Disclosure of Sexual Orientation Among Women Who Have Sex With Women During Gynecological Care: A Qualitative Study In Brazil.

BACKGROUND: Evidence shows that women who have sex with women (WSW) face disparities in access to health care when compared to heterosexual women in several countries. AIM: To investigate the experiences WSW have after disclosure of sexual orientation during gynecological care in Brazil. METHODS: We performed a qualitative study using content analysis. We recorded and transcribed interviews with 34 WSW from the 5 regions in Brazil. Data were analyzed using descriptive content analysis. OUTCOMES: The main categories of analysis were decision-making process to disclose and attitude of gynecologists after disclosure. RESULTS: WSW disclosed their sexual orientation in an un-favorable environment. Gynecologists rarely asked about patients' sexual orientation and used a script for hetero-normative anamnesis. The reactions of gynecologists were discriminatory, resulting in abbreviated consultations and un-comfortable gynecological exams. They missed a window of opportunity for prevention, diagnosis, and treatment of various diseases. The experiences Brazilian WSW had during gynecological care demonstrated the dominant hetero-normativity in the health care scenario. The attitudes of the gynecologists precarized the existence of WSW in health service. CLINICAL IMPLICATIONS: This study suggests that gynecologists missed an opportunity to use WSW's sexual orientation disclosure to offer specific care to them. STRENGTHS & LIMITATIONS: This is the first qualitative study about WSW's experiences during gynecological care in Brazil. Future studies should be developed from a wider sampling, especially among lower-class WSW. CONCLUSION: The results point out the need for a change in medical training and guidelines to assist WSW in the country. Rufino AC, Madeiro A, Trinidad AS, et al. Disclosure of Sexual Orientation Among Women Who Have Sex With Women During Gynecological Care: A Qualitative Study In Brazil. J Sex Med 2018;15:966-973.

Incidence and determinants of severe maternal morbidity: a transversal study in a referral hospital in Teresina, Piaui, Brazil.

BACKGROUND: Maternal near miss (MNM) investigation is a useful tool for monitoring standards for obstetric care. This study evaluated the prevalence and the determinants of severe maternal morbidity (SMM) and MNM in a tertiary referral hospital in Teresina, Piauí, Brazil. METHODS: A transversal and prospective study was conducted between September 2012 and February 2013. The cases were included according to criteria established by the WHO. Odds ratio, their respective confidence intervals, and multivariate analyses were examined. RESULTS: Five thousand eight hundred forty one live births, 343 women with SMM, 56 cases of MNM, and 10 maternal deaths were investigated. The rate for severe maternal outcomes was 11.2 cases per 1000 live births, the rate of MNM was 9.6 cases/1000 live births, and the rate for mortality was 171.2 cases/100,000 live births. Management criteria were most frequently observed among MNM/death cases. Hypertensive diseases (86.1%) and hemorrhagic complications (10.0%) were the main determinants of MNM, but infectious abortion was the most common isolated cause of maternal death. There was a correlation between MNM/death and hospitalized more than 5 days (p = 0.023) and between termination of pregnancy by cesarean (p = 0.002) and APGAR < 7 in the 1(st) minute (p = 0.015). CONCLUSIONS: SMM and MNM were quite prevalent in the population studied. Women whose condition progressed to MNM/death had a higher association with terminating pregnancy by cesarean, longer hospitalization times, and worse perinatal results. The results from the study can be useful to improve the quality of obstetric care and consequently diminish maternal mortality in the region.

Sexuality education in Brazilian medical schools.

INTRODUCTION: Sexuality education has been valued since the 1960s in medical schools worldwide. Although recent studies reaffirm the importance of incorporating sexuality into medical education, there are data gaps concerning how this happens in Brazil. AIM: To understand how Brazilian medical school professors teach sexuality in undergraduate courses. METHODS: An exploratory, cross-sectional descriptive study was conducted. A total of 207 professors from 110 Brazilian medical schools responded to an online semistructured questionnaire about the characteristics of the sexuality-related topics offered. MAIN OUTCOME MEASURES: The main variables assessed were contact hours devoted to sexuality, disciplines in which sexuality topics were taught, sexuality-related course titles, and sexuality-related topics addressed. Questionnaires were tabulated and analyzed using descriptive statistics for frequency distribution. RESULTS: The response rate to the questionnaire was 77.2%. Almost all professors (96.3%) addressed sexuality-related topics mainly in the third and fourth years as clinical disciplines, with a 6-hour load per discipline. Gynecology was the discipline in which sexuality-related topics were most often taught (51.5%), followed by urology (18%) and psychiatry (15%). Sexuality-related topics were addressed mainly in classes on sexually transmitted diseases and AIDS (62.4%) and on the anatomy and physiology of the reproductive system (55.4%). About 25% of the professors reported teaching courses with a sexuality-related title. There was emphasis on the impact of diseases and sexual habits (87.9%) and sexual dysfunction (75.9%). Less than 50% of professors addressed nonnormative sexuality or social aspects of sexuality. CONCLUSIONS: The teaching of sexuality in Brazilian medical schools occurred in a nonstandardized and fragmented fashion across several disciplines. The topic was incorporated with an organic and pathological bias, with a weak emphasis on the social aspects of sexuality and the variety of human sexual behaviors. The results point to the need for change in the provision of sexuality education in Brazilian medical schools.

Prevalence and factors associated with risky sexual behavior among Brazilian school adolescents. / Prevalência e fatores associados ao comportamento sexual de risco de adolescentes escolares brasileiros.

This article evaluated the prevalence and factors associated with risky sexual behavior (RSB) among Brazilian school adolescents. This is a cross-sectional study with data collected from the National Survey of School Health, 2019 edition, with a representative sample of 7th grade of elementary school to 3rd year of high school Brazilian school adolescents. This work evaluated sociodemographic, behavioral, sexual and reproductive health, mental health, sociability characteristics, medical advice received at school, and body image. RSB was characterized as the non-use of a condom during sexual intercourse. The data were analyzed using hierarchical Poisson regression modeling. The prevalence of RSB was of 40.3%, with the lowest proportion appearing in the North region (37.4%). The highest prevalence of RSB was found among female adolescents, whose first sexual intercourse occurred at 13 years of age or under, who were victims of sexual violence, who practiced bullying, and who used illicit drugs, cigarettes, and alcohol. Those who used a condom during their first sexual intercourse showed the lowest prevalence of RSB. The high prevalence of RSB among Brazilian school adolescents, together with the knowledge of the associated factors, serves to define strategies to favor improvements in the sexual and reproductive health of these young people.

O artigo avaliou a prevalência e fatores associados ao comportamento sexual de risco (CSR) de adolescentes escolares do Brasil. Trata-se de estudo transversal com dados da Pesquisa Nacional de Saúde do Escolar, 2019, com amostra representativa de adolescentes escolares brasileiros do 9º ano do ensino fundamental. Foram avaliadas características sociodemográficas, comportamentais, de saúde sexual e reprodutiva, de saúde mental e de sociabilidade, orientações recebidas na escola e autoimagem corporal. Caracterizou-se o CSR como o não uso de preservativo na última relação sexual. Os dados foram analisados por modelo hierarquizado com regressão robusta de Poisson. A prevalência de CSR foi de 40,3%, com menor proporção na região Norte (37,4%). Houve maior prevalência do CSR entre adolescentes do sexo feminino, cuja primeira relação sexual ocorreu com 13 anos ou menos, que foram vítimas de violência sexual, que praticaram bullying e que usaram drogas ilícitas, cigarro e álcool. Aqueles que usaram preservativo na primeira relação sexual apresentaram menor prevalência de CSR. A alta prevalência de CSR entre adolescentes escolares no Brasil, aliada ao conhecimento dos fatores associados, deve propiciar o estabelecimento de estratégias para favorecer a melhoria na saúde sexual e reprodutiva desses jovens.

Prevalence of sexual initiation and associated factors in school adolescents in Piauí, Brazil, 2015.

OBJECTIVE: to analyze prevalence of sexual initiation and associated factors in adolescents in Piauí. METHODS: this was a cross-sectional study, with secondary data from the 2015 National Adolescent School-based Health Survey. Hierarchical analysis was performed using robust Poisson regression. RESULTS: a total of 3.872 adolescents were interviewed. Prevalence of sexual initiation was 24.2%; risk factors for sexual initiation were being male [prevalence ratio (PR) = 2.18; 95% confidence interval (95%CI) 1.90;2.47], being 15 years old or over (PR = 2.49; 95%CI 2.18;2.76), living with mother (PR = 0.68; 95%CI 0.54;0.82), working (PR = 1.82; 95%CI 1.55;2.10), attending a public school (PR = 1.39; 95%CI 1.09;1.75), practicing bullying (PR = 1.50; 95%CI 1.31;1.72), using alcohol (PR = 2.35; 95%CI 2.09;2.64), using cigarettes (PR = 1.46; 95%CI 1.22;1.70) and using illicit drugs (PR = 1.40; 95%CI 1.15;1.66). CONCLUSION: prevalence of sexual initiation was high and associated with sociodemographic characteristics and vulnerable health behaviors, indicating the need for health promotion strategies.

Experiences of Violence Against Lesbian and Bisexual Women in Brazil.

BACKGROUND: Lesbophobia and biphobia are manifestations of homophobic violence directed at lesbian and bisexual women that results in daily violation of rights and social exclusion. AIM: To describe experiences of the violence against lesbian and bisexual women in Brazil. METHODS: Sequential mixed methods study was carried out in 2 stages. In the first one, quantitative, an electronic questionnaire was applied to women from all regions, with questions about sociodemographic characteristics, self-identification and lesbophobic and biphobic events. In the second one, qualitative, lesbian, and bisexual women were interviewed face to face about the violence suffered. OUTCOMES: The chi-square test was applied to compare violence against lesbian and bisexual women (type of violence, place of aggression, gender and age range of the aggressor, bond with the aggressor, repetition of violence, and denunciation of violence) and the content analysis for qualitative data (main categories of analysis were events of violence, denunciation, and consequences of violence). RESULTS: The report of violence was present in 65% of the answers. There was a predominance of psychological violence (39.8%), in the public environment (63%), practiced by men (73.2%), by strangers (66.2%) and repeatedly (82%). Lesbian women, compared to bisexuals, were more prone to violence in the public environment (59.5% vs 39.5%) and with repetition (84.3% vs 60.6%). The narratives explained intimidating experiences in the family environment (insults, threat of suicide or homicide and false imprisonment) and public (harassment, beatings, and rape). Discriminatory attitudes, insults, and refusal of service in restaurants and bars were recurrent. CLINICAL IMPLICATIONS: The data provide information that can serve to improve policy initiatives to reduce these episodes. STRENGTHS AND LIMITATIONS: This is the first study of mixed methods, with national coverage, on lesbophobia and biphobia events in Brazil. Future studies should include women underrepresented in this research as trans women, non-white, less educated, and from the most distant regions of the country. CONCLUSION: Lesbophobic or biphobic event has harmful repercussions for multiple aspects of these women's lives, including mental health. Rufino AC, Filho CEWBdeC, Madeiro A. Experiences of Violence Against Lesbian and Bisexual Women in Brazil. Sex Med 2022;10:100479.

Female homicides in the state of Maranhão, Brazil, 2000-2019: an ecological study. / Homicídios femininos no Maranhão, Brasil, 2000-2019: estudo ecológico.

OBJECTIVE: To analyze the profile and temporal trends of female homicides in Maranhão, Brazil, between 2000 and 2019. METHODS: This was an ecological study using data from the Mortality Information System. The profile of the deaths, mortality rate trends (joinpoint method) and correlation with socioeconomic and health indicators (Pearson correlation) were evaluated. RESULTS: 1,915 female homicides were reported, with predominance among those between 20-29 years old (29.9%), single (62.0%), with 4-7 years schooling (29.7%), mixed race (71.3%), homicides at home (31.9%) and by firearms (41.1%). The mortality rate showed a rising trend (APC = +8.21; 95%CI 5.18;10.28). There was negative correlation between homicides and per capita income (p-value = 0.031) and positive correlation with the proportion of families headed by women (p-value = 0.001) and with the rate of male mortality due to assault (p-value = 0.001). CONCLUSION: There was an increase in female homicides, related to structural violence in society, poverty and women with greater family authority.

Disrespect and abuse during childbirth in maternity hospitals in Piauí, Brazil: A cross-sectional study.

OBJECTIVES: To assess the prevalence and associated factors of disrespect and abuse during childbirth in Piauí, Brazil. METHODS: A cross-sectional study was performed with 698 postpartum women in 21 maternity hospitals in 14 municipalities between August 2018 and September 2019. Face-to-face interviews were performed at least 6 h after birth, with an assessment of disrespect and abuse during childbirth. Robust Poisson regression was used, with calculation of the adjusted prevalence ratio (aPR) and 95% confidence intervals (95% CIs). RESULTS: There was evidence that 19.8% of women experienced at least one type of disrespect and abuse during childbirth, with verbal abuse (12.6%), noncompliance with professional standards (11.6%), and health service restrictions being more common (8.3%). There was an association of disrespect and abuse during childbirth with women aged 10 to 19 years (aPR, 1.97; 95% CI, 1.58-2.44), absence of companions (aPR, 2.43; 95% CI, 1.85-2.89), cesarean sections after labor (aPR, 2.19; 95% CI, 1.64-3.59), public hospitals (aPR, 1.87; 95% CI, 1.42-2.85), and in the countryside (aPR, 2.29; 95% CI, 1.81-3.98). CONCLUSION: There was a high prevalence of disrespect and abuse during childbirth in Piauí, Brazil, associated with structural conditions of the services, care practices, and characteristics of women.

Sexual Function and Associated Factors in Postmenopausal Women.

OBJECTIVE: To assess the sexual function and associated factors in postmenopausal women. METHODS: This a descriptive, cross-sectional study with 380 women aged 40 to 65 years, users of public health services in 2019. Questionnaires were applied on demographic characteristics, on climacteric symptoms (menopause rating scale) and on sexual function (sexual quotient, female version). Bivariate and multiple analyses by logistic regression were performed, with adjusted odds ratios (ORad) and 95% confidence intervals (95%CIs). RESULTS: More than half (243/64%) of the participating women were at risk of sexual dysfunction, with lower scores in the domains of sexual desire and interest, comfort, orgasm, and satisfaction. Women with a partner (ORad 2.07; 95%CI 1.03-4.17) and those who reported sleep problems (ORad 2.72; 95%CI 1.77-4.19), depressed mood (ORad 2.03; 95%CI 1.32-3.10), sexual complaints (ORad 8.16; 95%CI 5.06-13.15), and vaginal dryness (ORad 3.44; 95%CI 2.22-5.32) showed greater chance of sexual dysfunction. CONCLUSION: There was a high prevalence of sexual dysfunction, with the influence of conjugality and climacteric symptoms on sexual function.

OBJETIVO: Avaliar a função sexual e fatores associados em mulheres na pós-menopausa. MéTODOS: Este é um estudo descritivo, transversal, com 380 mulheres de 40 a 65 anos, usuárias de serviços de saúde públicos em 2019. Foram aplicados questionários sobre características demográficas, sobre sintomas climatéricos (menopause rating scale) e sobre a função sexual (Quociente Sexual, versão feminina). Análises bivariada e múltipla por regressão logística foram realizadas, com cálculo de odds ratio ajustado (ORaj) e intervalos de confiança de 95% (ICs95%). RESULTADOS: Mais da metade (243/64%) das mulheres participantes no estudo apresentou risco de disfunção sexual, com escores mais baixos dos domínios desejo e interesse sexual, conforto, orgasmo e satisfação. Mulheres com companheiro (ORaj 2,07; IC95% 1,03­4,17) e aquelas que relataram problemas de sono (ORaj 2,72; IC95% 1,77­4,19), ânimo depressivo (ORaj 2,03; IC95% 1,32­3,10), queixas sexuais (ORaj 8,16; IC95% 5,06­13,15) e ressecamento vaginal (ORaj 3,44; IC95% 2,22­5,32) apresentaram maior chance de disfunção sexual. CONCLUSãO: Houve prevalência elevada de disfunção sexual, com influência da conjugalidade e dos sintomas climatéricos sobre a função sexual.

Prevalência e fatores associados ao comportamento sexual de risco de adolescentes escolares brasileiros / Prevalence and factors associated with risky sexual behavior among Brazilian school adolescents

Resumo O artigo avaliou a prevalência e fatores associados ao comportamento sexual de risco (CSR) de adolescentes escolares do Brasil. Trata-se de estudo transversal com dados da Pesquisa Nacional de Saúde do Escolar, 2019, com amostra representativa de adolescentes escolares brasileiros do 9º ano do ensino fundamental. Foram avaliadas características sociodemográficas, comportamentais, de saúde sexual e reprodutiva, de saúde mental e de sociabilidade, orientações recebidas na escola e autoimagem corporal. Caracterizou-se o CSR como o não uso de preservativo na última relação sexual. Os dados foram analisados por modelo hierarquizado com regressão robusta de Poisson. A prevalência de CSR foi de 40,3%, com menor proporção na região Norte (37,4%). Houve maior prevalência do CSR entre adolescentes do sexo feminino, cuja primeira relação sexual ocorreu com 13 anos ou menos, que foram vítimas de violência sexual, que praticaram bullying e que usaram drogas ilícitas, cigarro e álcool. Aqueles que usaram preservativo na primeira relação sexual apresentaram menor prevalência de CSR. A alta prevalência de CSR entre adolescentes escolares no Brasil, aliada ao conhecimento dos fatores associados, deve propiciar o estabelecimento de estratégias para favorecer a melhoria na saúde sexual e reprodutiva desses jovens.

Abstract This article evaluated the prevalence and factors associated with risky sexual behavior (RSB) among Brazilian school adolescents. This is a cross-sectional study with data collected from the National Survey of School Health, 2019 edition, with a representative sample of 7th grade of elementary school to 3rd year of high school Brazilian school adolescents. This work evaluated sociodemographic, behavioral, sexual and reproductive health, mental health, sociability characteristics, medical advice received at school, and body image. RSB was characterized as the non-use of a condom during sexual intercourse. The data were analyzed using hierarchical Poisson regression modeling. The prevalence of RSB was of 40.3%, with the lowest proportion appearing in the North region (37.4%). The highest prevalence of RSB was found among female adolescents, whose first sexual intercourse occurred at 13 years of age or under, who were victims of sexual violence, who practiced bullying, and who used illicit drugs, cigarettes, and alcohol. Those who used a condom during their first sexual intercourse showed the lowest prevalence of RSB. The high prevalence of RSB among Brazilian school adolescents, together with the knowledge of the associated factors, serves to define strategies to favor improvements in the sexual and reproductive health of these young people.

Prevalence and factors associated with breastfeeding in the first hour of life: a cross-sectional study / Prevalencia y factores asociados a la lactancia en la primera hora de vida: estudio transversal / Prevalência e fatores associados à amamentação na primeira hora de vida: estudo transversal

ABSTRACT Objective: To analyze the prevalence and factors associated with breastfeeding in the first hour of life. Methods: Cross-sectional study made with postpartum women who were patients at public maternity hospitals in the city of Teresina, Piauí, Brazil, between 2020-2021. Aspects such as sociodemographic and behavioral data of the woman and her intimate partner, obstetric characteristics, in addition to intimate partner violence during pregnancy were evaluated. A hierarchical analysis was performed using multiple logistic regression, in which the adjusted odds ratio (AOR) and 95% confidence intervals (CI95%) were calculated. Results: 413 women were interviewed. There was a 66.8% prevalence of breastfeeding in the first hour of life. Factors such as the presence of a companion (AOR=1.66; CI95% 1.34-2.29), skin-to-skin contact with the newborn (AOR=2.14; CI95% 1.04-4.38) and experiencing a natural birth (AOR=2.06; CI95% 1.90-4.73) increased the chances of breastfeeding in the first hour. The lack of a partner (AOR=0.47; CI95% 0.25-0.86) and having a non-white partner (AOR=0.45; CI95% 0.24-0.83) were factors that decreased the chances of breastfeeding. Conclusions: The prevalence of breastfeeding in the first hour of life was considered good. Obstetric and childbirth care factors contributed positively to the practice of breastfeeding. The collected data reinforce the importance of offering quality assistance during the parturition process.

RESUMEN Objetivo: Analizar la prevalencia y los factores asociados a la lactancia materna en la primera hora de vida. Método: Estudio transversal con puérperas de maternidades públicas de Teresina, Piauí, Brasil, entre 2020 y 2021. Se evaluaron datos sociodemográficos y conductuales de la mujer y su pareja, características obstétricas, además de la violencia de pareja durante el embarazo. El análisis jerárquico se realizó mediante regresión logística múltiple, con cálculo de odds ratio ajustado (ORaj) e intervalos de confianza del 95% (IC95%). Resultados: se entrevistó a 413 mujeres. Hubo una prevalencia de lactancia materna en la primera hora de vida del 66,8%. La presencia de acompañante (ORaj=1,66; IC95% 1,34-2,29), el contacto piel con piel con el recién nacido (ORaj=2,14; IC95% 1,04-4,38) y haber tenido un parto natural (ORaj=2,06; IC95% 1,90-4,73) aumentaron las posibilidades de amamantamiento en la primera hora. La falta de pareja (ORaj=0,47; IC95% 0,25-0,86) y la pareja con piel no blanca (ORaj=0,45; IC95% 0,24-0,83) disminuyeron las posibilidades de lactancia materna. Conclusiones: La prevalencia de lactancia materna en la primera hora de vida se consideró buena. Los factores relacionados con la atención obstétrica y con el parto contribuyeron positivamente a la lactancia materna. Los datos refuerzan la importancia de ofrecer una asistencia de calidad durante el proceso de parto.

RESUMO Objetivo: Analisar a prevalência e fatores associados à amamentação na primeira hora de vida. Métodos: Estudo transversal com puérperas de maternidades públicas de Teresina, Piauí, Brasil, entre 2020-2021. Foram avaliados dados sociodemográficos e comportamentais da mulher e do parceiro íntimo, características obstétricas, além da violência por parceiro íntimo na gravidez. Realizou-se análise hierarquizada por regressão logística múltipla, com cálculo de odds ratio ajustada (ORaj) e intervalos de confiança de 95% (IC95%). Resultados: Foram entrevistadas 413 mulheres. Houve prevalência de amamentação na primeira hora de vida de 66,8%. A presença de acompanhante (ORaj=1,66; IC95% 1,34-2,29), o contato com pele a pele com o recém-nascido (ORaj=2,14; IC95% 1,04-4,38) e ter parto normal (ORaj=2,06; IC95% 1,90-4,73) aumentaram as chances de amamentação na primeira hora. Ausência de parceria (ORaj=0,47; IC95% 0,25-0,86) e parceria com pele não branca (ORaj=0,45; IC95% 0,24-0,83) diminuíram as chances de amamentar. Conclusões: A prevalência da amamentação na primeira hora de vida foi considerada boa. Fatores obstétricos e de assistência ao parto contribuíram positivamente para o aleitamento materno. Os dados reforçam a importância de ofertar assistência de qualidade no processo de parturição.

Sexual practices and health care of women who have sex with women: 2013-2014. / Práticas sexuais e cuidados em saúde de mulheres que fazem sexo com mulheres: 2013-2014.

OBJECTIVE: to describe sexual practices and health care of women who have sex with women (WSW). METHODS: this was a cross-sectional study with data obtained by means of an electronic questionnaire answered by WSW from the five regions of the country (2013-2014). RESULTS: among 582 WSW, oral sex (95.2%) and digital penetration of the vagina (97.3%) were predominant, with rare use of barrier methods (6.7% and 5.8%, respectively); in the last five years, women who had sex exclusively with women, compared to those who had sex with women and men, were less likely to use barrier methods with women (28.3% versus 41.1%; p=0.041), less likely to have an annual check-up with a gynecologist (38.9% vs. 70.8%; p=0.033), less likely to receive guidance about sexually transmitted infections (STI) (44.0% vs. 59.1%; p=0.034) and about sexual doubts (50.0% vs. 63.0%; p=0.044). CONCLUSION: infrequent use of barrier methods may be a vulnerability factor for STI; it highlights the importance of guidelines for adequate health care for WSW.

Prevalência e fatores associados à iniciação sexual em adolescentes escolares do Piauí, 2015 / Prevalência y factores asociados a la iniciación sexual en adolescentes escolares de Piauí, Brasil, 2015 / Prevalence of sexual initiation and associated factors in school adolescents in Piauí, Brazil, 2015

Objective: to analyze prevalence of sexual initiation and associated factors in adolescents in Piauí. Methods: this was a cross-sectional study, with secondary data from the 2015 National Adolescent School-based Health Survey. Hierarchical analysis was performed using robust Poisson regression. Results: a total of 3.872 adolescents were interviewed. Prevalence of sexual initiation was 24.2%; risk factors for sexual initiation were being male [prevalence ratio (PR) = 2.18; 95% confidence interval (95%CI) 1.90;2.47], being 15 years old or over (PR = 2.49; 95%CI 2.18;2.76), living with mother (PR = 0.68; 95%CI 0.54;0.82), working (PR = 1.82; 95%CI 1.55;2.10), attending a public school (PR = 1.39; 95%CI 1.09;1.75), practicing bullying (PR = 1.50; 95%CI 1.31;1.72), using alcohol (PR = 2.35; 95%CI 2.09;2.64), using cigarettes (PR = 1.46; 95%CI 1.22;1.70) and using illicit drugs (PR = 1.40; 95%CI 1.15;1.66). Conclusion: prevalence of sexual initiation was high and associated with sociodemographic characteristics and vulnerable health behaviors, indicating the need for health promotion strategies.

Objetivo: analizar prevalencia y factores asociados a la iniciación sexual de adolescentes en Piauí. Métodos: estudio transversal, con datos de la Encuesta Nacional de Salud Adolescente, 2015. Se realizó análisis jerárquico mediante regresión robusta de Poisson. Resultados: han sido entrevistados 3.872 adolescentes. Hubo prevalencia de iniciación sexual del 24,2%, estando asociada con ser hombre (RP = 2,18; IC95% 1,90;2,47), tener 15 años o más (RP = 2.49; IC95% 2,18;2,76), vivir con la madre (RP = 0,68; IC95% 0,54;0,82), trabajar (RP = 1.82; IC95% 1,55;2,10), estudiar en escuela pública (RP = 1,39; IC95% 1,09;1,75), practicar bullying (RP = 1,50; IC95% 1,31;1,72), consumir alcohol (RP = 2.35; IC95% 2,09;2,64), consumir cigarrillos (RP = 1,46; IC95% 1,22;1,70) y consumir drogas ilícitas (RP = 1,40; IC95% 1,15;1,66). Conclusión: la prevalencia de iniciación sexual fue alta y se asoció con comportamientos vulnerables a la salud y características sociodemográficas, indicando estrategias para de promoción de la salud.

Objetivo: analisar prevalência e fatores associados à iniciação sexual de adolescentes do Piauí. Métodos: estudo transversal, com dados da Pesquisa Nacional de Saúde do Escolar, 2015. Realizou-se análise hierarquizada por regressão de Poisson. Resultados: foram entrevistados 3.872 adolescentes. A prevalência de iniciação sexual foi de 24,2%; sexo masculino [razão de prevalência (RP) = 2,18; intervalo de confiança de 95% (IC95%) 1,90;2,47], idade ≥ 15 anos (RP = 2,49; IC95% 2,18;2,76), morar com a mãe (RP = 0,68; IC95% 0,54;0,82), trabalhar (RP = 1,82; IC95% 1,55;2,10). estudar em escola pública (RP = 1,39; IC95% 1,09;1,75), praticar bullying (RP = 1,50; IC95% 1,31;1,72), usar álcool (RP = 2,35; IC95% 2,09;2,64), cigarro (RP = 1,46; IC95% 1,22;1,70) e drogas ilícitas (RP = 1,40; IC95% 1,15;1,66) foram fatores de risco para o evento. Conclusão: a prevalência de iniciação sexual foi alta e associada a características sociodemográficas e comportamentos vulneráveis à saúde, demandando estratégias de promoção de saúde.

Violência sexual contra mulheres estudantes em escolas médicas / Sexual violence against female students in medical schools

Resumo: Introdução: No mundo todo, a violência sexual é um evento prevalente contra mulheres estudantes de Medicina. A exposição ao toque, o contato físico e as incitações sexuais inoportunas podem ocorrer em vários ambientes da educação e da prática médica. Objetivo: Este estudo teve como objetivo analisar a violência sexual contra mulheres estudantes em escolas médicas. Método: Trata-se de estudo transversal realizado com 211 alunas de oito escolas médicas do Piauí, entrevistadas entre maio e novembro de 2021. Utilizou-se questionário on-line com perguntas sobre características sociodemográficas, informações da instituição e do curso, e aspectos relacionados à violência sexual no âmbito universitário. Realizou-se análise multivariada por regressão logística múltipla, com cálculo de odds ratios ajustadas (ORaj) e intervalos de confiança de 95% (IC95%). Resultado: Mais da metade (55%) das estudantes relatou algum tipo de violência sexual durante o curso de Medicina, mais frequentemente como evento único (69,3%). Comentários sexistas ou sexualmente degradantes (87,8%), ocorridos em ambientes de prática (55,3%), no primeiro e segundo anos do curso (65,8%) e em disciplinas do ciclo básico (63,0%) foram mais frequentes. O perfil majoritário dos agressores é representado por homens (99,0%), com mais de 40 anos (60,4%) e professores (59,3%). A violência sexual resultou em sofrimento emocional (47,3%) e queda da produtividade/qualidade do estudo (25%), porém a maioria não realizou denúncia (92,9%). Houve maior chance de violência sexual contra estudantes que se autodeclararam bissexuais (ORaj =3,87; IC95% 1,20-12,48) e de instituições de ensino públicas (ORaj = 3,12; IC95% 1,67-5,82). Conclusão: A prevalência de violência sexual durante o ensino médico foi elevada, revelada principalmente sob a forma de assédio sexual. Orientação sexual e características da instituição de ensino se associaram com a violência sexual. Os achados estimulam ações para prevenir e mitigar essa grave questão durante o ensino médico.

Abstract: Introduction: Sexual violence is a prevalent event against female medical students around the world. Exposure to touch, physical contact, and unwelcome sexual incitements can occur in a variety of educational and medical practice settings. Objective: To analyze sexual violence against female students in medical schools. Method: Cross-sectional study with 211 students from 8 medical schools in Piauí, interviewed between May and November 2021. An online questionnaire was used with questions about sociodemographic characteristics, information about the institution and the course, and aspects related to sexual violence at the university level. Multivariate analysis was performed using multiple logistic regression, with calculation of adjusted odds ratios (AOR) and 95% confidence intervals (95%CI). Result: More than half (55.0%) of the students reported some type of sexual violence during the medical course, more often as a single event (69.3%). Sexist or sexually degrading comments (87.8%), occurring in practice environments (55.3%), in the 1st and 2nd years of the course (65.8%) and in basic cycle subjects (63.0%) were more frequently. The profile of the majority of aggressors is represented by men (99.0%), over 40 years old (60.4%) and teachers (59.3%). Sexual violence resulted in emotional distress (47.3%) and reduced productivity/quality of study (25%), but the majority failed to report it (92.9%). There was a greater chance of sexual violence against students who self-reported as bisexual (AOR=3.87; 95%CI 1.20-12.48) and at public educational institutions (AOR=3.12; 95%CI 1.67-5.82). Conclusion: The prevalence of sexual violence during medical education was high, mainly revealed in the form of sexual harassment. Sexual orientation and educational institution characteristics were associated with sexual violence. The findings stimulate actions to prevent and mitigate this serious issue during medical education.

[Maltreatment and discrimination in induced abortion care: perception of women in Teresina, State of Piauí, Brazil]. / Maus-tratos e discriminação na assistência ao aborto provocado: a percepção das mulheres em Teresina, Piauí, Brasil.

Treatment of complications resulting from induced abortion may be hampered by discriminatory attitudes manifested by healthcare professionals in hospitals and abortion services. This article retrieved stories of institutional abuse directed at women who had an induced abortion in illegal and unsafe conditions. Seventy-eight women admitted to a public hospital in Teresina for complications after an induced abortion were interviewed. A semi-structured script was used with questions about practices and itineraries of abortion and institutional violence during hospitalization. Discriminatory practices and maltreatment during care were reported by 26 women, especially among those who confessed to induction of the abortion. Moral judgement, threat of filing a complaint to the police, negligence in the control of pain, long wait for uterine curettage, and hospitalization with mothers who have recently given birth were the main types of institutional violence reported by women. Cases of institutional violence in the care of induced abortion violates the duty of the healthcare service and prevents women from receiving the necessary health care.

Cobertura e fatores associados à não realização do exame citopatológico do colo do útero entre mulheres brasileiras de 18 a 39 anos / Pap test coverage and factors associated with non-performing among Brazilian women aged 18-39

Objetivos: avaliar a cobertura e os fatores associados à não realização do exame citopatológico do colo do útero entre mulheres de 18 a 39 anos no Brasil. Métodos: estudo transversal, de base populacional, com dados de inquérito domiciliar com 2.002 mulheres alfabetizadas de áreas urbanas, selecionadas por amostragem aleatória por conglomerados em 2016. Foram avaliados a prática do exame nos três anos anteriores e os fatores associados à não realização, com cálculo de razão de prevalência ajustada (RPaj) e intervalos de confiança de 95% (IC95%) por regressão de Poisson. Resultados: a cobertura do exame entre mulheres de 18-39 anos foi de 66,5%, sendo mais elevada naquelas de 35-39 anos (76,8%). Mulheres com renda familiar até 1 salário-mínimo (RPaj=2,08;IC95% 1,72-2,54), que estudaram até a 4a série (RPaj=2,30;IC95% 1,22-2,67), residentes na região Nordeste (RPaj=1,79;IC95% 1,34-2,09) e em municípios com até 20.000 habitantes (RPaj=3,15;IC95% 2,33-3,96) apresentaram maior prevalência de não realização do exame. Conclusão: a cobertura do exame citopatológico esteve abaixo do recomendado, com disparidades socioeconômicas e geográficas. Os dados sugerem necessidade de oportunizar o rastreamento entre mulheres jovens de maior risco para o câncer do colo do útero.

Objectives: to evaluate the coverage and factors associated with non-performing Pap smear test among women aged 18-39 years in Brazil. Methods: cross-sectional, population-based study with household survey data with 2,002 literate women from urban areas, selected by random sampling by clusters in 2016. The practice of Pap test in the previous three years and associated factors with non-participation were evaluated, with calculation of adjusted prevalence ratio (PRad) and 95% confidence intervals (95%CI) by Poisson regression. Results: coverage of Pap tests among women 18-39 years was 66.5%, being higher in those aged 35-39 years (76.8%). Women with a family income up to 01 minimum wage (PRad=2.08; 95%CI 1.72-2.54), who studied up to 4th grade (PRad=2.30; 95%CI 1.22-2.67) and residents in the Northeast region (PRad=1.79; 95%CI 1.34-2.09) and in municipalities up to 20,000 inhabitants (PRad=3.15; 95%CI 2.33-3.96) had a higher prevalence of non-participation in screening. Conclusions: the coverage of the Pap smear test was below recommended, with socioeconomic and geographical disparities. The data suggest the need to provide screening among young women at higher risk for cervical cancer.

Cesarean sections in Piauí State: trend and associated factors in the period 2000-2011, Brazil. / Partos cesáreos no Piauí: tendência e fatores associados no período 2000-2011.

OBJECTIVE: to analyze trends in cesarean sections proportion and associated factors in Piauí State, Brazil, from 2000 to 2011. METHODS: this is a time series and cross-sectional study, with data of all institutional childbirths in primiparous, recorded on the Information System on Live Births (Sinasc). RESULTS: cesarean sections proportion increased from 34.4% in 2000 to 52.1% in 2011 (annual percentage change +4.4; 95%CI 3.6;5.1); white-skinned women (PR=1.72; 95%CI 1.63;1.86), over 40 years (PR=2.17; 95%CI 2.09;2.28), with more than 12 years of schooling (PR=1.86; 95%CI 1.77;1.96), who attended 7 or more prenatal care appointments (PR=2.08; 95%CI 1.97;2.18), residents in municipalities with over 300,000 inhabitants (PR=1.68; 95%CI 1.62;1.80) and with higher Human Development Index (PR=1.61; 95%CI 1.51;1.73) presented the highest cesarean sections proportion. CONCLUSIONS: the occurrence of cesarean sections was high and more frequent in women with low obstetric risk.

Homicídios femininos no Maranhão, Brasil, 2000-2019: estudo ecológico / Homicidios de mujeres en el estado de Maranhão, Brasil, 2000-2019: estudio ecológico / Female homicides in the state of Maranhão, Brazil, 2000-2019: an ecological study

Objetivo: Analisar o perfil e tendência temporal dos homicídios femininos no Maranhão, Brasil, em 2000-2019. Métodos: Estudo ecológico, com dados do Sistema de Informações sobre Mortalidade. Foram avaliados o perfil dos óbitos, tendência das taxas de mortalidade (método joinpoint) e correlação com indicadores socioeconômicos e de saúde (correlação de Pearson). Resultados: Foram notificados 1.915 homicídios femininos, predominando a idade de 20-29 anos (29,9%), solteiras (62,0%), 4-7 anos de estudo (29,7%), raça/cor da pele parda (71,3%), no domicílio (31,9%), por arma de fogo (41,1%). A tendência das taxas de mortalidade foi crescente (VPA = +8,21; IC95% 5,18;10,28). Observou-se correlação negativa dos homicídios com renda per capita (p-valor = 0,031), e positiva com proporção de famílias chefiadas por mulheres (p-valor = 0,001) e taxa de mortalidade masculina por agressão (p-valor = 0,001). Conclusão: Houve crescimento dos homicídios femininos, relacionados com violência estrutural na sociedade, pobreza e mulheres com maior autoridade familiar.

Objetivo: Analizar el perfil y la tendencia temporal de los homicidios de mujeres en Maranhão entre 2000-2019. Métodos: Estudio ecológico, con datos del Sistema de Información de Mortalidad. Se evaluó el perfil de muertes, la tendencia de las tasas de mortalidad (método joinpoint) y la correlación con indicadores socioeconómicos y de salud (correlación de Pearson). Resultados: Ocurrieron 1.915 homicidios de mujeres, con predominio entre los 20-29 años (29,9%), solteras (62,0%), con 4-7 años de estudio (29,7%), raza/color de piel parda (71,3%), en casa (31,9%) y por arma de fuego (41,1%). La tendencia de las tasas de mortalidad fue creciente (VPA = +8,21; IC95% 5,18;10,28). Hubo correlación negativa entre homicidios e ingreso per capita (p-valor = 0,031) y correlación positiva con proporción de familias encabezadas por mujeres (p-valor = 0,001) y tasa de mortalidad masculina por agresión (p-valor = 0,001). Conclusión: Hubo aumento de los homicidios de mujeres, relacionado con violencia estructural en la sociedad, pobreza y mujeres con mayor autoridad familiar.

Objective: To analyze the profile and temporal trends of female homicides in Maranhão, Brazil, between 2000 and 2019. Methods: This was an ecological study using data from the Mortality Information System. The profile of the deaths, mortality rate trends (joinpoint method) and correlation with socioeconomic and health indicators (Pearson correlation) were evaluated. Results: 1,915 female homicides were reported, with predominance among those between 20-29 years old (29.9%), single (62.0%), with 4-7 years schooling (29.7%), mixed race (71.3%), homicides at home (31.9%) and by firearms (41.1%). The mortality rate showed a rising trend (APC = +8.21; 95%CI 5.18;10.28). There was negative correlation between homicides and per capita income (p-value = 0.031) and positive correlation with the proportion of families headed by women (p-value = 0.001) and with the rate of male mortality due to assault (p-value = 0.001). Conclusion: There was an increase in female homicides, related to structural violence in society, poverty and women with greater family authority.

Analysis of the structural adequacy of maternity hospitals in Piauí, Brazil, 2018-2019 / Análise da adequação estrutural das maternidades do Piauí, Brasil, 2018-2019

Abstract Objectives: to evaluate the structure and adequacy of maternal healthcare facilities in Piauí. Methods: cross-sectional study in 26 hospitals with more than 200 births/year between 2018-2019. The structure was assessed by direct observation and interview with manager, in four domains: physical aspects, human resources, equipment, and drugs. Fisher's chi-square/exact tests were used to assess differences in adequacy of structure. Results: only 46.2% of the maternal healthcare facilities had pre-delivery, parturition and immediate post-partum room. Pediatricians (73.1%) and anesthesiologists (61.5%) were the least present professionals on-duty regime. Regarding drugs, magnesium sulfate and oxytocin were observed in 76.9% of hospitals. Overall adequacy was 23.1%, being higher in maternal healthcare facilities in the capital (p=0.034) and in private ones (p=0.031). Conclusions: Data show inequalities in the structure of maternity hospitals of the state. The absence of health professionals, essential drugs, and appropriate physical structure can expose women and newborns to unnecessary and avoidable risks.

Resumo Objetivos: avaliar a estrutura e adequação das maternidades do Piauí. Métodos: estudo transversal em 26 hospitais com mais de 200 partos/ano entre 2018 e 2019. A estrutura foi avaliada por observação direta e entrevista com gestor, em quatro domínios: aspectos físicos, recursos humanos, equipamentos e medicamentos. Foram empregados os testes do quiquadrado/exato de Fisher para avaliar diferenças na adequação da estrutura. Resultados: apenas 46,2% das maternidades tinham quarto pré-parto, parto e puerpério. Pediatras (73,1%) e anestesistas (61,5%) foram os profissionais menos presentes em regime de plantão. Dos medicamentes, sulfato de magnésio e ocitocina foram observados em 76,9% dos hospitais. A adequação global foi de 23,1%, sendo maior em maternidades da capital (p=0,034) e privadas (p=0,031) Conclusões: os dados exibem desigualdades na estrutura das maternidades do estado. A ausência de profissionais de saúde, medicamentos essenciais e estrutura física apropriada pode expor mulheres e recém-nascidos a riscos desnecessários e evitáveis.

Sexual Function and Associated Factors in Postmenopausal Women / Função sexual e fatores associados em mulheres na pós-menopausa

Abstract Objective To assess the sexual function and associated factors in postmenopausal women. Methods This a descriptive, cross-sectional study with 380 women aged 40 to 65 years, users of public health services in 2019. Questionnaires were applied on demographic characteristics, on climacteric symptoms (menopause rating scale) and on sexual function (sexual quotient, female version). Bivariate andmultiple analyses by logistic regression were performed, with adjusted odds ratios (ORad) and 95% confidence intervals (95%CIs). Results More than half (243/64%) of the participating women were at risk of sexual dysfunction, with lower scores in the domains of sexual desire and interest, comfort, orgasm, and satisfaction. Women with a partner (ORad 2.07; 95%CI 1.03-4.17) and those who reported sleep problems (ORad 2.72; 95%CI 1.77-4.19), depressed mood (ORad 2.03; 95%CI 1.32-3.10), sexual complaints (ORad 8.16; 95%CI 5.06-13.15), and vaginal dryness (ORad 3.44; 95%CI 2.22-5.32) showed greater chance of sexual dysfunction. Conclusion There was a high prevalence of sexual dysfunction, with the influence of conjugality and climacteric symptoms on sexual function.

Resumo Objetivo Avaliar a função sexual e fatores associados em mulheres na pósmenopausa. Métodos Este é umestudo descritivo, transversal, com380 mulheres de 40 a 65 anos, usuárias de serviços de saúde públicos em 2019. Foram aplicados questionários sobre características demográficas, sobre sintomas climatéricos (menopause rating scale) e sobre a função sexual (Quociente Sexual, versão feminina). Análises bivariada e múltipla por regressão logística foram realizadas, com cálculo de odds ratio ajustado (ORaj) e intervalos de confiança de 95% (ICs95%). Resultados Mais da metade (243/64%) das mulheres participantes no estudo apresentou risco de disfunção sexual, com escores mais baixos dos domínios desejo e interesse sexual, conforto, orgasmo e satisfação. Mulheres com companheiro (ORaj 2,07; IC95% 1,03-4,17) e aquelas que relataram problemas de sono (ORaj 2,72; IC95% 1,77-4,19), ânimo depressivo (ORaj 2,03; IC95% 1,32-3,10), queixas sexuais (ORaj 8,16; IC95% 5,06-13,15) e ressecamento vaginal (ORaj 3,44; IC95% 2,22-5,32) apresentaram maior chance de disfunção sexual. Conclusão Houve prevalência elevada de disfunção sexual, com influência da conjugalidade e dos sintomas climatéricos sobre a função sexual.