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Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(11):587-595
To identify the prevalence of maternal morbidity and its socioeconomic, demographic and health care associated factors in a city in Northeastern Brazil.
A cross-sectional and population-based study was conducted, with a design based on multi-stage complex sampling. A validated questionnaire was applied to 848 women aged between 15 and 49 years identified in 8,227 households from 60 census tracts of Natal, the capital of the state of Rio Grande do Norte (RN), Brazil. The main outcome measure was maternal morbidity. The Poisson regression analysis, with 5% significance, was used for the analysis of the associated factors.
The prevalence of maternal morbidity was of 21.2%. A bivariate analysis showed the following variables associated with an increased number of obstetric complications: non-white race (prevalence ratio [PR] =1.23; 95% confidence interval [95%CI]: 1.04-1.46); lower socioeconomic status (PR = 1.33; 95%CI: 1.12-1.58); prenatal care performed in public services (PR = 1.42; 95%CI: 1.16-1.72): women that were not advised during prenatal care about where they should deliver (PR = 1.24; 95%CI: 1.05-1.46); delivery in public services (PR = 1.63; 95%CI: 1.30-2.03); need to search for more than one hospital for delivery (PR = 1.22; 95%CI: 1.03-1.45); and no companion at all times of delivery care (PR = 1.25, 95%CI: 1.05-1.48). The place where the delivery occurred (public or private) and the socioeconomic status remained significant in the final model.
Women in a worse socioeconomic situation and whose delivery was performed in public services had a higher prevalence of maternal morbidity. Such an association reinforces the need to strengthen public policies to tackle health inequalities through actions focusing on these determinants.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(11):587-595
To identify the prevalence of maternal morbidity and its socioeconomic, demographic and health care associated factors in a city in Northeastern Brazil.
A cross-sectional and population-based study was conducted, with a design based on multi-stage complex sampling. A validated questionnaire was applied to 848 women aged between 15 and 49 years identified in 8,227 households from 60 census tracts of Natal, the capital of the state of Rio Grande do Norte (RN), Brazil. The main outcome measure was maternal morbidity. The Poisson regression analysis, with 5% significance, was used for the analysis of the associated factors.
The prevalence of maternal morbidity was of 21.2%. A bivariate analysis showed the following variables associated with an increased number of obstetric complications: non-white race (prevalence ratio [PR] =1.23; 95% confidence interval [95%CI]: 1.04-1.46); lower socioeconomic status (PR = 1.33; 95%CI: 1.12-1.58); prenatal care performed in public services (PR = 1.42; 95%CI: 1.16-1.72): women that were not advised during prenatal care about where they should deliver (PR = 1.24; 95%CI: 1.05-1.46); delivery in public services (PR = 1.63; 95%CI: 1.30-2.03); need to search for more than one hospital for delivery (PR = 1.22; 95%CI: 1.03-1.45); and no companion at all times of delivery care (PR = 1.25, 95%CI: 1.05-1.48). The place where the delivery occurred (public or private) and the socioeconomic status remained significant in the final model.
Women in a worse socioeconomic situation and whose delivery was performed in public services had a higher prevalence of maternal morbidity. Such an association reinforces the need to strengthen public policies to tackle health inequalities through actions focusing on these determinants.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(11):520-525
DOI 10.1590/SO100-720320150005438
To translate, to adapt and to validate the Utian Quality of Life (UQOL) for the Brazilian population.
Women in the climacteric phase, residents in the city of Natal, Rio Grande do Norte, located in the Brazilian Northeast, were randomly selected. UQOL and SF-36 questionnaires were used, and the translation from English to Portuguese was made by three teachers, while the adaptation stage of the translated version was made by applying the questionnaire to 35 women, which could mark the answer choice "I did not understand the question"; reproducibility measurements (test-retest) and construct validity were used to validate, following international methodological standards.
The Brazilian version was fully recognized by the target population, which was comprised of 151 women, as no question showed a percentage of "non-understanding" equal to or greater than 20%. The results for intra and interobserver reproducibility demonstrated significant agreement on all the questionnaire items. This version showed consistency above the required criteria (>70), demonstrating its accuracy, while the construct validity was obtained by statistically significant correlations between the domains occupation, health and emotional of UQOL and the SF-36 domains. The Cronbach's alpha coefficient for the whole instrument was 0.82, representing good accuracy. Item-total correlation analysis showed the scale homogeneity
From the steps taken, the UQOL questionnaire was translated and adapted for its use in Brazil, with high reproducibility and validity. Thus, it can be included and used in Brazilian studies that aim at evaluating the quality of life of women during the peri- and postmenopausal.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(11):520-525
DOI 10.1590/SO100-720320150005438
To translate, to adapt and to validate the Utian Quality of Life (UQOL) for the Brazilian population.
Women in the climacteric phase, residents in the city of Natal, Rio Grande do Norte, located in the Brazilian Northeast, were randomly selected. UQOL and SF-36 questionnaires were used, and the translation from English to Portuguese was made by three teachers, while the adaptation stage of the translated version was made by applying the questionnaire to 35 women, which could mark the answer choice "I did not understand the question"; reproducibility measurements (test-retest) and construct validity were used to validate, following international methodological standards.
The Brazilian version was fully recognized by the target population, which was comprised of 151 women, as no question showed a percentage of "non-understanding" equal to or greater than 20%. The results for intra and interobserver reproducibility demonstrated significant agreement on all the questionnaire items. This version showed consistency above the required criteria (>70), demonstrating its accuracy, while the construct validity was obtained by statistically significant correlations between the domains occupation, health and emotional of UQOL and the SF-36 domains. The Cronbach's alpha coefficient for the whole instrument was 0.82, representing good accuracy. Item-total correlation analysis showed the scale homogeneity
From the steps taken, the UQOL questionnaire was translated and adapted for its use in Brazil, with high reproducibility and validity. Thus, it can be included and used in Brazilian studies that aim at evaluating the quality of life of women during the peri- and postmenopausal.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(3):107-112
DOI 10.1590/S0100-72032014000300003
To evaluate the impact of sexual and reproductive health theme insertion in the undergraduate medical curriculum at a Brazilian public university.
We developed an instrument for cognitive assessment in sexual and reproductive health based on the subjects addressed in the optional curriculum component Reproductive Health, resulting in an objective multiple choice test containing 27 items. The selected topics were: human, sexual and reproductive rights (HSRR), sexuality, institutional violence, gender, sexual violence, conception, contraception, abortion/legal interruption of pregnancy, maternal mortality and sexually transmitted infections (STIs) - HIV/AIDS. The subjects were grouped into three dimensions of knowledge: HSRR, legal/institutional and biomedical. Two multivariate models were adjusted in the analysis of covariance.
The study included 183 students, 127 of the group who took the elective curriculum course reproductive health (RH Group) and 56 who did not (Non-RH Group). Ninety-six students (52.5%) were males and 87 (47.5%) were females. Mean age was 24.7±1.9 years for the RH Group and 24.4±2.6 for the Non-RH Group. The average performance of the SR Group was higher than that of Non-RH subjects regarding the following subjects: HSRR, sexuality, institutional violence, sexual violence, abortion/legal interruption, and STDs - HIV/AIDS. There was no gender difference in performance, except for the theme maternal mortality, in which males scored worse than females (6.9±0.2 and 7.8±0.2, respectively; p<0.05).
The participation of students in the elective curriculum component Reproductive Health was associated with better performance in some dimensions of cognitive assessment, suggesting a positive impact of this initiative on general medical education.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(3):107-112
DOI 10.1590/S0100-72032014000300003
To evaluate the impact of sexual and reproductive health theme insertion in the undergraduate medical curriculum at a Brazilian public university.
We developed an instrument for cognitive assessment in sexual and reproductive health based on the subjects addressed in the optional curriculum component Reproductive Health, resulting in an objective multiple choice test containing 27 items. The selected topics were: human, sexual and reproductive rights (HSRR), sexuality, institutional violence, gender, sexual violence, conception, contraception, abortion/legal interruption of pregnancy, maternal mortality and sexually transmitted infections (STIs) - HIV/AIDS. The subjects were grouped into three dimensions of knowledge: HSRR, legal/institutional and biomedical. Two multivariate models were adjusted in the analysis of covariance.
The study included 183 students, 127 of the group who took the elective curriculum course reproductive health (RH Group) and 56 who did not (Non-RH Group). Ninety-six students (52.5%) were males and 87 (47.5%) were females. Mean age was 24.7±1.9 years for the RH Group and 24.4±2.6 for the Non-RH Group. The average performance of the SR Group was higher than that of Non-RH subjects regarding the following subjects: HSRR, sexuality, institutional violence, sexual violence, abortion/legal interruption, and STDs - HIV/AIDS. There was no gender difference in performance, except for the theme maternal mortality, in which males scored worse than females (6.9±0.2 and 7.8±0.2, respectively; p<0.05).
The participation of students in the elective curriculum component Reproductive Health was associated with better performance in some dimensions of cognitive assessment, suggesting a positive impact of this initiative on general medical education.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(11):477-482
DOI 10.1590/S0100-72032013001100001
PURPOSE: To evaluate the methodological and statistical design evolution of the publications in the Brazilian Journal of Gynecology and Obstetrics (RBGO) from resolution 196/96. METHODS: A review of 133 articles published in 1999 (65) and 2009 (68) was performed by two independent reviewers with training in clinical epidemiology and methodology of scientific research. We included all original clinical articles, case and series reports and excluded editorials, letters to the editor, systematic reviews, experimental studies, opinion articles, besides abstracts of theses and dissertations. Characteristics related to the methodological quality of the studies were analyzed in each article using a checklist that evaluated two criteria: methodological aspects and statistical procedures. We used descriptive statistics and the χ2 test for comparison of the two years. RESULTS: There was a difference between 1999 and 2009 regarding the study and statistical design, with more accuracy in the procedures and the use of more robust tests between 1999 and 2009. CONCLUSIONS: In RBGO, we observed an evolution in the methods of published articles and a more in-depth use of the statistical analyses, with more sophisticated tests such as regression and multilevel analyses, which are essential techniques for the knowledge and planning of health interventions, leading to fewer interpretation errors.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(11):477-482
DOI 10.1590/S0100-72032013001100001
PURPOSE: To evaluate the methodological and statistical design evolution of the publications in the Brazilian Journal of Gynecology and Obstetrics (RBGO) from resolution 196/96. METHODS: A review of 133 articles published in 1999 (65) and 2009 (68) was performed by two independent reviewers with training in clinical epidemiology and methodology of scientific research. We included all original clinical articles, case and series reports and excluded editorials, letters to the editor, systematic reviews, experimental studies, opinion articles, besides abstracts of theses and dissertations. Characteristics related to the methodological quality of the studies were analyzed in each article using a checklist that evaluated two criteria: methodological aspects and statistical procedures. We used descriptive statistics and the χ2 test for comparison of the two years. RESULTS: There was a difference between 1999 and 2009 regarding the study and statistical design, with more accuracy in the procedures and the use of more robust tests between 1999 and 2009. CONCLUSIONS: In RBGO, we observed an evolution in the methods of published articles and a more in-depth use of the statistical analyses, with more sophisticated tests such as regression and multilevel analyses, which are essential techniques for the knowledge and planning of health interventions, leading to fewer interpretation errors.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(11):503-510
DOI 10.1590/S0100-72032013001100005
PURPOSE: To evaluate the quality of life of women with polycystic ovary syndrome (POS) and to learn about the experience of these women regarding the symptoms of their disease. METHODS: The study complementarily employed two methodological approaches - quantitative and qualitative ones. The quality of life of 213 women was evaluated (quantitative approach) using the SF-36 questionnaire. Of these, 109 had POS (Case Group: 26.8±5.4 years of age) and 104 were healthy (Control Group: 23.9±6.7 years of age). Data were analyzed statistically by the Student t-test, the chi-square test and the Pearson correlation test, with the level of significance set at 5%. Fifteen women with POS participated in the quantitative study and were interviewed using a semi-structured questionnaire. The qualitative data were analyzed by the technique of categorical thematic analysis. RESULTS: The women with POS showed impaired quality of life compared to Control (functional capacity: 76.5±20.5 and 84.6±15.9, respectively; physical aspects 56.4±43.3 and 72.6±33.3; general health status: 55.2±21.0 and 62.5±17.2; vitality: 49.6±21.3 and 55.3±21.3; social aspects: 55.3±32.4 and 66.2±26.7; emotional aspects: 34.2±39.7 and 52.9±38.2; mental health: 50.6±22.8 and 59.2±20.2). Regarding the qualitative data, thematic categorical analysis revealed that feelings of "abnormality", sadness, fear and anxiety were associated with the main symptoms of POS, i.e., hirsutism, menstrual irregularity, infertility and obesity. These symptoms affected the social, professional and marital life of these women. CONCLUSION: POS compromises the quality of life of affected women, causing them to feel that they are different from other women. Thus, women with POS do not simply require medical treatment regarding the reproductive, aesthetic and metabolic effects of the disease, but also need multiprofessional care.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(11):503-510
DOI 10.1590/S0100-72032013001100005
PURPOSE: To evaluate the quality of life of women with polycystic ovary syndrome (POS) and to learn about the experience of these women regarding the symptoms of their disease. METHODS: The study complementarily employed two methodological approaches - quantitative and qualitative ones. The quality of life of 213 women was evaluated (quantitative approach) using the SF-36 questionnaire. Of these, 109 had POS (Case Group: 26.8±5.4 years of age) and 104 were healthy (Control Group: 23.9±6.7 years of age). Data were analyzed statistically by the Student t-test, the chi-square test and the Pearson correlation test, with the level of significance set at 5%. Fifteen women with POS participated in the quantitative study and were interviewed using a semi-structured questionnaire. The qualitative data were analyzed by the technique of categorical thematic analysis. RESULTS: The women with POS showed impaired quality of life compared to Control (functional capacity: 76.5±20.5 and 84.6±15.9, respectively; physical aspects 56.4±43.3 and 72.6±33.3; general health status: 55.2±21.0 and 62.5±17.2; vitality: 49.6±21.3 and 55.3±21.3; social aspects: 55.3±32.4 and 66.2±26.7; emotional aspects: 34.2±39.7 and 52.9±38.2; mental health: 50.6±22.8 and 59.2±20.2). Regarding the qualitative data, thematic categorical analysis revealed that feelings of "abnormality", sadness, fear and anxiety were associated with the main symptoms of POS, i.e., hirsutism, menstrual irregularity, infertility and obesity. These symptoms affected the social, professional and marital life of these women. CONCLUSION: POS compromises the quality of life of affected women, causing them to feel that they are different from other women. Thus, women with POS do not simply require medical treatment regarding the reproductive, aesthetic and metabolic effects of the disease, but also need multiprofessional care.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(1):16-21
DOI 10.1590/S0100-72032012000100004
PURPOSE: To analyze and compare the knowledge and opinions of Law and Medical students regarding the issue of abortion in Brazil. METHODS: This was a cross-sectional study involving 125 graduate students from the class of 2010. Of these, 52 were medical students (MED group) and 73 law students (LAW group). A questionnaire was applied based on published research about the topic. Dependent variables were: monitoring the abortion debate, knowledge concerning situations where abortion is permitted under Brazilian law, opinion about situations that agree with extending legal permission to terminate pregnancy and prior knowledge of someone who has undergone induced abortion. Independent variables were: sex, age, household income and graduation course. Statistical analysis: χ² and Fisher's exact tests, with the level of significance set at 5%. RESULTS: Most interviewees reported monitoring the debate on abortion in Brazil (67.3% of the MED group and 70.2% of the LAW group, p>0.05). When assessing knowledge on the subject, medical students had a significantly higher percentage of correct answers than law students (100.0 and 87.5%, respectively; p=0.005) regarding the legality of abortion for pregnancies resulting from rape. Elevated percentages of correct responses were also recorded for both groups in relation to pregnancies that threaten the life of the mother (94.2 and 87.5% for MED and LAW groups, respectively), but without statistical significance. A significant percentage of respondents declared they were in favor of extending legal abortion to other situations, primarily in cases of anencephaly (68%), pregnancy severely harming the mother's physical health (42.1%) or that of the fetus in cases of severe congenital malformation (33.7%). CONCLUSION: Results showed a satisfactory knowledge on the part of law and medical school graduate students regarding the legality of abortion in Brazil, combined with a favorable trend towards extending legal permission to other situations not covered by the law. It is important to underscore the inclusion of this topic in the undergraduate curriculum and the development of inter-professional teaching strategies.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(1):16-21
DOI 10.1590/S0100-72032012000100004
PURPOSE: To analyze and compare the knowledge and opinions of Law and Medical students regarding the issue of abortion in Brazil. METHODS: This was a cross-sectional study involving 125 graduate students from the class of 2010. Of these, 52 were medical students (MED group) and 73 law students (LAW group). A questionnaire was applied based on published research about the topic. Dependent variables were: monitoring the abortion debate, knowledge concerning situations where abortion is permitted under Brazilian law, opinion about situations that agree with extending legal permission to terminate pregnancy and prior knowledge of someone who has undergone induced abortion. Independent variables were: sex, age, household income and graduation course. Statistical analysis: χ² and Fisher's exact tests, with the level of significance set at 5%. RESULTS: Most interviewees reported monitoring the debate on abortion in Brazil (67.3% of the MED group and 70.2% of the LAW group, p>0.05). When assessing knowledge on the subject, medical students had a significantly higher percentage of correct answers than law students (100.0 and 87.5%, respectively; p=0.005) regarding the legality of abortion for pregnancies resulting from rape. Elevated percentages of correct responses were also recorded for both groups in relation to pregnancies that threaten the life of the mother (94.2 and 87.5% for MED and LAW groups, respectively), but without statistical significance. A significant percentage of respondents declared they were in favor of extending legal abortion to other situations, primarily in cases of anencephaly (68%), pregnancy severely harming the mother's physical health (42.1%) or that of the fetus in cases of severe congenital malformation (33.7%). CONCLUSION: Results showed a satisfactory knowledge on the part of law and medical school graduate students regarding the legality of abortion in Brazil, combined with a favorable trend towards extending legal permission to other situations not covered by the law. It is important to underscore the inclusion of this topic in the undergraduate curriculum and the development of inter-professional teaching strategies.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(8):375-378
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(8):375-378
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(5):261-267
DOI 10.1590/S0100-72032008000500009
The polycystic ovaries syndrome (POS) is a heterogeneous endocrinal disorder prevalent in 5 to 10% of women in reproductive age. In POS, there is an association with risk factors linked to the development of cardiovascular disease such as insulin resistance, dislipidemia, diabetes mellitus, arterial hypertension, endothelial dysfunction, central obesity, metabolic syndrome and chronic pro-inflammatory markers. Physical exercise practice together with nutritional guidance have been recommended as first rate strategies in the treatment of oligomenorrhea, hirsutism, infertility and obesity in POS women. This way, the objective of the present review was to analyze the specific role played by exercise and/or physical activity in changes of the body shape, in biochemical and hormonal plasmatic levels, and in the POS women’s reproductive function.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(5):261-267
DOI 10.1590/S0100-72032008000500009
The polycystic ovaries syndrome (POS) is a heterogeneous endocrinal disorder prevalent in 5 to 10% of women in reproductive age. In POS, there is an association with risk factors linked to the development of cardiovascular disease such as insulin resistance, dislipidemia, diabetes mellitus, arterial hypertension, endothelial dysfunction, central obesity, metabolic syndrome and chronic pro-inflammatory markers. Physical exercise practice together with nutritional guidance have been recommended as first rate strategies in the treatment of oligomenorrhea, hirsutism, infertility and obesity in POS women. This way, the objective of the present review was to analyze the specific role played by exercise and/or physical activity in changes of the body shape, in biochemical and hormonal plasmatic levels, and in the POS women’s reproductive function.