Saúde mental e abortamento voluntário na audiência pública da ADPF442/STF / Mental health and voluntary abortion in the public hearing of ADPF442/STF / Salud mental y aborto voluntario en la audiencia pública del ADPF442/STF

O estudo teve como objetivo identificar os argumentos da estratégia de persuasão dos discursos apresentados na audiência pública sobre a Arguição de Descumprimento de Preceito Fundamental-ADPF 442, realizada em 2018, cujo propósito era discutir sobre a interrupção voluntária da gravidez até a 12ª semana. Para tal, foi realizada uma pesquisa de abordagem qualitativa, analítico-descritiva e documental. O objeto de análise foi o registro da audiência, apresentado em vídeo, disponibilizado na plataforma digital YouTube, e em ata lavrada pelo STF, ambos de acesso público. A partir de uma análise do discurso, identificou-se os argumentos utilizados na estratégia de persuasão, que foram sistematizados em quatro categorias de argumentos para cada um dos dois grupos identificados: o grupo pró e o grupo contra a descriminalização do aborto. As três primeiras categorias, Saúde mental, Direito e Saúde pública, mesmo com diferenças na forma de apresentar o argumento, se repetem nos dois grupos. Todavia, a quarta categoria, Pressupostos, se diferenciou. No grupo pró descriminalização do aborto, apresentou-se como Pressupostos filosóficos e científicos, e no grupo contra, como Pressupostos morais. Por fim, a defesa da saúde mental das mulheres foi o principal argumento numa forma de humanizar o sofrimento vivido pelas que desejam abortar e não encontram o suporte do Estado para assegurar sua dignidade, cidadania e efetiva igualdade, garantidas constitucionalmente.(AU)

The study aimed to identify the arguments of the persuasion strategy of the speeches presented at the public hearing on the Action Against the Violation of Constitutional Fundamental Rights -ADPF 442, held in 2018, whose purpose was to discuss the voluntary interruption of pregnancy until the 12th week. To this end, a qualitative, analytical-descriptive, and documentary research was carried out. The object of analysis was the video recording of the hearing available on the YouTube platform, and in minutes drawn up by the STF, both of which are public. Based on a discourse analysis, the arguments used in the persuasion strategy were identified, which were systematized into four categories of arguments for each of the two identified groups: the group for and the group against the decriminalization of abortion. The first three categories, Mental Health, Law and Public Health, even with differences in the way of presenting the argument, are repeated in both groups. However, the fourth category, Assumptions, differed. In the group for the decriminalization of abortion, it was presented as Philosophical and Scientific Assumptions, whereas the group against, as Moral Assumptions. Finally, the defense of women's mental health was the main argument in a way of humanizing the suffering experienced by those who wish to have an abortion and do not find the support of the State to guarantee their dignity, citizenship, and effective equality, constitutionally guaranteed.(AU)

El estudio tuvo como objetivo identificar los argumentos de la estrategia de persuasión de los discursos presentados en la audiencia pública sobre el Argumento por Incumplimiento de un Percepto Fundamental -ADPF 442, realizada en 2018, con el objetivo de discutir la interrupción voluntaria del embarazo hasta la 12.ª semana. Para ello, se llevó a cabo una investigación cualitativa, analítico-descriptiva y documental. El objeto de análisis fue la grabación de la audiencia, que está disponible en la plataforma digital YouTube, y actas levantadas por el Supremo Tribunal Federal -STF, ambas de acceso público. A partir de un análisis del discurso se identificaron los argumentos utilizados en la estrategia de persuasión, los cuales se sistematizaron en cuatro categorías de argumentos para cada uno de los dos grupos identificados: el grupo pro y el grupo en contra de la despenalización del aborto. Las tres primeras categorías ("salud mental", "derecho" y "salud pública") aún con diferencias en la forma de presentar el argumento se repiten en ambos grupos. Pero difiere la cuarta categoría "supuestos". En el grupo a favor de la despenalización del aborto se presentó como "supuestos filosóficos y científicos", y en el grupo en contra, como "supuestos morales". Finalmente, la defensa de la salud mental de las mujeres fue el principal argumento en un intento por humanizar el sufrimiento que viven aquellas que desean abortar y no encuentran el apoyo del Estado para garantizar su dignidad, ciudadanía e igualdad efectiva, preconizadas por la Constitución.(AU)

Vasectomy and vasectomy reversal: a comprehensive approach to the evolving spectrum of care.

Male reproduction and male contraception form an important spectrum within men's health. In this issue's Views and Reviews, four author groups detail important new developments in vasectomy clinical practice guidelines, emerging and investigational techniques in the fields of hormonal and nonhormonal male contraception, useful paradigms for patient care when deciding between sperm extraction with in vitro fertilization and vasectomy reversal, and finally, a state-of-the-art overview of recent developments in vasectomy reversal microsurgery. These articles will provide readers with a contemporary understanding of the rapidly evolving spectrum of male reproductive and contraceptive health care.

The use of the Multidimensional Condom Attitude Scale in Chinese young adults.

BACKGROUND: Attitude towards condom use is an important predictor of consistent condom use. However, this topic is an understudied area in Chinese populations, and no validated Chinese instrument is available to capture condom attitude. To fill this research gap, the present study aimed to evaluate the psychometric properties of the University of California, Los Angeles (UCLA) Multidimensional Condom Attitudes Scale (MCAS) and assessed the attitudes towards condom use amongst Chinese adults aged 18-29 years old. METHODS: In this cross-sectional study, a total of 500 people aged 18-29 years old were randomly recruited in Hong Kong. The primary outcome was the attitude towards condom use as measured by the UCLA MCAS. Factor structure, internal construct validity, known-group validity and internal consistency were assessed. RESULTS: Instead of the five-factor structure designed by the original developers of the MCAS questionnaire, this study proposed a novel six-factor scale: (1) Reliability and Effectiveness, (2) Excitement, (3) Displeasure, (4) Identity Stigma, (5) Embarrassment about Negotiation and (6) Embarrassment about Purchase. The internal construct validity and reliability of the new scale were high. The revised MCAS could differentiate between subgroups, including gender, sexual orientation and sexual experience. In terms of attitudes, over 40% of the participants believed that condoms are not reliable, though the vast majority of the sample did not perceive any stigma related to condom use. In addition, more than half (55.4%) of the respondents felt embarrassed to be seen when buying condoms while a quarter (25.8%) felt uncomfortable buying condoms at all. CONCLUSIONS: Overall, the psychometric analysis found that attitude to condom use is culturally specific. The study also highlighted the need for more public health campaigns and interventions to help people cope with the embarrassment of purchasing condoms.

Male Participation in Reproductive Health Interventions in Sub-Saharan Africa: A Scoping Review.

CONTEXT: Despite improvements in reproductive health indicators among women living in Sub-Saharan Africa, the persistence of poor outcomes underscores the need to examine recent interventions to inform future research, programming and policy. Because men in this context have an outsize role in reproductive decision making, assessing their involvement in reproductive health programs is an important step in meeting men's needs, supporting women's health and improving family health. METHODS: A scoping review was conducted to identify relevant literature and assess evidence of the impact of male involvement in reproductive health interventions. Seven databases were searched using terms related to male involvement and reproductive health; searches were limited to research conducted in Sub-Saharan Africa and published in English between 2007 and 2018. Remaining studies were assessed by participant characteristics, settings, research design, theoretical frameworks, outcome measures and findings. RESULTS: Searches identified 18 studies conducted in eight countries. Interventions engaged participants by using such strategies as community health workers, written invitation, peers, community or religious leaders and media campaigns. Results show that men are willing to participate in reproductive health programs and that their involvement is associated with increased uptake of family planning services, and HIV counseling and testing; reduction in risk behaviors; and improved maternal health and spousal communication. CONCLUSIONS: Given the findings that male involvement is positively associated with improved reproductive health outcomes in Sub-Saharan Africa, health providers and program planners should consider including men in reproductive health interventions, when feasible.

RESUMEN Contexto: A pesar de las mejoras observadas en los indicadores de salud reproductiva en las mujeres que viven en África subsahariana, la persistencia de malos resultados subraya la necesidad de examinar intervenciones recientes para sustentar futuras investigaciones, programas y políticas. Debido a que los hombres en este contexto tienen un papel enorme en la toma de decisiones reproductivas, evaluar su participación en los programas de salud reproductiva es un paso importante para responder a las necesidades de los hombres, apoyar la salud de las mujeres y mejorar la salud familiar. Métodos: Se realizó una revisión de alcance para identificar bibliografía relevante y evaluar la evidencia del impacto de la participación masculina en las intervenciones de salud reproductiva. Se realizaron búsquedas en siete bases de datos utilizando términos relacionados con la participación masculina y la salud reproductiva; las búsquedas se limitaron a investigaciones realizadas en África subsahariana y que fueron publicadas en inglés entre 2007 y 2018. Los estudios restantes se evaluaron según las características de los participantes, los entornos, el diseño de la investigación, los marcos teóricos, las medidas de resultado y los hallazgos. Resultados: Las búsquedas identificaron 18 estudios conducidos en ocho países. Las intervenciones involucraron a los participantes mediante estrategias tales como la labor de trabajadores de salud comunitarios, invitaciones por escrito, interacción con pares, líderes comunitarios o religiosos y campañas en los medios. Los resultados muestran que los hombres están dispuestos a participar en programas de salud reproductiva y que su participación está asociada con una mayor aceptación de los servicios de planificación familiar, así como de consejería y pruebas de VIH, reducción de comportamientos de riesgo, y mejor salud materna y comunicación conyugal. Conclusiones: Con base en los hallazgos que indican que la participación masculina se asocia positivamente con mejores resultados de salud reproductiva en el África subsahariana, los proveedores de servicios de salud y los planificadores de programas deberían considerar incluir a los hombres en las intervenciones de salud reproductiva cuando sea posible.

RÉSUMÉ Contexte: Malgré l'amélioration des indicateurs de santé reproductive chez les femmes d'Afrique subsaharienne, la persistance de résultats défavorables souligne la nécessité d'examiner les interventions récentes en vue d'éclairer la recherche, la programmation et les politiques futures. Étant donné, dans ce contexte, l'immense rôle des hommes dans les décisions ayant trait à la reproduction, l'évaluation de leur participation aux programmes de santé reproductive représente une étape importante en termes de réponse aux besoins des hommes, de soutien de la santé des femmes et d'amélioration de la santé des familles. Méthodes: Un examen de portée a été effectué pour identifier la littérature pertinente et évaluer les signes de l'impact de la participation masculine aux interventions de santé reproductive. La recherche a été menée dans sept bases de données au moyen de termes associés à la participation masculine et à la santé reproductive; elle s'est limitée aux études effectuées en Afrique subsaharienne et publiées en anglais entre 2007 et 2018. Les études restantes ont été évaluées d'après les caractéristiques des participants, les contextes, le plan de recherche, les cadres théoriques, les mesures de résultat et les observations. Résultats: La recherche a identifé 18 études menées dans huit pays. Les interventions engageaient les participants au moyen de stratégies recourant, notamment, aux agents de santé communautaire, aux invitations écrites, aux pairs, aux dirigeants communautaires ou religieux et aux campagnes médiatiques. Les résultats montrent que les hommes sont disposés à participer aux programmes de santé reproductive et que leur participation est associée à une adoption accrue des services de planification familiale et du conseil et dépistage du VIH, à la réduction des comportements à risques et à l'amélioration de la santé maternelle et de la communication au sein du couple. Conclusions: Face au constat de l'association positive entre la participation masculine et l'amélioration des résultats de santé reproductive en Afrique subsaharienne, il convient que les prestataires de santé et les planificateurs de programmes incluent si possible les hommes dans les interventions de santé reproductive.

"O problema é a enorme produção de espermatozoides": concepções de corpo no campo da contracepção masculina / "The problem is the vast production of sperm": conceptions of body in the field of male contraception

Resumo Desde o final dos anos 1960, há tentativas de produção de um contraceptivo masculino reversível com eficácia equivalente à da pílula anticoncepcional. Até hoje, esse produto não foi lançado, e as justificativas para tal baseiam-se em entraves de ordem política, econômica, cultural e biológica. O argumento do obstáculo fisiológico tem bastante proeminência nessas explicações e será o nosso foco neste artigo. Com base nos estudos de gênero e ciência, buscamos compreender como esse raciocínio aparece no trabalho de viabilização dessa tecnologia por um ator de destaque no campo, a organização não governamental (ONG) estadunidense Male Contraception Initiative. Por meio da técnica de análise de documentos e com base na metodologia de análise do discurso, buscamos compreender como o corpo masculino é representado e, consequentemente, materializado nesse processo de viabilização de uma "pílula masculina", e debater o caráter generificado das concepções e intervenções biomédicas. Observa-se que a função reprodutiva dos homens cisgêneros é construída como complexa e, em certo sentido, resistente a intervenções farmacológicas. Tal caracterização se dá em comparação com o corpo feminino cisgênero, que é configurado como mais acessível para a realização da contracepção. A tradicional associação entre mulheres e reprodução e homens e sexo é facilmente reconhecida nessas perspectivas.

Abstract Since the late 1960s, attempts have been made to produce a reversible male contraceptive with efficacy equivalent to that of the contraceptive pill. To date, this product has not been launched and the justifications for this are based on political, economic, cultural and biological barriers. The argument of a physiological obstacle has a lot of prominence in these explanations and will be our focus in this article. From the perspective of gender and science studies, we aim to understand how this argument appears in current efforts to promote this technology by a prominent actor in the field, the US NGO Male Contraception Initiative (MCI). By using the document analysis technique and the methodology of discourse analysis, we aim to understand how the male body is represented and, thus, how it is materialized in this process of developing a "male pill", and to discuss the gendered character of biomedical conceptions and interventions in the field of contraception. We observed that the reproductive function of cisgender men is constructed as complex and, in a sense, as resistant to pharmacological interventions. Such characterization occurs in comparison with the female cisgender body, which is seen as more accessible for contraception. The traditional association between women and reproduction and men and sex is easily recognized in these perspectives.

Factores asociados con el uso del preservativo entre hombres jóvenes que tienen sexo con hombres / Fatores associados ao uso do preservativo entre jovens homens que fazem sexo com homens / Factors associated with condom use among young men who have sex with men

Introducción: El aumento de las infecciones por el VIH en Brasil entre los hombres que tienen sexo con hombres (HSH), en el grupo de edad de15-24 años de edad, tiene como uno de los factores la baja utilización del condón. Objetivo: Describir los factores que se asocian o no con el uso del condón entre los jóvenes HSH. Metodologíia: Estudio descriptivo, cuantitativo, con el uso de una muestra de conveniencia. El escenario fue seis discotecas dirigidas a un publico de lesbianas, gays, bisexuales, travestis y transexuales, en la ciudad de Rio de Janeiro - Brasil, seleccionados mediante un guía de discotecas gays. Los participantes fueran hombres que hacen sexo com hombres, con edades entre 18-24 años. La recolección de datos se realizó durante el mes de octubre de 2012. Hemos entrevistado a 220 jóvenes con la ayuda de un instrumento de recolección de datos. Se realizó el análisis utilizando el programa EpiInfo. Resultados: El uso del preservativo está asociado a la prevención de enfermedades. La falta del uso del condón en el sexo oral, en la primera y última relación sexual fue justificada por la incomodidad que causa, la falta de experiencia/conocimiento y confianza en el compañero, respectivamente. Conclusión: El estudio indica que los entrevistados son susceptibles a la infección por VIH cuando abandonan el uso de condones por su confianza en el compañero, la falta de conocimiento y/o experiencia. Orientación de las acciones y aclaraciones con materiales de información son relevantes, teniendo en cuenta la vulnerabilidad de este grupo a las infecciones de transmisión sexual (AU)

Introdução: O aumento das infecções pelo HIV no Brasil entre Homens que fazem Sexo com Homens, na faixa etária de 15 a 24 anos, tem como um dos fatores a baixa utilização do preservativo. Objetivo: Descrever os fatores que estão associados ou não a utilização do preservativo entre jovens HSH. Metodologia: Estudo descritivo, de natureza quantitativa, com emprego de amostra por conveniência. O cenário foram seis boates direcionadas para o público de lésbicas, gays, bissexuais, travestis e transexuais no Município do Rio de Janeiro - Brasil, selecionadas por meio de um guia de boates gay. Os participantes foram homens que fazem sexo com homens na faixa etária entre 18 a 24 anos. A coleta de dados ocorreu durante o mês de outubro de 2012. Foram entrevistados 220 jovens com auxílio de um instrumento de coleta de dados. A análise dos dados foi realizada utilizando o programa EpiInfo. Resultados: O uso do preservativo está associado à prevenção de doenças. A falta de uso do preservativo no sexo oral, na primeira e última relação sexual, foi justificada pelo incômodo que causa, falta de experiência/conhecimento e a confiança no parceiro, respectivamente. Conclusão: O estudo sinaliza que os entrevistados apresentam suscetibilidade à infecção pelo HIV quando abandonam ou não utilizam o preservativo pela confiança no parceiro, falta de conhecimento e/ou experiência. Ações de orientação e esclarecimento com material informativo são relevantes, considerando a vulnerabilidade desse grupo às infecções sexualmente transmissíveis (AU)

Introduction: The increase of HIV infections in Brazil among Men who have Sex with Men (MSM), aged between 15 and 24 years, has the low condom use as one of the factors. This research aims to describe the factors that are associated or not to condom use among young MSM. Methodology: Descriptive study, of quantitative nature, using sample for convenience. The scenario was six LGBT nightclubs in the city of Rio de Janeiro - Brazil, selected through a gay nightclub guide. Participants are MSM in the age group between 18 and 24 years who reported having had sex with men. Data collection took place during October 2012. A total of 220 young people were interviewed with the aid of a data collection instrument. Data analysis was performed through the EpiInfo program. Results: Condom use is associated with disease prevention. The justifications for not using condom in oral sex, in the first and last sexual relation were discomfort, lack of experience/knowledge and confidence in the partner respectively. Conclusion: This study indicates that the interviewees are susceptible to HIV infection when they abandon or do not use the condom because of their lack of knowledge and/or experience. Guidance and clarification activities with informative material are relevant, considering the vulnerability of this group to STIs (AU)

Adaptaçao portuguesa e validaçao da versao reduzida da Condom Use Self-efficacy Scale / Portuguese adaptation and validation of the brief version of Condom Use Self-efficacy Scale

Introdução. O preservativo é o método mais eficaz na prevenção de infeções sexualmente transmissíveis. É reconhecido o papel da autoeficácia na predição de comportamentos de saúde e a autoeficácia para usar preservativo tem‐se mostrado um constructo‐chave relacionado com o uso efetivo do preservativo. Objetivos. Proceder à adaptação e validação da versão reduzida da Condom Use Self‐efficacy Scale (CUSES) para estudantes do ensino superior português. Material e métodos. Foi realizado um estudo quantitativo, descritivo‐correlacional numa amostra de conveniência de 1.946 estudantes do ensino superior, 64% raparigas e 36% rapazes, com idade média de 21 anos (20,74±2,32). Resultados. A análise das características psicométricas da escala foi avaliada com recurso à análise fatorial exploratória (AFE) e confirmatória (AFC), realizada em 2 subgrupos aleatorizados da amostra inicial. Os resultados da AFE revelaram uma estrutura com 4 fatores, semelhante à escala original, que explicam 70,6% da variância e uma boa consistência interna (alpha=0,86). A AFC revelou a necessidade de ajustamento do modelo aos dados, apresentando o modelo modificado índices aceitáveis de ajustamento. A versão modificada revelou valores adequados de fiabilidade, validade fatorial e validade concorrente e discriminante. Conclusões. As propriedades psicométricas avaliadas permitem considerar a utilização deste instrumento no desenvolvimento de programas de saúde sexual e reprodutiva para estudantes do ensino superior português, pois permite determinar os domínios relevantes da perceção da autoeficácia para usar o preservativo (AU)

Introduction. Condoms are the most effective method to prevent sexually transmitted infections. The role of self‐efficacy in predicting health behaviors and self‐efficacy to use condoms has been shown to be a key related construct to the effective use of condoms. Objectives. Adaptation and validation of the reduced version of Condom Use Self‐efficacy Scale (CUSES) for Portuguese college students. Material and methods. We conducted a quantitative, descriptive and correlational in a convenience sample of 1946 university students study, 64% girls and 36% boys, mean age 21 years (20.74±2.32). Results. The analysis of the psychometric characteristics of the scale was carried using exploratory (EFA) and confirmatory factor analysis (EFC), held in 2 randomized subgroups of the original sample. The results of EFA revealed a structure with four factors, which explains 70.6% of variance and have a good values of internal consistency (alpha=0.86). The AFC revealed the need to adjust the model to the data, presenting acceptable levels of adjustment. The modified version had good reliability, factorial validity and concurrent and discriminant validity. Conclusions. The psychometric properties assessed allow considering the use of this instrument in the development of sexual and reproductive health programs for students of Portuguese higher education as it allows determining the relevant fields of self‐efficacy perception to use condom (AU)

Contraceptive Methods.

The prevention of pregnancy remains an important part of the practice of medicine. Contraception can occur at a number of points in the basic reproductive biological process and through a number of contraceptive product options. Pharmacists are health care providers appropriately positioned to assist patients in suitable contraceptive product selection based on their personal situations and lifestyles. This article provides an overview of available products for prevention of pregnancy and associated risks and benefits. Contraceptive products are categorized by their hormonal content and method of action. Hormonal options include oral contraceptive pills, contraceptive patch, implants, injection, intravaginal, and intrauterine devices. Barrier products prevent pregnancy by creating a physical obstacle to the successful fertilization of an egg by sperm. All products and methods are associated with benefits and potential complications that must be considered as patients, and health care providers select the most satisfactory option.

Viabilizando tecnologias improváveis: uma análise sobre o fomento de contraceptivos masculinos pela ONG Male Contraception Initiative / Making feasible technologies unlikely: An analysis on the promotion of male contraceptives by the NGO Male Contraception Initiative

O lançamento de uma "pílula masculina", um contraceptivo reversível voltado para os homens com eficácia equivalente à da pílula anticoncepcional feminina, já foi anunciado diversas vezes desde a década de 1970. Esse produto nunca chegou ao mercado, mas a sua presença na mídia foi recorrente ao longo dos anos e a promessa de que ele finalmente seria lançado foi sendo renovada a cada década. Atualmente, presenciamos mais um momento de otimismo em relação a sua disponibilização. Diversos meios de comunicação anunciam o desenvolvimento de vários anticoncepcionais masculinos reversíveis e afirmam que eles podem estar no mercado nos próximos anos. Para além da possibilidade do seu lançamento, o objetivo da presente pesquisa é analisar o trabalho para a viabilização dessas tecnologias realizado por um ator de destaque no campo da contracepção masculina, a ONG estadounidense Male Contraception Initiative (MCI). O propósito desta organização é permitir o desenvolvimento de contraceptivos masculinos e demonstrar a demanda existente para tais artefatos. Para isso, atua provendo recursos técnicos e financeiros para pesquisadores e constitui-se como um centro para conectar, informar e engajar defensores dessas tecnologias. O processo de viabilização de anticoncepcionais masculinos reflete e materializa a atual configuração das relações de gênero no âmbito da contracepção e aspectos a ela relacionados. Deste modo, ele nos parece, nos termos de Lévi ­Strauss, "bom para pensar" questões como: (bio)medicalização dos corpos masculinos; políticas populacionais; masculinidades contemporâneas; paternidade; e direitos reprodutivos. A partir de uma abordagem socioantropológica, utilizamos a técnica de análise de documentos para compreender como a MCI atua para a produção e a aceitação de tais tecnologias e que sentidos atribui a elas quando aponta a necessidade da sua disponibilização no mercado. Foram utilizados textos publicados no site da organização, na sua página na rede social Facebook e textos midiáticos que citam a MCI ou são de autoria de algum dos seus membros, assim como os vídeos produzidos pela ONG e disponibilizados pelo YouTube

Lights, camera, condoms! Assessing college men's attitudes toward condom use in pornography.

OBJECTIVE: Investigate male college students' attitudes toward actors' use of condoms in pornography. PARTICIPANTS: Two hundred thirteen undergraduate males attending a large, state-supported midwestern university in the fall semester, 2012. METHODS: Using a Web-based procedure, participants completed questionnaires assessing their pornography use, sexual history characteristics, and their attitudes toward condom use by adult performers. RESULTS: Factor analysis of the 11-item condom use attitudes questionnaire supported 2 distinct subscales: Condom Supportive Attitudes and Condom Critical Attitudes. Although participants typically agreed with statements supportive of condom use and generally disagreed with statements critical of condom use in pornography, gay men had significantly higher condom supportive subscale scores than did heterosexual men. Neither subscale was correlated with weekly viewing of pornography. CONCLUSIONS: Although some producers of adult films argue that actors wearing condoms will displease many viewers, current findings suggest that young men express support for use of condoms by pornographic film actors.

Consenso sobre el abordaje diagnóstico y terapéutico del dolor y el estrés en el recién nacido / Consensus on the diagnostic and therapeutic approach to pain and stress in the newborn

El dolor y estrés en el recién nacido (RN) se ha tratado en forma insuficiente; los recién nacidos que ingresan a las unidades de cuidados intensivos neonatales (UCIN), a menudo deben someterse a procedimientos invasivos, dolorosos y estresantes y el tratamiento inadecuado incrementa la morbimortalidad. El V Consenso Clínico de la Sociedad Iberoamericana de Neonatología convocó a 32 neonatólogos de Iberoamérica para establecer las recomendaciones sobre diagnóstico y terapéutica del dolor y estrés neonatal. Se desarrollaron temas de relevancia, utilizando la mejor evidencia científica disponible en bases de datos indizadas. Todos participaron en forma activa en una reunión presencial en Santiago de Chile para consensuar las recomendaciones y conclusiones. El dolor y el estrés neonatal afectan el neurodesarrollo y la conducta a largo plazo, requieren el diagnóstico oportuno, el manejo y la terapéutica adecuada, incluso con fármacos que permitan balancear la efectividad y toxicidad. El Consenso señala la importancia de evaluar el dolor en el RN en forma multidimensional y proporciona recomendaciones de las indicaciones y limitaciones para la terapia farmacológica individualizada. El uso de los analgésicos tiene indicaciones precisas y debe limitarse por la carencia de estudios aleatorizados en RN, ya que en todos los casos existen efectos adversos a considerar. Se proponen medidas no farmacológicas para mitigar el dolor. El manejo del estrés debe comenzar en la sala de partos e incluir el contacto materno, la reducción de estímulos, la implementación de protocolos de intervención reducida, entre otros. SIBEN propone las recomendaciones para mejorar las prácticas clínicas relacionadas con el dolor y el estrés neonatal.

Pain and stress experienced by the newborn have not been addressed adequately. Infants in neonatal intensive care units often undergo painful and stressful invasive procedures, and inappropriate treatment increases morbidity and mortality. At the 5th Clinical Consensus of the Ibero-American Society of Neonatology, 32 neonatologists from the region were invited to establish recommendations for the diagnosis and treatment of neonatal pain and stress. Key themes were explored based on the best scientific evidence available in indexed databases. All attendees participated actively in a meeting in Santiago, Chile, with the objective of reaching a consensus on recommendations and conclusions. Pain and neonatal stress affect neurological development and long-term behavior and require timely diagnosis and appropriate management and treatment, including the use of drugs with an appropriate balance between effectiveness and toxicity. The Consensus emphasized the importance of assessing pain in the newborn from a multidimensional viewpoint, and provided recommendations on the indications and limitations for an individualized pharmacological therapy. The use of analgesics has precise indications but also important limitations; there is a lack of randomized studies in newborns, and adverse effects need to be considered. Nonpharmacological measures to mitigate pain were proposed. Stress management should begin in the delivery room, including maternal contact, stimulus reduction and the implementation of intervention reduction protocols. Recommendations for improving clinical practices related to neonatal pain and stress are presented.

Demand for male contraception.

The biological basis for male contraception was established decades ago, but despite promising breakthroughs and the financial burden men increasingly bear due to better enforcement of child support policies, no viable alternative to the condom has been brought to market. Men who wish to control their fertility must rely on female compliance with contraceptives, barrier methods, vasectomy or abstinence. Over the last 10 years, the pharmaceutical industry has abandoned most of its investment in the field, leaving only nonprofit organisations and public entities pursuing male contraception. Leading explanations are uncertain forecasts of market demand pitted against the need for critical investments to demonstrate the safety of existing candidate products. This paper explores the developments and challenges in male contraception research. We produce preliminary estimates of potential market size for a safe and effective male contraceptive based on available data to estimate the potential market for a novel male method.

Group sex events amongst non-gay drug users: an understudied risk environment.

This article discusses relevant literature on group sex events--defined as events at which some people have sex with more than one partner--as risk environments, with a particular focus on group sex events where people who take drugs by non-injection routes of administration participate and where the event is not primarily LGBT-identified, at a "classic" crack house, nor in a brothel. It also briefly presents some findings from a small ethnography of such events. Group sex participation by people who take drugs by non-injection routes of administration seems to be widespread. It involves both behavioural and network risk for HIV and STI infection, including documented high-risk behaviour and sexual mixing of STI- and HIV-infected people with those who are uninfected. Indeed several HIV and STI outbreaks have been documented as based on such group sex events. Further, group sex events often serve as potential bridge environments that may allow infections to pass from members of one high-risk-behavioural category to another, and to branch out through these people's sexual and/or injection networks to other members of the local community. The ethnographic data presented here suggest a serious possibility of "third party transmission" of infectious agents between people who do not have sex with each other. This can occur even when condoms are consistently used since condoms and sex toys are sometimes used with different people without being removed or cleaned, and since fingers and mouths come into contact with mucosal surfaces of other members of the same or opposite sex. In addition to being risk environments, many of these group sex events are venues where risk-reducing norms, activities and roles are present--which lays the basis for harm reduction interventions. Research in more geographical locations is needed so we can better understand risks associated with group sex events in which drug users participate--and, in particular, how both participants and others can intervene effectively to reduce the risks posed to participants and non-participants by these group sex events. Such interventions are needed and should be developed.

Acceptability of contraception for men: a review.

Methods of contraception for use by men include condoms, withdrawal and vasectomy. Prevalence of use of a method and continuation rates are indirect measures of acceptability. Worldwide, none of these "male methods" accounts for more than 7% of contraceptive use although uptake varies considerably between countries. Acceptability can be assessed directly by asking about intended (hypothetical) use and assessing satisfaction during/after use. Since they have been around for a very long time, there are very few data of this nature on condoms (as contraceptives rather than for prevention of infection), withdrawal or vasectomy. There are direct data on the acceptability of hormonal methods for men but from relatively small clinical trials which undoubtedly do not represent the real world. Surveys undertaken among the male general public demonstrate that, whatever the setting, at least 25% of men - and in most countries substantially more - would consider using hormonal contraception. Although probably an overestimate of the number of potential users when such a method becomes available, it would appear that hormonal contraceptives for men may have an important place on the contraceptive menu. Despite commonly expressed views to the contrary, most women would trust their male partner to use a hormonal method.

The contraceptive effect of a novel filtering-type nano-copper complex/polymer composites intra-vas device on male animals.

Contraceptive techniques which target vas deferens have been paid great attention for their good efficacy, safety and reversibility. We have made a filtering-type intra-vas device (IVD) using nano-copper complex/polymer composites. Twenty male adult Beagle dogs and 40 male rabbits were randomly assigned to four groups (sham-operation, IVD, reversal and vasectomy groups). Dogs' semen parameters, concentration of α-glucosidase, copper and zinc ions were tested pre-operation and 1, 3, 6 and 12 months post-operation. The pregnancy rates of the rabbits were evaluated by mating trials after the IVDs were implanted. The histology of testis, epididymides and vas deferens of the animals was examined using an electron microscope. Apoptosis of the cells in the testes, epididymides and vas deferens was detected by TUNEL method. There was no sperm in the semen of dogs, which had been inserted IVD and vasectomized at 1, 3, 6 and 12 months post-operation. The concentration of α-glucosidase in the IVD group, reversal group and sham-operation group was not significantly different between pre- and post-operation. The pregnancy rates of the female rabbits in the vasectomy, IVD and reversal groups were all zero, but the pregnancy rate in the reversal group, after taking out IVD, and that of the sham-operation group was 60% and 80%, respectively. The ultrastructures of the testes, epididymides and vas deferens of the male animals in the IVD group and sham-operation group were in normal ranges compared with the vasectomy group. The apoptosis of the cells in the testes, epididymides and vas deferens in the vasectomy group of both dogs and rabbits was obvious compared with the other groups. No significant changes in the quantities of copper and zinc ions were found in semen of the male dogs both pre- and post-operation. Our studies demonstrated that the filtering-type nano-copper complex/polymer composites intra-vas device may be an efficacious, safe and reversible male contraceptive device.

Initial studies on a novel filtering-type intra-vas device in male dogs.

BACKGROUND: To relieve the side effects induced by the complete obstruction of the vas deferens, we created a filtering-type intra-vas device (IVD) which is made of materials composed of nano-SiO(2)-copper complex cross-linking polymer composites. STUDY DESIGN: Eight male beagle dogs were grouped into nonimplanted control group and IVD-implanted group. We tested the efficacy of the sperm filtering effect of the new IVD material for 12 months and examined the influence of the IVD materials on the cells of the vas deferens, epididymis and testis. RESULTS: The densities of sperm were reduced significantly after the IVD was implanted; no motile sperm were found after the third month. No obvious morphological changes were found in the cells of the vas deferens, epididymis and testis in the IVD-implanted group. CONCLUSIONS: The filtering-type nano-SiO(2)-copper complex/polymer composite IVD is able to filter the sperm of the male dogs, and the IVD material did not cause obvious damage to the cells of the male reproductive organs after 1 year of implantation.