Andrea Lemos

Effectiveness of contraceptive counselling of women following an abortion: a systematic review and meta-analysis

Objective To perform a systematic review of the effectiveness of contraceptive counselling in women undergoing an abortion and its impact on the acceptance and use of contraceptive methods. Methods Randomized controlled trials (RCTs) assessing women who had undergone an abortion and received contraceptive counselling at that time met the inclusion criteria. Articles published between 1997 and 2007 were selected from searches of the LILACS, SCIELO, MEDLINE, PubMed and Cochrane Library databases. Two reviewers independently assessed eligibility and the quality of the trial. The internal validity of the RCTs was evaluated by means of the Jadad scale. A meta-analysis of the three retained studies involving 694 women was performed. The Stata 9.2 SE statistical software was used, and a level of significance of 0.05 adopted. Results There were no differences between intervention and control groups, despite clinical heterogeneity. The results of the meta-analysis were not significant (OR = 1.32; CI: 0.90–1.94). Conclusion There was no evidence indicating that contraceptive counselling is effective in increasing acceptance and use of contraceptive methods after an abortion. This may not apply to developing countries, where the matter still needs to be investigated.

Do perineal exercises during pregnancy prevent the development of urinary incontinence? A systematic review

Objectives:  The aim of the current article was to conduct a systematic review of the performance of perineal exercises during pregnancy and their utility in the prevention of urinary incontinence.

Efeitos de um programa de exercícios em grupo sobre a força de preensão manual em idosas com baixa massa óssea

OBJECTIVES: To evaluate the effects of an exercise program on handgrip strength (HS) in elderly women with low bone mass. SUBJECTS AND METHODS: Thirty-six elderly women were randomized to the intervention group - GI (n = 18) and control group - GC (n = 18). Participants were evaluated by means of a HS test, using a handgrip dynamometer. GI performed strength, balance and functional mobility exercises, and GC performed stretching exercises. Both groups had sessions twice a week for 50 minutes, during 4 months. RESULTS: GI had a significant increase in handgrip strength equal to 31.38%. No differences were observed in GC. There were correlations between HS test and bone mineral density (BMD) of the femoral neck (r = 0.582, p = 0.003) and total femur (r = 0.485, p = 0.01). CONCLUSION: Results indicate a propensity to increase elderly HS, and showed significant correlations between HS and BMD.

Postural control assessment in students with normal hearing and sensorineural hearing loss

INTRODUCTION Children with sensorineural hearing loss can present with instabilities in postural control, possibly as a consequence of hypoactivity of their vestibular system due to internal ear injury. OBJECTIVE To assess postural control stability in students with normal hearing (i.e., listeners) and with sensorineural hearing loss, and to compare data between groups, considering gender and age. METHODS This cross-sectional study evaluated the postural control of 96 students, 48 listeners and 48 with sensorineural hearing loss, aged between 7 and 18 years, of both genders, through the Balance Error Scoring Systems scale. This tool assesses postural control in two sensory conditions: stable surface and unstable surface. For statistical data analysis between groups, the Wilcoxon test for paired samples was used. RESULTS Students with hearing loss showed more instability in postural control than those with normal hearing, with significant differences between groups (stable surface, unstable surface) (p<0.001). CONCLUSIONS Students with sensorineural hearing loss showed greater instability in the postural control compared to normal hearing students of the same gender and age.

Tabagismo como fator de risco para a doença renal crônica: revisão sistemática

INTRODUCTION Chronic kidney disease (CKD) and smoking are public health problems. OBJECTIVE To assess smoking as a risk factor for progression of CKD. METHODS We conducted a systematic review in Medline, LILACS, SciELO, Google Scholar, Embase and Trials.gov with articles published until February/2013. Were included: cohort, clinical trials and case-control. Performed in humans, aged ≥ 18 years with smoking as a risk factor for progression of CKD. We excluded studies that reported no smoking and CKD in the title or had proposed to reduce smoking. RESULTS Among 94 citations, 12 articles were selected. Of these, six were multicenter conducted in developed countries, four were randomized. Males predominated 51-76%. There was associated with smoking progression in 11 studies. It was found that the consumption ≥ 15 packs/ year increases the risk of progression of CKD. CONCLUSION Smoking is a risk factor for progression of CKD.

Abdominal muscle electrical activity during labor expulsive stage: a cross-sectional study

BACKGROUND During the second stage of labor, the progression of the fetal expulsion depends on many factors related to maternal and fetal parameters, including the voluntary abdominal pushing. OBJECTIVES This study aimed to correlate the maternal and fetal parameters that may influence the voluntary maternal pushes during the second stage of labor by using surface electromyography. METHODS The electromyographic activity of the rectus abdominis and external oblique muscles were measured during the second stage of labor in 24 Brazilian pregnant women. The diastasis of the rectus abdominis, the body mass index and the uterine fundal height were analyzed as maternal parameters and the fetal weight, cephalic circumference, APGAR scores and arterial pH and CO2 were analyzed as fetal parameters. The oxytocin usage and the expulsive phase duration were considered. RESULTS A negative correlation between the rectus abdominis diastasis and the rectus abdomini muscle electromyographic parameters was found (r=-0.407 p=0.04). No statistically significant correlations were found among the rectus abdominis and external oblique muscles electromyography and the other maternal or fetal parameters, as well as among expulsive phase duration and the oxytocin usage. CONCLUSIONS This study suggests that the rectus abdominis diastasis may be an influential parameter in generating voluntary pushes during the second stage of labor, however it cannot be considered the only necessary parameter for a successful labor.

The Valsalva maneuver duration during labor expulsive stage: repercussions on the maternal and neonatal birth condition

OBJECTIVES This cross-sectional study was designed to examine the effects of the Valsalva Maneuver (VM) and its duration on the acid- base equilibrium of the neonate and its maternal repercussions during the expulsive stage of labor, after standard breathing and pushing instructions were given. METHODS A convenience sample of women with low risk pregnancy (n=33; mean age 22.5±3.7 y and gestational age 38.1±1.12 wks) and their newborns were studied during the expulsive stage of vaginal labor. Coaching consisted of standard recommendations for breathing including prolonged VMs coordinated with pushing. Maternal outcomes included the need for uterus fundal pressure maneuver and episiotomy, perineal trauma and posture. Neonatal outcomes included blood gases sampled from the umbilical cord, and Apgar scores. Data were analyzed with the Fishers exact test, chi-square test, and Pearson correlation coefficient. RESULTS None of the maternal outcomes were associated with VM duration. With respect to neonatal outcomes, increased VM duration was associated with reduced venous umbilical pH (r=-0.40; p=0.020), venous base excess (r=-0.42; p=0.014) and with arterial base excess (r=-0.36; p=0.043). Expulsive stage time was negatively associated with umbilical venous and arterial pH. CONCLUSIONS VM duration during fetal expulsion in labor negatively affects fetal acid-base equilibrium and potentially the wellbeing of the neonate. Our results support the need to consider respiratory strategies during labor, to minimize potential risk to the mother and neonate.

Respiratory muscle strength in pregnancy.

BACKGROUND Muscle respiratory strength studies during pregnancy are very scarce. The aim of this paper is to describe maximum inspiratory (PImax) and expiratory (PEmax) mean pressure values in women during their first pregnancy and to determine the relationship between the anthropometric, morphologic and physiologic variables of these pressures. METHODS One hundred and twenty women (120) primigravidas were studied from the 5th to 40th gestational week, ages ranging from 20 to 29 years old, euthrophic and with low risk pregnancies. RESULTS PImax and PEmax mean values were 88.5 ± 16.52 cmH(2)O and 99.76 ± 18.19 cmH(2)O respectively. There was no association between gestational age and PImax (r = -0.06; p = 0.49) or PEmax (r = -0.11; p = 0.22). There was also no difference between PImax and PEmax during pregnancy trimesters and no correlation between pregnancy age and the pressures in each trimester. Height was the only anthropometric variable indicating a significant PImax (r = 0.20; p = 0.02) association. Fundal uterus height and inter-recti abdominis distance were not associated to respiratory pressure values. PEmax is not associated with the group of predictor variables (p = 0.127) and PImax demonstrated an independent association with height and dyspnea during physical exertion reflected by the following equation: PImax = 0.6 + 57.9 height - 1.68 dyspnea under effort. The present study suggests that inspiratory and expiratory maximum pressure values are not altered during different stages of pregnancy, however longitudinal studies are needed to assess changes over time.

Função sexual e fatores associados à disfunção sexual em mulheres no climatério

PURPOSE To evaluate the sexual function and factors associated with sexual dysfunction in climacteric women. METHODS A cross-sectional study was conducted on 173 women aged 35 to 65 years old, with a steady partner during the last 6 months, who are literate, without cognitive impairment, and with sexual activity for at least 6 months. The instrument used to assess sexual performance was the Sexual Quotient, female version. The association between sexual dysfunction and sociodemographic data, personal, obstetric and sexual history was determined by Pearsons χ2 test and strength of association by the odds ratio (OR) with a 95% confidence interval (95%CI). RESULTS In this study, 46.2% of the women reported sexual dysfunction. There was a decrease in the chance of sexual dysfunction for the age group between 35 and 49 years old (OR=0.3; 95%CI 0.2-0.6) and for women who felt comfortable talking about sex (OR=0.5; 95%CI 0.2-0.8). However, the presence of osteoporosis (OR=3.3; 95%CI 1.5-7.6), urinary incontinence (OR=2.0; 95%CI 1.1-3.7), and surgical corrections of the pelvic floor (OR=2.2; 95%CI 1.1-4.5) increased this chance. CONCLUSIONS The frequency of sexual dysfunction in women aged 35 to 65 years old was 46.2% and factors such as osteoporosis, urinary incontinence and surgical corrections of the pelvic floor increased the chance of sexual dysfunction.

Força muscular respiratória: comparação entre primigestas e nuligestas

OBJECTIVE To describe and to compare MIP and MEP in primigravidae and nulligravidae in the 20-29 year age bracket and paired by age. METHODS We included 120 primigravidae with low obstetric risk (5th-40th week of gestation) and 40 nulligravidae. All of the participants were of normal weight and none exercised regularly. All were recruited from the metropolitan area of Recife, Brazil. Measurements of MIP and MEP were obtained from RV and TLC, respectively, with a digital manometer. We used Students t-test to compare the two groups, and we used multiple linear regression in order to determine whether group or chronological age correlated with MIP or MEP. RESULTS In the primigravida and nulligravida groups, the mean MIP values were 88.50 ± 16.52 cmH₂O and 94.22 ± 22.63 cmH₂O, respectively, (p = 0.08), whereas the mean MEP values were 99.76 ±18.19 cmH₂O and 98.67 ± 20.78 cmH₂O (p = 0.75). Gestational age did not correlate with MIP (r = -0.06; p = 0.49) or MEP (r = -0.11; p = 0.22). The relationship between chronological age and MIP/MEP did not differ between primigravidae and nulligravidae (angular coefficient = 0.028 and 0.453, respectively). CONCLUSIONS Within this sample of women in the 20-29 year age bracket, the respiratory pressures of primigravidae remained stable during pregnancy and did not differ significantly from those of nulligravidae.