Maria José Duarte Osis

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.

Paism: um marco na abordagem da saúde reprodutiva no Brasil

O Programa de Assistencia Integral a Saude Mulher (PAISM) foi lancado pelo Ministerio da Saude em 1983, sendo anunciado como uma nova e diferenciada abordagem da saude da mulher. Paradoxalmente, o PAISM constitui-se tambem na primeira vez em que o Estado brasileiro propos explicitamente, e implantou, embora de modo parcial, um programa que contemplava a regulacao da fecundidade. Isso suscitou suspeitas acerca de possiveis intencoes ocultas de controle da natalidade. Porem, analisando brevemente a historia desse Programa e seu significado social, conclui-se que o PAISM foi pioneiro, inclusive no cenario mundial, ao propor o atendimento a saude reprodutiva das mulheres, no âmbito da atencao integral a saude, e nao mais a utilizacao de acoes isoladas em planejamento familiar. Por isso mesmo, os movimentos de mulheres, de imediato, passaram a lutar por sua implementacao. Seu conteudo inclui plenamente a definicao de saude reprodutiva adotada pela Organizacao Mundial da Saude em 1988, ampliada e consolidada no Cairo em 1994 e em Beijing em 1995. Consequentemente, a adocao do PAISM representou, sem duvida, um passo significativo em direcao ao reconhecimento dos direitos reprodutivos das mulheres, mesmo antes que essa expressao ganhasse os diversos foros internacionais de luta.

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.

The opinion of Brazilian women regarding vaginal labor and cesarean section

Objectives: The opinions of Brazilian women regarding vaginal delivery and cesarean sections was studied. Methods: Six hundred and fifty‐six women who had given birth in seven hospitals in São Paulo and Pernambuco, using the Public Health Service, were interviewed. The opinions of women who had delivered only by cesarean section was compared with those of women who had had at least one vaginal delivery. Results: Significantly more women who had experienced at least one vaginal delivery considered this to be the best way of giving birth (90.4% vs. 75.9% among C‐section‐only women). Similar proportions in both groups (45.5% and 42.8%) stated that vaginal labor is better because it causes less pain and suffering for the woman. Significantly more women who had experienced a vaginal labor (47.1% vs. 30.3%) reported that it had no disadvantage. More women who had only had cesarean sections referred not having contractions/pain as an advantage of this method (56.7% vs. 41.7%). Conclusions: Apparently, pain and womens perception of pain were the characteristics which differentiated women with history of vaginal delivery from those with cesarean sections in the sample studied. However, the opinion that vaginal delivery is better than cesarean section was expressed independently of the recognition that pain could be its main disadvantage.OBJECTIVES The opinions of Brazilian women regarding vaginal delivery and cesarean sections was studied. METHODS Six hundred and fifty-six women who had given birth in seven hospitals in São Paulo and Pernambuco, using the Public Health Service, were interviewed. The opinions of women who had delivered only by cesarean section was compared with those of women who had had at least one vaginal delivery. RESULTS Significantly more women who had experienced at least one vaginal delivery considered this to be the best way of giving birth (90.4% vs. 75.9% among C-section-only women). Similar proportions in both groups (45.5% and 42.8%) stated that vaginal labor is better because it causes less pain and suffering for the woman. Significantly more women who had experienced a vaginal labor (47.1% vs. 30.3%) reported that it had no disadvantage. More women who had only had cesarean sections referred not having contractions/pain as an advantage of this method (56.7% vs. 41.7%). CONCLUSIONS Apparently, pain and womens perception of pain were the characteristics which differentiated women with history of vaginal delivery from those with cesarean sections in the sample studied. However, the opinion that vaginal delivery is better than cesarean section was expressed independently of the recognition that pain could be its main disadvantage.

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.

Risk factors for tubal sterilization regret, detectable before surgery

Brazil has one of the highest prevalence rates of female surgical sterilization in the world. At the same time there is an increased demand for sterilization reversal. In order to understand which women tend to later request reversal of the procedure, a case-control study was carried out comparing 216 women who requested reversal with sterilized women who did not, paired by year of surgery. The relative risk of requesting reversal for women sterilized before age 25 was 18 times that of women sterilized after age 29. The elevated risk remained even after controlling for a number of variables present at the time of surgery. Multiple regression analysis showed that request for reversal was associated with younger age, less information about the procedure, and fewer contraceptive methods known before sterilization. These results support the recommendation that women should be fully informed about the tubal ligation procedure and have access to other contraceptive options before being sterilized.

Atenção ao planejamento familiar no Brasil hoje: reflexões sobre os resultados de uma pesquisa

This two-component study (descriptive cross-sectional and qualitative) assessed the availability of contraceptives in primary care clinics in Brazilian municipalities. The family planning program was also analyzed as part of the countrys Family Health Strategy. Phone interviews were held with local health managers to obtain information on contraceptive supply in a selected sample of municipalities. Four municipalities were selected and visited for the qualitative analysis, using direct observation and semi-structured interviews with health professionals and managers. Descriptive statistical and multiple logistic regression analyses were performed. Content analysis technique was used for qualitative data. According to the results, family planning activities are often not integrated with other health activities. Health professionals and managers failed to understand family planning as part of primary health care and felt unable to assist patients. Family planning in Brazil is marked by the unavailability of contraceptives in public health programs.

Evidências sobre o suporte durante o trabalho de parto/parto: uma revisão da literatura

Os efeitos do suporte a mulher durante o trabalho de parto/parto por profissionais de saude, mulheres leigas e doulas, sobre os resultados maternos e neonatais tem sido avaliados em varios ensaios clinicos randomizados, metanalises e revisoes sistematicas. Este artigo apresenta a revisao desses estudos, enfocando as principais caracteristicas, o provedor de suporte, a simultaneidade na presenca ou nao do companheiro/familiares da parturiente durante o trabalho de parto e parto, e os resultados obtidos. Foram incluidos os estudos publicados entre os anos de 1980 e 2004, que contemplam explicitamente os aspectos avaliados. De maneira geral, os resultados do suporte sao favoraveis, destacando-se reducao da taxa de cesarianas, da analgesia/medicamentos para alivio da dor, da duracao do trabalho de parto, da utilizacao de ocitocina e produzindo aumento na satisfacao materna com a experiencia vivida. Quando o provedor de suporte nao e um profissional de saude, os beneficios tem sido mais acentuados. Os estudos disponiveis nao avaliam o acompanhante escolhido pela parturiente como um provedor de suporte, o que constitui lacuna de conhecimento a ser preenchida.The effects of support for women during labor and delivery provided by health professionals, lay women, and doulas on the maternal and neonatal outcomes have been evaluated through randomized clinical trials, meta-analyses, and systematic reviews. This article presents a review of these studies, focusing on the principal characteristics, support provider, simultaneous presence of the womans spouse and/or family members during labor and delivery and the outcomes. The analysis included studies published from 1980 to 2004 which explicitly approached these aspects. In general, the results of such support were favorable, highlighting a reduction in the cesarean rate, analgesia/ medication for pain relief, duration of labor, and utilization of oxytocin and an increase in maternal satisfaction with the experience. The benefits were greater when the support provider was not a health professional. The available studies did not evaluate the specific companion chosen by the woman as a support provider, which constitutes a gap in the knowledge that should be filled by future research.

Knowledge, attitude and practice of breast self-examination in health centers

OBJECTIVE Breast cancer is one of the most important problems of public health and education regarding breast self-examination is one of the important steps for identifying breast tumors at an early stage. The present study was carried out to assess knowledge, attitude, and practice of breast self-examination among patients attending health centers. METHODS In a KAP (Knowledge, Attitude and Practice) survey 663 women of 13 randomly selected municipal health centers were interviewed. The number of interviews in each health center was proportional to the mean number of women seen per month. In the data analysis, womens answers for knowledge, attitude and practice regarding breast self-examination were classified according to their adequacy as previously defined. Adequacy was compared among categories of control variables with Chi2 test. RESULTS The results showed that knowledge and practice of breast self-examination were adequate in 7.4% and 16.7%, respectively. However, attitude was adequate in 95.9% of the women interviewed. The study also showed that 58.1% of the women interviewed referred that forgetfulness was the main barrier for not performing self-examination. CONCLUSIONS Women attending the health centers sampled in this study had inadequate knowledge and practice about breast self-examination but they had an adequate and favorable attitude about it.