Are sexual and reproductive health and rights taught in medical school? Results from a global survey.

Our aim was to investigate the inclusion of sexual and reproductive health and rights (SRHR) topics in medical curricula and the perceived need for, feasibility of, and barriers to teaching SRHR. We distributed a survey with questions on SRHR content, and factors regulating SRHR content, to medical universities worldwide using chain referral. Associations between high SRHR content and independent variables were analyzed using unconditional linear regression or χ2 test. Text data were analyzed by thematic analysis. We collected data from 219 respondents, 143 universities and 54 countries. Clinical SRHR topics such as safe pregnancy and childbirth (95.7%) and contraceptive methods (97.2%) were more frequently reported as taught compared with complex SRHR topics such as sexual violence (63.8%), unsafe abortion (65.7%), and the vulnerability of LGBTQIA persons (23.2%). High SRHR content was associated with high-income level (P = 0.003) and low abortion restriction (P = 0.042) but varied within settings. Most respondents described teaching SRHR as essential to the health of society. Complexity was cited as a barrier, as were cultural taboos, lack of stakeholder recognition, and dependency on fees and ranking.

How the coronavirus disease 2019 pandemic is impacting sexual and reproductive health and rights and response: Results from a global survey of providers, researchers, and policy-makers.

INTRODUCTION: We aimed to give a global overview of trends in access to sexual and reproductive health and rights (SRHR) during the coronavirus disease 2019 (COVID-19) pandemic and what is being done to mitigate its impact. MATERIAL AND METHODS: We performed a descriptive analysis and content analysis based on an online survey among clinicians, researchers, and organizations. Our data were extracted from multiple-choice questions on access to SRHR services and risk of SRHR violations, and written responses to open-ended questions on threats to access and required response. RESULTS: The survey was answered by 51 people representing 29 countries. Eighty-six percent reported that access to contraceptive services was less or much less because of COVID-19, corresponding figures for surgical and medical abortion were 62% and 46%. The increased risk of gender-based and sexual violence was assessed as moderate or severe by 79%. Among countries with mildly restrictive abortion policies, 69% had implemented changes to facilitate access to abortion during the pandemic, compared with none among countries with severe restrictions (P < .001), 87.5% compared with 46% had implemented changes to facilitate access to contraception (P = .023). The content analysis showed that (a) prioritizations in health service delivery at the expense of SRHR, (b) lack of political will, (c) the detrimental effect of lockdown, and (d) the suspension of sexual education, were threats to SRHR access (theme 1). Requirements to mitigate these threats (theme 2) were (a) political will and support of universal access to SRH services, (b) the sensitization of providers, (c) free public transport, and (d) physical protective equipment. A contrasting third theme was the state of exception of the COVID-19 pandemic as a window of opportunity to push forward women's health and rights. CONCLUSIONS: Many countries have seen decreased access to and increased violations of SRHR during the COVID-19 pandemic. Countries with severe restrictions on abortion seem less likely to have implemented changes to SRHR delivery to mitigate this impact. Political will to support the advancement of SRHR is often lacking, which is fundamental to ensuring both continued access and, in a minority of cases, the solidification of gains made to SRHR during the pandemic.

Sexual and reproductive health and rights of refugee and migrant women: gynecologists' and obstetricians' responsibilities.

Ensuring universal access to sexual and reproductive healthcare services is Target 3.7 of the United Nations Sustainable Development Goals (SDG). Refugee and migrant women and children are at particular risk of being forgotten in the global momentum to achieve this target. In this article we discuss the violations of sexual and reproductive health and rights (SRHR) of particular relevance to the refugee and migrant reality. We give context-specific examples of denial of health services to vulnerable groups; lack of dignity as a barrier to care; the vulnerability of adolescents; child marriage; weaponized rape; gender-based violence; and sexual trafficking. We discuss rights frameworks and models that are being used in response to these situations, as well as what remains to be done. Specifically, we call for obstetricians and gynecologists to act as individual providers and through their FIGO member societies to protect women's health and rights in these exposed settings.

Prevalence of human papillomavirus infection in Argentinean women attending two different hospitals prior to the implementation of the National Vaccination Program.

Cervarix vaccine was included in the National Immunization Program of Argentina in 2011 but data about the local distribution of human papillomavirus (HPV) infection in women exposed to the virus are scarce. This cross-sectional study determined the prevalence and type distribution of HPV infection in unvaccinated women attending routine gynecological screening in two public hospitals located in Buenos Aires and Santa Fe, Argentina. Socio-demographic, sexual behavior, and co-factors information was obtained from all participants (Buenos Aires, n = 429; Santa Fe, n = 433). Cervicovaginal swabs were tested with an MY11/09 primer-based assay and with the CUT primer system targeting mucosal/cutaneous HPVs. Participants from Buenos Aires showed significantly higher rates of HPV infection (52.4% vs. 40.6%), of multiple infections (24.2% vs. 16.4%), and of low-risk (20.3% vs. 13.9%) and high-risk types (44.1% vs. 33.3%) than those from Santa Fe. HPV-66 (Buenos Aires: 17%) and HPV-16 (Santa Fe: 8.5%) were the most prevalent types. Novel HPV-66 putative subtype and variants were identified. Vaccine types 16 and 18 were frequent (Buenos Aires: 13.5%; Santa Fe: 10.2%) but few participants had co-infections with both (Buenos Aires: 1.4%; Santa Fe: 0.2%). A common risk factor for HPV infection was having a new sexual partner in the last year (Buenos Aires: OR 2.53, P < 0.001; Santa Fe: OR 1.85, P = 0.04). This study provides valuable baseline data for future assessment of the impact of massive vaccination in Argentina and it underlines the use of additional HPV testing strategies, such as the CUT system, for surveillance and vaccinology.

Estudio cuali-cuantitativo de la mortalidad femenina por causas externas y su relación con la violencia de género / A quali-quantitative study of female mortality due to external causes and its relationship with gender-based violence

RESUMEN. En los últimos años, ha crecido el interés por las causas de violencia de género contra las mujeres en Argentina. OBJETIVO: obtener un cuadro de situación agregado y actualizado sobre esta problemática, visualizar su peso y gravedad e identificar las consecuencias en salud que produce. MÉTODO: estudio cuali-cuantitativo, descriptivo y exploratorio en tres etapas: 1) Se realizó un mapeo nacional de la mortalidad de las mujeres por causas externas a partir de las estadísticas vitales nacionales y de estadísticas policiales. Se desagregaron datos sobre suicidios, homicidios y accidentes, y se relacionaron los resultados entre jurisdicciones con el fin de establecer heterogeneidades regionales en el mapeo. 2) Se relevaron las noticias sobre casos de muertes por causas externas que se vincularon con situaciones de violencia hacia las mujeres en los principales diarios del país durante 2005. 3) Se relevaron los registros de casos de violencia contra mujeres en el Hospital Álvarez de Buenos Aires. RESULTADOS: las principales causas de suicidio en mujeres relevadas en estadísticas vitales oficiales son por ahorcamiento y por utilización de armas de fuego, en tanto que para los forenses estas causas son las menos frecuentes. CONCLUSIONES: algunos casos consignados como suicidios podrían en realidad tratarse de femicidios, hipótesis que requiere de futuras investigaciones específicas.

ABSTRACT. In recent years, has increased interest in the causes of gender violence against women in Argentina. OBJECTIVE: to get a picture of the situation added and updated on this issue, evaluate their weight and gravity and identify the health consequences it produces. METHOD: qualitative and quantitative, descriptive, exploratory study in 3 stages:1) A national mapping of mortality from external causes women was built with national vital statistics and policestatistics. Data on suicides, homicides and accidents were disaggregated, and outcomes compared between jurisdiction sin order to establish regional heterogeneities in themapping. 2) News on deaths from external causes related to situations of violence against women were analyzed in 4 major newspapers. 3) Search of records of violence against women in a public hospital in Buenos Aires city. RESULTS: the more frequent causes of suicide in women from the vital statistics are by hanging and use of firearms For the forensics, these causes are the less frequent ones. CONCLUSIONS: it can be suspected that some cases considered assuicides would actually be femicide cases. This hypothesis should be verified in future research.

Anticoncepción quirúrgica varones / Male surgical contraception

El Programa Nacional de Salud Sexual y Procreación Responsable tiene comopropósitos promover la igualdad de derechos, la equidad y la justicia social. Coneste fin el Programa se ha propuesto mejorar el acceso a servicios integrales desalud sexual y reproductiva en un marco de respeto de los derechos sexuales yreproductivos y con perspectiva de género.La Ley Nacional 26.130 establece el derecho de todas las personas a acceder a lasprácticas quirúrgicas denominadas ôligadura de trompas de Falopioö y ôligadurade conductos deferentes o vasectomíaö.Esta norma nacional entró en vigencia en el mes de septiembre de 2006 (BoletínOficial 30978). La nueva ley prevé que las prácticas deben realizarse en hospitalesy clínicas del país, sean públicos o privados.Con esta norma, todas las personas capaces y mayores de 21 años tienen derechoa realizarse una ligadura de trompas de Falopio o vasectomía.La ley no requiere adhesión provincial. No es necesario que las provincias adhierana la norma nacional para que las mujeres y varones que decidan acceder ala anticoncepción quirúrgica puedan hacerlo. Las provincias tiene la obligaciónde garantizar el acceso a la anticoncepción quirúrgica desde el momento mismode la entrada en vigor de la ley nacional, ya que deben garantizar el acceso a losderechos constitucionales en juego: los derechos a la salud y derechos sexualesy reproductivos. Concretamente, esto significa que todos los hospitales provincialesque cuenten con la complejidad requerida deben realizar las prácticas enlos términos establecidos por la ley nacional. La entrada en vigencia de la ley tampocoestá supeditada a su reglamentación. Además, ninguna jurisdicción puededictar normativa legal o reglamentaria que establezca más requisitos o mayorescondiciones que las establecidas en la ley nacional.

Varicella seroprevalence and molecular epidemiology of varicella-zoster virus in Argentina, 2002.

There is limited data on immunity against varicella-zoster virus (VZV) in adults in different parts of Argentina, and it is not known which VZV strains are circulating in Argentina. The objectives of this study were as follows: (i) to evaluate seroprevalence of varicella among adults, assessing the accuracy of clinical history and determining the sociodemographic factors associated with seropositivity; and (ii) to determine the VZV strains circulating in Argentina. A cross-sectional serological survey enrolling 2,807 women aged 15 to 49 years attending public health-care settings in four cities in Argentina (i.e., Buenos Aires, Salta, Mendoza, and Rosario) and one rural area was conducted from August to November 2002. Specimens for identification of VZV strains were obtained from vesicular lesions from 13 pediatric patients with varicella from different areas of the country. PCR amplification was used for genotyping. The overall seroprevalence of varicella antibodies was 98.5% (95% confidence interval, 98.0 to 98.9), ranging from 97.2% in central Buenos Aires to 99.3% in southern Buenos Aires and Salta. Varicella seroprevalence increased with age. Crowding and length of residence in the same place were associated with seropositivity. The positive predictive value of varicella history for immunity to varicella was 99.4%; however, the negative predictive value was 2.5%. The European genotype was identified in all viral specimens. In Argentina, seroprevalence in women more than 15 years old was high regardless of the area of residence. Negative or uncertain varicella history was not a good predictor of immunity. VZV genotype was stable in all areas of the country.

Guía para la atención del parto normal en maternidades centradas en la familia

En 1993, la Dirección de Salud Materno Infantil del Ministerio de Salud radactó y publicó la Propuesta Normativa Perinatal. En el 2001 se redacta la Guía para la práctica del cuidado preconcepcional y del control prenatal. Continuando con la misma metodología y con el objetivo de actualizar la atención del parto normal y del recién nacido de bajo riesgo, enmarcados en la filosofía de las maternidades centradas en la familia, se decide redactar la presente guía. Incluye: propuesta para transformar el modelo de atención hacia maternidades centradas en la familia; atención del parto normal (primer, segundo y tercer período de parto), cuidados postparto; atención inmediata del recién nacido; y, el recién nacido en internación conjunta madre-hijo

Substancias reactivas al ácido tiobarbitúrico, vitamina E, fibronectina y PAI-1 como predictores preclínicos de hipertensión inducida por embarazo / Reactive substances to thiobarbituric acid, vitamin E, fibronectin and PAI-1 like preclinic predictors of hypertension induced by pregnancy

Introducción: niveles circulantes bajos de vitamina E y altos de malondialdehído (como TBARs) como expresión de alteraciones en el equilibrio rédox, niveles circulantes altos de fibronectina como expresión de disfunción endotelial y niveles elevados de PAI-1 como expresión de inhibición de fibrinolisis han sido asociados con pre-eclampsia y eclampsia y con diabetes gestacional (DG) ya instaladas pero no hay información sobre su evolución a lo largo de embarazos no patológicos, ni sobre la cronología de eventuales modificacioes antes de que se expresen clinicamente los trastornos ni sobre el posible poder predictivo de estos marcadores. Objetivo: determinar niveles séricos de substancias reactivas al ácido tiobarbitúrico (TBARs), vitamina E, fibronectina e inhibidor tipo I del activador del plasminógeno (PAI-1) en mujeres eumenorreicas, en menopaúsicas y en primigrávidas. Material y método: se incorporaron 25 mujeres eumenorreicas sanas, 26 postmenopáusicas sanas y 101 primigrávidas sanas al momento de la incorporación. Niveles séricos de TBARs (µM), vitamina E(µM), fibronectina (mg/dl) y PAI-I (ng/ml) se determinaron a las 8 horas en los días 7º-9º y 23º-25º del ciclo en las eumenorreicas, en las menopáusicas al momento de la consulta y a las semanas 8ª-10ª, 21ª-22ª y 31ª-32ª en las embarazadas... (TRUNCADO)

Substancias reactivas al ácido tiobarbitúrico, vitamina E, fibronectina y PAI-1 como predictores preclínicos de hipertensión inducida por embarazo / Reactive substances to thiobarbituric acid, vitamin E, fibronectin and PAI-1 like preclinic predictors of hypertension induced by pregnancy

Introducción: niveles circulantes bajos de vitamina E y altos de malondialdehído (como TBARs) como expresión de alteraciones en el equilibrio rédox, niveles circulantes altos de fibronectina como expresión de disfunción endotelial y niveles elevados de PAI-1 como expresión de inhibición de fibrinolisis han sido asociados con pre-eclampsia y eclampsia y con diabetes gestacional (DG) ya instaladas pero no hay información sobre su evolución a lo largo de embarazos no patológicos, ni sobre la cronología de eventuales modificacioes antes de que se expresen clinicamente los trastornos ni sobre el posible poder predictivo de estos marcadores. Objetivo: determinar niveles séricos de substancias reactivas al ácido tiobarbitúrico (TBARs), vitamina E, fibronectina e inhibidor tipo I del activador del plasminógeno (PAI-1) en mujeres eumenorreicas, en menopaúsicas y en primigrávidas. Material y método: se incorporaron 25 mujeres eumenorreicas sanas, 26 postmenopáusicas sanas y 101 primigrávidas sanas al momento de la incorporación. Niveles séricos de TBARs (µM), vitamina E(µM), fibronectina (mg/dl) y PAI-I (ng/ml) se determinaron a las 8 horas en los días 7º-9º y 23º-25º del ciclo en las eumenorreicas, en las menopáusicas al momento de la consulta y a las semanas 8ª-10ª, 21ª-22ª y 31ª-32ª en las embarazadas... (TRUNCADO)(AU)

El nacimiento quirúrgico: ¿un problema de salud pública o un problema de conciencia? / Cesarean section: a problem of public health or a problem of conscience

El nacimiento por cesárea se ha incrementado en forma alarmante en los últimos años, debido a una multiplicidad de factores responsables de esa situación

El nacimiento quirúrgico: ¿un problema de salud pública o un problema de conciencia? / Cesarean section: a problem of public health or a problem of conscience

El nacimiento por cesárea se ha incrementado en forma alarmante en los últimos años, debido a una multiplicidad de factores responsables de esa situación

Níveles plasmáticos de un marcador de peroxidación lipídica y de vitamina E en mujeres sanas eumenorreicas, en postmenopáusicas sanas y en primigestas que desarrollaron o no hipertensión inducida / Even plasmatic od a marker of lipid peroxidation and E vitamin in women healthy eumenorreicas, in health postmenopausal and in primigravidas that develope or not induced hypertension

Modificaciones en níveles circulantes de malondialdehido y de vitamina E se han asociaado con hipertensión inducida por embarazo, con diabetes gestacional y con parto pretérmino. Hay solo información fragmentaria aa esstos respectos

Níveles plasmáticos de un marcador de peroxidación lipídica y de vitamina E en mujeres sanas eumenorreicas, en postmenopáusicas sanas y en primigestas que desarrollaron o no hipertensión inducida / Even plasmatic od a marker of lipid peroxidation and E vitamin in women healthy eumenorreicas, in health postmenopausal and in primigravidas that develope or not induced hypertension

Modificaciones en níveles circulantes de malondialdehido y de vitamina E se han asociaado con hipertensión inducida por embarazo, con diabetes gestacional y con parto pretérmino. Hay solo información fragmentaria aa esstos respectos(AU)