developing a captive breeding system for the widely hunted Caribbean species of opossum Didelphis marsupialis insularis can greatly aide in the management and conservation of this species in the neo-tropics. Although this species possesses ideal traits for captive breeding in this region (tolerance to high heat and humidity, high reproductive rate, and resistance to disease), challenges due to its aggressive behaviour and limited information on its breeding behaviour have prevented a system from being developed for this species. The present study describes a breeding system, and the reproductive behaviour of this species under captive conditions. Six (1 male; 5 females) adult opossums were maintained and managed for breeding over a ten (10) month period. Pouch litter sizes averaged 5±2.5 with a range of 2 to 8. Gestation length was found to be 13.25±0.96 days and 4 litters (n=23) were successfully weaned at 11-13 weeks. It was found that the male D. m. insularis exhibits behaviours of interest that can serve as indicators for receptivity of the female, and overall, that this species can be successfully reared and bred under captive conditions in the neo-tropics.

O desenvolvimento de um sistema de criação em cativeiro para as espécies de gambá do Caribe amplamente caçadas, Didelphis marsupialis insularis, pode auxiliar bastante no manejo e conservação dessa espécie nos neotrópicos. Embora essa espécie possua características ideais para a criação em cativeiro nessa região (tolerância a altas temperaturas e umidade, alta taxa de reprodução e resistência a doenças), alguns fatores, como o seu comportamento agressivo e informações limitadas sobre seu comportamento reprodutivo, impediram o desenvolvimento de um sistema para D. m. insularis. O presente estudo descreve um sistema de criação e o comportamento reprodutivo dessa espécie em condições de cativeiro. Seis gambás adultos (1 macho e 5 fêmeas) foram mantidos para reprodução durante um período de 10 meses. O tamanho da ninhada em bolsa foi em média de 5 ± 2,5 com um intervalo de 2 a 8. A duração da gestação foi de 13,25 ± 0,96 dias, e 4 ninhadas (n = 23) foram desmamadas com sucesso de 11 a 13 semanas. Verificou-se que o macho D. m. insularis exibe comportamentos de interesse que podem servir como indicadores de receptividade da fêmea, e, em geral, essa espécie pode ser criada com sucesso em condições de cativeiro nos neotrópicos.

Detección y control del cáncer de cuello uterino en mujeres de 35 a 44 años en Ecuador / Detection and control of cervical cancer in women aged 35 to 44 yearsin Ecuador

INTRODUCCIÓN: El cáncer de cuello uterino es un problema de salud pública que se origina en las células que recubren el cuello del útero, cuya etiología se relaciona frecuentemente con el virus del Papiloma Humano. Esta patología solo se presenta en las mujeres, siendo el segundo más común entre las tipologías de cáncer; su aparición puede ser prevenible mediante el control y la detección oportuna. OBJETIVO: Determinar el nivel de control y detección de cáncer cérvico-uterino que tienen las mujeres de 35 a 44 años. METODOLOGÍA: La investigación es cuantitativa, descriptiva y de corte transversal. La muestra fue de 267 mujeres de 35 a 44 años. Se aplicó una encuesta virtual de manera voluntaria y aleatoria a la población femenina de dichas edades, en la cual se establecieron preguntas categorizadas en: Conocimiento general, Control y Detección, éstas nos ayudarán a comprobar el grado de información, control y detección del cáncer cérvico-uterino que tenga dicha población. RESULTADOS: El porcentaje general varía de acuerdo a las categorías de las encuestas empleadas, a partir de las cuales se refleja que el 52,8% tiene conocimiento acerca de los métodos de control y detección del cáncer cérvico-uterino, el 44,3% no ha recibido información acerca del tema y, el 2,9% tiene un conocimiento incompleto. CONCLUSIÓN: El cáncer cérvico-uterino afecta con mayor frecuencia a las mujeres sexualmente activas dentro del rango de edad de 35 y 44 años, siendo la falta de información de la población femenina y la ausencia de controles sanitarios algunos de los factores que predisponen a una alta incidencia y prevalencia de la morbi ­mortalidad a causa de esta patología.

INTRODUCTION: Cervical cancer is a public health problem that originates in the cells lining the cervix, whose etiology is often associated with the Human Papillomavirus. This pathology only occurs in women, being the second most common among cancer typologies; its appearance can be preventable through control and timely detection. OBJECTIVE: To determine the level of control and detection of cervical-uterine cancer in women aged 35 to 44. METHODOLOGY: The research is quantitative, descriptive and cross-sectional. The sample was 267 women aged 35 to 44 years. A voluntary and random virtual survey was applied to the female population of these ages, in which questions categorized in: General knowledge, Control and Detection were established, these will help us to verify the degree of information, control and detection of cervical-uterine cancer in that population. RESULTS: The percentage varies according to the categories of surveys used, showing that 50.3 per cent have knowledge of methods for the control and detection of cervical-uterine cancer, 41.1 per cent have not received information on the subject and 8.6% have incomplete knowledge. CONCLUSIONS: Cervical-uterine cancer most often affects sexually active women in the 35-44 age range, The lack of information from the female population and the absence of health controls are some of the factors that predispose to a high incidence and prevalence of morbidity -mortality due to this pathology.

Membrane-initiated actions of sex steroids and reproductive behavior: A historical account.

It was assumed for a long time that sex steroids are activating reproductive behaviors by the same mechanisms that produce their morphological and physiological effects in the periphery. However during the last few decades an increasing number of examples were identified where behavioral effects of steroids were just too fast to be mediated via changes in DNA transcription. This progressively forced behavioral neuroendocrinologists to recognize that part of the effects of steroids on behavior are mediated by membrane-initiated events. In this review we present a selection of these early data that changed the conceptual landscape and we provide a summary the different types of membrane-associated receptors (estrogens, androgens and progestagens receptors) that are playing the most important role in the control of reproductive behaviors. Then we finally describe in more detail three separate behavioral systems in which membrane-initiated events have clearly been established to contribute to behavior control.

Shared decision making in pregnancy in inflammatory bowel disease: design of a patient orientated decision aid.

BACKGROUND: Research has indicated a lack of disease-specific reproductive knowledge among patients with Inflammatory Bowel Disease (IBD) and this has been associated with increased "voluntary childlessness". Furthermore, a lack of knowledge may contribute to inappropriate medication changes during or after pregnancy. Decision aids have been shown to support decision making in pregnancy as well as in multiple other chronic diseases. A published decision aid for pregnancy in IBD has not been identified, despite the benefit of pre-conception counselling and patient desire for a decision support tool. This study aimed to develop and test the feasibility of a decision aid encompassing reproductive decisions in the setting of IBD. METHODS: The International Patient Decision Aid Standards were implemented in the development of the Pregnancy in IBD Decision Aid (PIDA). A multi-disciplinary steering committee was formed. Patient and clinician focus groups were conducted to explore themes of importance in the reproductive decision-making processes in IBD. A PIDA prototype was designed; patient interviews were conducted to obtain further insight into patient perspectives and to test the prototype for feasibility. RESULTS: Issues considered of importance to patients and clinicians encountering decisions regarding pregnancy in the setting of IBD included fertility, conception timing, inheritance, medications, infant health, impact of surgery, contraception, nutrition and breastfeeding. Emphasis was placed on the provision of preconception counselling early in the disease course. Decisions relating to conception and medications were chosen as the current focus of PIDA, however content inclusion was broad to support use across preconception, pregnancy and post-partum phases. Favourable and constructive user feedback was received. CONCLUSIONS: The novel development of a decision aid for use in pregnancy and IBD was supported by initial user testing.

Associations between periconceptional lifestyle behaviours and adverse pregnancy outcomes.

BACKGROUND: While the potential adverse outcomes of prenatal exposure to unhealthy lifestyle are widely evidenced, little is known about these exposures in the periconception period. We investigated the associations between lifestyle behaviours and adverse pregnancy outcomes with a unique distinction between preconceptional- and prenatal lifestyle behaviours. METHODS: A secondary analysis took place within a prospective multicentre cohort study in the Netherlands, including 3,684 pregnant women. Baseline characteristics and preconceptional and first trimester lifestyle behaviours were assessed through a self-administered questionnaire in the first trimester. Adverse pregnancy outcomes (hypertensive disorders in pregnancy (HDP), small for gestational age (SGA), gestational diabetes (GDM) and spontaneous preterm birth (sPTB)) were reported by healthcare professionals. Data were collected between 2012 and 2014 and analysed using multivariate logistic regression. RESULTS: Women who are overweight, and especially obese, have the highest odds of developing any adverse pregnancy outcome (adjusted odds ratio (aOR) 1.61 (95 % Confidence Interval (CI) 1.31-1.99) and aOR 2.85 (95 %CI 2.20-3.68), respectively), particularly HDP and GDM. Women who prenatally continued smoking attained higher odds for SGA (aOR 1.91 (95 %CI 1.05-1.15)) compared to the reference group, but these odds decreased when women prenatally quit smoking (aOR 1.14 (95 %CI 0.59-2.21)). Women who did not use folic acid supplements tended to have a higher odds of developing adverse pregnancy outcomes (aOR 1.28 (95 %CI 0.97-1.69)), while women who prenatally started folic acid supplements did not (aOR 1.01 (95 %CI 0.82-1.25)). CONCLUSIONS: Our results indicate that smoking cessation, having a normal body mass index (BMI) and initiating folic acid supplements preconceptionally may decrease the risk of adverse pregnancy outcomes. Therefore, intervening as early as the preconception period could benefit the health of future generations.

Efectos demográficos, clínicos y biológicos de la postergación de la maternidad / Demographic, clinical, and biological effects of delayed maternity

En el presente artículo se analizan los efectos de la postergación de la maternidad en tres ámbitos: i) demográfico, ii) clínico y iii) biológico. Desde luego, la literatura demográfica existente procede fundamentalmente de países con un buen grado de desarrollo, pero se ha realizado un esfuerzo por reunir la mayor cantidad de datos de países en desarrollo. Así se analiza la situación en Europa, EE.UU. y Latinoamérica para finalizar esta sección con la realidad específica en Chile. Desde el punto de vista clínico, se pone especial interés en los cambios que experimenta la probabilidad de embarazo por ciclo (definida como fecundabilidad) y la fertilidad en general. En los aspectos perinatológicos se enfatiza el incremento de frecuencia de la muerte fetal in útero temprana (aborto espontáneo) y tardía con especial mención de algunas patologías (frecuencia del síndrome de Down y otros). Se establece además la frecuencia significativamente mayor de bajo y muy bajo peso de nacimiento, necesidad de hospitalización del recién nacido (morbilidad perinatal) así como el efecto sobre la mortalidad neonatal.Biológicamente la postergación de la maternidad tiene su correlato en la pérdida de reserva ovárica y la disminución de la calidad ovocitaria que involucra un aumento en la incidencia de fallas de fecundación y embriones con bajo potencial de desarrollo y aneuploidías dependientes fundamentalmente de la edad materna. También se hace mención a algunos aspectos del envejecimiento uterino y sus consecuencias en el desarrollo y función placentaria. El enfoque se centra fundamentalmente en la mujer, pero incluye aspectos de la contribución masculina a esta temática.

This article analyzes the effects of the postponement of maternity in three areas: i) demographic, ii) clinical and perinatological and iii) biological. Of course, the existing demographic literature comes primarily from well-developed countries, but an effort has been made to collect as much data from developing countries. The situation in Europe, the U.S. and Latin America is analyzed to end this section with the specific reality in Chile. From the clinical point of view, special interest is placed on changes in the probability of pregnancy by cycle (defined as fecundability) and fertility in general. In the perinatological aspects, the increased frequency of early fetal death (spontaneous abortion) and stillbirth is emphasized, with special mention of some pathologies (frequency of Down syndrome and others). It is also stressed the significant higher frequency of low and very low birth weight, the need newborn hospitalization (perinatal morbidity), as well as the effects on neonatal mortality. Biologically, the postponement of maternity has its correlation in the loss of ovarian reserve and the decrease in oocyte quality that involves an increased incidence of fertilization failure and embryos with low potential for development and aneuploidies, mainly dependent on maternal age. Some aspects of uterine aging and its consequences on placental development and function are also mentioned. The discussion is mainly focused on women, but includes some aspects of the male contribution to this issue

Functions of galanin, spexin and kisspeptin in metabolism, mood and behaviour.

The bioactive peptides galanin, spexin and kisspeptin have a common ancestral origin and their pathophysiological roles are increasingly the subject of investigation. Evidence suggests that these bioactive peptides play a role in the regulation of metabolism, pancreatic ß-cell function, energy homeostasis, mood and behaviour in several species, including zebrafish, rodents and humans. Galanin signalling suppresses insulin secretion in animal models (but not in humans), is potently obesogenic and plays putative roles governing certain evolutionary behaviours and mood modulation. Spexin decreases insulin secretion and has potent anorectic, analgesic, anxiolytic and antidepressive-like effects in animal models. Kisspeptin modulates glucose-stimulated insulin secretion, food intake and/or energy expenditure in animal models and humans. Furthermore, kisspeptin is implicated in the control of reproductive behaviour in animals, modulation of human sexual and emotional brain processing, and has antidepressive and fear-suppressing effects. In addition, galanin-like peptide is a further member of the galaninergic family that plays emerging key roles in metabolism and behaviour. Therapeutic interventions targeting galanin, spexin and/or kisspeptin signalling pathways could therefore contribute to the treatment of conditions ranging from obesity to mood disorders. However, many gaps and controversies exist, which must be addressed before the therapeutic potential of these bioactive peptides can be established.