Update on Syphilis for Women's Health Nurses.

After declining for many years, rates of syphilis in the United States are increasing. This article discusses possible reasons why women, and specifically pregnant women, are not getting tested properly. Lack of prenatal care, poor access to prenatal care, and improper prenatal care all have contributed to cases of congenital syphilis. Clinicians working in women's health care can address this issue by taking accurate sexual histories, remaining open to sexual fluidity among their patients, ensuring they are up to date on appropriate syphilis testing guidelines, and routinely offering screening to any woman at risk. Syphilis is a treatable and preventable sexually transmitted infection, and nurses, advanced practice nurses, and midwives can significantly contribute to reversing the current trend.

Shared Decision-Making With Choosing Wisely.

Choosing Wisely is a national health care improvement campaign promoting conversations between women and their health care professionals about selecting high-value health care practices. It disseminates lists of recommendations and downloadable educational materials from professional societies on its website. In November 2018, we searched for and categorized Choosing Wisely recommendations pertinent to women's health care. Of 78 recommendations, 28 (36%) were related to perinatal care, 22 (28%) were related to gynecologic care, and 28 (36%) were related to women's health and general care. Twelve recommendations (17.6%) were related to antenatal care, 10 (14.7%) to intrapartum and postpartum care, and 10 (14.7%) to cervical cancer screening. These free resources can help frame the shared decision-making process in clinical practice.

Breast Arterial Calcium: A Game Changer in Women's Cardiovascular Health?

In 2018, cardiovascular disease (CVD) was the leading cause of death among women, and current CVD prevention paradigms may not be sufficient in this group. In that context, it has recently been proposed that detection of calcification in breast arteries may help improve CVD risk screening and assessment in apparently healthy women. This review provides an overview of breast arterial anatomy; and the epidemiology, pathophysiology, and measurement of breast artery calcium (BAC); and discusses the features of the BAC-CVD link. The potential clinical applications that BAC may offer for CVD prevention in the context of current clinical practice guidelines and recommendations are also discussed. Finally, current gaps in evidence gaps are outlined, and future directions in the field are explored with a focus on the implementation of BAC mammography as a CVD risk-screening tool in routine clinical practice.

A Project to Improve Postpartum Depression Screening Practices Among Providers in a Community Women's Health Care Clinic.

OBJECTIVE: The purpose of this project was to improve health care providers' postpartum depression (PPD) knowledge and screening practices with the implementation of a standardized screening tool. DESIGN: The plan-do-study-act model was used as a framework to measure and implement a practice change aimed at universal screening for PPD. SETTING/LOCAL PROBLEM: Health care providers' screening practices for PPD were inconsistent and lacked use of a standardized screening tool at a southwestern U.S. community women's health care clinic serving minority women of lower socioeconomic status. PARTICIPANTS: Health care providers at a community women's health care clinic. INTERVENTION/MEASUREMENTS: A single educational in-service was presented to health care providers regarding preventive PPD screening practices and documentation recommendations. Measurements included pre- and post-education questionnaire results and electronic health record chart reviews. RESULTS: PPD screening documentation rates increased from 56% to 92.7% (p < .5). CONCLUSION: PPD screening education for health care providers and the addition of EPDS criteria to the electronic health record were associated with increased screening rates for PPD at a community women's health care clinic.

Fetal mortality and the challenges for women's health care in Brazil / Mortalidade fetal e os desafios para a atenção à saúde da mulher no Brasil

ABSTRACT OBJECTIVE: To establish a historical series of fetal mortality in Brazil and regions between 1996 and 2015, identifying its behavior and trend. METHODS: A descriptive study on cases of fetal deaths in Brazil and in each region reported from 1996 to 2015, registered in DATASUS and classified by ICD-10. Maternal age and schooling, duration of gestation and type of delivery were considered. We calculated the fetal mortality rate between 1996 and 2015 to build historical series. RESULTS: The time series shows a steady chart of the fetal mortality rate (FMR) from 2000 in Brazil and in all regions. The country's fetal mortality rate rose from 8.19 in 1996 to 9.50 per 1,000 births in 2015. There was an increasing trend in fetal deaths whose root cause appears in chapter XVII of ICD-10 in Brazil and in all regions. Deaths from Chapter XVI causes showed a trend of increase only in the Northeast region, while other basic causes showed a trend of increase in the Southeast and South regions. In the Brazilian scope, there was an increasing trend of fetal deaths in mothers in the 10-14 and 25-44 years age groups. In Brazil and in all regions, there was an increase of the FMR in women with more than 8 years of schooling. Fetal deaths predominated between 28 and 36 weeks of gestation, with a growing trend in Brazil and all regions, except in the South (steady). Vaginal delivery prevailed, with a steady trend, while cesarean sections showed an increasing trend in Brazil and in all regions. CONCLUSIONS: The quality of information about fetal deaths, investments in research committees, and improvement in the quality of prenatal care should be prioritized to enable more effective coping and to reduce the fetal mortality rate in Brazil.

RESUMO OBJETIVO: Traçar uma série histórica da mortalidade fetal no Brasil e regiões entre 1996 e 2015, identificando seu comportamento e tendência. MÉTODOS: Estudo descritivo sobre casos de óbitos fetais no Brasil e em cada região notificados de 1996 a 2015, registrados no Datasus e classificados pela CID-10. A idade e escolaridade da mãe, duração da gestação e tipo de parto foram considerados. Foi realizado o cálculo da taxa de mortalidade fetal entre 1996 e 2015 para construção das séries históricas. RESULTADOS: A série temporal apresenta um quadro estacionário na taxa de mortalidade fetal a partir de 2000 no Brasil e em todas as regiões. A taxa de mortalidade fetal do país passou de 8,19 em 1996 para 9,50 por 1.000 nascimentos em 2015. Houve tendência crescente dos óbitos fetais cuja causa básica consta no capítulo XVII da CID-10 no Brasil e em todas as regiões. Óbitos por causas do capítulo XVI apresentaram tendência de aumento somente na região Nordeste, enquanto outras causas básicas mostraram tendência de aumento nas regiões Sudeste e Sul. No âmbito brasileiro, houve tendência crescente de óbitos fetais em mães nas faixas etárias de 10-14 anos e 25-44 anos. No Brasil e em todas as regiões, houve aumento nas mulheres com mais de oito anos de escolaridade. Os óbitos fetais predominaram entre a 28ª e a 36ª semana de gestação, com tendência crescente no Brasil e todas as regiões, exceto no Sul (estacionário). O tipo de parto predominante foi vaginal, com tendência estacionária, enquanto as cesarianas apresentaram tendência crescente no Brasil e em todas as regiões. CONCLUSÕES: A qualidade da informação sobre os óbitos fetais, investimentos nos comitês de investigação e melhora na qualidade do pré-natal devem ser priorizados para possibilitar um enfrentamento mais efetivo e diminuir a taxa de mortalidade fetal no Brasil.

Naval Medicine's Involvement in Global Health: The Participation of Women's Healthcare Providers in Continuing Promise 2017.

INTRODUCTION: This is a retrospective review of information collected during operation Continuing Promise 2017 from the Wayuu population in Colombia, South America. MATERIALS AND METHODS: Team objective was to present an overview of women's health care needs in an isolated underserved population of Colombia by a humanitarian mission of health care providers from the U.S. Navy. We analyzed demographics, contraceptive selection, presenting complaint, diagnosis, and disposition of those female patients presenting for care. RESULTS: The acute care clinics of this mission saw patients for 10 full clinic days in each of the countries of Guatemala, Honduras, and Colombia. In the Wayuu clinic of Colombia, 356 patients were seen in the acute care women's clinic. These women averaged 36 years of age with an age range of 9-77 years of age and a gravidity of 3 ± 3.3 and a range of 0-18. Of the women less than the age of 50, not permanently sterilized, 186/220 (84.5%) were not using any form of contraception. The most common chief complaints were vaginal discharge and pelvic pain and the most common final diagnosis was bacterial vaginosis. The two most common secondary diagnoses of the pregnant women were urinary tract infection and anemia. Other significant diagnoses included uterine cancer, preterm labor, and fetal posterior urethral valve syndrome. CONCLUSIONS: A majority of Wayuu women presenting to an acute clinic setting in Colombia, South America were in their mid-thirties having had three pregnancies and the majority were not using any form of contraception. The most common diagnoses were straightforward diagnoses such as vaginal infections, urinary tract infections, and abnormal uterine bleeding. Our findings suggest a need for access to routine gynecologic care, general hygiene education, and increased availability of birth control among the Wayuu population.

Violência sexual na região do ABC Paulista: retrato de 142 casos / Sexual violence in the ABC Paulista: portrait of 142 cases

INTRODUÇÃO: O abuso sexual deixa sequelas graves, como limitações sociais. Objetivo: Descrever o perfil das vítimas de violência sexual atendidas em um serviço especializado, na cidade de Mauá, São Paulo, entre 2008 a 2009. MÉTODOS: Analisou-se 138 mulheres, assistidas em um Hospital Universitário. Estudo retrospectivo com levantamento de prontuários para coleta de dados. As variáveis estudadas foram: idade, etnia, relacionamento conjugal e sexual, hora da violência, número de agressores, busca por auxílio médico, uso de medicações e exames protocolares, comunicação por parte da vítima às autoridades competentes, uso de arma pelo agressor e número de gestações decorrentes. RESULTADOS: A média de idade foi de 22 anos. A maioria não possuía relação estável, tinha atividade sexual previamente à violência, etnia branca, procurou auxílio médico em até 72 horas após o ocorrido usou medicações protocolares. No período noturno ocorreram mais crimes e a violência nesse momento teve maior probabilidade de ser praticada por mais de um agressor. Apenas 26,7% pacientes reconheceram os agressores e somente 42,9% e 21,8% das mulheres fizeram boletim de ocorrência e exame de corpo de delito, respectivamente. Em 40,8% foi utilizado algum tipo de arma na abordagem ou durante o crime. Por fim, nenhuma das pacientes que fez contracepção de emergência engravidou. Somente quatro engravidaram em decorrência da agressão. CONCLUSÃO: A caracterização das pessoas que sofrem violência sexual é de extrema importância para a criação de estratégias de atendimento para a profilaxia de doenças sexualmente transmissíveis e seguimento ambulatorial até finalizar o tratamento, além de acompanhamento psicológico.

INTRODUCTION: Sexual abuse leaves severe sequels, such as social limitations. OBJECTIVE: To investigate aspects of sexual violence and the victims treated at a specialized service in the city of Mauá, São Paulo, between 2008 to 2009. METHODS: We analyzed 138 women, assisted at a University Hospital. Study is retrospective with survey of medical records for data collection. We studied: age, ethnicity, marital and sexual relationship, time of violence, number of aggressors, search for medical assistance, use of medications and protocol examinations, communication to the competent authorities, use of the weapon by the aggressor and number of resulting pregnancies. RESULTS: The mean age was 22 years. Most had no stable relationship, had sexual activity before the violence, were of white ethnicity, sought medical help within 72 hours after the event and used protocol medications. At night there were more crimes and violence at that time was more likely to be committed by more than one perpetrator. Only 26.7% of the patients acknowledged the perpetrators and only 42.9% and 21.8% of the women did report bullying and examination of the body of crime, respectively. In 40.8% some kind of weapon was used in the approach or during the crime. Finally, none of the patients who did emergency contraception became pregnant. CONCLUSION: The characterization of people who suffer sexual violence is of extreme importance for the creation of strategies for the care of prophylaxis of sexually transmitted diseases and outpatient follow-up until the end of treatment, as well as psychological counseling.

Às margens do cuidado: regulações de gênero em uma equipe de saúde / On the margins of care: gender regulations in a health care team

Resumo Embasado em uma perspectiva feminista, este artigo analisa como uma equipe de saúde tece as redes de cuidado e define práticas de saúde a partir do percurso de uma usuária. A metodologia utilizada é da pesquisa-intervenção inspirada na perspectiva cartográfica. Na tentativa de reduzir taxas de mortalidade materno-infantil, a equipe oferece à usuária uma rede que obedece a uma lógica burocrática com regras, normas e regulações. É possível observar como políticas voltadas para a maternidade definem processos de subjetivação responsáveis por formatar as usuárias, desenhando atos performativos enrijecidos. A equipe de saúde acaba por requisitar os corpos das usuárias de diferentes maneiras pelo fato de serem mulheres. Usuárias essas que, na maioria dos casos, são mães e pobres, o que traz singularidades em relação às suas trajetórias e nos modos como são vistas pelas equipes. Laqueadura, pré-natal, cuidados com a casa e (as)os filhas(os), acesso a determinados benefícios, todos juntos constituem elementos que orientam as decisões das equipes e agem como tecnologias de regulação de gênero capazes de legitimar violências institucionais cotidianas. A politização das práticas técnico-científicas se faz urgente a fim de assegurar que questões sobre direitos humanos e sociais possam fazer parte do dia a dia das equipes que estão nos territórios.

Abstract From a feminist perspective, this article analyzes how a healthcare team weaves care networks and defines health practices from the course of a female user. The methodology used is the intervention research inspired by the cartographic perspective. In the attempt to reduce mother-and-child mortality rates, the staff offers female user a network that obeys a bureaucratic logic with rules, norms and regulations. We can notice how policies for maternity define processes of subjectivation responsible for shaping the female users, outlining rigid performative acts. The healthcare team eventually requires the female users' bodies in different ways by the fact that they are women. In most cases those users are mothers and poor, which involves singularities in relation to their trajectories and to the way the teams regard them. Tubal ligation, pre-natal care, care with house and children, access to certain benefits, together are elements that guide the staffs' decisions and act as technologies for gender regulation able to legitimate quotidian institutional violence. The politicization of the technical-scientific practices becomes urgent in order to ensure that issues on human and social rights may be part of the daily routine of teams that work in those territories.

Systematic review of cost-effectiveness analyses for combinations of prevention strategies against human papillomavirus (HPV) infection: a general trend.

BACKGROUND: Due to the arrival of multi-valent HPV vaccines, it is more and more important to have a better understanding of the relationship between vaccination and screening programmes. This review aimed to: (1) collect published evidence on the cost-effectiveness profile of different HPV prevention strategies and, in particular, those combining vaccination with changes in screening practices; (2) explore the cost-effectiveness of alternative preventive strategies based on screening and vaccination. METHODS: A systematic literature review was conducted in order to identify the relevant studies regarding the cost-effectiveness of prevention strategies against HPV infection. Analysis comparing the modelling approaches between studies was made along with an assessment of the magnitude of impact of several factors on the cost-effectiveness of different screening strategies. RESULTS: A total of 18 papers were quantitatively summarised within the narrative. A high degree of heterogeneity was found in terms of how HPV prevention strategies have been assessed in terms of their economic and epidemiological impact, with variation in screening practice and valence of HPV vaccination found to have large implications in terms of cost-effectiveness. CONCLUSIONS: This review demonstrated synergies between screening and vaccination. New prevention strategies involving multi-valence vaccination, HPV DNA test screening, delayed commencement and frequency of screening could be implemented in the future. Strategies implemented in the future should be chosen with care, and informed knowledge of the potential impact of all possible prevention strategies. Highlighted in this review is the difficulty in assessing multiple strategies. Appropriate modelling techniques will need to be utilised to assess the most cost-effective strategies.

Implantação do módulo acolhimento do Programa Cegonha Carioca no município do Rio de Janeiro / Despliegue del módulo de acogida del programa Cigüeña Carioca en el municipio de Rio de Janeiro / Implementation of the user embracement module from the Cegonha Carioca program in the city of Rio de Janeiro

Objective: To describe the strategies from the public administration for the implementation of the user embracement module from the Cegonha Carioca Program. Method: Qualitative study. Semi-structured interviews happened in the period from January to March 2013 with three superintendents of Children’s and Maternity Hospitals responsible for the creation and implementation of the Carioca Program. Results: The strategies adopted by the public administration for the implementation of the user embracement module were: linking the prenatal care to a reference Maternity Hospital; the reorganization of the City’s obstetric emergencies and the insertion of the obstetrical nurse in the user embracement module. Conclusion: The obstetrical nurse was inserted into these emergencies in order to put the user embracement practices into action, being recognized by the superintendents as a technical authority on the humanized obstetrical care.

Objetivo: Descrever as estratégias da gestão pública para a implantação do módulo acolhimento do Programa Cegonha Carioca. Método: Estudo qualitativo. Foram realizadas entrevistas semiestruturadas, no período de janeiro a março de 2013, com três gerentes da Superintendência de Hospitais Pediátricos e Maternidades, responsáveis pelo processo de elaboração e implantação do Programa Cegonha Carioca.Resultados: As estratégias utilizadas pela gestão pública para implantação do módulo acolhimento foram: a vinculação do pré-natal à maternidade de referência; a reorganização das emergências obstétricas municipais e a inserção da enfermeira obstétrica no módulo acolhimento. Conclusão: a enfermeira obstétrica foi inserida nessas emergências para implementar as ações de acolhimento, sendo reconhecida pelas gerentes como uma autoridade técnica no cuidado obstétrico humanizado.

Objetivo: Describir las estrategias de la administración pública para implementar el módulo de acogida del Programa Cigüeña Carioca. Método: Estudio cualitativo. Las entrevistas semi-estructuradas se llevaron acabo en el período de enero a marzo de 2013, con tres gestores de la Supervisión de los Hospitales Pediátricos y Maternidades, responsables por el proceso de elaboración e implementación del Programa Cigüeña Carioca. Resultados: Las estrategias utilizadas por la administración pública a la implementación del módulo de acogidafueron: maternidad de referencia vinculante prenatal; la reorganización de las emergencias obstétricas municipales y la inserción de enfermera obstétrica en el módulo de acogida. Conclusión: La enfermera obstétrica fue insertada en estas emergencias para implementar acciones de acogida, siendo reconocidas por los administradores como una autoridad técnica en la atención obstétrica humanizada.

Barreras en la atención de la salud sexual en Argentina: percepción de las mujeres que tienen sexo con mujeres / Barriers to sexual health care in Argentina: perception of women who have sex with women

Objetivo El objetivo es describir las barreras en la atención de la salud sexual de las Mujeres que tienen Sexo con Mujeres (MSM) en Argentina durante el año 2013. Métodos Estudio descriptivo de corte transversal, cuantitativo. Se realizó una encuesta por internet, de abril a julio a mujeres homo y bisexuales mayores de 18 años que residen en Argentina, mediante la metodología de bola de nieve. Resultados Se encuestaron 161 mujeres, de las cuales el 97,5 % asistió alguna vez a un médico, éste no interrogo sobre su orientación sexual en el 82,8 %. El 93,6 % no recibió información; el 83,8 % percibe poco/nada de riesgo de contraer ETS. El 48,4 % desconocen métodos de protección entre mujeres. Refirieron no utilizarlos el 77,5 %, siendo los motivos: pareja estable, incomodidad y que no se consiguen. Discusión Los resultados de la presente investigación identifican la baja percepción de las MSM sobre las ETS, y la dificultad del abordaje de los profesionales de la salud en torno a esta temática.(AU)

Objective The objective is to describe the barriers to sexual health care of Women Who Have Sex with Women (WSW) in Argentina during 2013. Methods A cross-sectional, descriptive and quantitative study. An online survey was conducted using the Internet, in the period of April-July 2013, with homosexual and bisexual women over 18 living in Argentina, making use of the snowball methodology. Results A total of 161 women were surveyed. The results showed that 97.5 % had previously visited a doctor. The doctor did not ask about their sexual orientation in 82.8 % of cases. 93.6 % of the surveyed did not receive information about STDs; 83.8 % perceive little/no risk regarding STDs. 48.4 % are unaware of the methods of protection of STDs among women and 51.6 % obtained this information from websites and friends. 77.5 % reported not using protection methods. The main reasons were: stable partner, discomfort and the inability to acquire them. Discussion The results of this research allow for identifying the low perception among WSW regarding STDs, and the difficulty of approaching health professionals about this subject.(AU)

Atenciones psiquiátricas por consumo de alcohol en mujeres

Se presenta un estudio realizado en base a historias clínicas de pacientes de sexo femenino con dependencia alcohólica que concurren por primera vez al Instituto Provincial de Alcoholismo y Drogadicción (IPAD) en los años 2011-2012. El objetivo del trabajo fue comparar el número de consultas de primera vez en el IPAD durante el bienio 2011-2012 en mujeres con dependencia al alcohol, y el grupo etario que presenta el mayor número de consultas. Determinar el tipo de bebida consumida con mayor asiduidad, edad de comienzo de consumo y tiempo transcurrido entre la primera consulta y el inicio de ingesta etílica en forma dependiente. Establecer la comorbilidad psiquiátrica más frecuentemente asociada, el grado de instrucción predominante alcanzado por las pacientes y la actividad laboral desempeñada por las mismas. Se recolectaron datos de historia clínicas de la Institución, realizándose un análisis descriptivo de corte transversal de las variables estudiadas, por medio de gráficos y tablas. De las historias clínicas analizadas 40 corresponden al año 2011 y 86 al año siguiente, la bebida de mayor consumo es el vino, la edad de inicio de consumo de etanol se instala en menores de 21 años, el grupo etario que presenta el mayor número de consultas corresponde de 21 a 40 años, el tiempo transcurrido en entre el inicio de la adicción y la primera consulta se ubicó en el 2011 en una media de 15, 5 años y en el 2012 la media se ubicó en 12, 4 años. La comorbilidad psiquiátrica más frecuente es la depresión, el grado de instrucción predominante es el secundario incompleto y la actividad desempeñada por las mismas en orden de frecuencia es ama de casa y desocupada en ambos años.

Abstract: A study based on medical records of female patients with alcohol dependence who go first to the Provincial Institute of Alcoholism and Drug Abuse (IPAD) in 2011-2012 is presented. The objective was to compare the number of first consultations on the iPad during the 2011-2012 biennium in women with alcohol dependence and the age group with the greatest number of consultations. Determine the type of beverage consumed with greater frequency, age at onset of consumption between the first consultation and the initiation of alcohol intake as time dependent. Establish the most common associated psychiatric comorbidity, the predominant level of education attained by patients and work activities performed by them. Clinical history data were collected Institution, A descriptive cross-sectional analysis of the variables, by means of graphs and tables. Of the 40 analyzed clinical records for the year 2011 and 86 the following year, the most consumed beverage is wine, the age of onset of ethanol is installed under 21, the age group with the highest number of query corresponds to 21-40 years, elapsed between the onset of addiction and the first consultation period started in 2011 at an average of 15, 5 and in 2012 the average was at 12, 4 years. The most frequent psychiatric comorbidity is depression, the predominant level of education is incomplete secondary and the activity undertaken by them in order of frequency is housewife and unemployed in both years.

Preventive health care for women in Croatia: ongoing trends from 1995 to 2012.

The privatization of gynecological services and the introduction of additional reimbursements to capitation fees are ongoing mini reforms in Croatia. In order to evaluate the outcomes of this, study was performed with the main aim of determining trends in preventive activities carried out in public and private gynecological practices from 1995 to 2012. The Croatian Health Service Yearbooks served as the basis for data collection. Data were collected on the number of general check-ups, the number of targeted check-ups, and the number of follow-up check-ups. The results indicate a trend of continuous decline in the number of general and follow-up check-ups, as well as breast examinations and Pap smears, in public gynecological practices even after the introduction of contractual obligations and additional reimbursements and fee-for-service payments. One important note is that many resources were invested in general checks-up interventions, which proved to be ineffective, while fewer resources were invested in the more effective Pap smear interventions.

A role of Croatian family doctors in the provision of women's health care: a study based on routinely collected data.

The aim of this study was to investigate how often Croatian FDs are involved in the provision of women's health, having in mind that women's health is primarily organized by the gynecological service. Only the data related to women's health were collected from the Croatian health statistical yearbooks from 1995 to 2012, in which ICD X was used. Results showed that total number of diagnoses are increasing. The greatest increase is observed in the category named as other diseases of female organs, then diagnoses related to the pregnancy, delivery and postpartum and malignant diseases, especially, breast cancer. Contrary, number of menopausal disorders continuing decreased. Diagnoses related to family planning (Z30) are relative small in amount and stabile. Results indicated that policy makers should take in account readiness of FDs to be involved in the provision of women's health.

Limites e possibilidades da rede de atenção à saúde da mulher com câncer de mama na cidade do Recife: perspectivas da continuidade assistencial / Limits and Possibilities of the Health Care Network of Women With Breast Cancer in the City of Recife: Prospects of Continuity Care

O objetivo deste estudo foi analisar a continuidade assistencial de mulheres portadoras de câncer de mama, nos diferentes níveis assistenciais no município de Recife, Pernambuco, a partir da perspectiva destas mulheres, com o intuito de identificar os limites e possibilidades na rede de atenção à saúde da mulher com câncer de mama. Tratou-se de um estudo de caso em profundidade com uma abordagem qualitativa, no qual foram entrevistadas três mulheres portadoras de câncer de mama, residentes e tratadas em Recife. Nesta pesquisa foi utilizado o câncer de mama como condição traçadora para a análise da continuidade assistencial. Este estudo é um recorte da pesquisa --Impacto na equidade de acesso e eficiência de Redes Integradas de Serviços de Saúde na Colômbia e Brasil – Equity-LA. Utilizou-se como técnica de coleta de dados, a análise documental de prontuários, entrevistas individuais semi-estruturadas que foram realizadas a partir de um roteiro temático pré-estabelecido. Nos resultados identificou-se que as mulheres tiveram a primeira consulta na atenção básica em estágio avançado da doença e consideraram este, como sendo o fator principal para a brevidade em seus tratamentos. Houve impacto financeiro negativo durante as suas trajetórias, evidenciado pela elevação dos custos com habitação, alimentação, medicamentos e transporte. Todas identificaram coerência entre os objetivos e tratamento realizado. As três mulheres perceberam que não houve comunicação efetiva entre os todos os níveis assistenciais. Os resultados sugerem uma melhor qualificação dos profissionais da atenção básica e planejamento na estruturação da linha de cuidado para mulheres com câncer de mama na rede de atenção do Recife...

Where are we 10 years after the Women's Health Initiative?

The media attention surrounding the publication of the initial results of WHI in 2002 led to fear and confusion regarding the use of hormonal therapy (HT) after menopause. This led to a dramatic reduction in prescriptions for HT in the United States and around the world. Although in 2002 it was stated that the results pertained to all women receiving HT, subsequent studies from the Women's Health Initiative (WHI) and others clearly showed that younger women and those close to menopause had a very beneficial risk-to-benefit ratio. Indeed, the results showed similar protective effects for coronary disease and a reduction in mortality that had been shown in earlier observational studies, which had also focused on younger symptomatic women. In younger women, the increased number of cases of venous thrombosis and ischemic stroke was low, rendering them "rare" events using World Health Organization nomenclature. Breast cancer rates were also low and were found to be decreased with estrogen alone. In women receiving estrogen and progestogen for the first time in the WHI, breast cancer rates did not increase significantly for 7 years. Other data suggest that other regimens and the use of other progestogens may also be safer. It has been argued that in the 10 years since WHI, many women have been denied HT, including those with severe symptoms, and that this has significantly disadvantaged a generation of women. Some reports have also suggested an increased rate of osteoporotic fractures since the WHI. Therefore, the question is posed as to whether we have now come full circle in our understanding of the use of HT in younger women. Although it is appropriate to treat women with symptoms at the onset of menopause, because there is no proven therapy for primary prevention, in some women the use of HT for this role may at least be entertained.

O perfil das detentas HIV positivo de uma penitenciária estadual do Paraná, Brasil / The HIV positive detainees profile of one state prison of Paraná, Brazil

Objetivo - Mapear o perfil de detentas portadoras do vírus HIV e da atenção à saúde oferecida às mesmas, em uma penitenciária estadual do Paraná. Métodos - Essa pesquisa baseou-se em um estudo transversal utilizando-se de um questionário contendo perguntas abertas e fechadas. Resultados - Participaram desse estudo 13 detentas infectadas pelo HIV, com idade media de 35,31 anos. O fator que mais contribuiu para a infecção do grupo estudado foi o sexo sem preservativo. Conclusões - Conclui-se que, a baixa escolaridade e a falta de perspectiva futura fazem com que essas mulheres tenham comportamentos por vezes relapsos com relação à sua saúde. Isso foi percebido não só na questão de prevenção, mais também, na opção em desenvolver corretamente o tratamento. Entretanto, percebeu-se ao longo do estudo que essas mulheres recebem de uma forma integra e humanizada, uma assistência de enfermagem juntamente com uma equipe médica qualificada e adequada.

Objective - To map the profile of inmates with HIV and health care services offered the same in a state penitentiary of Paraná. Methods - This research was based on a cross-sectional study using a questionnaire containing open and closed questions. Results - Thirteen HIV-infected inmates with a mean age of 35.31 years participated in this study. The factor that most contributed to the infection of the sample was sex without a condom. Conclusions - It is concluded that poor education and lack of future perspective makes these women are sometimes lax behavior regarding their health. This was noticed not only the question of prevention, but also, the option to develop the correct treatment, however, it was noted during the study that these women are in an integrated and humanized, a nursing care with a medical team qualified and appropriately.

A homossexualidade feminina no campo da saúde: da invisibilidade à violência / Female homosexuality in health: from invisibility to violence

O artigo tem como objetivo geral analisar os modelos que podem explicar a invisibilidade de lésbicas e mulheres bissexuais na área da assistência integral à saúde da mulher. Ao se discutir a homossexualidade em geral, contribui-se para que sejam desconstruídas visões naturalistas que destituem das pessoas o papel de agentes de sua própria sexualidade, impedindo-as de exercer o direito de viverem orientações sexuais diferentes das heteronormatizadas. Para o referencial teórico, foram utilizados os conceitos habitus e o campo de Pierre Bourdieu. Como método de estudo, empregou-se o desenho de ensaio, baseando-se em dois conjuntos de fontes: artigos publicados na área da saúde sobre o assunto, acessados no portal da Biblioteca Virtual de Saúde (BVS), e documentos governamentais relacionados ao atendimento às demandas de saúde de lésbicas, mulheres bissexuais ou que vivenciam relações homoafetivas e/ou homoeróticas. Concluiu-se que lésbicas e mulheres bissexuais não têm apoio por parte dos profissionais de saúde para verbalizar suas orientações sexuais quando buscam assistência. Tal situação escamoteia um atendimento seguro, produzindo exclusão e violência simbólica, apesar dos programas governamentais preconizarem o contrário.

This paper aims to analyze the models that may explain the invisibility of lesbian and bisexual women in the area of women's whole health care assistance. Discussing homosexuality in general, a contribution is made to deconstruct naturalist views which destitute people from their role of agents of their own sexuality, preventing them of exercising their right to live different sexual orientations other than those hetero-normative. For the theoretical reference, Pierre Bourdieu's concept of habitus and field was used. Papers published on the subject in the health care field accessed through the site of the Virtual Health Library (BVS) and government documents that provide health care programs and services to women who admit publicly to be lesbian or bisexual or for those who are experiencing homo-affective and/or homoerotic relations. It was then concluded that lesbian and bisexual women do not have any kind of support from health care professionals, in the whole health care field for women, helping them verbalize their sexual orientation, when they seek assistance.