Aarão Mendes Pinto Neto

Incontinência urinária entre mulheres climatéricas brasileiras: inquérito domiciliar

OBJECTIVE: To investigate the prevalence of stress urinary incontinence and its associated factors in perimenopause women using a population-based household survey. METHODS: A descriptive, exploratory cross-sectional population-based study with secondary analysis of a population-based household survey on perimenopause and menopause was conducted among women living in the city of Campinas, Brazil. Through a sampling process, 456 women between 45 and 60 years old were selected. Complaints of urinary incontinence and related risk factors, such as age, socioeconomic status, education level, race, parity, smoking habits, body mass index, previous gynecological surgeries, menopausal status, and hormonal replacement therapy were explored. Data were collected through home interviews using an adapted version of the structured pre-tested questionnaire elaborated by the International Health Foundation, International Menopause Society and the American Menopause Society. Statistical analysis were performed using prevalence rates (CI 95%). RESULTS: Thirty-five percent of the interviewees referred stress urinary incontinence. None of the sociodemographic factors studied was associated to the risk of urinary incontinence. In addition, parity did not significantly change the risk of urinary incontinence. Other factors, such as previous gynecological surgeries, body mass index, and smoking habits, were not associated with the prevalence of stress urinary incontinence. Also, menopausal status and hormonal replacement therapy did not change the risk of stress urinary incontinence. CONCLUSION: Though there was a high prevalence of stress urinary incontinence among perimenopause women, there was not found any associations with sociodemographic and reproductive factors.

Conhecimento sobre métodos anticoncepcionais por estudantes adolescentes

OBJETIVO: Comparar o conhecimento sobre metodos anticoncepcionais e identificar os fatores associados ao conhecimento adequado dos adolescentes de escolas publicas e privadas. METODOS: Realizou-se estudo transversal, do qual participaram 1.594 adolescentes entre 12 e 19 anos, de 13 escolas publicas e cinco privadas do Municipio de Sao Paulo entre junho e dezembro de 2003. As escolas foram selecionadas aleatoriamente e os alunos responderam um questionario sobre caracteristicas sociodemograficas, reprodutivas e metodos anticoncepcionais. As razoes de prevalencia foram calculadas com intervalo de confianca de 95% para cada questao sobre conhecimento de metodos e o tipo de escola. Atribuiu-se meio ponto para cada questao correta sobre conhecimento de anticoncepcionais, o ponto de corte foi 50% de acerto. Os testes estatisticos utilizados foram o qui-quadrado, o Wilcoxon-Gehan e a regressao multipla de Poisson. RESULTADOS: Dentre os adolescentes, 61% eram do sexo feminino nos dois grupos de escolas. Predominou nivel socioeconomico baixo nas escolas publicas e alto nas privadas (p<0,001). Cerca de 18,6% dos adolescentes nas escolas privadas e 28,6% nas publicas tinham atividade sexual (p<0,002). Quanto ao conhecimento, 25,7% dos adolescentes das escolas publicas e 40,8% das privadas apresentaram escore superior ou igual a cinco. Os fatores associados ao maior conhecimento foram ser do sexo feminino, estudar em escola privada, estar no ensino medio, ter nivel socioeconomico alto, ter relacao sexual e ter maior idade. CONCLUSOES: O nivel de conhecimento adequado sobre metodos anticoncepcionais foi baixo para os adolescentes de ambos os tipos de escolas. Os resultados revelam que, assim como os mais desfavorecidos, os adolescentes de maior nivel socioeconomico necessitam de informacoes adequadas sobre planejamento familiar, visando a melhorar esse conhecimento para mudanca seu comportamento.

Idade de ocorrência da menopausa natural em mulheres brasileiras: resultados de um inquérito populacional domiciliar

A descriptive, exploratory, cross-sectional, population-based study was conducted to identify age at menopause and its associated factors as well as socio-cultural, demographic, and economic characteristics of climacteric women in Campinas, Sao Paulo State. Subjects were 456 Brazilian women between 45 to 60 years of age, selected through area cluster sampling. Data were collected through home interviews using a structured, pre-tested questionnaire. This instrument was an adaptation, done by the authors, of questionnaires provided by the International Health Foundation/International Menopause Society and by the North American Menopause Society. Statistical analysis was performed through life table analysis and Cox logistic regression. Mean age at menopause was 51.2 years. There was no association between study factors and age at natural menopause.

Postdischarge surveillance following cesarean section: The incidence of surgical site infection and associated factors

BACKGROUND The rate of surgical site infections (SSI) and their associated risk factors was identified by performing postdischarge surveillance following cesarean section at a public university teaching hospital in Brazil. METHODS The study was conducted at the Center for Womens Integrated Health Care in Brazil between May 2008 and March 2009. Women were contacted by telephone 15 and 30 days after cesarean section. During hospitalization, a form was completed on factors associated with post-cesarean SSI. The chi(2) test and Fisher exact test were used to analyze categorical variables and the Mann-Whitney test for numerical variables. Relative risks (RR) and their respective 95% confidence intervals (95% CI) were calculated for factors associated with SSI. P values < .05 were considered significant. RESULTS The final sample consisted of 187 women. SSI was detected in 44 cases (23.5%). In 42 of 44 women (95%), SSI appeared following discharge from hospital, becoming evident within the first 15 days following surgery. Number of prenatal consultations < or =7 (RR, 2.09; 95% CI: 1.26-3.48) and hypertension (RR, 2.07; 95% CI: 1.25-3.43) were significantly associated with SSI in the bivariate analysis. In the multivariate analysis, only hypertension (RR, 2.47; 95% CI: 1.21-5.04) remained significant. CONCLUSION Postdischarge surveillance is essential for ensuring accurate estimates of post-cesarean section SSI. A 15-day postdischarge follow-up was shown to be sufficient. Hypertension was a factor associated with SSI.

Qualidade de vida em usuárias e não usuárias de terapia de reposição hormonal

OBJECTIVE. To compare the quality of life in postmenopausal women who were users and non-users of hormone replacement therapy (HRT). METHODS. A cross-sectional study was conducted on postmenopausal women aged between 40 and 65 years, who had been menopausal for up to 15 years. Women considered HRT users were those who had undergone this type of treatment for at least six months. Non-users of HRT were those who had not received this type of treatment during the last six months. Two hundred and seven women were included in the study: 106 users and 101 non-users of HRT. Sociodemographic, clinical and behavioral characteristics were assessed. The Kupperman Menopausal Index was applied to rate the intensity of climacteric symptoms and the Medical Outcomes Study 36- item Short-Form Health Survey (SF-36) was applied to assess women’s quality of life. For data analysis, a Student’s t test, a chi-square analysis, a Fisher’s exact test and a Mann-Whitney test were used. RESULTS. The mean age of HRT users was 52.6 ± 4.9 years and the mean age of non-users of HRT was 54.3 ± 4.7 years (p=0.01). There was a statistically significant difference regarding marital status (p=0.04). HRT users reported a lower frequency of moderate and severe climacteric symptoms (p=0.001). Of the eight quality of life domains evaluated, only vitality scored below 50 (45) in both groups. There were no differences between groups regarding the SF-36 components. CONCLUSIONS. Postmenopausal women who were users and non-users of HRT presented a good quality of life. There were no differences between users and non-users of hormone therapy.

Performance of the copper T 200 in parous adolescents: Are copper IUDs suitable for these women?

The clinical performance of a cohort of 995 parous adolescents, first-time users of the T-Cu 200B was studied and compared with a cohort of paired controls 10 years older, of the same parity. Life-table analysis showed that pregnancy, expulsion rates, as well as removals for bleeding and/or pain were higher in adolescents but within ranges already reported in the literature on this device. Removals for infection were few and not significantly different. Although the clinical performance of the T-Cu 200B in adolescents is not as good as in older women, the performance is similar or better than that reported for other reversible methods in this age group. Our conclusion is that IUDs should not be contraindicated for parous adolescents as long as adequate counseling, screening of risk factors, skillful insertion and follow-up are provided.

Quality of life in women with postmenopausal osteoporosis: Correlation between QUALEFFO 41 and SF-36

OBJECTIVE To evaluate quality of life (QoL) in women with postmenopausal osteoporosis, correlating the QUALEFFO 41 with the short-form health survey 36 (SF-36) and evaluated some factors that can influenced the QoL of women with osteoporosis. METHODS A cross-sectional study was conducted in 220 postmenopausal women (ages ranging from 55 to 80 years). Of the total number, 110 women had osteoporosis and 110 women did not have osteoporosis and these women were age-matched (+/-3 years). Two questionnaires were administered to all subjects for evaluation of QoL: the quality of life questionnaire of the European foundation for Osteoporosis 41 (QUALEFFO 41) and the short-form health survey 36 (SF-36). For data analysis, a significance level of 5% was set (p<0.05). RESULTS Clinical characteristics between the groups were similar, with statistically significant differences only in body mass index (BMI), race, school education, age at menopause and use of hormone therapy (HT) (p<0.001). Women with osteoporosis had a worse QoL both in the QUALEFFO 41 and in the SF-36, in all domains studied. Data was adjusted for BMI, race, school education and use of HT (p<0.001). There was a significant correlation between all domains in the QUALEFFO 41 questionnaire and their corresponding domains in the SF-36 (p<0.001). The only factors related to worse QoL were BMI>25 and sedentary lifestyle. In contrast, paid work was associated with a better QoL (CI=95%). CONCLUSION Women with osteoporosis had an impaired QoL, especially relating to the physical, psychological and social aspects. The factors associated with QoL were obesity, sedentary lifestyle and paid work.

Habitual physical activity and cardiovascular risk in post menopause

BACKGROUND To evaluate the prevalence of habitual physical activity and cardiovascular risk in postmenopausal women. METHODS A cross-sectional study was made of 162 women, aged 40-65 years, amenorrheic for at least 12 months, receiving care at the menopause clinic of CAISM/UNICAMP. The women verbally answered the International Physical Activity Questionnaire for assessment of physical activity levels. This instrument evaluates the frequency and duration of activities performed during transportation, at work, at home or in leisure- over the course of a normal week. Women were classified as sedentary, insufficiently active, active or very active. Laboratory tests were carried out to measure total serum cholesterol, high density lipoproteins and fasting glucose. Systolic and diastolic pressure was measured. RESULTS The mean age of women in this study was 56.5 years and mean age at menopause was 46 years. Prevalence of physical activity was 83.3% of which 80.8% were classified as active, 2.5% as very active and 16.7% as insufficiently active. Principal activities were performed during transportation and while carrying out household chores. Only 38.3% of women had leisure-time physical activities. In the population, 87.7% of the women presented a Framingham score <10, considered of low cardiovascular risk. CONCLUSIONS Postmenopausal women show a high prevalence of habitual physical activity and low adherence to physical exercise. Cardiovascular risk was low in the population studied. It is important to encourage these women to practice physical activity compatible with their physical condition, to orient and stimulate them to practice not only their habitual physical activity but also physical exercise.

Estudo exploratório da associação entre o perfil lipídico e a densidade mineral óssea em mulheres menopausadas, em hospital de referência de Campinas

A total of 72 postmenopausal patients presenting no risk factors for cardiovascular disease nor osteoporosis, were studied. The study evaluated total serum cholesterol and fractions and bone mass by densitometry of the lumbar spine and femur using a Lunar-DPX. There was no association between lipid profile variables and bone mineral density, except for high density lipoprotein (HDL), which showed an inverse correlation (p=0.001). Multiple regression showed that total cholesterol levels higher than 240 mg% had a positive association with BMD (p=0.026). In addition, the ratio between LDL and HDL (Castelli 2 index) showed a negative association with BMD (p=0.002). The diagnostic validation test showed that all lipid profile variables had low sensitivity and specificity as indicators for osteoporosis. The conclusions were that lipid profile variables did not show a significant association with bone mass and could not be used as indicators for bone mineral density.O objetivo deste estudo foi avaliar a possivel associacao entre algumas variaveis do perfil lipidico e a densidade mineral ossea e se estas variaveis poderiam ser usadas como indicadoras de massa ossea em mulheres menopausadas, atendidas no ambulatorio de menopausa do CAISM-Unicamp, no ano de 1995. Estudaram-se 72 pacientes pos-menopausadas, sem fatores de risco para doencas cardiovasculares e para osteoporose, por meio da dosagem de colesterol total e fracoes e da avaliacao da densidade mineral ossea por densitometria ossea em aparelho Lunar DPX (Dexa). Dentre as variaveis do perfil lipidico, a densidade mineral ossea associou-se inversamente a lipoproteina HDL de alta densidade (p = 0,001). A analise de regressao multipla observou que niveis de colesterol total acima de 240mg% associaram-se a menor densidade mineral ossea (p = 0,026). A razao entre a lipoproteina de baixa densidade e a lipoproteina de alta densidade (indice de Castelli 2) correlacionou-se positivamente com a densidade mineral ossea (p = 0,002). O teste de validacao diagnostica mostrou que todas as variaveis do perfil lipidico apresentaram baixa sensibilidade e especificidade como indicadoras de diminuicao de massa ossea. Conclui-se que, apesar de algumas variaveis do perfil lipidico apresentarem associacao estatisticamente significativa com a massa ossea, elas foram contraditorias e nao tem boa capacidade diagnostica.A total of 72 postmenopausal patients presenting no risk factors for cardiovascular disease nor osteoporosis, were studied. The study evaluated total serum cholesterol and fractions and bone mass by densitometry of the lumbar spine and femur using a Lunar-DPX. There was no association between lipid profile variables and bone mineral density, except for high density lipoprotein (HDL), which showed an inverse correlation (p = 0.001). Multiple regression showed that total cholesterol levels higher than 240 mg% had a positive association with BMD (p = 0.026). In addition, the ratio between LDL and HDL (Castelli 2 index) showed a negative association with BMD (p = 0.002). The diagnostic validation test showed that all lipid profile variables had low sensitivity and specificity as indicators for osteoporosis. The conclusions were that lipid profile variables did not show a significant association with bone mass and could not be used as indicators for bone mineral density.

Caracterização das usuárias de terapia de reposição hormonal do Município de Campinas, São Paulo

This study employed a descriptive, cross-sectional, population-based design to characterize climacteric women from Campinas, São Paulo State, based on use of hormone replacement therapy (HRT). An area cluster sample was selected with 456 women 45 to 60 years of age, residing in Campinas, based on data from the Brazilian Institute of Statistics and Geography (IBGE). Women were selected by area cluster, and the reference unit was the census tract as defined by the IBGE. Data were collected through home interviews using a structured and pre-tested questionnaire provided by the International Health Foundation/International Menopause Society and by the North American Menopause Society and adapted by the authors. In order to characterize women according to current, past, or no use of HRT, a polytonic logistic regression model was used, with a backward selection process of variables. The authors conclude that the main characteristics of HRT users in the city of Campinas were perimenopausal status and higher literacy and socioeconomic class.