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

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

Sexualidade; -Educação Sexual; -Currículo; -Estudantes de Medicina. RESUMO Realizou-se estudo descritivo e transversal com 242 alunos matriculados no internato em medicina de duas universidades públicas e duas faculdades privadas em Teresina, Piauí. Foi aplicado questionário semiestruturado para conhecer como a sexualidade humana foi ensinada nos cursos médicos. A taxa de resposta ao questionário foi de 86,3%. O ensino da sexualidade foi identificado por 95,2% dos alunos em algum momento do curso. As disciplinas que mais falaram sobre o assunto foram: ginecologia (91,9%), psiquiatria (55,3%), psicologia médica (30,6%) e urologia (24,1%). A sexualidade foi tema de aula em apenas 8,4% dos relatos, mas foi comentada em outras aulas, como: câncer (70,9%), aborto (67,5%), DST e HIV/Aids (67%). Quando o docente falou sobre sexualidade, enfatizou as disfunções sexuais (84,1%), com menor evidência para homossexualidade (50%) e direitos sexuais e reprodutivos (40,6%).Os alunos apontaram influências positivas do ensino da sexualidade na graduação (96,1%). Esses dados indicam que a sexualidade foi ofertada com destaque para a discussão de aspectos biológicos e de doenças associadas à sexualidade, com menor ênfase na construção social do tema e orientação sexual. ABSTRACT We conducted a descriptive and cross-sectional study with 242 medical undergraduates at two public universities and two private colleges in Teresina, Piauí. A semi-structured questionnaire to understand how human sexuality was taught in medical courses was applied. The questionnaire response rate was 86.3%. The teaching of sexuality was identified by 95.2% of students at some time during the course. Gynecology was the discipline that discussed sexuality the most (91.9%), followed by Psychiatry (55.3%), Medical Psychology (30.6%) and Urology (24.1%). Sexuality was cited as a specific topic in only 8.4% of the reports, but it was reported in classes about other topics such as cancer (70.9%), abortion (67.5%), STD and HIV/AIDS (67%). In class, the teacher emphasized sexual dysfunctions (84.1%), with less emphasis on homosexuality (50%) and sexual and reproductive rights (40.6%). Students indicated that there were positive influences of sexual education in undergraduate study (96.1%). There was great emphasis on the discussion of biological aspects and diseases associated with sexuality, with less emphasis on the social construction of the theme and sexual orientation.

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Background Evidence shows that women who have sex with women (WSW) face disparities in access to health care when compared to heterosexual women in several countries. Aim To investigate the experiences WSW have after disclosure of sexual orientation during gynecological care in Brazil. Methods We performed a qualitative study using content analysis. We recorded and transcribed interviews with 34 WSW from the 5 regions in Brazil. Data were analyzed using descriptive content analysis. Outcomes The main categories of analysis were decision-making process to disclose and attitude of gynecologists after disclosure. Results WSW disclosed their sexual orientation in an un-favorable environment. Gynecologists rarely asked about patients’ sexual orientation and used a script for hetero-normative anamnesis. The reactions of gynecologists were discriminatory, resulting in abbreviated consultations and un-comfortable gynecological exams. They missed a window of opportunity for prevention, diagnosis, and treatment of various diseases. The experiences Brazilian WSW had during gynecological care demonstrated the dominant hetero-normativity in the health care scenario. The attitudes of the gynecologists precarized the existence of WSW in health service. Clinical Implications This study suggests that gynecologists missed an opportunity to use WSW's sexual orientation disclosure to offer specific care to them. Strengths & Limitations This is the first qualitative study about WSW’s experiences during gynecological care in Brazil. Future studies should be developed from a wider sampling, especially among lower-class WSW. Conclusion The results point out the need for a change in medical training and guidelines to assist WSW in the country.

Objetivo: descrever o perfil das notificações da violência física ou sexual contra mulheres de 10 a 49 anos no Piauí. Métodos: estudo descritivo e de série temporal, tendo como base os dados do Sistema de Informação de Agravos de Notificações entre 2009 e 2016. Análises bivariada e múltipla por regressão logística foram realizadas, com cálculo de odds ratio ajustadas (ORaj) e intervalos de confiança de 95% (IC95%). Resultados: houve notificação de 7.783 casos de violência contra mulheres de 10 a 49 anos, sendo 62,3% de agressão física e 23,1% de abuso sexual. Ocorreu maior chance de violência física entre mulheres com 20 anos ou mais (ORaj=1,68;IC95% 1,49-2,07), casadas/ união estável (ORaj=2,18;IC95% 1,98-2,32), praticada pelo parceiro íntimo (ORaj=2,20;IC95% 1,44-2,97) e no ambiente doméstico (ORaj=2,22;IC95% 1,55-3,41). Por sua vez, houve maior chance de violência sexual entre adolescentes de 10 a 19 anos (ORaj=1,78;IC95% 1,44-2,19), solteiras (ORaj=1,94;IC95% 1,33-2,51), perpetrada por desconhecidos (ORaj=1,88;IC95% 1,30-2,84) e na via pública (ORaj=2,04;IC95% 1,66-2,49). Conclusão: o perfil da violência física é diferente daquele da violência sexual, sendo a agressão física mais frequente entre mulheres casadas, no âmbito privado e por parceiro íntimo, enquanto o abuso sexual foi mais comum entre solteiras, praticado em local público e por desconhecidos. Os dados reforçam que o conhecimento desses perfis possibilita intervenções intersetoriais para prevenção e redução de danos da violência contra a mulher.

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

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