RESUMO
INTRODUCCIÓN: La pandemia de COVID-19 ha comportado una disminución de la consulta ginecológica al servicio de urgencia. OBJETIVO: Caracterizar las consultas en el servicio de urgencia ginecológica, evaluando la cantidad de hospitalizaciones, la necesidad de intervención quirúrgica y los factores de morbilidad, entre otros, comparado a la situación con la previa a la pandemia. MÉTODO: Se realizó un estudio de cohorte no concurrente de pacientes hospitalizadas tras una consulta espontánea al servicio de urgencia ginecológica entre las semanas 12 y 28 de 2019 y 2020 en el Hospital Clínico de la Pontificia Universidad Católica, en Santiago (Chile). Se determinaron distintos factores de morbilidad: diagnóstico de ingreso, intervención quirúrgica, complicación operatoria, días de hospitalización, hemoglobina/hematocrito de ingreso y necesidad de transfusión de unidades sanguíneas. RESULTADOS: Hubo 511 consultas al servicio de urgencia entre las semanas 12 y 28 del año 2019, en comparación con 196 el año 2020. En 2019 fueron hospitalizadas 103 mujeres, y en 2020 ingresaron 72 (odds ratio [OR]: 2.3). Disminuyó el ingreso por aborto retenido (24 vs. 12; p = 0.01), mientras que aumentó el ingreso por metrorragia posmenopáusica (9 vs 22; p = 0.01). No hubo cambio en las intervenciones quirúrgicas realizadas (86.4% vs. 84.7%; p = 0.7). Aumentaron los días de hospitalización (2.3 vs. 3.1; p < 0.0001) y la necesidad de transfusión sanguínea (2 vs. 7; p = 0.02; OR: 5.4; intervalo de confianza: 1.09-26). CONCLUSIONES: La pandemia de COVID-19 provocó una disminución en la consulta espontánea por patología ginecológica al servicio de urgencia, provocando un aumento en la relación consulta/ingreso y una mayor morbilidad en las pacientes hospitalizadas, caracterizada por una mayor necesidad de transfusión sanguínea y un aumento de los días de hospitalización.
INTRODUCTION: The COVID-19 pandemic has meant a decrease in gynecological visits to the emergency department. OBJECTIVE: To characterize the attending in the gynecological emergency service, evaluating the amount of admissions, hospitalizations, need for surgical intervention, morbidity factors, among others, compared to the pre-pandemic situation. METHOD: A non-concurrent cohort study of hospitalized patients was carried out through a spontaneous attending to the gynecological emergency service between weeks 12 and 28 of 2019 and 2020 at the Hospital Clínico of the Pontificia Universidad Católica, in Santiago (Chile). Different morbidity factors were measured: admission diagnosis, surgical intervention, surgical complication, hospital stay, admission hemoglobin, and need for transfusion of blood units. RESULTS: A total of 511 visitors to the emergency service were registered between weeks 12 and 28 of 2019, compared to 196 in 2020. In 2019 and 2020, 103 and 72 women were hospitalized respectively (odds ratio [OR]: 2.3). Admission for pregnancy loss decreased (24 vs. 12; p = 0.01), while admission for postmenopausal bleeding increased (9 vs. 22; p = 0.01). There was no change in the surgical interventions performed (86.4% vs. 84.7%; p = 0.7). The hospital stays increased (2.3 vs. 3.1; p < 0.0001) and the need for blood transfusion (2 vs. 7; p = 0.02; OR: 5.4; confidence interval: 1.09-26). CONCLUSIONS: The COVID-19 pandemic caused a decrease in spontaneous attending for gynecological pathology at the emergency service, causing an increase in the attend/admission ratio and greater morbidity in hospitalized patients characterized by a greater need for blood transfusion and an increase on the hospital stay.
Assuntos
Humanos , Feminino , Adulto , Serviço Hospitalar de Emergência/estatística & dados numéricos , COVID-19 , Ginecologia/estatística & dados numéricos , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Unidade Hospitalar de Ginecologia e Obstetrícia/estatística & dados numéricos , Transfusão de Sangue , Intervalos de Confiança , Chile , Estudos de Coortes , Pandemias , SARS-CoV-2 , Hospitalização/estatística & dados numéricos , Tempo de InternaçãoRESUMO
INTRODUCTION: Condylomas or genital warts (GW) are the most frequently diagnosed sexually transmitted infection (STI) in STI centers in Chile, but there are no population statistics available. OBJECTIVES: To describe the prevalence of GW in patients from 18-60 years of age who attend outpatient dermatology, gynecology and urology practice; the demographic characteristics of the patients and the diagnostic and treatment tools. METHODS: A sample of Chilean specialists stratified by region, population and gender of patients was provided with a logbook and answered a questionnaire. RESULTS: The GW prevalence was 2.44% for the whole group; 3.76% for the 18-34 age group and 1.29% for the 35-60 years group (p = 0.0000). The average age of patients with GW was 29.4 years in women and 32.7 years in men (p = 0.019). The distribution by age was different according to gender and health system. Visual inspection was the most frequent diagnostic method used and imiquimod cream the most common treatment, however, there were differences in the use of diagnostic and therapeutic tools according to the patient's gender, specialty of the doctor and health system. CONCLUSIONS: The high prevalence of GW confirmed the need and importance of public health interventions to address this problem.
Assuntos
Condiloma Acuminado/epidemiologia , Pacientes Ambulatoriais/estatística & dados numéricos , Adolescente , Adulto , Antineoplásicos/uso terapêutico , Chile/epidemiologia , Condiloma Acuminado/diagnóstico , Condiloma Acuminado/tratamento farmacológico , Demografia/estatística & dados numéricos , Dermatologistas/estatística & dados numéricos , Feminino , Ginecologia/estatística & dados numéricos , Instituições Privadas de Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos , Humanos , Imiquimode/uso terapêutico , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Atenção Primária à Saúde/estatística & dados numéricos , Prática Profissional/estatística & dados numéricos , Urologistas/estatística & dados numéricos , Adulto JovemRESUMO
OBJETIVE: To describe the characteristics of the scientific production of midwives in Latin American obstetrics and gynecology journals indexed to Scopus during the period 2011 to 2016. METHODS: This paper reports a descriptive bibliometric study, with intentional non-probabilistic sampling. We analyzed articles of research papers published by midwives in medical specialty journals in obstetrics and gynecology of Latin America indexed to Scopus, in the 2011 to 2016 period. RESULTS: We found eight obstetrics and gynecology journals in Latin America indexed in Scopus. There were 1,696 articles published between 2011 and 2016, of which 4.9% were authored or co-authored by midwives. Of these publications, 93.8% were related to topics of the specialty, 62.5% had midwives as corresponding authors, 64.1% of papers were in Spanish, only 3.1% were published in English, and 57.8% of midwives worked in Chile at the time of publication. In 2016, there was one-fifth the number of publications compared to 2012. CONCLUSIONS: We found little scientific production by midwives in Latin American obstetrics and gynecology journals indexed in Scopus. Strategies that encourage and allow research and scientific production by midwives are needed.
OBJETIVO: Describir las características de la producción científica de matrones en revistas latinoamericanas de obstetricia y ginecología, indizadas a Scopus durante el periodo 2011 a 2016. MÉTODOS: Estudio bibliométrico descriptivo, con muestreo intencional no probabilístico. Se analizaron artículos de trabajos de investigación publicados por matrones en revistas de especialidad médica en obstetricia y ginecología de Latinoamérica indizadas a Scopus, en el periodo comprendido entre 2011 y 2016. RESULTADOS: Se encontraron ocho revistas de obstetricia y ginecología en Latinoamérica indizadas en Scopus. Se contabilizaron 1 696 artículos publicados entre 2011 y 2016, de los cuales 4,9% los matrones fueron autores o coautores. De ese subtotal, 93,8% publicó temas propios de la especialidad; 62,5% fueron autores corresponsales; 64,1% de las publicaciones fueron en español; solo 3,1% publicó en inglés y 57,8% de matrones trabajaban en Chile al momento de la publicación. En 2016 se publicaron cinco veces menos que en 2012. CONCLUSIÓN: Se halló escasa producción científica realizada por matrones en revistas latinoamericanas de obstetricia y ginecología indizadas en Scopus. Se sugiere emplear estrategias que incentiven y permitan la investigación y producción científica en los matrones.
Assuntos
Ginecologia/estatística & dados numéricos , Tocologia/estatística & dados numéricos , Obstetrícia/estatística & dados numéricos , Publicações Periódicas como Assunto/estatística & dados numéricos , Bibliometria , Humanos , América LatinaRESUMO
Resumen Introducción: Los condilomas o verrugas genitales (VG) son la infección de transmisión sexual (ITS) más diagnosticada en los centros de ITS en Chile, pero no existen estadísticas poblacionales. Objetivos: Describir la prevalencia de VG en pacientes de 18-60 años que acuden a consulta ambulatoria de dermatología, ginecología y urología; características demográficas de los pacientes y prácticas de diagnóstico y tratamiento. Material y Métodos: A una muestra de especialistas chilenos estratificados por región, población y sexo de pacientes se les proporcionó un diario de registro y aplicó un cuestionario. Resultados: Prevalencia VG grupo total: 2,4%; en grupo etario 18-34 años: 3,7%; en grupo etario 35-60 años: 1,29% (p = 0,0000). La edad media de los pacientes con VG fue 29,4 años en mujeres y 32,7 años en hombres (p = 0,019); la distribución por edad fue diferente según sexo y sistema de salud. La inspección visual fue el método diagnóstico más frecuente y la crema de imiquimod el tratamiento más común. Hubo diferencias en el uso de herramientas diagnósticas y terapéuticas según sexo del paciente, especialidad del médico y sistema de salud. Conclusiones: Existe una alta prevalencia de VG, que debería ser tomada en cuenta para planificar las intervenciones de salud pública para abordar este problema.
Introduction: Condylomas or genital warts (GW) are the most frequently diagnosed sexually transmitted infection (STI) in STI centers in Chile, but there are no population statistics available. Objectives: To describe the prevalence of GW in patients from 18-60 years of age who attend outpatient dermatology, gynecology and urology practice; the demographic characteristics of the patients and the diagnostic and treatment tools. Methods: A sample of Chilean specialists stratified by region, population and gender of patients was provided with a logbook and answered a questionnaire. Results: The GW prevalence was 2.44% for the whole group; 3.76% for the 18-34 age group and 1.29% for the 35-60 years group (p = 0.0000). The average age of patients with GW was 29.4 years in women and 32.7 years in men (p = 0.019). The distribution by age was different according to gender and health system. Visual inspection was the most frequent diagnostic method used and imiquimod cream the most common treatment, however, there were differences in the use of diagnostic and therapeutic tools according to the patient's gender, specialty of the doctor and health system. Conclusions: The high prevalence of GW confirmed the need and importance of public health interventions to address this problem.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Pacientes Ambulatoriais/estatística & dados numéricos , Condiloma Acuminado/epidemiologia , Atenção Primária à Saúde/estatística & dados numéricos , Prática Profissional/estatística & dados numéricos , Condiloma Acuminado/diagnóstico , Condiloma Acuminado/tratamento farmacológico , Chile/epidemiologia , Demografia/estatística & dados numéricos , Incidência , Prevalência , Inquéritos Epidemiológicos , Dermatologistas/estatística & dados numéricos , Urologistas/estatística & dados numéricos , Imiquimode/uso terapêutico , Ginecologia/estatística & dados numéricos , Instituições Privadas de Saúde/estatística & dados numéricos , Antineoplásicos/uso terapêuticoRESUMO
INTRODUCTION: Genital hygiene can play an essential role in avoiding vulvovaginal discomfort and preventing infections. The scientific evidence on best practices on genital hygiene is scarce, and without doubt, gynecologists should be the best person to discuss and guide the subject. OBJECTIVE: Evaluate the general genital female gynecologist hygiene. METHODS: This descriptive analytic study identified genital hygiene and sexual practices of 220 female gynecologists, through a questionnaire with 60 self-answered questions. The data were analyzed and presented using frequency, percentage, mean and standard deviation. RESULTS: The studied population was constituted by middle age (37.3 years) and white (71.3%) female gynecologists. More than a half (53.6%) declared spending over 10 hours a day away from home and complained of vaginal discharge in 48.1% of the cases. Regular vulvovaginal hygiene: 17.8% reported washing genitals once a day and 52% twice a day. The use of dry paper alone was reported in 66.4% post urination and 78.5% post-evacuation. Using running water and soap was practiced by 25.9% and 21.5% respectively. Vulvovaginal hygiene related to sex: More than half of them had intercourse 1-3 times a week, and 37.4% and 24.1% had frequent oral sex and eventually anal sexof the participants, respectively. Genital hygiene before sex was positive in 52.7% of the subjects and, post-sex hygiene in 78.5% of them. CONCLUSION: Genital hygiene habits of female gynecologists can be improved, despite the high grade of scientific knowledge they hold.
Assuntos
Genitália , Ginecologia/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Higiene , Adulto , Feminino , Remoção de Cabelo/estatística & dados numéricos , Humanos , Estilo de Vida , Inquéritos e QuestionáriosRESUMO
SUMMARY INTRODUCTION: Genital hygiene can play an essential role in avoiding vulvovaginal discomfort and preventing infections. The scientific evidence on best practices on genital hygiene is scarce, and without doubt, gynecologists should be the best person to discuss and guide the subject. OBJECTIVE: Evaluate the general genital female gynecologist hygiene. METHODS: This descriptive analytic study identified genital hygiene and sexual practices of 220 female gynecologists, through a questionnaire with 60 self-answered questions. The data were analyzed and presented using frequency, percentage, mean and standard deviation. RESULTS: The studied population was constituted by middle age (37.3 years) and white (71.3%) female gynecologists. More than a half (53.6%) declared spending over 10 hours a day away from home and complained of vaginal discharge in 48.1% of the cases. Regular vulvovaginal hygiene: 17.8% reported washing genitals once a day and 52% twice a day. The use of dry paper alone was reported in 66.4% post urination and 78.5% post-evacuation. Using running water and soap was practiced by 25.9% and 21.5% respectively. Vulvovaginal hygiene related to sex: More than half of them had intercourse 1-3 times a week, and 37.4% and 24.1% had frequent oral sex and eventually anal sexof the participants, respectively. Genital hygiene before sex was positive in 52.7% of the subjects and, post-sex hygiene in 78.5% of them. Conclusion: Genital hygiene habits of female gynecologists can be improved, despite the high grade of scientific knowledge they hold.
RESUMO INTRODUÇÃO: A higiene genital pode desempenhar um papel importante na prevenção de desconfortos vulvovaginais e infecções. Evidências científicas sobre as melhores práticas em higiene genital são escassas, e o ginecologista, sem dúvida, é a melhor pessoa para discutir e orientar o assunto. OBJETIVO: Avaliar a higiene genital feminina usual de médicas ginecologistas. MÉTODOS: Estudo analítico descritivo que identificou higiene genital e práticas sexuais de 220 ginecologistas por meio de um questionário com 60 perguntas autorrespondidas. Os dados foram analisados e apresentados por frequência, porcentagem, média e desvio padrão. Resultados: A população estudada consistiu de médicas ginecologistas femininas brancas (71,3%) com idade média de 37,3 anos. Mais da metade (53,6%) relatou ficar fora de suas casas por períodos superiores a 10 horas por dia e queixaram-se de descarga vaginal em 48,1% dos casos. Higiene vulvovaginal regular: 17,8% relataram lavar os genitais uma vez por dia e 52%, duas vezes por dia. O uso apenas de papel (seco) foi relatado em 66,4% dos casos após micção e em 78,5% após a evacuação. A higiene ideal com água corrente e sabão foi praticada apenas em 25,9% e 21,5%, respectivamente. Higiene vulvovaginal relacionada ao sexo: mais da metade delas relatou relações sexuais 1-3 vezes por semana, sexo oral frequente e anal eventual em 37,4% e 24,1%, respectivamente. A higiene genital pré-sexo foi relatada por 52,7% das pessoas e em 78,5% após o coito. Conclusão: Os hábitos de higiene genital dos ginecologistas femininos estão sujeitos a melhorias, mesmo considerando o alto grau de conhecimento científico que possuem.
Assuntos
Humanos , Feminino , Adulto , Conhecimentos, Atitudes e Prática em Saúde , Higiene , Genitália , Ginecologia/estatística & dados numéricos , Inquéritos e Questionários , Remoção de Cabelo/estatística & dados numéricos , Estilo de VidaRESUMO
BACKGROUND: The association between gynecological diagnoses and their distribution in the health sectors provides benefits in the field of women's health promotion and in medical and interdisciplinary education, along with rationalization according to level of care complexity. Thus, the objective is analyze the clinical-demographic characteristics, main diagnoses in gynecological ambulatory care, and their distribution in health services. METHOD: This is a research project of retrospective audit study design with a chart review of data from 428 women treated at University Ambulatory Clinic of Women's Health, the facility in gynecology and training for Family and Community Medical Residents, São Paulo, Brazil, from 2012 to 2014. Clinical and demographic information, gynecological diagnoses (International Classification of Diseases), and distribution of health services (primary, secondary, and tertiary) were described. RESULTS: The female patients present non-inflammatory disorders of the female genital tract (81.07%, n = 347) and diseases of the urinary system (22.66%, n = 97) among the gynecological diagnoses. The chances of having benign breast disease and non-inflammatory disorders of the female genital tract during the reproductive period corresponds to being 3.61 (CI 1.00-16.29) and 2.56 times (CI 1.58-4.16) higher, respectively, than during the non-reproductive period. The non-inflammatory disorders of the female genital tract (93.33%, n = 28) are most related to the tertiary sector. The distribution in health services was the following: 71.30% (n = 305) in the primary sector, 21.70% (n = 93) in the secondary sector and 7% (n = 30) in the tertiary sector. CONCLUSION: The studied women presented non-inflammatory disorders of the female genital tract and diseases of the urinary system as determined by gynecological diagnoses. Low-assistance complexity followed in most cases.
Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Doenças Mamárias/epidemiologia , Doenças dos Genitais Femininos/epidemiologia , Ginecologia/estatística & dados numéricos , Doenças Urológicas/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Doenças Mamárias/diagnóstico , Comorbidade , Demografia , Feminino , Doenças dos Genitais Femininos/diagnóstico , Serviços de Saúde/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Atenção Primária à Saúde/estatística & dados numéricos , Encaminhamento e Consulta , Estudos Retrospectivos , Atenção Secundária à Saúde/estatística & dados numéricos , Atenção Terciária à Saúde/estatística & dados numéricos , Doenças Urológicas/diagnóstico , Adulto JovemRESUMO
Introducción: El Síndrome Metabólico (SM) es una epidemia y un problema de salud pública, debido a la creciente prevalencia de obesidad y estilos de vida poco saludables. Está asociado a un incremento de 5 veces de riesgo de Diabetes Mellitus tipo 2, y de 2 a 3 veces de aumento en el riesgo de enfermedad cardiovascular, con disminución en la supervivencia. Después de la menopausia, la prevalencia de SM aumenta todavía más, generando un aumento muy significativo del riesgo cardiovascular. Objetivos: Conocer la prevalencia de SM en pacientes internadas de enero a junio del 2017 en el Servicio de Ginecología HC-IPS y comparar la prevalencia de SM obtenida según criterios de la NCEP ATPIII y la IDF en mujeres pre menopáusicas y post menopáusicas. Metodología: Estudio retrospectivo, descriptivo de corte transversal. Resultados: De 380 pacientes observadas, el promedio de edades fue de 43 años.77 % tenían un IMC mayor a 25. 56,8 % eran pre menopáusicas y 43,1 % post menopáusicas. La prevalencia de SM fue diferente según criterios de NCEP ATPIII y la IDF, siendo 23,1 % con el primero y 63 % con el segundo. Se encontró que 80% de las pre menopáusicas y 90 % de las post menopáusicas presentaban IMC mayor a 25. La patología ginecológica mayormente asociada fue el engrosamiento endometrial, observado en un 18% de los casos de SM en las post menopáusicas. En las pre menopáusicas se observó que en el 40% el SM estaba relacionado a HUA y miomatosis uterina. El porcentaje de cáncer endometrial fue bastante importante siendo del 11%. Palabras claves: menopausia, hipertensión, diabetes.
Introduction: The Metabolic Syndrome (MS) is an epidemic and a public health problem, due to the growing prevalence of obesity and unhealthy lifestyles. It is associated with a 5-fold increase in the risk of Diabetes Mellitus type 2, and a 2 to 3-fold increase in the risk of cardiovascular disease, with a decrease in survival. After menopause, the prevalence of MS increases even more, generating a very significant increase in cardiovascular risk. Objectives: To know the prevalence of MS in patients hospitalized from January to June 2017 in the HC-IPS Gynecology Service and to compare the prevalence of MS obtained according to NCEP ATPIII and IDF criteria in premenopausal and postmenopausal women. Methodology: Retrospective, descriptive crosssectional study. Results: Of 380 patients observed, the average age was 43.77% had a BMI greater than 25. 56.8% were premenopausal and 43.1% postmenopausal. The prevalence of MS was different according to the criteria of NCEP ATPIII and the IDF, being 23.1% with the first and 63% with the second. It was found that 80% of premenopausal and 90% of postmenopausal women had a BMI greater than 25. The gynecological pathology most associated was endometrial thickening, observed in 18% of cases of MS in postmenopausal women. In premenopausal women it was observed that in 40% the MS was related to HUA and uterine myomatosis. The percentage of endometrial cancer was quite important being 11%. Keywords: menopause, hypertension, diabetes
Assuntos
Humanos , Feminino , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/complicações , Diabetes Mellitus/metabolismo , Ginecologia/estatística & dados numéricos , Hipertensão/metabolismo , Obesidade/complicaçõesRESUMO
OBJECTIVE: This study explored choice factors in four specialties in Mexico. METHOD: Mixed methods design. Qualitative phase: four focus groups with first-year residents, to obtain information of how specialty choice was done. With this information a web-based cross-sectional questionnaire was applied to residents registered in the 1st year of Postgraduate Studies Division, UNAM. RESULTS: 32 residents participated in qualitative phase and for the quantitative phase, the survey was answered by 35 surgical, 28 gynecology, 61 internal medicine and 62 pediatric residents. The specialty choice decision was done during the last years of the medical career. The majority of the resident choice was a subspecialty after the general residency. The type of patient was more crucial to choose pediatrics while a good academic program was for internal medicine. Negative models and bullying were decisive to rule out surgery as well as a not well-known hospital was to rule out pediatrics. CONCLUSION: The specialty choice is done during undergraduate training, with the intention of doing a subspecialty. Demographic and personality traits were identified.
Assuntos
Escolha da Profissão , Cirurgia Geral/estatística & dados numéricos , Ginecologia/estatística & dados numéricos , Medicina Interna/estatística & dados numéricos , Internato e Residência , Pediatria/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Grupos Focais , Humanos , Masculino , México , Pesquisa Qualitativa , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To report on the Brazilian Association of Gestational Trophoblastic Disease's (GTD) formation of a network of regional care at specialized centers for women with GTD. STUDY DESIGN: We developed a questionnaire composed of 15 questions, which was sent by email to the 38 Brazilian GTD Reference Center (BGTDRC) Directors who are members of the Brazilian Association of GTD, in order to characterize the professionals involved in the care of patients with GTD and the type of assistance provided. RESULTS: The Directors of the BGTDRCs are usually specialists in Gynecology and Obstetrics (97%), with a median experience of a decade in treating women with GTD. The BGTDRCs are linked to university hospitals in 75% of centers and provide completely free medical care in 87%. However, 52% of centers do not perform chemotherapy in their reference center, and patients are referred elsewhere for chemotherapy. Despite some difficulties, the rate of patients lost to follow-up before human chorionic gonadotropin remission is 9%, and the GTD mortality rate is 0.9%. CONCLUSION: Due to large regional disparities, the BGTDRCs are not uniformly organized. However, under the coordination of the Brazilian Association of GTD there is now strong communication and collaboration among reference centers, which has significantly advanced both patient care and research into the management of these diseases.
Assuntos
Atenção à Saúde/organização & administração , Países em Desenvolvimento , Doença Trofoblástica Gestacional/terapia , Ginecologia/estatística & dados numéricos , Obstetrícia/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Neoplasias Uterinas/terapia , Adulto , Brasil , Gonadotropina Coriônica/sangue , Feminino , Doença Trofoblástica Gestacional/sangue , Ginecologia/organização & administração , Humanos , Perda de Seguimento , Pessoa de Meia-Idade , Obstetrícia/organização & administração , Médicos/estatística & dados numéricos , Gravidez , Especialização , Inquéritos e Questionários , Centros de Atenção Terciária/organização & administração , Neoplasias Uterinas/sangueRESUMO
BACKGROUND: Previously, the REDLINC VI study showed that the main reason for the low use of menopausal hormone therapy (MHT) was its low rate of prescription by doctors. OBJECTIVE: To determine the use of MHT and perceived related risks among gynecologists. METHODS: A self-administered and anonymous questionnaire was delivered to certified gynecologists in 11 Latin American countries. RESULTS: A total of 2154 gynecologists were contacted, of whom 85.3% responded to the survey (n = 1837). Mean age was 48.1 ± 11.4 years; 55.5% were male, 20.3% were faculty members and 85% had a partner. Overall, 85.4% of gynecologists responded that they would use MHT if they had menopausal symptoms (81.8% in the case of female gynecologists) or prescribe it to their partner (88.2% in the case of male gynecologists; p < 0.001). Perceived risk related to MHT use (on a scale from 0 to 10) was higher among female than among male gynecologists (4.06 ± 2.09 vs. 3.83 ± 2.11, p < 0.02). The top two perceived reported risks were thromboembolism (women 33.6% vs. men 41.4%, p < 0.009) and breast cancer (women 38.5% vs. men 33.9%, p < 0.03). Overall, gynecologists reported prescribing MHT to 48.9% of their symptomatic patients (women 47.3% vs. men 50.2%, p < 0.03) and 86.8% currently prescribed non-hormonal remedies and 83.8% alternative therapies for the management of the menopause. Gynecologists who were older and academic professionals prescribed MHT more often. CONCLUSION: Although this Latin American survey showed that gynecologists are mostly supporters of MHT use (for themselves or their partners), this is not necessarily reflected in their clinical practice.
Assuntos
Terapia de Reposição de Estrogênios/estatística & dados numéricos , Ginecologia/estatística & dados numéricos , Menopausa , Adulto , Estudos Transversais , Feminino , Terapia de Reposição Hormonal , Humanos , América Latina , Masculino , Pessoa de Meia-Idade , Risco , Inquéritos e QuestionáriosRESUMO
Objectives Evaluate the management of hypothyroidism in fertile-aged and pregnant women and compare these practices to the recommendations of the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Latin American Thyroid Society, published in 2013. Materials and methods In the first trimester of 2014, SBEM made available to all members an electronic questionnaire based on clinical scenarios in the management of gestational hypothyroidism. The responses of 406 physicians, most of them endocrinologists, were analyzed. Results Eighty-one per cent of the endocrinologists screen all their pregnant patients for thyroid dysfunction, mostly during the pregestational period or after the first prenatal visit. Following screening, 82% of the respondents initiate treatment when TSH levels are > 2.5 mIU/L while 67% monitor their pregnant patients even if TSH was normal on first trimester screening. For hypothyroid women who are planning pregnancy, 96% of the clinicians are aware of the importance of adjusting the levothyroxine (LT4) dose as soon as pregnancy is confirmed. However, opinions diverge with respect to adjusting the LT4 dose before or after reassessing thyroid function. The most widely used tests for monitoring pregnant women in use of LT4 are TSH and free T4 (62%) or TSH alone (21%). Unanimously, the treatment goal is to achieve the target TSH level for each trimester of gestation. Conclusion The recommendations of the consensus statements are incorporated into the respondents’ clinical practice. It is noteworthy that the great majority of the clinicians favor universal screening.
Assuntos
Feminino , Humanos , Gravidez , Gerenciamento Clínico , Hipotireoidismo/diagnóstico , Hipotireoidismo/terapia , Cuidado Pré-Concepcional , Complicações na Gravidez/diagnóstico , Tiroxina/sangue , Brasil , Tomada de Decisão Clínica , Endocrinologia/estatística & dados numéricos , Medicina Geral/estatística & dados numéricos , Ginecologia/estatística & dados numéricos , Hipotireoidismo/sangue , Obstetrícia/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Complicações na Gravidez/sangue , Inquéritos e Questionários , Tiroxina/uso terapêuticoRESUMO
OBJECTIVES: Evaluate the management of hypothyroidism in fertile-aged and pregnant women and compare these practices to the recommendations of the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Latin American Thyroid Society, published in 2013. MATERIALS AND METHODS: In the first trimester of 2014, SBEM made available to all members an electronic questionnaire based on clinical scenarios in the management of gestational hypothyroidism. The responses of 406 physicians, most of them endocrinologists, were analyzed. RESULTS: Eighty-one per cent of the endocrinologists screen all their pregnant patients for thyroid dysfunction, mostly during the pregestational period or after the first prenatal visit. Following screening, 82% of the respondents initiate treatment when TSH levels are > 2.5 mIU/L while 67% monitor their pregnant patients even if TSH was normal on first trimester screening. For hypothyroid women who are planning pregnancy, 96% of the clinicians are aware of the importance of adjusting the levothyroxine (LT4) dose as soon as pregnancy is confirmed. However, opinions diverge with respect to adjusting the LT4 dose before or after reassessing thyroid function. The most widely used tests for monitoring pregnant women in use of LT4 are TSH and free T4 (62%) or TSH alone (21%). Unanimously, the treatment goal is to achieve the target TSH level for each trimester of gestation. CONCLUSION: The recommendations of the consensus statements are incorporated into the respondents' clinical practice. It is noteworthy that the great majority of the clinicians favor universal screening.
Assuntos
Gerenciamento Clínico , Hipotireoidismo/diagnóstico , Hipotireoidismo/terapia , Cuidado Pré-Concepcional , Complicações na Gravidez/diagnóstico , Tiroxina/sangue , Brasil , Tomada de Decisão Clínica , Endocrinologia/estatística & dados numéricos , Feminino , Medicina Geral/estatística & dados numéricos , Ginecologia/estatística & dados numéricos , Humanos , Hipotireoidismo/sangue , Obstetrícia/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Gravidez , Complicações na Gravidez/sangue , Inquéritos e Questionários , Tiroxina/uso terapêuticoRESUMO
BACKGROUND: The causals for legal abortion in Mexico vary as established by the Constitution of each State; from 2007 it is legal in Mexico City. OBJECTIVE: To identify knowledge, attitudes and practice of abortion between gynecologists and obstetricians. MATERIAL AND METHODS: Survey study conducted between some of the gynaeco-obstetricians attended the 64th Mexican Congress of Gynecology and Obstetrics held in Mexico City, October 2013. RESULTS: From the 1,085 respondents, 77% correctly identified that abortion is legal accord to Constitutional Signs of each State; 17.5% said it is never legal and 5.7% thought that is always legal. The 67% comment that public institutions should have infrastructure and trained medical personnal to legal abortion practice. The 72% response they would attend or denounce the woman who underwent an abortion outlawed. The remaining 28% showed negative attitudes, from informing the couple or parents (18%), scold women (2%) or reporting it to the authorities (8%). In 39%, they felt that the medical profession who practice discriminates abortions; 28% admit stigmatize partener and 27% feel stigmatized if performing abortions. Percentage high hospitalized patients in case of early abortions, for surgical or medical treatment. CONCLUSIONS: It is necessary to increase and improve knowledge technical and legal about abortion, especially among gynaeco-obstetricians, they are who responsibility to comply about prescribed by law, in accordance with international recommendations and the exercise of reproductive rights of women.
Assuntos
Aborto Induzido , Aborto Legal , Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Adulto , Feminino , Ginecologia/estatística & dados numéricos , Pesquisas sobre Atenção à Saúde , Humanos , Masculino , México , Pessoa de Meia-Idade , Obstetrícia/estatística & dados numéricos , Gravidez , Direitos Sexuais e Reprodutivos/legislação & jurisprudência , Direitos da Mulher/legislação & jurisprudênciaRESUMO
In the framework of an increasing feminization of the medical profession in Mexico, this article explores the characteristics of this process in the obstetrics and gynecology specialty. Understanding feminization as a process of change to be analyzed both quantitatively and qualitatively, the article focuses special attention on the experiences of female obstetrician-gynecologists within a medical specialty that has since its origins functioned as a mechanism of control over women's bodies. Based on ethnographic research, the article combines statistical and archival sources and field observation. The interviews reveal the experiences and tensions women obstetrician-gynecologists encounter in this context.
Assuntos
Atitude do Pessoal de Saúde , Ginecologia/tendências , Obstetrícia/tendências , Relações Médico-Paciente , Médicas/tendências , Sexismo , Feminino , Ginecologia/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Masculino , México , Obstetrícia/estatística & dados numéricos , Médicas/psicologia , Médicas/estatística & dados numéricos , Pesquisa Qualitativa , Sexismo/psicologia , Sexismo/tendênciasRESUMO
OBJECTIVES: The purpose of this study was to determine the publication rate of full-text articles after the presentation of abstracts at consecutive annual meetings of the American Urogynecologic Society (AUGS) over a 2-year period. METHODS: Using abstract books published by the Journal of Pelvic Medicine and Surgery, we obtained the text of all abstracts presented at the 2007 and 2008 AUGS annual meetings. A literature search was performed in the US National Library of Medicine to identify the peer-reviewed publications arising from each of those abstracts and to calculate the full-text publication rate and the mean duration from presentation to publication. RESULTS: The overall full-text publication rate was 56% (239/438 publications). The mean time from presentation to publication was 15.7 months. The published articles appeared in 49 peer-reviewed journals, with notable distribution in the International Urogynecology Journal (27%), American Journal of Obstetrics and Gynecology (26%), and Obstetrics and Gynecology (10%). Oral presentations (85%) were more likely than posters (71%) to have first authors with university affiliations (P = 0.002). The greater the number of abstract authors, the more likely that the article was to be published (P = 0.0059). The odds of an oral presentation being published were 7 times the odds of a poster being published (odds ratio, 6.99; P < 0.001). CONCLUSIONS: Because not all presentations are published, it is questionable whether it is acceptable to cite AUGS abstracts that have not passed a journal's peer review process and to implement their results in clinical practice.
Assuntos
Congressos como Assunto/estatística & dados numéricos , Ginecologia/estatística & dados numéricos , Obstetrícia/estatística & dados numéricos , Editoração/estatística & dados numéricos , Feminino , Humanos , Estudos Longitudinais , Publicações Periódicas como Assunto/estatística & dados numéricos , Pôsteres como Assunto , Sociedades Médicas , Estados UnidosRESUMO
BACKGROUND: The patient-centered medical home model may be a strategic approach to improve delivery of women's health care and consistently provide women with accessible and comprehensive care. We examined whether primary care physicians (family medicine, internal medicine, and hospital general medicine clinics) and obstetrician-gynecologists differ in scope and the number of medical issues addressed during preventive gynecologic visits. METHODS: We analyzed data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey to characterize visits with a primary diagnosis of gynecological examination or routine cervical Papanicolaou test between 1999 and 2008. We compared the number and type of concurrent nongynecologic diagnoses addressed by primary care physicians and obstetrician-gynecologists during visits. RESULTS: A total of 7882 visits were included, representing 271 million primary visits for Papanicolaou tests. Primary care physicians were 2.41 times more likely to include one or more concurrent medical diagnoses during the preventive gynecologic visit compared with obstetrician-gynecologists (odds ratio, 2.41; 95% confidence interval, 1.63-3.57). CONCLUSIONS: Primary care physicians are significantly more likely to address concurrent medical problems during preventive gynecologic visits compared with obstetrician-gynecologists. These findings demonstrate the vital role of primary care physicians in providing comprehensive health care to women, consistent with principles of the patient-centered medical home model.
Assuntos
Exame Ginecológico/estatística & dados numéricos , Ginecologia/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Teste de Papanicolaou , Serviços Preventivos de Saúde , Esfregaço Vaginal , Adulto JovemRESUMO
OBJECTIVE: To characterize the legal and clinical knowledge of Guatemalan obstetrician-gynecologists (OB/GYNs) regarding medical abortion and to determine factors associated with approval of its use for specific indications. METHODS: A trained interviewer administered a multiple-choice survey to 172 private-practice OB/GYNs across Guatemala. Univariate, bivariate, and multivariate analyses characterized medical abortion opinion and knowledge, and logistic regression identified influential factors. RESULTS: 73% of OB/GYNs knew that abortion is legally permitted when the woman's life is at risk. Although 92% knew that misoprostol can be used to induce abortion, only 35% knew the WHO-recommended dosage. Only 25% knew of mifepristone. Compared with older OB/GYNs, those under 40 years of age were 7 times more likely, and 40-49 year olds were twice as likely to approve of medical abortion for fetal death and severe eclampsia with fetal death, respectively. CONCLUSION: Current indications for abortion under Guatemalan law, as well as OB/GYN practices and beliefs regarding medical abortion, are hindering women's access to safe medical abortion and, therefore, potential reductions in maternal morbidity and mortality. Future research should aim to identify whether and why Guatemalan OB/GYNs are unfamiliar with these drugs, prefer to use other methods, or are completely against abortion.
Assuntos
Aborto Induzido/psicologia , Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Médicos/estatística & dados numéricos , Abortivos/administração & dosagem , Abortivos/uso terapêutico , Aborto Induzido/legislação & jurisprudência , Aborto Induzido/métodos , Adulto , Coleta de Dados , Relação Dose-Resposta a Droga , Feminino , Guatemala , Ginecologia/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Mifepristona/administração & dosagem , Mifepristona/uso terapêutico , Misoprostol/administração & dosagem , Misoprostol/uso terapêutico , Análise Multivariada , Obstetrícia/estatística & dados numéricos , GravidezRESUMO
OBJETIVO: Analisar concepções de gênero e sexualidade presentes no campo de intervenções terapêuticas em torno do sexo. PROCEDIMENTOS METODOLÓGICOS: Observação etnográfica, complementada por análise documental de material impresso referente ao X Congresso Brasileiro de Sexualidade Humana, promovido pela Sociedade Brasileira de Estudos em Sexualidade Humana, e ao VIII Congresso Brasileiro sobre Inadequações Sexuais, promovido pela Associação Brasileira para o Estudo das Inadequações Sexuais, realizados em 2005. A análise privilegiou a interação entre a perspectiva quantitativa no processamento das variáveis profissão e gênero dos participantes e temas das palestras, e perspectiva qualitativa na análise e interpretação do conjunto mais geral de dados. RESULTADOS: Os temas das sessões e o enfoque das apresentações sugerem que o campo é definido pelo contraste entre duas especialidades médicas: a ginecologia e a urologia, a primeira voltada para disfunções femininas e do casal e a segunda para as disfunções masculinas. CONCLUSÕES: A sexualidade masculina é abordada por perspectiva predominantemente biomédica, centrada na fisiologia da ereção e na prescrição de medicamentos, enquanto a sexualidade feminina é apresentada como condicionada por problemas relacionais, mais adequados à intervenção psicológica.
OBJECTIVE: To analyze concepts of gender and sexuality present in the field of sex therapeutic interventions. METHODOLOGICAL PROCEDURES: An ethnographic observation was conducted, and it was completed with the analysis of printed material originated from the X Congresso Brasileiro de Sexualidade Humana (10th Brazilian Congress on Human Sexuality), promoted by the Sociedade Brasileira de Estudos em Sexualidade Humana (Brazilian Society of Human Sexuality Studies), and the VIII Congresso Brasileiro sobre Inadequações Sexuais (8th Brazilian Congress on Sexual Inadequacies), promoted by the Associação Brasileira para o Estudo das Inadequações Sexuais (Brazilian Association of Sexual Inadequacy Studies), both held in 2005. The analysis emphasized the interaction between the quantitative perspective in the processing of the variables (participants' gender and profession and lecture topics) and the qualitative perspective in the analysis and interpretation of the more general set of data. RESULTS: The topics of sessions and focus of presentations suggest that the field is divided by the contrast between two medical specialties: gynecology and urology, the former is aimed at female and couple dysfunctions, while the latter is aimed at male dysfunctions. CONCLUSIONS: Male sexuality is approached from the predominantly biomedical perspective, centered on the physiology of erection and drug prescription, whereas female sexuality is considered to be conditioned by relationship problems, when psychological intervention is more adequate.
OBJETIVO: Analizar concepciones de género y sexualidad presentes en el campo de intervenciones terapéuticas en torno al sexo. PROCEDIMIENTOS METODOLÓGICOS: Observación etnográfica, complementada por análisis documental de material impreso referentes al X Congreso Brasileño de Sexualidad Humana, promovido por la Sociedad Brasileña de Estudios en Sexualidad Humana y el VIII Congreso Brasileño sobre Inadecuaciones Sexuales, promovido por la Asociación Brasileña para el Estudio de las Inadecuaciones Sexuales, realizados en 2005. El análisis privilegió la interacción entre la perspectiva cuantitativa en el procesamiento de las variables profesión y género de los participantes y temas de las palestras y cualitativa en el análisis e interpretación del conjunto más general de datos. RESULTADOS: Los temas de las sesiones y el enfoque de las presentaciones sugieren que el campo es definido por el contraste entre dos especialidades médicas: la ginecología y la urología, la primera dirigida a disfunciones femeninas y de la pareja y la segunda a las disfunciones masculinas. CONCLUSIONES: La sexualidad masculina es abordada por perspectiva predominantemente biomédica, centrada en la fisiología de la erección y en la prescripción de medicamentos, mientras que la sexualidad femenina es presentada como condicionada por problemas de relación, más adecuados a la intervención psicológica.