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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.

Síndrome do climatério: inquérito populacional domiciliar em Campinas, SP

OBJECTIVES To study the prevalence of climacteric, urogenital and sexual symptoms in a population of Brazilian women. METHODS A cross-sectional descriptive population-based study was conducted. The selection of 456 women aged 45-60 years, living in Campinas, SP, in 1997, was done through area cluster sampling, according to data from the Brazilian Institute of Geography and Statistics. Data were collected via home interviews, using structured pretested questionnaires. Data were analyzed using the chi-squared test and the nonparametric Kruskal-Wallis test; a probability of <0.05 was considered statistically significant. The degree of climacteric symptoms was analyzed through circulatory and psychological indices. Analysis of the main components was used to determine symptom interrelationships. RESULTS The most prevalent symptoms were nervousness (82%), hot flushes (70%), headache (68%), irritability (67%) and sweating (59%). Hot flushes, sweating and insomnia were significantly more prevalent in the peri and postmenopausal phases. The frequency (severity) of vasomotor and psychological symptoms did not vary according to the menopause phase. The prevalence of urinary incontinence was 27.4%. Complaints of dyspareunia and vaginal dryness were infrequent. Decreased libido was the most frequent sexual complaint. It was observed that some climacteric complaints were interrelated. The first cluster included hot flushes and sweating (vasomotor cluster). The second cluster included nervousness, depression and irritability (psychological cluster). The third cluster included dizziness and palpitation (atypical cluster). CONCLUSION Climacteric symptoms in this population were highly prevalent and similar to those described in developed Western countries.OBJETIVO: Estudar a prevalencia de sintomas climatericos, urogeniatais e sexuais em populacao de mulheres do Brasil. METODOS: Estudo descritivo de corte transversal, de base populacional. Selecionaram-se, por meio de processo de amostragem, 456 mulheres, residentes no municipio de Campinas, SP, na faixa etaria de 45-60 anos de idade, em 1997, segundo informacoes da agencia local do Instituto Brasileiro de Geografia e Estatistica. Os dados foram coletados por meio de entrevistas domiciliares, com questionarios estruturados e pre-testados. A analise dos dados foi realizada pelo teste do qui-quadrado, teste nao parametrico de Kruskal-Wallis, com nivel de significância estatistica menor que 0,05. A intensidade dos sintomas climatericos foi analisada pelos indices circulatorio e psicologico. A analise de componentes principais foi utilizada para determinar a inter-relacao dos sintomas climatericos. RESULTADOS: Os sintomas climatericos mais prevalentes foram: nervosismo (82%), fogachos (70%), cefaleia (68%), irritabilidade (67%) e sudorese (59%). Os fogachos, a sudorese e a insonia foram significativamente mais prevalentes na peri e pos-menopausa. A frequencia (intensidade) dos sintomas vasomotores e psicologicos nao variou segundo o estado menopausal. A prevalencia de incontinencia urinaria foi de 27,4%. A queixa de dispareunia e secura vaginal foi pouco frequente. Em relacao as queixas sexuais, a diminuicao do interesse sexual foi a mais frequente. Constatou-se que algumas queixas climatericas sao inter-relacionadas. O primeiro aglomerado incluiu as ondas de calor e a sudorese (aglomerado vasomotor). O segundo, depressao, nervosismo e irritabilidade (aglomerado psicologico) e o terceiro, tontura e palpitacao (aglomerado atipico). CONCLUSOES: A prevalencia de sintomas climatericos na populacao estudada foi elevada e semelhante a descrita em paises ocidentais desenvolvidos.

Risk of malignancy in endometrial polyps in premenopausal and postmenopausal women according to clinicopathologic characteristics.

ObjectiveThe aim of this study was to evaluate the prevalence of endometrial premalignant and malignant polyps in premenopausal and postmenopausal women, as well as the clinical, ultrasound, and hysteroscopic factors associated with malignancy. MethodsAll women undergoing hysteroscopic resection of endometrial polyps from January 1998 to December 2008 were selected using a computerized database from the operating theater of the Prof. Dr. José Aristodemo Pinotti Women’s Hospital, Women’s Health Care Center/University of Campinas. Eight hundred seventy women with ages ranging from 25 to 85 years were included. Polyps were classified into benign (endometrial polyps and polyps with nonatypical simple hyperplasia and nonatypical complex hyperplasia), premalignant (polyps with atypical simple hyperplasia or atypical complex hyperplasia), and malignant. Statistical analysis was performed by measurement of the frequencies, means, and SD. The risk factors for malignancy were assessed by bivariate and multiple regression analyses, using the Epi-Info 2000 program and SAS (Statistical Analysis Software), version 9.2. ResultsThe mean (SD) age of the women was 57.5 (10.6) years. Of these women, 76.4% were postmenopausal. Women were diagnosed with benign lesions in 95.8% of cases. Premalignant polyps accounted for 1.6% of the total number of cases. Malignant polyps represented 2.5% of the total sample. Postmenopausal bleeding and age greater than 60 years were the only factors that remained associated with a higher risk of malignancy with a prevalence ratio of 3.67 (95% CI, 1.69-7.97) and 1.5 (95% CI, 1.01-1.09), respectively. ConclusionsThe prevalence rate of malignancy in endometrial polyps was higher in women with postmenopausal bleeding and advanced age.

Menopause symptoms and quality of life in women aged 45 to 65 years with and without breast cancer.

Objective:To compare the prevalence of menopause symptoms, sexual activity, and quality of life in women with and without breast cancer. Design:A cross-sectional study using one group for comparison was conducted on women aged 45 to 65 years who had not received hormone therapy or tamoxifen during the last 6 months. Participants were recruited from the Menopause and Breast Cancer Outpatient Facilities. One hundred eighty-two women were included, 97 with breast cancer and 85 without breast cancer. Sociodemographic and clinical features and prevalence of menopause symptoms were assessed. The quality of life was assessed by the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) questionnaire. To compare sociodemographic and clinical features between groups, the Students t test or Fisher exact test was used. Multiple logistic regression and linear regression models were used to control for potential confounding variables. Results:The mean age of participants with breast cancer was 53.2 ± 6.2 years, and the mean age of those without cancer was 57.8 ± 4.9 years (P < 0.01). Age at menopause was 47.2 ± 5.1 years and 47.4 ± 4.9 years for women with and without breast cancer (P = 0.76), respectively. Approximately one-fourth of women with breast cancer and 4.7% of women without cancer were premenopausal (P < 0.01). The prevalence of menopause symptoms was similar between the groups. Women with breast cancer reported less sexual activity (51.5%) than women without cancer (62.4%) (P < 0.01). Quality of life scores were good in both groups. There was a significant difference regarding physical functioning, with a median score of 90 for the cancer group and 75 for the group without cancer (P < 0.01). Conclusion:The prevalence of menopause symptoms was similar in women with and without breast cancer. Sexual activity was less frequent in women with breast cancer. Quality of life was good in women from both groups, although women with breast cancer had the highest level of physical functioning.

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 in Brazilian Breast Cancer Survivors Age 45–65 Years: Associated Factors

Abstract:  The objectives of this study were to evaluate quality of life (QOL) and identify its associated factors in climacteric women with a history of breast cancer. A cross‐sectional study was performed including 75 breast cancer survivors age 45–65 years who had undergone complete oncologic treatment and nonusers of hormone therapy or tamoxifen in the last 6 months. Sociodemographic and clinical characteristics in addition to the prevalence of climacteric symptoms were evaluated. QOL was evaluated by the Medical Outcomes Study 36‐item Short‐Form Health Survey (SF‐36) questionnaire, including eight components that can be condensed into two summaries: a physical component summary (physical functioning, role‐physical, body pain, general health) and a mental component summary (vitality, social functioning, role‐emotional, and mental health). Generalized linear models were used to analyze the data, allowing the identification of factors affecting QOL, adjusting for confounding variables. The mean age of the participants was 53.1 ± 5.9 years. Breast cancer survivors reported good QOL. The most prevalent symptoms were nervousness (69%) and hot flashes (56%). Factors associated with poorer QOL were dizziness, postmenopausal status, and breast‐conserving therapy (physical component), as well as insomnia and being married (mental component). In conclusion, participants demonstrated good QOL. We identified factors that may influence QOL in women with breast cancer, highlighting being married, climacteric symptoms, postmenopausal status, and breast‐conserving therapy. Given the impact of these factors, health professionals and patients must discuss choices for alleviating climacteric symptoms and explanations for the potential repercussions of breast cancer treatment.

Procura de Serviço Médico por Mulheres com Incontinência Urinária

Purpose: to evaluate the percentage of 45- to 60-year-old women complaining of urinary incontinence, who look for medical treatment, and the factors possibly associated with the decision of visiting the doctor and the reasons for not doing so. Methods: a secondary analysis of a population-based survey on climacterium and menopause in women living in the city of Campinas, Sao Paulo state, was carried out through a descriptive, exploratory and cross-sectional population study. A total of 456 women between 45 and 60 years of age were selected through a sampling process. The age at menopause and its associated factors were evaluated, as well as the prevalence of climacteric symptoms, the use of medical care, self-perception of the health status, and the sociocultural, sociodemographic and socioeconomic characteristics. Urinary incontinence complaint and the search for medical help due to the presence of symptoms were explored. The data were collected through home interviews, using a structured and pretested questionnaire provided by the International Health Foundation/International Menopause Society and by the North American Menopause Society, and adapted by the authors. The statistical analysis was performed using Fishers exact test. Results: thirty-five percent of the interviewees reported constant or intermittent stress incontinence, although only 59% of the patients with the complaint sought medical help. Conclusion: the majority of the women presenting urinary incontinence do not complain to the doctor if they are not questioned objectively.

Prevalência de Osteoporose em Mulheres na Pós-menopausa e Associação com Fatores Clínicos e Reprodutivos

PURPOSE: to evaluate the prevalence of osteoporosis in climacteric women and analyze the influence of general and reproductive risk factors on bone mineral density. METHODS: a cross-sectional study with the evaluation of the 473 hospital records of climacteric women followed up at the Menopause Outpatient Facility of CAISM/Unicamp, between 03/28/2000 and 04/17/2001. These women were at least 12 months in amenorrhea and presented the results of a bone densitometry study performed at the Nuclear Medicine Department of HC/Unicamp. The following variables were evaluated: age, color, body mass index, level of education, smoking, use of medication, age at menopause, parity, use and length of hormone replacement therapy and its effect on bone mineral density. Statistical analyses were performed using logistic regression ajusted by age and hormone replacement therapy use. RESULTS: the mean age of the studied women was 53.9 years (± 7.1 SD) with mean age at menopause being 45.9 years (± 6.9 SD). Osteoporosis occurred in 14.7% and osteopenia in 38% of the cases in the lumbar vertebrae (L2-L4 interspace) and in 3.8 and 32.7% in the femur, respectively. Logistic regression adjusted to age and hormone therapy showed an association between the following variables: level of education, age at menopause and body mass index. CONCLUSION: there was a high prevalence of osteoporosis and osteopenia in the studied population. Advanced age, lower level of education, late menarche, early menopause and lower body mass index were identified as risk factors for developing decreased bone mass in the studied population.

The effect of dietary soy supplementation compared to estrogen and placebo on menopausal symptoms: A randomized controlled trial

OBJECTIVES To compare the effects of daily ingestion of dietary soy supplementation, low-dose hormone therapy (HT) and placebo on psychological, somatic and urogenital symptoms in postmenopausal women. STUDY DESIGN A double-blind, randomized, controlled trial. Sixty healthy, symptomatic, postmenopausal women of 40-60 years of age were allocated to use dietary soy supplementation (containing 90 mg of isoflavone) or HT (1mg estradiol and 0.5mg norethisterone acetate) or placebo. MAIN OUTCOME MEASURES the Menopause Rating Scale (MRS) was used to assess menopausal symptoms at baseline and after 16 weeks of treatment. Intention-to-treat analyses were performed using the chi-square test, Fishers exact test, the Kruskal-Wallis non-parametric test and analysis of variance (ANOVA). RESULTS No statistically significant differences were found between the groups with respect to baseline clinical and sociodemographic characteristics. The psychological, somatic and urogenital symptoms analyzed in the MRS improved during treatment in all the groups, except for urogenital symptoms in the placebo group in which no significant changes were detected. Comparison between groups revealed a statistically significant improvement in somatic symptoms (hot flashes and muscle pain) in the users of HT (-45.6%) and dietary soy supplementation (-49.8%). Urogenital symptoms (vaginal dryness) improved significantly in HT users (-38.6%) and in users of the dietary soy supplementation (-31.2%). There was no statistically significant difference between the groups with respect to overall MRS score or to scores obtained in the psychological symptoms subscale. CONCLUSION Dietary soy supplementation may constitute an effective alternative therapy for somatic and urogenital symptoms of the menopause.

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.