Palavras-Chave: Pappilomavirus humano; Mulheres; Genótipo; Infecções por Papillomavirus/diagnóstico; Bahia; Brasil

Abortion is not only a major cause of obstetric hospitalization in poor countries, but it also represents the failure of the public health system to provide enough information about contraceptive methods and thus prevent pregnancies. In Brazil, the high utilization rates of health facilities due to abortions reflect the ongoing difficulties with family planning and contraception. In addition, mortality resulting from abortions serves as an indicator of the quality of abortion procedures, an important point in a country where the practice is illegal and therefore done clandestinely. In this study, we analyzed the rates of mortality resulting from abortions among women 10 to 54 years old, including women who died from spontaneous and induced abortion, from 1980 to 1995, for the various regions of the country. The information we used came from the mortality data bank of the public health system of the Ministry of Health. Population data were obtained from the Brazilian Institute for Geography and Statistics. We studied 2,602 deaths, 15% of which were due to missed abortion, spontaneous abortion, or legally permitted induced abortion. The other 85% of the deaths were due to illegal induced abortions or to nonspecified abortions. The mortality rates from abortion-related causes have steadily decreased in all the regions of Brazil, but this improvement has been unevenly distributed in the country. The region with the smallest decrease in this rate (38% over 15 years) was the Northeast. The age of women dying from abortions progressively declined over the period studied.

Metabolic syndrome (MS) is a clinical condition and a relevant risk factor in the development of cardiovascular diseases; it occurs as a result of lifestyle factors, e.g., work. The aim of this research was to estimate the interaction between work and MS among primary health care (PHC) nursing professionals in the state of Bahia, Brazil. A sectional multicentered study carried out in 43 municipalities in Bahia, whose study population consisted of nursing professionals. The exposure variables were occupation, professional exhaustion, and working time, and the outcome variable was MS. Interaction measures based on the additivity criteria were verified by calculating the excess risks due to the interactions and according to the proportion of cases attributed to the interactions and the synergy index. The global MS prevalence is 24.4%. There was a greater magnitude in the exposure group regarding the three investigated factors (average level occupation, professional exhaustion, and working time in PHC for more than 5 years), reaching an occurrence of 44.9% when compared to the prevalence of 13.1% in the non-exposure group (academic education, without professional burnout, and working time in PHC for up to 5 years). The study’s findings showed a synergistic interaction of work aspects for MS occurrence among PHC nursing professionals.

To determine adherence to dual contraception using depot-medroxyprogesterone acetate (DMPA) and condom among HIV-infected women. A cross-sectional study carried out from December 2013 to September 2014 at a local reference center, with application of questionnaire elaborated after Delphi panel and content validation to 114 HIV(+) women aged 15 to 49 years, using DMPA plus condom for contraception. Mean age was 33.2 ± 7.2 years, mean time since HIV detection was 8.1 ± 5.2 years, mean time of antiretroviral use was 6.8 ± 5 years and mean CD4 cells/mm3 count was 737.6 ± 341.1. Sexual HIV acquisition was reported by 98.2% (112/114), antiretroviral use by 85.9% (98/114), and 77.7% (84/114) had a CD4>500/mm3 count. Having a single sex partner was reported by 78.9% (90/114), with HIV serodiscordance in 41.2% (47/114) of couples, 21.9% did not know the serological status of their partner and in 37.7% of cases (43/114) the partner was unaware of the HIV(+) status of the woman. The last pregnancy was unplanned in 71.9% of cases (82/114) and 14.9% of the women had become pregnant the year before, with pregnancy being unplanned in 70.5% (12/17) of cases. Current use of DMPA was reported by 64.9% (74/114), with genital bleeding in 48.2% (55/114) and weight gain in 67.5% (77/114). Use of a male condom was reported by 62.2% of the subjects (71/114). Three reported that they always used a female condom and ten that they eventually used it. Unprotected vaginal sex was reported by 37.7% (43/114) and unprotected anal intercourse was reported by 32.4% (37/114). Partner resistance to use a condom occurred in 30.7% of cases (35/114). Dual contraception using DMPA with condom was reported by 42.9% (49/114). A partner who resisted wearing a condom was associated with poor adhesion (PR=0.3; 95%CI 0.2-0.7; p<0.001). A partner who was unaware that a woman was infected with HIV favored adherence (PR=1.8; 95%CI 1.2-2.7; p=0.013). The percentage of dual contraception using DMPA plus condom was 42.9%, maintaining unplanned pregnancies and unprotected sex. Resistance of partners to use a condom increased three times the chance of a woman not adhering to dual contraception, and the partner not knowing women's HIV infection almost doubled the chance to adhere to safe contraception. to offer new hormonal contraceptives and to involve the partners in contraception and serologic detection tests.

Este estudo tem o objetivo de comparar o quantitativo de cirurgias contraceptivas antes e depois da vigência da Lei nº 14.443/2022, que retirou a necessidade de autorização pelo cônjuge, e avaliar a proporção de laqueaduras tubárias intra-cesárias sobre o total de laqueaduras. Trata-se de um estudo ecológico, com dados agregados por base territorial. Mediante o emprego da ferramenta de tabulação Tabnet, foram extraídos do DATASUS os quantitativos de vasectomias e laqueaduras tubárias custeadas pelo Sistema Único de Saúde por Unidade Federativa, de março de 2022 a fevereiro de 2024. Considerando o marco temporal da entrada em vigor da Lei nº 14.443/2022, a comparação entre o volume cirúrgico de março/2022 a fevereiro/2023 com o de março/2023 a fevereiro/2024, mostrou um incremento no número de laqueaduras de 92,6%, enquanto o aumento no número de vasectomias foi de apenas 35,9%. Um ano após a promulgação da nova lei, foi constatado que a quantidade de vasectomias representou 31,2% das cirurgias contraceptivas realizadas. Foi verificado também aumento de 103% no número de laqueaduras tubárias intra-cesárias nesse mesmo período. Portanto, apesar de ser um método de menor risco, mais simples e de menor custo, a vasectomia continua sendo a cirurgia contraceptiva menos realizada no Brasil. Após a promulgação da Lei nº 14.443/2022, houve um aumento ainda maior do número de laqueaduras em relação ao número de vasectomias. Diante disso, fica evidente a necessidade de políticas públicas mais eficientes para garantir o acesso equitativo à contracepção cirúrgica no Brasil. Palavras-chave: Esterilização tubária. Vasectomia. Esterilização reprodutiva. Planejamento familiar. This study aims to compare the number of contraceptive surgeries before and after the enactment of Law No. 14,443/2022, which removed the need for spousal authorization, and to evaluate the proportion of intra-cesarean tubal ligations in the total number of tubal ligations. This is an ecological study, with data aggregated on a territorial basis. Using the Tabnet tabulation tool, the numbers of vasectomies and tubal ligations paid for by the public health system by Federative Unit were extracted from DATASUS, from March 2022 to February 2024. Considering the time frame of the entry into force of Law No. 14,443/2022, the comparison between the surgical volume from March/2022 to February/2023 with that from March/2023 to February/2024 showed an increase in the number of tubal ligations of 92.6%, while the increase in the number of vasectomies was only 35.9%. One year after the enactment of the new law, it was found that the number of vasectomies represented 31.2% of the contraceptive surgeries performed. A 103% increase in the number of intra-cesarean tubal ligations was also observed in the same period. Therefore, despite being a lower-risk, simpler, and less expensive method, vasectomy continues to be the least performed surgical contraceptive method in Brazil. After the enactment of Law No. 14,443/2022, there was an even greater increase in the number of tubal ligations in relation to the number of vasectomies. Given this, the need for more efficient public policies to guarantee equitable access to surgical contraception in Brazil becomes evident. Keywords: Sterilization, tubal. Vasectomy. Sterilization, reproductive. Family planning. Resumen: Este estudio tiene como objetivo comparar el número de cirugías anticonceptivas antes y después de la promulgación de la Ley N.° 14.443/2022, que eliminó la necesidad de autorización conyugal, y evaluar la proporción de ligaduras tubáricas intracesáreas respecto al total de ligaduras tubáricas. Se trata de un estudio ecológico, con datos agregados por base territorial. Utilizando la herramienta de tabulación Tabnet, se extrajo de DATASUS el número de vasectomías y ligaduras de trompas financiadas por el Sistema Único de Salud (SUS) por Unidad Federativa, de marzo de 2022 a febrero de 2024. Considerando el marco temporal de la entrada en vigor de la Ley n.º 14.443/2022, la comparación entre el volumen quirúrgico de marzo de 2022 a febrero de 2023 con el de marzo de 2023 a febrero de 2024 mostró un aumento en el número de ligaduras de trompas del 92,6%, mientras que el aumento en el número de vasectomías fue de solo el 35,9%. Un año después de la promulgación de la nueva ley, se encontró que el número de vasectomías representó el 31,2% de las cirugías anticonceptivas realizadas. También se verificó un aumento del 103% en el número de ligaduras de trompas intracesáreas en el mismo período. Por lo tanto, a pesar de ser un método de menor riesgo, más sencillo y económico, la vasectomía sigue siendo la cirugía anticonceptiva menos realizada en Brasil. Tras la promulgación de la Ley n.º 14.443/2022, se observó un aumento aún mayor en el número de ligaduras de trompas en comparación con el de vasectomías. Ante esto, es evidente la necesidad de políticas públicas más eficientes para garantizar el acceso equitativo a la anticoncepción quirúrgica en Brasil. Palabras clave: Esterilización tubaria. Vasectomía. Esterilización reproductiva. Planificación familiar.

A partir de uma recente mudança legal no Brasil, que eliminou a necessidade de autorização conjugal para procedimentos de contracepção cirúrgica, esse estudo investiga a proporção entre vasectomias e laqueaduras realizadas em diferentes estados brasileiros durante o período de 2010 a 2019. Para tanto, foi utilizada uma abordagem ecológica com base nos dados do DATASUS. Mais adiante, foi proposta uma análise comparativa entre a proporção encontrada e o Índice de Desenvolvimento Humano (IDH) das unidades federativas, discutindo-se as implicações sociais, jurídicas e biomédicas da preferência por um procedimento cirúrgico em detrimento do outro. A análise dos dados aponta para uma tendência de permanência do ônus desproporcional sobre a mulher no controle da contracepção, o que reforça um diagnóstico de desigualdade de gênero associada a outros indicadores sociais de vulnerabilidade.