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.

Reduced insulin sensitivity in differentiated thyroid cancer patients with suppressed TSH.

OBJECTIVE: TSH-suppression is a therapy for thyroid cancer management, but it may lead to adverse effects, which should be balanced with its benefits. Previous studies evaluating the consequences of TSH suppression on insulin sensitivity have only been done with indirect techniques, and results were controversial. Therefore, we aimed to assess insulin sensitivity in patients with thyroid cancer and suppressed thyroid-stimulating hormone (TSH) with the most appropriate direct method (hyperinsulinemic-euglycemic clamp) in order to get a more conclusive response about the topic. METHODS: A group of 20 non-obese and non-diabetic thyroid cancer patients with suppressed TSH underwent a hyperinsulinemic-euglycemic clamp to evaluate insulin sensitivity. Their results were compared to the results of a sex and body mass index (BMI) -paired control group composed of 20 healthy volunteers. RESULTS: Patients were all female, aged 36.8 ± 10.2 years-old, with mean TSH 0.1 ± 0.1 µIU/mL and mean BMI 26.2 ± 3.3 kg/m2. Insulin sensitivity, determined by the insulin-stimulated glucose uptake (M-value), was lower in the patients group (4.2 ± 1.6 mg/min*kg versus 5.8 ± 1.7, age-adjusted p-value = 0.0205). CONCLUSION: This study shows for the first time that subclinical thyrotoxicosis in patients with thyroid cancer is associated with insulin resistance, as measured by hyperinsulinemic-euglycemic clamp technique. Such finding may be taken into consideration by clinicians when balancing risks and benefits of TSH-suppression therapy in thyroid cancer patients.

Body composition, resting energy expenditure and inflammatory markers: impact in users of depot medroxyprogesterone acetate after 12 months follow-up

ABSTRACT Objective The aim of this study was to evaluate for 12 months the changes of body weight using Depot Medroxyprogesterone Acetate (DMPA) and if these changes are related to inflammatory markers. Subjects and methods Twenty women of childbearing age who chose the DMPA, without previous use of this method, BMI < 30 kg/m2, and 17 women using IUD TCu 380A, participated in the study. At the baseline and after one year, changes in weight gain, body composition by the bioimpedance electric method, resting energy expenditure (REE) by the indirect calorimetry method, inflammatory markers and HOMA-IR were assessed. Results After 12 months of evaluation, we could observe a significant increase in the DMPA group in weight (3,01 kg) and BMI, while the IUD group’s only significant increase was observed in the BMI. Relative to REE there was an increase of basal metabolic rate (BMR) in both groups after one year. The sub-group DMPA that gained < 3 kg had increased significant weight, BMI and body surface (BS) with respiratory quotient (RQ) reduction, while the sub-group that gained ≥ 3 kg had a significant increase in weight, BMI, BS, fat-free mass, fat mass, BMR, Leptin, HOMA-IR and waist circumference, with RQ significantly reduced. Conclusion Our study found significant changes in weight, body composition and metabolic profile of the population studied in the first 12 months of contraceptive use. These changes mainly increased body weight, leptin levels and HOMA-IR which can contribute to the development of some chronic complications, including obesity, insulin resistance and diabetes mellitus.

Body composition, resting energy expenditure and inflammatory markers: impact in users of depot medroxyprogesterone acetate after 12 months follow-up.

OBJECTIVE: The aim of this study was to evaluate for 12 months the changes of body weight using Depot Medroxyprogesterone Acetate (DMPA) and if these changes are related to inflammatory markers. SUBJECTS AND METHODS: Twenty women of childbearing age who chose the DMPA, without previous use of this method, BMI < 30 kg/m2, and 17 women using IUD TCu 380A, participated in the study. At the baseline and after one year, changes in weight gain, body composition by the bioimpedance electric method, resting energy expenditure (REE) by the indirect calorimetry method, inflammatory markers and HOMA-IR were assessed. RESULTS: After 12 months of evaluation, we could observe a significant increase in the DMPA group in weight (3,01 kg) and BMI, while the IUD group's only significant increase was observed in the BMI. Relative to REE there was an increase of basal metabolic rate (BMR) in both groups after one year. The sub-group DMPA that gained < 3 kg had increased significant weight, BMI and body surface (BS) with respiratory quotient (RQ) reduction, while the sub-group that gained ≥ 3 kg had a significant increase in weight, BMI, BS, fat-free mass, fat mass, BMR, Leptin, HOMA-IR and waist circumference, with RQ significantly reduced. CONCLUSION: Our study found significant changes in weight, body composition and metabolic profile of the population studied in the first 12 months of contraceptive use. These changes mainly increased body weight, leptin levels and HOMA-IR which can contribute to the development of some chronic complications, including obesity, insulin resistance and diabetes mellitus.

[Rape-related pregnancy in Brazil: the experience of women seeking legal abortion]. / Gravidez após violência sexual: vivências de mulheres em busca da interrupção legal.

In Brazil, abortion is permitted by law in cases of rape-related pregnancy. This study reports on various aspects in the experience of women that have been sexually assaulted: diagnosis of the pregnancy, seeking legal abortion, and hospitalization in a university hospital. This was a qualitative study that interviewed ten women 18 to 38 years of age, with at least eight years of schooling, one to five years after legal abortion. The women had been previously unaware of their right to a legal abortion, were ashamed about the sexual assault, kept it secret, and had not sought immediate care. The diagnosis of pregnancy provoked anxiety and the wish to undergo an abortion. Women treated through private health plans received either insufficient orientation or none at all. Respectful treatment by the healthcare staff proved relevant for the women to cope with the abortion. The study highlights the need to publicize the right to abortion in cases of rape-related pregnancy and the healthcare services that perform legal abortion, in addition to training healthcare and law enforcement teams to handle such cases.

Gravidez após violência sexual: vivências de mulheres em busca da interrupção legal / Rape-related pregnancy in Brazil: the experience of women seeking legal abortion / Embarazo tras actos de violencia sexual: experiencias de mujeres en búsqueda de la interrupción legal

No Brasil, a realização de interrupção legal de gestação consequente à violência sexual é permitida por lei. O objetivo deste estudo foi relatar vivências de mulheres após a violência sexual, no diagnóstico de gravidez, na busca pelo serviço de interrupção legal da gestação e durante a internação em um hospital universitário. Foi realizada pesquisa qualitativa com entrevistas semiestruturadas em dez mulheres de 18-38 anos e escolaridade ≥ 8 anos, após 1-5 anos da interrupção legal da gestação. As mulheres desconheciam o direito à interrupção legal da gestação, sentiram a violência sexual como experiência vergonhosa, mantiveram segredo e não procuraram qualquer atendimento imediato. O diagnóstico de gravidez provocou sentimentos de angústia e desejo de abortar. Para as mulheres que procuraram o setor de saúde suplementar as orientações foram precárias ou não aconteceram. O atendimento dos profissionais mostrou-se relevante para assimilação da experiência do aborto. É necessário divulgar o direito à interrupção legal da gestação e a existência de serviços que a realizam, e capacitar profissionais de saúde e segurança pública para atender esses casos.

In Brazil, abortion is permitted by law in cases of rape-related pregnancy. This study reports on various aspects in the experience of women that have been sexually assaulted: diagnosis of the pregnancy, seeking legal abortion, and hospitalization in a university hospital. This was a qualitative study that interviewed ten women 18 to 38 years of age, with at least eight years of schooling, one to five years after legal abortion. The women had been previously unaware of their right to a legal abortion, were ashamed about the sexual assault, kept it secret, and had not sought immediate care. The diagnosis of pregnancy provoked anxiety and the wish to undergo an abortion. Women treated through private health plans received either insufficient orientation or none at all. Respectful treatment by the healthcare staff proved relevant for the women to cope with the abortion. The study highlights the need to publicize the right to abortion in cases of rape-related pregnancy and the healthcare services that perform legal abortion, in addition to training healthcare and law enforcement teams to handle such cases.

En Brasil, la interrupción legal del embarazo, como consecuencia de actos de violencia sexual, está permitido por la ley. El objetivo de este trabajo es presentar la experiencia de mujeres tras actos de violencia sexual, el diagnóstico de su embarazo, su búsqueda del servicio de interrupción legal del embarazo y su internamiento en un hospital universitario. La investigación cualitativa se llevó a cabo mediante entrevistas semiestructuradas con 10 mujeres de 18-38 años, más de 8 años de escolaridad, tras 1-5 años de la interrupción legal del embarazo. Las mujeres no eran conscientes de su derecho a la interrupción legal del embarazo, sintieron la experiencia de sus violaciones como algo vergonzoso, las mantuvieron en secreto y no buscaron ninguna atención inmediata. El diagnóstico de embarazo les causó sentimientos de angustia y deseo de abortar. Para las mujeres que buscaron atención adicional de salud la información recibida era pobre o no se produjo. La asistencia de profesionales resultó relevante para asimilar la experiencia del aborto. Es necesario promover el derecho a la interrupción legal del embarazo y la existencia de servicios que lo realicen.

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

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

[Sexual violence: a descriptive study of rape victims and care in a university referral center in São Paulo State, Brazil]. / Violência sexual: estudo descritivo sobre as vítimas e o atendimento em um serviço universitário de referência no Estado de São Paulo, Brasil.

Rape is a global public health problem, and steps have been taken to encourage studies on the issue and propose interventions for its prevention and appropriate care. This study aimed to characterize the population of female rape victims and describe the characteristics of the sexual assault and the care provided at a university referral center. This was a quantitative retrospective study of care provided to female rape victims from June 2006 to December 2010. The majority of the women (n = 687) were white, single, had no children, with a mean age of 23.7 years and primary to secondary schooling, employed, and practiced a religion. One-fourth of the victims reported no sexual intercourse prior to the sexual assault. Rape occurred mainly at night, on the street, perpetrated by a single stranger, with vaginal penetration, and with threatened or actual force. Most of the victims had reported the rape to someone and felt supported. Early care occurred for almost 90% of women, allowing preventive measures. From 2006 to 2010 there was an increase in the proportion of women that sought help. Better knowledge of the characteristics of this group and the event itself can help improve the structure and functioning of models to assist rape victims.

Violência sexual: estudo descritivo sobre as vítimas e o atendimento em um serviço universitário de referência no Estado de São Paulo, Brasil / Sexual violence: a descriptive study of rape victims and care in a university referral center in São Paulo State, Brazil / Violencia sexual: estudio descriptivo sobre las víctimas y la atención en un servicio universitario de referencia en el estado de São Paulo, Brasil

Rape is a global public health problem, and steps have been taken to encourage studies on the issue and propose interventions for its prevention and appropriate care. This study aimed to characterize the population of female rape victims and describe the characteristics of the sexual assault and the care provided at a university referral center. This was a quantitative retrospective study of care provided to female rape victims from June 2006 to December 2010. The majority of the women (n = 687) were white, single, had no children, with a mean age of 23.7 years and primary to secondary schooling, employed, and practiced a religion. One-fourth of the victims reported no sexual intercourse prior to the sexual assault. Rape occurred mainly at night, on the street, perpetrated by a single stranger, with vaginal penetration, and with threatened or actual force. Most of the victims had reported the rape to someone and felt supported. Early care occurred for almost 90% of women, allowing preventive measures. From 2006 to 2010 there was an increase in the proportion of women that sought help. Better knowledge of the characteristics of this group and the event itself can help improve the structure and functioning of models to assist rape victims.

A violência sexual é problema de saúde pública global e ações têm sido implementadas para estimular estudos no tema, a fim de propor intervenções de prevenção e atendimento adequado. Este trabalho objetivou caracterizar a população de mulheres que sofreram violência sexual, e descrever as características da agressão e do atendimento dispensado em um serviço universitário de referência. Estudo quantitativo e retrospectivo com atendimentos por violência sexual de junho de 2006 a dezembro de 2010. Avaliadas 687 mulheres, a maioria branca, solteira, sem filhos, com idade média de 23,7 anos, escolaridade entre fundamental e média, empregadas, com religião e prática religiosa. Um quarto sem relação sexual anterior. Violência sexual principalmente à noite, na rua, por agressor desconhecido e único, via vaginal e com intimidação. A maioria contou para outras pessoas e se sentiu apoiada. Atendimento precoce para quase 90% das mulheres, instaurando medidas profiláticas. Ocorreu aumento da procura precoce ao longo do período. Conhecer melhor as características da população e do evento pode auxiliar a estruturação e qualificação de modelos de atendimento.

La violencia sexual es un problema global de salud pública y se han implementado acciones para estimular estudios en el tema, a fin de proponer intervenciones de prevención y atención adecuadas. Este trabajo tuvo por objetivo caracterizar la población de mujeres que sufrió violencia sexual, y describir las características de la agresión y de la atención dispensada en un servicio universitario de referencia. Se trata de un estudio cuantitativo y retrospectivo sobre la atención por violencia sexual de junio de 2006 a diciembre de 2010. Se evaluaron a 687 mujeres, la mayoría blanca, soltera, sin hijos, con una edad media de 23,7 años, escolaridad entre básica y media, con empleo, con religión y practicantes. Un cuarto sin relación sexual anterior. La violencia sexual principalmente se produce por la noche, en la calle, cometida por un agresor desconocido y único, vía vaginal y con intimidación. La mayoría se lo contó a otras personas y se sintió apoyada. Hubo atención precoz para casi un 90% de las mujeres, estableciendo medidas profilácticas. Se produjo un aumento de la búsqueda temprana del servicio a lo largo del período. Conocer mejor las características de la población y de los hechos puede auxiliar en la estructuración y cualificación de modelos de atención.

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

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

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

[Prevalence of Chlamydia trachomatis infection among women candidates for in vitro fertilization at a public institution of the State of São Paulo, Brazil]. / Prevalência de infecção por Chlamydia trachomatis em mulheres candidatas à fertilização in vitro em serviço público de referência do Estado de São Paulo.

PURPOSE: To evaluate the prevalence of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) among women candidates to in vitro fertilization (IVF) in a reference public service in southeastern Brazil. METHODS: Women who were referred for IVF from April 1st, 2008 to December 31st, 2009 were enrolled sequentially in the study. A gynecological-obstetrical background questionnaire was applied and endocervical swab samples were obtained to search for CT and NG using hybrid capture and PCR. The variables studied were: age, color, education, duration of infertility, number of pregnancies and living children, history of miscarriage, ectopic pregnancy, number of sex partners, pelvic inflammatory disease (PID), pelvic surgery, manipulation of the uterine cavity, smoking, and illicit drug use. The women were distributed according to the presence/absence of confirmed chlamydia infection and descriptive analysis was employed. RESULTS: Among 176 women tested the prevalence of CT infection was 1.1% and there was no NG infection. Two thirds of the women were ≥30 years old, with schooling ≥8 years and ≤5 years of infertility, and 56.2% had no children. The main background data were pelvic surgery (77.8%), manipulation of the uterine cavity (62.5%) and PID (27.8%). The tubal factor was the most prevalent, 73.3% of women (from 129), 37.5% had been sterilized, 35.8% had not been sterilized, and other factors had a prevalence <30%. CONCLUSIONS: CT and NG infections had a low prevalence in this sample. Studies at other centers in the country are needed to confirm the prevalence of infection in this particular group of infertile women.

Prevalência de infecção por Chlamydia trachomatis em mulheres candidatas à fertilização in vitro em serviço público de referência do Estado de São Paulo / Prevalence of Chlamydia trachomatis infection among women candidates for in vitro fertilization at a public institution of the State of São Paulo, Brazil

OBJETIVO: Avaliar a prevalência de infecção por Chlamydia trachomatis (CT) e Neisseria gonorrhoeae (NG) em mulheres candidatas ao tratamento tópico e de fertilização in vitro (FIV) em serviço público de referência da Região Sudeste do Brasil. MÉTODOS: Mulheres que tiveram indicação de FIV, no período de 1º de abril de 2008 a 31 de outubro de 2009, foram admitidas sequencialmente no estudo. Foi aplicado um questionário sobre antecedentes ginecológicos e obstétricos e coletada amostra de swab endocervical para pesquisa de CT e NG através de captura híbrida e PCR. As variáveis estudadas foram: faixa etária, cor, escolaridade, tempo de infertilidade, número de gestações e filhos vivos, antecedentes de aborto, gestação ectópica, número de parceiros, Doença Inflamatória Pélvica (DIP), cirurgia pélvica, manipulação de cavidade uterina, tabagismo e uso de drogas ilícitas. As mulheres foram distribuídas segundo presença ou não de infecção por clamídia e a análise foi descritiva. RESULTADOS: Entre as 176 mulheres estudadas a prevalência de infecção por CT foi de 1,1%, não houve infecção por NG. Dois terços das mulheres tinham idade >30 anos, escolaridade >8 anos, <5 anos de infertilidade e 56,2% não tinham filhos. Os principais antecedentes foram cirurgia pélvica (77,8%), manipulação de cavidade uterina (62,5%) e DIP (27,8%). O fator tubário foi o mais prevalente, em 129 mulheres (73,3%), 37,5% com e 35,8% sem laqueadura, os demais fatores tiveram prevalência <30%. CONCLUSÕES: As infecções por CT e NG tiveram baixa prevalência na amostra estudada e são necessários estudos em outros centros do país para confirmar a prevalência de infecções nesse grupo particular de mulheres inférteis.

PURPOSE: To evaluate the prevalence of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) among women candidates to in vitro fertilization (IVF) in a reference public service in southeastern Brazil. METHODS: Women who were referred for IVF from April 1st, 2008 to December 31st, 2009 were enrolled sequentially in the study. A ginecological-obstetrical background questionnaire was applied and endocervical swab samples were obtained to search for CT and NG using hybrid capture and PCR. The variables studied were: age, color, education, duration of infertility, number of pregnancies and living children, history of miscarriage, ectopic pregnancy, number of sex partners, pelvic inflammatory disease (PID), pelvic surgery, manipulation of the uterine cavity, smoking, and illicit drug use. The women were distributed according to the presence/absence of confirmed chlamydia infection and descriptive analysis was employed. RESULTS: Among 176 women tested the prevalence of CT infection was 1.1% and there was no NG infection. Two thirds of the women were >30 years old, with schooling >8 years and <5 years of infertility, and 56.2% had no children. The main background data were pelvic surgery (77.8%), manipulation of the uterine cavity (62.5%) and PID (27.8%). The tubal factor was the most prevalent, 73.3% of women (from 129), 37.5% had been sterilized, 35.8% had not been sterilized, and other factors had a prevalence <30%. CONCLUSIONS: CT and NG infections had a low prevalence in this sample. Studies at other centers in the country are needed to confirm the prevalence of infection in this particular group of infertile women.

Posttraumatic stress disorder, depression, and hopelessness in women who are victims of sexual violence.

OBJECTIVE: To evaluate posttraumatic stress disorder (PTSD), depression, and hopelessness in women 1 and 6 months after they experienced sexual violence. METHODS: This prospective study, in which the clinician-administered PTSD scale, the Beck depression inventory, and the Beck hopelessness scale were used, included 67 women at 1 month and 52 women at 6 months after they experienced sexual violence. RESULTS: Overall, 77.6% of the women were ≤ 24years of age, and 52% were adolescents; 15% had a history of drug abuse, and 13.5% had a history of previous sexual violence. The aggressor was unknown in 76% of cases, and there was more than 1 aggressor in 9% of cases. In the first month, 43% of the women had moderate or very severe PTSD; 52.2% had moderate or severe depression; and 22.4% had moderate or severe hopelessness, which decreased to 21%, 20% and 10%, respectively, at 6 months. In the first month, severity of PTSD was associated with moderate or severe depression, and at 6 months severity of PTSD was associated with multiple aggressors and previous psychiatric disorders. All scores decreased in the sixth month. CONCLUSION: Severe mental health disorders were still present 6 months after women had experienced sexual violence.

Emerging female contraceptives.

INTRODUCTION: Fifty years after the first contraceptive, the market remains restricted regarding composition, cost and routes of administration, and satisfying the needs of millions of women with different requirements according to their stage in life. AREAS COVERED: Women need contraception for almost 30 years of their life. Currently available contraceptives are highly effective with few side effects. This review provides information on emerging female contraceptives including some registered and others at different stages of development. Research efforts aim to reduce costs, improve acceptability and refine 'forgettable' reversible methods. Although developing and testing a new method is laborious and expensive, many new contraceptives are currently under development including different routes of administration. EXPERT OPINION: New methods should be affordable, simple to use and suitable for many women. Much work remains to be done and new methods that act on the fusion process between both gametes are desirable without affecting the hormonal milieu.

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

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

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

Variations in body mass index of users of depot-medroxyprogesterone acetate as a contraceptive.

BACKGROUND: Weight gain is a frequent reason for discontinuing the contraceptive with depot-medroxyprogesterone acetate (DMPA). STUDY DESIGN: This 3-year retrospective cohort study assessed body mass index (BMI; kg/m(2)) variations in 379 current or past DMPA users compared to TCu380A intrauterine device (IUD) users matched for age and BMI, categorized into G1 (normal weight), G2 (overweight) or G3 (obese) according to baseline BMI. Variations in weight and BMI were evaluated using analysis of variance. RESULTS: BMI increased progressively in all groups but significantly more in G1 and G2 DMPA users compared to nonusers and according to duration of use. In the G3 subgroup, weight trends were similar in the DMPA and IUD users. CONCLUSIONS: Normal and overweight women increased BMI with DMPA use; however, obese women did not increase weight. Weight increase in DMPA users could be associated with metabolic alterations related to duration of use in normal and overweight women and to alterations already present in obese women. Prospective studies are required to determine triggering factors. DMPA use or=30.

[Variation of weigth among users of the contraceptive with depot-medroxyprogesterone acetate according to body mass index in a six-year follow-up]. / Variação de peso de usuárias de acetato de medroxiprogesterona de depósito segundo índice de massa corporal em seguimento de seis anos.

PURPOSE: To determine weight variation in women with different Body Mass Index (BMI) in use of trimestral injections of depot-medroxyprogesterone acetate (DMPA), and compare it to women users of a non-hormonal method. METHODS: Retrospective study with the chart review of 226 DMPA users and 603 controls, users of DIU TCu380A. Women were distributed in categories, according to their initial BMI, as having normal weight (<25 kg/m(2)), overweight (25 to 29,9 kg/m(2)) and being obese (>or=30 kg/m(2)), and were followed-up for six years, with yearly measurements of weight and BMI. The statistic test ANOVA was used to measure the weight variation among the groups in each BMI category every year. RESULTS: The average age at the onset of the method employed was higher in the study group than in the controls, in all the BMI categories: 31.6+/-SD 7.1 X 27.4+/-SD 5.5 in the normal weight category (p<0.0001); 37.3+/-SD 6.8 X 29.2+/-SD 6.0 in the overweight category (p<0.0001); and 35.3+/-SD 6.4 X 29.7+/-SD 5.8 among obese women (p<0.0001). DMPA users showed weight increase as compared to the controls in the overweight category (p=0.0082); and the weight increase along the observation period was also higher among the DMPA users than among the controls, for the normal weight (p<0.0001) and overweight (p=0.0008) categories. In the obese group, there was no BMI variation between the groups, nor along the period during which they were using the method. CONCLUSIONS: There was no change in weight gain among DMPA users from the obese category. Prospective studies should be done with metabolic tests to establish the determining factors of weight gain in normal and overweight women.

[Chlamydia trachomatis and Neisseria gonorrhoeae among women in a family planning clinic]. / Infecção por Chlamydia trachomatis e Neisseria gonorrhoeae em mulheres atendidas em serviço de planejamento familiar.

PURPOSE: to study infection prevalence by Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), among adolescent and young women in a family planning outpatient clinic. METHODS: a total of 230 women up to 24 years old and history of up to four sexual partners have been followed-up for 48 months, with urine collection to search CT and NG, by the polymerase chain reaction method at the 1st, 12nd, 24th, 36th and 48th months. The variables studied were age group, schooling, marital status, number of gestations, abortions and children alive, age at the onset of sexual life, previous and present use of condom, previous use of intrauterine device, number of sexual partners in the previous six months and follow-up time. Bivariate analysis of variables according to positive tests for CT and NG, and multiple analyses by logistic regression were done. RESULTS: the ratio of infections by CT was 13.5% and by NG, 3%. Two women presented both tests as positive. The previous intrauterine device use was associated with positive tests for NG. CONCLUSIONS: the prevalence of infections by CT and NG was higher among the age group studied and the screening of young women must be taken into consideration in our services, to control the dissemination of sexually transmitted diseases and prevention of sequels.

Variação de peso de usuárias de acetato de medroxiprogesterona de depósito segundo índice de massa corporal em seguimento de seis anos / Variation of weigth among users of the contraceptive with depot-medroxyprogesterone acetate according to body mass index in a six-year follow-up

OBJETIVO: determinar a variação de peso de mulheres com diferentes Índices de Massa Corporal (IMC), usuárias do injetável trimestral de acetato de medroxiprogesterona de depósito (AMPD) e compará-la à de mulheres em uso de método não hormonal. MÉTODOS: Estudo retrospectivo com revisão de prontuários de 226 usuárias de AMPD e 603 controles usuárias de DIU TCu380A. As mulheres foram distribuídas conforme o IMC inicial nas categorias de peso normal (<25 kg/m²), sobrepeso (25 a 29,9 kg/m²) e obesas (>30 kg/m²) e seguidas anualmente durante seis anos com medidas de peso e IMC. Aplicou-se o teste estatístico ANOVA para medir a variação de peso entre os grupos em cada categoria de IMC a cada ano. RESULTADOS: a média de idade no início do uso do método foi maior no grupo de estudo do que no controle em todas as categorias de IMC 31,6 ± DP 7,1 X 27,4 ± DP 5,5 na categoria peso normal (p<0,0001); 37,3 ± DP 6,8 X 29,2± DP 6,0 na categoria sobrepeso (p<0,0001); e 35,3 ± DP 6,4 X 29,7 ± DP 5,8 na categoria obesas (p<0,0001). As usuárias de AMPD tiveram elevação de peso em relação às controles na categoria de sobrepeso (p=0,0082); e o aumento de peso em relação ao tempo também foi maior no grupo de usuárias de AMPD do que nas controles para as categorias de peso normal (p<0,0001) e sobrepeso (p=0,0008). No grupo de obesas não houve variação do IMC entre os grupos nem em relação ao tempo de uso do método. CONCLUSÕES: não houve variação de ganho de peso em mulheres obesas usuárias de AMPD. Estudos prospectivos deverão ser realizados com testes metabólicos para determinar os fatores desencadeadores do ganho de peso em mulheres com peso normal e sobrepeso.

PURPOSE: to determine weight variation in women with different Body Mass Index (BMI) in use of trimestral injections of depot-medroxyprogesterone acetate (DMPA), and compare it to women users of a non-hormonal method. METHODS: retrospective study with the chart review of 226 DMPA users and 603 controls, users of DIU TCu380A. Women were distributed in categories, according to their initial BMI, as having normal weight (<25 kg/m²), overweight (25 to 29,9 kg/m²) and being obese (>30 kg/m²), and were followed-up for six years, with yearly measurements of weight and BMI. The statistic test ANOVA was used to measure the weight variation among the groups in each BMI category every year. RESULTS: the average age at the onset of the method employed was higher in the study group than in the controls, in all the BMI categories: 31.6±SD 7.1 X 27.4±SD 5.5 in the normal weight category (p<0.0001); 37.3±SD 6.8 X 29.2±SD 6.0 in the overweight category (p<0.0001); and 35.3±SD 6.4 X 29.7±SD 5.8 among obese women (p<0.0001). DMPA users showed weight increase as compared to the controls in the overweight category (p=0.0082); and the weight increase along the observation period was also higher among the DMPA users than among the controls, for the normal weight (p<0.0001) and overweight (p=0.0008) categories. In the obese group, there was no BMI variation between the groups, nor along the period during which they were using the method. CONCLUSIONS: there was no change in weight gain among DMPA users from the obese category. Prospective studies should be done with metabolic tests to establish the determining factors of weight gain in normal and overweight women.

Infecção por Chlamydia trachomatis e Neisseria gonorrhoeae em mulheres atendidas em serviço de planejamento familiar / Chlamydia trachomatis and Neisseria gonorrhoeae among women in a family planning clinic

OBJETIVO: estudar a prevalência de infecções por Chlamydia trachomatis (CT) e Neisseria gonorrhoeae (NG) entre mulheres adolescentes e jovens em ambulatório de planejamento familiar. MÉTODOS: um total de 230 mulheres com idade menor ou igual a 24 anos e antecedente de até quatro parceiros sexuais foram acompanhadas por até 48 meses, com coletas de urina para pesquisa de CT e NG pelo método da reação em cadeia da polimerase nos meses 1, 12, 24, 36 e 48. As variáveis estudadas foram faixa etária, escolaridade, estado marital, número de gestações, abortos e filhos vivos, idade de início da vida sexual, uso anterior e atual de condom, uso anterior de dispositivo intrauterino, número de parceiros nos últimos seis meses e tempo de seguimento. Realizou-se análise bivariada das variáveis segundo os testes positivos para CT e NG e análise múltipla por regressão logística. RESULTADOS: a frequência de infecções por CT foi de 13,5% e por NG de 3%, duas mulheres apresentaram ambos os testes positivos. O antecedente de uso de dispositivo intrauterino foi associado aos testes positivos para NG. CONCLUSÕES: as prevalências de infecção por CT e NG foram altas na faixa etária estudada e o rastreamento de mulheres jovens deve ser considerado em nossos serviços para controle da disseminação e prevenção de sequelas das doenças sexualmente transmissíveis.

PURPOSE: to study infection prevalence by Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), among adolescent and young women in a family planning outpatient clinic. METHODS: a total of 230 women up to 24 years old and history of up to four sexual partners have been followed-up for 48 months, with urine collection to search CT and NG, by the polymerase chain reaction method at the 1st, 12nd, 24th, 36th and 48th months. The variables studied were age group, schooling, marital status, number of gestations, abortions and children alive, age at the onset of sexual life, previous and present use of condom, previous use of intrauterine device, number of sexual partners in the previous six months and follow-up time. Bivariate analysis of variables according to positive tests for CT and NG, and multiple analyses by logistic regression were done. RESULTS: the ratio of infections by CT was 13.5% and by NG, 3%. Two women presented both tests as positive. The previous intrauterine device use was associated with positive tests for NG. CONCLUSIONS: the prevalence of infections by CT and NG was higher among the age group studied and the screening of young women must be taken into consideration in our services, to control the dissemination of sexually transmitted diseases and prevention of sequels.