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Biomedical subjects

A Faúndes

Publications and source records attributed to A Faúndes.

At least 73 records · Page 4Linked to original sources
PubMed1993

A Latin American experience with levonorgestrel IUD.

The intrauterine contraceptive device is an effective, safe and convenient contraceptive method. Its use in less developed countries has been limited by the increase in menstrual blood loss, an important issue in populations with a high prevalence of anaemia. The levonorgestrel releasing IUD (LNg IUD) is the first device which is at the same time highly effective, long-lasting and reduces the blood loss during menstruation. This device was tested in 200 volunteers in Santo Domingo, Dominican Republic and in 381 in Campinas, Brazil. The cumulative pregnancy rate was 0 up to 7 years of use. The reduced bleeding was confirmed, and ferritin concentration among long-term users of the LNg IUD was significantly higher than among copper IUD users and controls using no contraception. Mean levonorgestrel plasma levels remained above 100 pg/ml until the seventh year of use. Endometrial histology showed mainly a marked reduction in epithelial growth, with variable signs of decidualization of the stroma. The most important reason for discontinuation in the two centres was amenorrhea, with cumulative rates of 10 and 15, respectively. This device should be very well accepted and will have a clear niche among reversible contraceptives, when available.

Adult↗
PubMed1993

[Reproductive variables and risk of breast cancer: a case-control study carried out in Brazil].

The purposes of the study were to identify reproductive risk factors for breast cancer and to test the hypothesis that reproductive variables operate through a common factor: the number of times that the mammary tissue has been exposed to the endocrine changes of the ovulatory cycle. The study was conducted in Campinas, and was based on interviews with 348 women with breast cancer first diagnosed between October 1979 and August 1984. The control group consisted of 348 women with healthy breasts. The data were obtained in interviews in the home, which were conducted using a structured questionnaire that had been pretested. The data were analyzed by calculation of the odds ratio, Mantel's statistic, to determine the linear trend; by Cornfield's method to calculate the confidence intervals; and by logistic regression adjusted for paired data. It was found that nulliparity, not having breast-fed, and a high number of menstrual cycles were significantly associated with the risk of presenting the disease. In the multivariate analysis, which included all the women, the only variable associated with the risk of mammary cancer was no history of breast-feeding. When the nulliparas were excluded, logistic regression showed that higher age of the woman at her first delivery was significantly associated with breast cancer.

Adult↗
PubMed1992

Evaluation of the performance of the copper T380A IUD up to ten years. Is this IUD a reversible but potentially permanent method?

The clinical experience of a cohort of 340 women using a TCu380A IUD for up to 10 years at the Family Planning Clinic of the State University of Campinas, Brazil was evaluated by life-table analysis. Removals for medical reasons were more frequent during the first year of use, while from the third year on, removals for personal reasons were more frequent. Expulsions were concentrated in the first two years of use, and none were detected after the fourth. Gross pregnancy rate accumulated to 2.0, 2.8 and 5.3 and continuation rate was 64.2, 43.4 and 27.8 per 100 women at three, six and ten years of use, respectively. The effectiveness of the device did not decrease significantly after the eighth year of use and it could be considered a reversible but potentially permanent method.

Adolescent↗
PubMed1991

Hormonal changes associated with bleeding during low dose progestogen contraception delivered by Norplant subdermal implants.

The main side effect associated with the use of Norplant contraceptive implants is a disruption of the menstrual bleeding pattern. To explore the relationship between bleeding and hormonal changes, we analyzed the estradiol (E2) and progesterone (P) patterns that preceded bleeding episodes or that corresponded to periods of amenorrhea in 103 cycles observed among 82 women using Norplant subdermal implants. Five different bleeding patterns were defined: 'normal' (24-45 day cycles), oligomenorrhea (46-90 day cycles), amenorrhea (over 90 day cycles), irregular/frequent bleeding (less than 25 day cycles), and prolonged bleeding (continuous bleeding/spotting for more than 10 days). All 'normal' cycles were associated with a rise followed by a fall in E2 levels preceding bleeding. In half of the 'normal' cycles (28/54), a rise and fall of P was also observed. The same pattern was found in oligomenorrheic cycles, but only two of 12 cycles had a rise and fall of both E2 and P. None of the subjects with amenorrhea had luteal activity. Six of the nine amenorrheic cycles displayed persistently low E2 levels (below 75 pg/ml). The remaining three had a moderate elevation in E2 levels during the sampling period. Sixty percent of the subjects who showed irregular/frequent bleeding (15/25) had low E2 levels (less than 75 pg/ml), without luteal activity, and bleeding occurred without clear evidence of a further drop in E2 levels. In the remaining 40%, bleeding was preceded by a rise and drop of E2 without luteal activity, with the exception of one women, who exhibited a rise and fall of both E2 and P. Samples were obtained in only three subjects during continuous bleeding. One had low E2 levels, and the remaining two bled continuously, in spite of having E2 levels in the normal range. We conclude that ovarian hormones continue to influence endometrial shedding during the use of Norplant contraceptive implants.

Amenorrhea↗
PubMed1991

Comparison of local signs and symptoms after the insertion of Norplant implants with and without a scalpel.

The study compares NORPLANT subdermal implants acceptors enrolled randomly for two different insertion procedures. One group (420 women) received the implants with the use of a scalpel according to the manufacturer's instructions. The other group (423 women) received the implant without an incision, directly through a sharpened trocar. The local signs and symptoms were observed at 7 and 30 days after insertion. Pain, tenderness, edema/swelling, ecchymosis and defective scar were considered. Complication rates were low and no significant differences were found between the two procedures. Based on the data of this study, we recommend inserting NORPLANT implants without the use of a scalpel.

Drug Administration Routes↗
PubMed1991

[Adequacy of contraceptive pill use among women in union].

A total of 2,364 women in marital union, 15 to 49 years of age, were interviewed at home. They lived in poor neighbourhoods in the metropolitan area and in the interior of S. Paulo State, Brazil. The prevalence of contraceptive pill use and the association between socio-demographic characteristics of users and the presence or not of risk factors for pill use were studied. One fourth (25.8 percent) of the women interviewed were using contraceptive pills. Prevalence was higher among younger women, those with no more than one live child and those who had completed between three and eight grades of schooling. Over 40 percent of the users referred having risk factors for pill use at the time they initiated the method. No association was found between age and the percentage of women with risk factors. This percentage increased with number of children and decreased with women's schooling. The fact that pills were prescribed or obtained through the health system was not associated with the proportion of users with risk factors. The percentage of users with risk factors was similar when comparing women who did not consult any health service before initiating use with those who had consulted a public service. The prevalence of use observed in this study is similar to that described by other authors. Results show that the health system in the State of S. Paulo played no role in the improvement in the prescription of hormonal contraceptive pills. Central policy seemed not to have filtered down to the peripheral areas of the system.

Adolescent↗
PubMed1990

[Reproductive variables and risk of benign breast diseases. A case-control study].

The purpose of the study was the identification of risk factors for benign breast diseases (BBD); 257 women with BBD diagnosed through pathological anatomy or cytology and a matched control for each were studied. Subjects were selected at The State University of Campinas Hospital and at a private clinic. To enter the study cases had to have a first diagnosis of BBD between October 1979 and August 1984. The following BBD were considered: dysplasia, fibroadenoma, cystic disease, papilloma and ductal ectasia. Reproductive variables were studied as risk factors, including menstrual ovulatory cycles. The date on which the BBD was diagnosed was defined as the index date. For controls, data were considered up to when they had reached the same age as the matched case on the occasion of her diagnosis. Nulliparity was a risk factor for BBD. First birth at or above age 30 was a protective factor. Women who had used contraceptive pills for two or more years had a significantly lower risk than those who had never used them. The number of menstrual ovulatory cycles was not found to be associated with the risk of BBD. The results obtained from the study of Brazilian women confirm some of the conclusions found in the literature, mainly those that associate some reproductive variables with the risk of BBD. A few of these variables are also confirmed as risk factors for breast cancer.

Brazil↗
PubMed1989

Unwanted pregnancy: challenges for health policy.

In Latin America, governments fail to recognize that information and services for sexuality, reproduction and contraception are essential to women's health. Governments should adopt comprehensive women's health policies and programs to help women avoid unwanted pregnancies that lead to dangerous illegal abortions. This includes sex education, especially for adolescents; contraceptive choices; accessible services; decriminalization of abortion and removal of obstacles to legal abortion services; and support for women who wish to carry their pregnancies to term.

Abortion, Illegal↗
PubMed1986

Abnormal endocrine profile among women with confirmed or presumed ovulation during long-term Norplant use.

FSH, LH, estradiol and progesterone were serially assayed during 8 cycles of six subjects using six subdermal implants releasing levonorgestrel (NORPLANT) for a period of 2 to 6 years. All 8 cycles studied had a very low LH peak and a low or nonexistent FSH peak as compared to 8 control cycles. The mean LH peak for NORPLANT users was 33.9 mIU/ml as compared to 142 mIU/ml in the control group; and FSH was 13.0 mIU/ml as compared to 31.3 mIU/ml in controls. A subsequent rise in progesterone was observed in the 8 cycles studied, but the mean mid-luteal levels were significantly lower than in controls (9.0 ng/ml vs. 15.6 ng/ml). No differences were observed in the estradiol curve. Two of the subjects using NORPLANT had a laparotomy performed on days 17 and 20 of the cycle, for surgical sterilization purposes. A distinctive corpus luteum with a stigma was observed. Our results indicate that women under prolonged use of NORPLANT do not have normal endocrine cycles, even though they may ovulate. It is doubtful however, that these ovulatory cycles can be fertile under the abnormal endocrine conditions found in our subjects. In addition to the possible effect of luteal insufficiency, the normal maturation of the oocyte may be impaired.

Adult↗
PubMed1986

Preliminary experiment with computerized anamnesis in gynecology and reproductive health.

The Hospital of the Faculty of Medical Sciences of the State University of Campinas is implementing an Integrated Health Care Programme, whose objectives are early detection of risk factors of several diseases and the evaluation of the patient's reproductive health at the moment of the first visit to the Hospital. The initial results of this program encouraged us to try to apply it all to our own clientele. The present lack of material resources and qualified manpower leads us to concentrate all our attention on the patient's immediate complaints. This situation indicated to us that the only way to implement the program should be by means of a computerized questionnaire able to detect diseases and risk factors early. This paper presents the preliminary results of the application of computerized questionnaires to evaluate health risks. The authors conclude: The application of a computerized questionnaire met with very favorable reception by the clientele; In some segments of the population, the questionnaire can be answered by the patients in direct interaction with the computer; Programmes which evaluate risk factors need to be carefully revised before being put to use; The system operates on a relatively low cost basis, which could bring undeniable benefits to primary health care.

Computers↗
PubMed1985

Anovulation, inadequate luteal phase and poor sperm penetration in cervical mucus during prolonged use of Norplant implants.

Blood samples for progesterone assay were collected for a total of 49 cycles, from 27 volunteers using the NORPLANT system. Levonorgestrel determinations were carried out in the same samples. A group of 12 women with normal cycles were studied in the same manner to serve as controls. Of the 49 cycles studied, 20 (41%) were ovulatory. The mean levonorgestrel level in ovulatory patients was 0.34 +/- 0.11 ng/ml (S.D.) compared to 0.42 +/- 0.14 ng/ml (S.D.) in anovulatory cycles. Compared to the control group, progesterone levels were significantly lower for users of NORPLANT implants during days -12 to -10 (p less than 0.025), -9 to -7 (p less than 0.05), -6 to -4 (p less than 0.0005) and days -3 to -1 (p less than 0.01). Cervical mucus evaluations and post-coital tests were done around mid-cycle in 29 of the cycles studied. All samples of cervical mucus were of poor quality, viscous and scarce, with a mean SPK of 4.1 +/- 2.3 cm. Most had absent or atypical ferning. Twenty-one subjects (73%) had a post-coital score of 1, and 4 (14%) of zero. Thus, anovulation, inadequate luteal phase and the direct effect of the continuous administration of levonorgestrel over cervical function, all seem to contribute to the effectiveness of NORPLANT implants.

Anovulation↗
PubMed1985

Menstrual pattern and ovarian function in women with hyperprolactinemia.

Prolactin (PRL) and progesterone were systematically measured in all women presenting with amenorrhea, oligomenorrhea or galactorrhea at the Infertility Clinic of the Department of Obstetrics and Gynecology, State University of Campinas, Brazil, during a period of 34 months. The same hormonal assays were done to all infertile patients presenting for the first time during the last 6 months of the same period, for a total of 190 subjects. Fifty-five patients with amenorrhea, 38 with oligomenorrhea and 97 with normal cycles, 20 of whom had galactorrhea, were included in the study. Fifty-five percent of amenorrheic patients, 37% of oligomenorrheic and 9% of those with normal menses had elevated PRL. The mean PRL was higher the greater the menstrual disturbance but was not influenced by presence or absence of galactorrhea. Short luteal phase was the ovarian function condition most frequently associated with high PRL among women with normal menses.

Female↗
PubMed1984

Obstetric and gynecological care for Third World women.

The particular characteristics which women's health care in the Third World should have as compared with the situation in developed countries is discussed. Women in the Third World present a different prevalence of specific pathologies, give less attention to symptoms and to preventive measures, and the health system is usually not well adapted to respond to those characteristics. Examples of the difference between the needs of health care of Third World women compared to developed countries are taken from pre-natal care, prevention of cancer of the cervix and family planning. A critical analysis of the prevalent characteristics of present women's care in the Third World was done. Accordingly, some basic points to be considered in the implementation of women's health care for the Third World were proposed: avoid the uncritical replication of developed country's models to solve developing countries' health problems; application of a larger proportion of the resources to primary health care; a more aggressive attitude to increase preventive behavior, trying to maintain a continuous and not sporadic contact between the health system and the target population; great attention to reference and contra-reference to improve the integration of the various levels of the health system; delegation of functions from physicians to paramedical personnel; emphasis on health education, both formal and in the day-to-day contact between health agents and target population.

Delivery of Health Care↗
PubMed1982

Randomized clinical study of the T-Cu 380A and the Lippes loop C, in Campinas, Brazil.

The copper IUD model T-Cu 380A has shown the best performance when compared with other copper and inert IUDs in studies carried out in the U.S.A., but it had not been tried out in developing countries yet. T-Cu 380A and Lippes loop C were inserted at random in 328 healthy parous women, in Campinas, SP, Brasil. Forty-five percent of the T-Cu 380A insertions and 40% of the Lippes loop insertions were performed by trained midwives. No pregnancies occurred in 1419 woman-months of use of T-Cu 380A, against 5 pregnancies in 1454 woman-months of use of Lippes loop. The difference was significant at the 5% level. No other significant differences were found. The continuation rate after one year of use was 82.5 for the T-Cu 380A and 75.1 for the Lippes loop. These results suggest that the performance of the T-Cu 380A in developing countries could be similar to the one observed in the United States, provided that the users are carefully selected and that an adequate insertion technique is followed.

Adolescent↗
PubMed1982

Prognosis of varicocelectomy in the treatment of infertility, based on pre-surgery characteristics.

The semen characteristics, before and after varicocelectomy, were studied in 220 husbands from infertile couples, whose wives had no significant abnormalities. All couples were followed for one year or until the wife became pregnant. Sperm density, vitality, motility and percent with normal morphology were analysed before surgery. Based on these results, subjects were divided into 2 groups according to whether their semen had normal or abnormal characteristics. The group with semen had normal or abnormal characteristics. The group with semen parameters within normal limits showed significantly less improvement after surgery, and the posttreatment pregnancy rate was independent of the effect of surgery on the characteristics of sperm. Between 71 and 84% of the subjects with abnormal semen characteristics showed improvement after surgery, and between 56 and 72% of those who improved, impregnated their wives. Subjects whose abnormal semen characteristics did not improve after surgery, had a very low pregnancy rate.

Female↗