Dino Roberto Soares De Lorenzi

Fatores associados à qualidade de vida após menopausa

OBJETIVO: Avaliar a qualidade de vida de mulheres na pos-menopausa. METODOS: Estudo transversal de 323 mulheres pos-menopausicas com idade entre 45 e 60 anos atendidas em um servico universitario de atencao ao climaterio entre junho e outubro de 2002. A qualidade de vida foi avaliada atraves do Womens Health Questionnaire. Na analise estatistica, utilizou-se o teste t de Student e a analise de variância, seguidos de regressao linear multipla. RESULTADOS: A qualidade de vida se mostrou comprometida entre a populacao estudada, em especial nos dominios relacionados a sintomas somaticos, humor deprimido e ansiedade. Por meio de analise multivariada, constatou-se que quanto menor a escolaridade (p<0,01) e a frequencia da atividade sexual (p<0,01), assim como a confirmacao de comorbidades clinicas previas (p=0,03), piores os indices de qualidade de vida. Em contrapartida, a atividade fisica regular se associou aamelhor qualidade vida (p=0,01). A terapia hormonal, em particular, nao se associou a qualidade de vida (p=0,48). CONCLUSAO: A qualidade de vida mostrou-se comprometida neste estudo, sendo influenciada tanto por fatores biologicos, quanto por fatores culturais e psicossociais. Possivelmente, as mulheres atribuem a menopausa eventuais sintomas decorrentes de comorbidades clinicas ou dificuldades emocionais previas, distorcendo a sua percepcao acerca desta etapa de suas vidas. Neste sentido, a escolaridade contribuiu para uma maior compreensao das mudancas corporais dessa fase, reduzindo os niveis de ansiedade e estimulando o autocuidado. A sexualidade mostrou-se igualmente um aspecto importante da qualidade de vida no climaterio.

Fatores indicadores da sintomatologia climatérica

PURPOSE: to identify factors associated with climacteric symptoms. METHODS: a cross-sectional study of 254 women aged between 45 and 60 years was carried out at the Climacterium Outpatient Clinic of Caxias do Sul University, RS, from June to October 2002. Women with previous hysterectomy or under hormonal therapy were excluded. The climacteric symptoms were evaluated by means of the Kuppermann index and the attitudes toward menopause by a specific questionnaire. Data were analyzed by Students t test, analysis of variance (ANOVA) and multiple linear regression analysis. RESULTS: twenty eight percent of the women reported mild climacteric symtoms, whereas 42.3% reported moderate symptoms and 30.7%, intense symptoms. The most prevalent symptoms were: irritability (87.1%), arthralgias/myalgias (77.5%) and melancholy (73.2%), while the most severe were hot flushes in 60.2% of the women, irritability and insomnia. Attitudes toward menopause, skin color and physical activity were predictors of climacteric symptoms. Positive attitudes toward menopause (p=0.01), white color (p=0.02) and the habit of practicing physical activity (0.04) were associated with less intense climacteric symptoms. Negative attitudes toward menopause were associated with worse climacteric symptoms (p<0.01). CONCLUSIONS: in the current study, the climacteric symptoms were influenced by psychosocial factors and physical activity, as well as by climacteric hypoestrogenism.

Factors related to frequency of sexual activity of postmenopausal women

OBJECTIVE To identify factors related to the frequency of sexual activity of postmenopausal women METHODS A cross-section study of 206 postmenopausal women between 45 and 60 years of age was made at a university health care service in the South of Brazil between June and October 2002. Evaluations were made of sexual activity according to the number of sexual intercourses in the previous month and the climacteric symptoms using the Kupperman index. Statistical analysis was performed with multiple linear regression analysis. RESULTS Of those surveyed 176 (85%) women were sexually active. Although 60.6% reported a decrease in sexual activity after menopause, mostly attributing it to the husbands sexual impotence (41.7%). Approximately 25.7% stated they had no satisfaction with sexual intercourse. By means of multiple linear regression analysis the following aspects were associated to sexual activity: age (p<0.1), degree of sexual satisfaction (p=0.01), and climacteric symptomatology (p=0.02). As age increased the climacteric symptoms were more intense and sexual activity was less frequent with lower sexual satisfaction. The climacteric symptoms correlated with sexual activity were: hot flashes (p=0.05), irritability (p=0.04), melancholy/sadness (p=0.04), arthralgia/myalgia (p<0.01) and weakness/tiredness (p<0.01). CONCLUSION Findings of this study were similar to those in literature. They agree with the hypothesis that sexuality of climacteric women is not only influenced by factors related to hypoestrogenism, but also by psychosocial and cultural aspects associated with aging itself. Nevertheless, longitudinal studies are necessary to provide more conclusive data. Special attention should be given to the sexual dysfunction of men.

Assistência à mulher climatérica: novos paradigmas

O envelhecimento populacional e uma realidade demografica brasileira. Como consequencia, espera-se, nos proximos anos, um aumento progressivo na procura dos servicos de saude por mulheres com queixas relacionadas ao climaterio. Paralelamente, a assistencia ao climaterio tem passado por uma modificacao de paradigmas, impondo aos profissionais de saude uma mudanca de atitude. Reconhece-se que o climaterio e influenciado tanto por fatores biologicos, como por fatores psicossociais e culturais, cujo conhecimento e fundamental para uma assistencia mais qualificada e humanizada. Este artigo propoe refletir sobre as mudancas de paradigmas na assistencia ao climaterio, destacando a multidisciplinaridade e interdisciplinaridade, no sentido acolher melhor essa parcela da populacao e proporcionar-lhe um cuidado integral e individualizado, aproximando o saber da sensibilidade, voltado a uma melhor qualidade vida.Population aging is a demographic reality for Brazil. Consequently, in the next years it is expected a progressive increase in seeking health care services in the country by women with complaints related to climacterium. Parallel to it, assistance at this part of womans life has been going through a paradigm shift which has imposed to health professionals a change of attitude in relation to this stage of womans life. Today it is acknowledged that the climacterium is influenced by biological, psychosocial and cultural factors, whose knowledge is fundamental for planning a more qualified and humanized care. This article proposes a reflection on the paradigm shifts in assistance at climacterium, highlighting important aspects as multidisciplinarity and interdisciplinarity, so as to serve better this portion of population, and provide it with more integrated and individualized care, bringing together knowledge and sensitivity, and always aiming at a better quality of life.

Sífilis Congênita como Indicador de Assistência Pré-natal

Purpose: to study the prevalence of congenital syphilis in a universitary hospital of the south of Brazil, emphasizing its role as a prenatal care marker. Patients and Method: a descriptive study of the congenital syphilis cases which occurred at the Hospital Geral (HG-UCS) from June 1st, 2000 to May 31st, 2001, based on the diagnosis criteria proposed by the Center for Disease Control and Prevention (CDC, 1998). Results: The prevalence of congenital syphilis was 1.5 (27 cases in 1739 births). The coefficient of congenital syphilis observed was 15.5/1000 newborns. Twenty-three pregnant women (85.2%) received prenatal care; however, the maternal infection with syphilis was diagnosed before the delivery in only 16 (69.6%) cases. Only 4 pregnant women reported an appropriate prenatal treatment of syphilis. In 8 (29.6%) cases an association of maternal syphilis with other sexually transmissible diseases was observed. The coefficient of perinatal mortality was 1.15/1000 births (two perinatal deaths). Conclusions: The authors reaffirm the importance of congenital syphilis as an indicator of perinatal health, since it is a disease that may be completely prevented by prenatal care. In addition, a high prevalence of congenital syphilis allows one to question the quality of the prenatal care, which was available to the studied group.

Prevalência de sobrepeso e obesidade no climatério

PURPOSE: to evaluate the prevalence of overweight and obesity among climacteric women. METHODS: this cross-sectional study included 611 women aged between 45 and 60 years attended at a climacteric clinic from January to June 2003. The prevalence of overweight and obesity was evaluated through the body mass index (BMI). Overweight or obesity was considered when there was a BMI equal or higher than 25 kg/m2. Sociodemographic and reproductive variables as well as life style were also evaluated. The c2 test followed by logistic regression was performed for statistical analysis. RESULTS: the average age of the studied women was 51.4 (±4.4) years, whereas 52.9% of them were postmenopausal. About 63.7% of them had a BMI equal or higher than 25 kg/m2. The prevalence of overweight and obesity was 33.6 and 30.1%, respectively. The prevalence of overweight and obesity was higher among older women (OR=1.2; 95%IC: 1.1-1.4) or non hormonal therapy users (OR=1.8; 95%IC: 1.2-2.8). The opposite was observed among the women without a professional occupation (OR=0.6; 95%IC: 0.5-0.9) or a steady partner (OR=0.7; 95%IC: 0,4-0,9). CONCLUSIONS: in this study, the prevalence of overweight and obesity was influenced by age, but not by the menopausal status. The association between the marital status and occupation and the BMI strengthens the hypothesis that the health of the climacteric women may be influenced by biological factors as well as by psychosocial factors and life style. The lowest prevalence of overweight and obesity among the users of hormonal therapy may be explained by possible restrictions in relation to its prescription for women with previous overweight or obesity. Further studies are necessary to get more conclusive results, in particular with longitudinal studies.

Caracterização da qualidade de vida segundo o estado menopausal entre mulheres da Região Sul do Brasil

OBJECTIVES: to characterize the quality of life of climacteric women residing in the South region by menopausal status. METHODS: two hundred and thirty-six women aged between 40 and 65 were interviewed during a health fair held in March 2005 in a city in the South of Brazil. Their quality of life was assessed using the Brazilian version of the Menopause Rating Scale. RESULTS: of those interviewed, 133 were pre-menopausal and 103 post-menopausal. Moderate and severe climacteric symptoms were reported by 37.6% and 24.0% of the former, respectively, while 36.9% and 39.4% of the post-menopausal women reported moderate and severe symptoms, respectively. There were no differences between the two groups studied in terms of overall scores on the quality of life scale (p=0.12), although the pre-menopausal group reported more psychological symptoms (p=0.05) and the post-menopausal group more somatic-vegetative (p<0.01) and urinogenital (p=0.01) symptoms. CONCLUSIONS: quality of life was not influenced by menopausal status among the women covered by this study. The greater severity of somatic-vegetative symptoms in the post-menopausal group is probably due to the greater likelihood of hypoestrogenism at this stage in life, which may lead to vasomotor symptoms and urinogenital atrophy. The greater severity of psychological symptoms among pre-menopausal women may be related to a higher level of concern regarding menopause and its possible health implications.

Fatores de Risco para Natimortalidade em um Hospital Universitário da Região Sul do Brasil

Objetivo: estudar a influencia da assistencia pre-natal e de fatores materno-fetais nas taxas de natimortalidade de um hospital universitario da regiao sul do Brasil. Metodos: estudo caso-controle de 61 casos de natimortos ocorridos antes do inicio do trabalho de parto no Hospital Geral da Universidade de Caxias do Sul, RS, entre marco de 1998 e junho de 2001. Os controles (n=224) foram selecionados aleatoriamente entre os fetos nascidos vivos no mesmo periodo. A analise da qualidade da atencao pre-natal baseou-se nos criterios estabelecidos pelo Programa de Humanizacao do Parto e Nascimento do Ministerio da Saude (PNHPN, 2000). Para avaliar possiveis fatores de risco de natimortalidade foi utilizado o odds ratio (OR). Eventuais fatores de confusao foram avaliados por meio de regressao logistica. Resultados: observou-se maior prevalencia de prematuridade entre os casos de natimortos (idade gestacional media de 31,7+4,7 vs 38,6+0,9 semanas). O peso medio entre os natimortos foi de 1.705 g (+837 g) e de 3.080 g (+576 g) entre os controles. Acompanhamento pre-natal foi referido por 81,5% das maes dos natimortos e 91,6% do grupo controle. A analise inicial revelou associacao de tres fatores com o evento da natimortalidade: a atencao pre-natal inadequada quanto ao numero de consultas medicas e solicitacao de exames complementares basicos (43,6 vs 23,4%), a historia previa de natimortalidade (6,6 vs 0,9%) e a idade materna (27+7,9 anos vs 24+6,4 anos). Todavia, apos o ajustamento desses resultados pela regressao logistica, apenas a idade materna manteve associacao significativa com o obito fetal. Conclusoes: no presente estudo, a idade materna foi o fator mais fortemente associado com a natimortalidade.

Influência do exercício físico na qualidade de vida de mulheres na pós-menopausa: um estudo caso-controle

OBJETIVO: Avaliar a influencia de atividade fisica na qualidade de vida e sintomas referidos por um grupo de mulheres pos-menopausicas. METODOLOGIA: estudo caso-controle envolvendo de 197 mulheres na pos- menopausa com idade entre 50-65 anos: 132 sedentarias e 65 praticantes de exercicios fisicos aerobicos de intensidade leve a moderada. A qualidade de vida e a sintomatologia climaterica foram avaliadas pela Menopause Rating Scale (MRS). Na analise estatistica, procedeu-se a analise multivariada por regressao linear multipla. RESULTADOS: O grupo fisicamente apresentou indices de qualidade de vida significativamente melhores em todos os dominios do instrumento MRS: sintomas somato-vegetativos (p<0,01), sintomas psicologicos (p<0,01) e geniturinarios e sexuais (p<0,01); 63,6% do grupo sedentario e 33,4% do fisicamente ativo referiram sintomas de intensidade moderada a severa. A capacidade cardiorrespiratoria se mostrou tambem significativamente maior entre as mulheres fisicamente ativas (26,5±7,0 ml/Kg/min and 20,2±7,8 ml/kg/min, respectivamente). Atraves da analise multivariada, mostraram-se fatores preditores da qualidade de vida no presente estudo, a confirmacao de atividade fisica regular (p<0,01) e a renda familiar per capita (p<0,01), de modo que as mulheres fisicamente ativas ou com melhor renda tenderam a referir menor sintomatologia climaterica e melhor qualidade de vida. CONCLUSOES: No presente estudo, a atividade fisica regular de intensidade leve a moderada e a renda familiar per capita influenciaram positivamente a qualidade de vida e a intensidade da sintomatologia climaterica.

Assistance to the climacteric woman: new paradigms

O envelhecimento populacional e uma realidade demografica brasileira. Como consequencia, espera-se, nos proximos anos, um aumento progressivo na procura dos servicos de saude por mulheres com queixas relacionadas ao climaterio. Paralelamente, a assistencia ao climaterio tem passado por uma modificacao de paradigmas, impondo aos profissionais de saude uma mudanca de atitude. Reconhece-se que o climaterio e influenciado tanto por fatores biologicos, como por fatores psicossociais e culturais, cujo conhecimento e fundamental para uma assistencia mais qualificada e humanizada. Este artigo propoe refletir sobre as mudancas de paradigmas na assistencia ao climaterio, destacando a multidisciplinaridade e interdisciplinaridade, no sentido acolher melhor essa parcela da populacao e proporcionar-lhe um cuidado integral e individualizado, aproximando o saber da sensibilidade, voltado a uma melhor qualidade vida.Population aging is a demographic reality for Brazil. Consequently, in the next years it is expected a progressive increase in seeking health care services in the country by women with complaints related to climacterium. Parallel to it, assistance at this part of womans life has been going through a paradigm shift which has imposed to health professionals a change of attitude in relation to this stage of womans life. Today it is acknowledged that the climacterium is influenced by biological, psychosocial and cultural factors, whose knowledge is fundamental for planning a more qualified and humanized care. This article proposes a reflection on the paradigm shifts in assistance at climacterium, highlighting important aspects as multidisciplinarity and interdisciplinarity, so as to serve better this portion of population, and provide it with more integrated and individualized care, bringing together knowledge and sensitivity, and always aiming at a better quality of life.