Délio Marques Conde

Menopause symptoms in women infected with HIV: Prevalence and associated factors

Objective. To evaluate the prevalence and factors associated with menopause symptoms in HIV-infected women. Methods. A cross-sectional study of two groups of women was conducted: 96 with HIV and 155 without HIV. Women aged 40 years or older, non-users of hormone therapy in the last 6 months and native Brazilians were included. The prevalence of menopause symptoms was calculated according to the studied variables. Symptoms were grouped into six categories: vasomotor, psychological, genitourinary, weight gain, palpitations and insomnia. The generalized estimating equation model was applied to identify the factors associated with menopause symptoms in all women and for HIV-infected women only. Results. The mean (±standard deviation) age of women with and without HIV was 48.9 ± 7.4 and 51.0 ± 8.7 years (p = 0.07), respectively. The median age at menopause for HIV-infected women was 47.5 years. Menopause symptoms were more frequent in HIV-infected women, highlighting psychological and vasomotor symptoms. HIV infection was associated with menopause symptoms (odds ratio (OR) = 1.65, p = 0.03), as well as age ranging from 45 to 54 years (OR = 1.77, p = 0.01), higher parity (OR = 2.38, p = 0.01) and self-perception of health as fair/poor (OR = 2.07, p < 0.01). Among HIV-infected women, the likelihood of presenting symptoms decreased in those aged 55 or older (OR = 0.16, p = 0.03) and increased in retired women (OR = 2.61, p = 0.02). Conclusion. Menopause symptoms were common in HIV-infected women. HIV infection was independently associated with menopause symptoms, whereas age and being retired were associated with the occurrence of these symptoms in HIV-infected women.

Quality of life of women with gynecologic cancer: associated factors

ObjectiveTo evaluate quality of life (QOL) and identify its associated factors in a cohort of women with gynecologic cancer.MethodsA cross-sectional study was conducted, including 103 women with cervical or endometrial cancer, aged between 18 and 75xa0years who were receiving their entire treatment at the institution where the investigation was carried out. QOL was measured by the World Health Organization’s QOL instrument-abbreviated version (WHOQOL-BREF). Clinical and sociodemographic characteristics, in addition to prevalence of cancer-related symptoms prior to radiotherapy were investigated. Bivariate analysis was performed, applying the Mann–Whitney test. Multivariate analysis was used to identify factors associated with QOL.ResultsThe mean age of the participants was 56.8xa0±xa011.6xa0years. The study included 67 (65%) women with cervical cancer and 36 (35%) women with endometrial cancer. Most participants were at an advanced stage (63.1%). The most common complaints were pain (49.5%) and vaginal bleeding (36.9%). The prevalence of anemia was 22.3%. On multivariate analysis, it was observed that anemia (Pxa0=xa00.006) and nausea and/or vomiting (Pxa0=xa00.010) determined impairment in physical domain. Pain negatively influenced physical domain (Pxa0=xa00.001), overall QOL (Pxa0=xa00.024), and general health (Pxa0=xa00.013), while the history of surgery positively affected general health (Pxa0=xa00.001).ConclusionCancer-related symptoms were factors that most interfered with QOL in women with gynecologic cancer. Therefore, more attention should be focused on identifying these symptoms, adopting measures to minimize their repercussions on QOL.

Quality of Life in Breast Cancer Survivors

O câncer de mama e uma das neoplasias mais comuns entre mulheres. O diagnostico e a terapia antineoplasica determinam repercussoes sociais, economicas, fisicas, emocionais/psicologicas e sexuais. Os principais parâmetros empregados na avaliacao dos resultados da terapia antineoplasica sao a sobrevida livre de doenca e a sobrevida global. Mais recentemente, a qualidade de vida (QV) tem sido considerada mais um desses parâmetros. Nao existe consenso quanto a definicao de QV. Porem, a maioria das definicoes contempla os aspectos multidimensional e subjetivo da QV. A identificacao dos fatores relacionados a QV e a compreensao da forma como esses fatores contribuem para a percepcao da QV sao motivos de discussao, uma vez que o conceito de QV esta diretamente relacionado ao contexto sociocultural em que o individuo esta inserido. A idade ao diagnostico, uso de quimioterapia, tipo de cirurgia, sintomas climatericos, relacionamento conjugal e sexualidade sao alguns fatores associados a QV de mulheres com câncer de mama. A QV associada a diferentes terapias antineoplasicas pode auxiliar pacientes e medicos na escolha da melhor modalidade terapeutica. Nesse sentido, o presente artigo revisa diversos aspectos da QV de mulheres com câncer de mama, apresentando e discutindo o estado atual do conhecimento sobre o tema.

Prevalence of sexual dysfunction and its associated factors in women aged 40-65 years with 11 years or more of formal education: a population-based household survey.

OBJECTIVE To evaluate the prevalence of sexual dysfunction and its associated factors in middle-aged women with 11 years or more of formal education. METHODS A cross-sectional, population-based study was carried out using an anonymous, self-response questionnaire. A total of 315 Brazilian-born women, 40–65 years of age with 11 years or more of schooling, participated in the study. The instrument used in the evaluation was based on the Short Personal Experiences Questionnaire. Sexual dysfunction was calculated from the mean score of sexual responsiveness (pleasure in sexual activities, excitation and orgasm), frequency of sexual activities and libido. Sociodemographic and clinical factors were evaluated. Poisson multiple regression analysis was carried out and the prevalence ratios with respective 95% confidence intervals (95%CI) were calculated. RESULTS The prevalence of sexual dysfunction was 35.9% among our study population. Multiple regression analysis showed that sexual dysfunction was positively associated with older age (prevalence ratios=1.04; 95%CI:1.01–1.07) and with the presence of hot flashes (prevalence ratios=1.37; 95%CI:1.04–1.80). Having a sexual partner (PR=0.47; 95%CI:0.34–0.65) and feeling well or excellent (prevalence ratios= 0.68; 95%CI: 0.52–0.88) were factors associated with lower sexual dysfunction scores. CONCLUSIONS Sexual dysfunction was present in more than one-third of women that were 40–65 years of age with 11 years or more of formal education. Within that age group, older age and hot flashes were associated with higher sexual dysfunction scores, whereas feeling well and having a sexual partner were associated with better sexuality.

Quality of life and acute toxicity of radiotherapy in women with gynecologic cancer: a prospective longitudinal study

ObjectiveTo investigate the incidence of acute toxicity of radiotherapy, evaluate quality of life (QOL) and identify its predictors in a cohort of gynecologic cancer patients.MethodsA longitudinal prospective study was conducted including 107 women between the ages of 18 and 75xa0years with cervical or endometrial cancer. Acute toxicity was evaluated according to the Common Toxicity Criteria and the Radiotherapy Oncology Group toxicity criteria. QOL was measured with World Health Organization’s Quality of Life instrument-abbreviated version (WHOQOL-BREF) before and at completion of radiotherapy and during the first clinical follow-up visit. QOL scores were assessed by ANOVA for repeat measures. Percentage variation of QOL scores from the time before radiotherapy to the first clinical visit was compared with control variables by the Wilcoxon test. Multiple linear regression analysis was used to identify predictors of QOL.ResultsNinety-five women completed the three QOL assessments. The incidence of acute toxicity was 93.5% and the most common complaint was lower gastrointestinal (79.6%). A significant increase in QOL scores was observed in the physical and psychological domains, as well as general health and overall QOL. Upper gastrointestinal toxicity (pxa0=xa00.043) and surgery (pxa0=xa00.027) negatively affected general health, while improvement in vaginal bleeding (pxa0=xa00.047) positively influenced general health.ConclusionA high incidence of acute toxicity of radiotherapy was observed. At the completion of treatment, QOL improved in gynecologic cancer patients. Women with upper gastrointestinal toxicity and history of surgery are at risk for having a worse QOL.

Qualidade de vida

Increased life expectancy through general social advancement and progress of health sciences has given rise to a higher prevalence of chronic disease. Diabetes is one such diseases without any known cure, and is a major cause of morbidity and mortality. Serious and severe complications include cardiovascular problems, hypertension, renal failure, blindness, and limb amputation. These impact significanly on the diabetic patient’s quality of life. In this article the importance of diabetes in health status assessments is mentioned, and some ways of measuring the impact of diabetes on the patients’ quality of life are presented. Two measuring tools are highlighted: a generic one called SF-36, and a disease-specific one named Diabetic’s Health Profile. Finally, professionals are urged to systematically collect data on this very important area for people’s lives. Key-Words: Measurement of Health Outcomes; Diabetes.

Cardiorespiratory Fitness and Quality-of-Life Analysis Posttreatment in Breast Cancer Survivors

This study compared VO2peak, treatment frequency and dosage, and QOL between 22 post-treated breast cancer survivors (CATotal) and 22 apparently healthy, age-matched women (CO). The CATotal group included 11 with no history of any other co-morbidities (CA) and 11 with controlled hypertension (CA + H). VO2peak was measured using the Bruce Protocol. QOL was measured using the SF-36 survey. Significant differences were observed in VO2peak between CATotal and CO (p = 0.014), CA and CA + H (p = 0.001), and CA + H and CO (p = 0.001). Physical, emotional, and mental health domains of the SF-36 were significantly different between CATotal and CO (p = 0.006, 0.001, and 0.05 respectively). These results suggest that breast cancer survivors with controlled hypertension can experience a significant reduction in VO2peak when compared to apparently healthy, age-matched controls. Also, treatment frequency and dosage affected QOL in this group of survivors.

Age at menopause of HIV-infected women: A review

The advent of highly active antiretroviral therapy has promoted a reduction in mortality due to HIV. Thus more women are living longer after receiving a diagnosis of HIV infection. With an increase in survival, topics related to the menopausal transition in HIV-infected women have emerged, such as age at menopause, bone mineral density and menopause-related symptoms. To this end, several studies have investigated age at menopause (AM) in HIV-infected women. The present paper reviews these studies and discusses the possible clinical implications of determining AM for HIV-positive women.

Efeito de um programa de exercícios para o fortalecimento dos músculos do assoalho pélvico de multíparas

OBJETIVOS: Investigar o efeito de um programa individualizado e supervisionado de exercicios para os musculos do assoalho pelvico (MAP) no pos-parto de multiparas e verificar a correlacao entre dois metodos de medida de forca dos MAP. METODOS: Conduziu-se um ensaio clinico aberto em que foram incluidas puerperas, multiparas com idade entre 18 e 35 anos. A amostra foi de 23 puerperas divididas em dois grupos: Grupo Intervencao (GI, n=11) e Grupo Controle (GC, n=12). As puerperas do GI participaram de um programa de exercicios para os MAP durante oito semanas, com frequencia de duas vezes por semana. As puerperas do GC nao receberam orientacao quanto a pratica de exercicios. A forca dos MAP foi medida em duas oportunidades, utilizando-se a palpacao vaginal digital e o perineometro. A analise estatistica foi realizada atraves dos seguintes testes: exato de Fisher, do c2, t de Student, Kolmogov-Smirnov para duas amostras e coeficiente de correlacao de Pearson. Foi considerado como significativo p<0,05. RESULTADOS: A media de idade das participantes do GI foi de 24±4,5 anos e do GC foi de 25,3±4 anos (p=0,4). Apos o programa de exercicios, verificou-se diferenca significativa entre os grupos nas duas medidas da forca muscular (p<0,001). Os dois metodos de medida da forca muscular apresentaram correlacao significativa nas duas avaliacoes (1a avaliacao: r=0,889, p<0,001; 2a avaliacao: r=0,925, p<0,001). CONCLUSOES: O programa de exercicios resultou em aumento significativo da forca dos MAP. Verificou-se boa correlacao entre a palpacao vaginal digital e o perineometro, indicando que a palpacao vaginal pode ser utilizada na pratica clinica por ser um metodo de baixo custo e que demonstrou uma correlacao significativa com um metodo objetivo, o perineometro.

Update in Gynecology and Obstetrics: reviews and databases.

There is a considerable body of new information on Gynecology and Obstetrics. To aid in keeping gynecologists updated, renowned periodicals publish review articles. Review articles enable the reader to obtain the best evidence for clinical or research issues from several individual articles. This enables the professional to make clinical decisions in the light of current knowledge. The different types of reviews and database that may be used for the elaboration of reviews are discussed in the present article. It is suggested that future reviews on Gynecology and Obstetrics include articles published in other idioms apart from English and that a larger number of database is researched. Thus, reviews will be not only more inclusive but more representative of the international literature.