Néville de Oliveira Ferreira

Quality of life in women with postmenopausal osteoporosis: Correlation between QUALEFFO 41 and SF-36

OBJECTIVE To evaluate quality of life (QoL) in women with postmenopausal osteoporosis, correlating the QUALEFFO 41 with the short-form health survey 36 (SF-36) and evaluated some factors that can influenced the QoL of women with osteoporosis. METHODS A cross-sectional study was conducted in 220 postmenopausal women (ages ranging from 55 to 80 years). Of the total number, 110 women had osteoporosis and 110 women did not have osteoporosis and these women were age-matched (+/-3 years). Two questionnaires were administered to all subjects for evaluation of QoL: the quality of life questionnaire of the European foundation for Osteoporosis 41 (QUALEFFO 41) and the short-form health survey 36 (SF-36). For data analysis, a significance level of 5% was set (p<0.05). RESULTS Clinical characteristics between the groups were similar, with statistically significant differences only in body mass index (BMI), race, school education, age at menopause and use of hormone therapy (HT) (p<0.001). Women with osteoporosis had a worse QoL both in the QUALEFFO 41 and in the SF-36, in all domains studied. Data was adjusted for BMI, race, school education and use of HT (p<0.001). There was a significant correlation between all domains in the QUALEFFO 41 questionnaire and their corresponding domains in the SF-36 (p<0.001). The only factors related to worse QoL were BMI>25 and sedentary lifestyle. In contrast, paid work was associated with a better QoL (CI=95%). CONCLUSION Women with osteoporosis had an impaired QoL, especially relating to the physical, psychological and social aspects. The factors associated with QoL were obesity, sedentary lifestyle and paid work.

Predictors of Falls in Women With and Without Osteoporosis

STUDY DESIGN Cross-sectional study. OBJECTIVE To evaluate the relationship between the occurrence of falls and muscle strength, flexibility, and balance in postmenopausal women with and without osteoporosis. BACKGROUND Osteoporosis and falls are common problems encountered in the elderly. METHODS A total of 133 women with and 133 without osteoporosis, aged 60 years or greater, were included in the study. Women were interviewed about clinical and social demographic characteristics and the occurrence of falls in the previous 12 months. The variables evaluated were presence of osteoporosis, muscle strength, flexibility, and balance. RESULTS A significantly higher percentage of women with osteoporosis (51%) compared to those without osteoporosis (29%) had a history of at least 1 fall within the previous 12 months. There was a significant and inverse association between trunk extension strength and trunk flexion range of motion with falls. Logistic regression analyses showed that the variables associated with falls were trunk extension strength and presence of osteoporosis. Greater trunk extension strength was associated with a lower risk for falls (odds ratio, 0.97), while the presence of osteoporosis increased fall risk by a factor of 2.17. CONCLUSIONS A greater percentage of women with postmenopausal osteoporosis had a history of 1 or more falls within the previous year and a higher risk of recurrent falls than women without osteoporosis. Muscle strength of the lumbar spine and the presence of osteoporosis are intrinsic factors associated with the risk of falls.

Treinamento dos músculos do assoalho pélvico nas disfunções sexuais femininas

Objetivo: avaliar o efeito do treinamento dos musculos do assoalho pelvico (MAP) nas disfuncoes sexuais femininas. Sujeitos e Metodos: realizou-se um ensaio clinico com 26 mulheres que apresentavam diagnostico de disfuncao sexual (transtorno de desejo sexual, transtorno de excitacao, transtorno orgastico e dispareunia) no periodo de fevereiro de 2008 a maio de 2009. Foi administrado um questionario denominado FSFI (Female Sexual Function Index) para verificar a funcao sexual. A contracao dos musculos do assoalho pelvico foi avaliada por meio da palpacao vaginal (bi-digital) e, em seguida, realizou-se uma eletromiografia de superficie para avaliar amplitudes de contracao. Tais procedimentos ocorreram previamente, na metade e apos o tratamento. As mulheres realizaram exercicios para os musculos do assoalho pelvico em diferentes posicoes, uma ou duas vezes por semana, totalizando 10 sessoes de tratamento. Na analise das variaveis ao longo do tempo, utilizou-se o teste nao-parametrico e o Anova de Friedman, o teste de Bonferroni e o teste de correlacao de Spearman. Adotou-se um nivel de significância de p<0,05 para analise dos dados. Resultados: Observou-se uma melhora significativa (p<0,0001) dos escores de todos os dominios e do escore total do FSFI ao final do tratamento quando comparadas a avaliacao inicial e intermediaria. Em relacao a eletromiografia de superficie, as amplitudes das contracoes fasicas e tonicas aumentaram significativamente (p<0,0001) ao longo do tratamento. Houve tambem um aumento na forca do assoalho pelvico, com 69% das mulheres apresentando grau 4 ou 5 na avaliacao final. Ao final do tratamento, a maioria das participantes (18) recebeu alta por nao mais apresentar queixas relativas a funcao sexual. Conclusao: O treinamento dos MAP resultou em melhora na forca e nas amplitudes da eletromiografia, acompanhadas de aumento significativo nos escores de funcao sexual, o que indica que essa abordagem terapeutica pode ser utilizada com sucesso no tratamento das disfuncoes sexuais femininasPURPOSE To evaluate the effect of pelvic floor muscle training (PFMT) on female sexual dysfunctions. METHODS Twenty-six women with a diagnosis of sexual dysfunction (sexual desire, arousal, orgasmic disorders and/or dyspareunia) were included in a clinical trial with a before/after approach . The assessment was carried out before, during (after five sessions) and at the end of the treatment (after ten sessions) by two-digit palpation (assessment of pelvic floor muscle, PFM, strength), intravaginal electromyography (EMG) (capture of PFM contraction amplitudes) and Female Sexual Function Index (FSFI, a questionnaire for the evaluation of sexual function). The women underwent PFMT in different positions for ten sessions (once or twice a week). For statistical analysis, absolute and relative frequencies were used for clinical characteristics and PFM strength. The Friedman test was used to compare the FSFI domain scores and EMG values, the Students t-test was used to determine the association between these values and the characteristics of the women, and the Wilcoxon test for percent modification of the EMG. The Mann-Whitney test permitted us to compare these values with clinical characteristics. The Spearman correlation test was used to correlate the EMG values with mean total score. Results were considered statistically significant if p<0.05. RESULTS A significant improvement (p<0.0001) of FSFI scores was observed at the end of treatment compared to the values observed before and in the middle of treatment. Regarding the EMG, the amplitudes of tonic and phasic contractions increased significantly during treatment (p<0.0001). Pelvic floor strength increased, which 69% of the women presenting grade 4 or 5 at the end of treatment, with a total improvement of sexual complaints. CONCLUSIONS The PFMT improved muscle strength and electromyography contraction amplitudes, with improved sexual function, indicating that this physiotherapy approach may be successfully used for the treatment of female sexual dysfunctions.

Maternal and Perinatal Outcomes of Exercise in Pregnant Women with Chronic Hypertension and/or Previous Preeclampsia: A Randomized Controlled Trial

Objectives. To evaluate the association between physical exercise supervised in pregnant women with chronic hypertension and/or previous preeclampsia and maternal and neonatal outcomes. Method. Randomized controlled trial, which included 116 pregnant women with chronic hypertension and/or previous preeclampsia, considered risk of preeclampsia development. They were divided into two groups: study group that performed physical exercise with a stationary bicycle once a week, for 30 minutes; the intensity was controlled (heart rate 20% above resting values), under professional supervision and a control group that was not engaged in any physical exercise. The data was retrieved from medical charts. Significance level assumed was 5%. Results. Women from study group performed 9.24 ± 7.03 of physical exercise sessions. There were no differences between groups comparing type of delivery and maternal outcomes, including maternal morbidity and hospitalization in intensive unit care, and neonatal outcomes, including birth weight, adequacy of weight to gestational age, prematurity, Apgar scale at first and fifth minutes, hospitalization in intensive unit care, and neonatal morbidity. Conclusions. Physical exercise using a stationary bicycle in pregnant women with chronic hypertension and/or previous preeclampsia, once a week, under professional supervision, did not interfere in the delivery method and did not produce maternal and neonatal risks of the occurrence of morbidity. This trial is registered with ClinicalTrials.gov NCT01395342.

Urinary symptoms and pelvic floor muscle function during the third trimester of pregnancy in nulliparous women

Aim:  To evaluate pelvic floor muscle (PFM) function and its association with urinary symptoms in the third trimester of pregnancy.

Manual therapy associated with upper limb exercises vs. exercises alone for shoulder rehabilitation in postoperative breast cancer

Our objective was to evaluate the effectiveness of manual therapy (MT) associated with upper limb (UL) exercises in women with impaired shoulder range of motion (ROM) after axillary lymph node dissection (ALND) for breast cancer. A randomized, prospective, blinded clinical trial with 131 women with a ROM  <–  100° for shoulder flexion and/or abduction on the first day postoperatively were evaluated. Sixty-six women were allocated to group exercises and 65 underwent the exercises followed by MT. Shoulder ROM was measured by goniometry, and function was evaluated by the Modified-University of California at Los Angeles Shoulder Rating Scale—the UCLA Scale, in the 1st, 6th, 12th, and 18th month after surgery. The chi-square test was used for the relationship between clinical characteristics and oncological treatment between groups, and ANOVA for repeat measures was used. No difference in recovery of shoulder ROM as well as UL function was observed between groups. Improvement in ROM was gradual from the 1st to the 18th month, and the function achieving a good classification at 18th month. MT associated with exercises did not enhance the results obtained with exercises alone for shoulder ROM and ipsilateral UL function.

Sintomas urinários e função muscular do assoalho pélvico após o parto

PURPOSE: to evaluate the prevalence of urinary symptoms and association between pelvic floor muscle function and urinary symptoms in primiparous women 60 days after vaginal delivery with episiotomy and cesarean section after labor. METHODS: a cross-sectional analysis was conducted on women from an out patient clinic in Sao Paulo state, Brazil, 60 days after delivery. Pelvic floor muscle function was assessed by surface electromyography (basal tone, maximal voluntary contraction and mean sustained contraction) and by a manual muscle test (grades 0-5). In an interview, the urinary symptoms were identified and women with difficulty to understand, with motor/neurological impairment, pelvic surgery, diabetes, restriction for vaginal palpation and practicing exercises forpelvic floor muscles were excluded. The χ2 and Fisher Exact test were used to compare proportions and the Mann-Whitney test was used to analyze mean differences. RESULTS: 46 primiparous were assessed on average 63.7 days postpartum. The most prevalent symptoms were nocturia (19.6%), urgency (13%) and increased daytime urinary frequency (8.7%). Obese and overweight women had 4.6 times more of these symptoms (PR=4.6 [95%CI; 1.2-18.6; p value=0.0194]). Stress urinary incontinence was the most prevalent incontinence (6.5%). The mean values found for the basic tone, maximal voluntary contraction and sustained contraction were: 3 µV, 14.6 µV and 10.3 µV. Most of the women (56.5%) had grade 3 muscular strength. There was no association between urinary symptoms and pelvic floor muscle function. CONCLUSION: the prevalence of urinary symptoms was low 60 days postpartum and there was no association between pelvic floor muscle function and urinary symptoms.PURPOSE to evaluate the prevalence of urinary symptoms and association between pelvic floor muscle function and urinary symptoms in primiparous women 60 days after vaginal delivery with episiotomy and cesarean section after labor. METHODS a cross-sectional analysis was conducted on women from an out patient clinic in São Paulo state, Brazil, 60 days after delivery. Pelvic floor muscle function was assessed by surface electromyography (basal tone, maximal voluntary contraction and mean sustained contraction) and by a manual muscle test (grades 0-5). In an interview, the urinary symptoms were identified and women with difficulty to understand, with motor/neurological impairment, pelvic surgery, diabetes, restriction for vaginal palpation and practicing exercises for pelvic floor muscles were excluded. The χ2 and Fisher Exact test were used to compare proportions and the Mann-Whitney test was used to analyze mean differences. RESULTS 46 primiparous were assessed on average 63.7 days postpartum. The most prevalent symptoms were nocturia (19.6%), urgency (13%) and increased daytime urinary frequency (8.7%). Obese and overweight women had 4.6 times more of these symptoms (PR=4.6 [95%CI; 1.2-18.6; p value=0.0194]). Stress urinary incontinence was the most prevalent incontinence (6.5%). The mean values found for the basic tone, maximal voluntary contraction and sustained contraction were: 3 µV, 14.6 µV and 10.3 µV. Most of the women (56.5%) had grade 3 muscular strength. There was no association between urinary symptoms and pelvic floor muscle function. CONCLUSION the prevalence of urinary symptoms was low 60 days postpartum and there was no association between pelvic floor muscle function and urinary symptoms.