Pain and quality of life in breast cancer patients

OBJECTIVE: To evaluate the influence of pain on quality of life in breast cancer patients. METHODS: A cross-sectional study of 400 patients, including 118 without metastasis, 160 with loco-regional metastasis and 122 with distant metastasis. The instruments used were the European Organization for Research and Treatment for Cancer Quality of Life Questionnaire-Core 30 and the Breast Cancer-specific 23 and short McGill Pain Questionnaire. RESULTS: In total, 71.7% of patients reported pain. The most frequent sensory descriptor used by patients was 'jumping.' In the evaluative dimension, the main descriptor chosen was troublesome. The Global Health self-assessment showed pain to be inversely correlated with quality of life: the group without metastasis had a mean score of 55.3 (SD=24.8) for those in pain, which rose to 69.7 (SD=19.2) for those without pain (p=0.001). Subjects with loco-regional metastasis had score of 59.1 (SD=21.3) when in pain, and those without pain had a significantly higher score of 72.4 (SD=18.6) (p<0.001). Patients from the distant metastasis group showed similar results with a mean score of 48.6 (SD=23.1) for those in pain and 67.6 (SD=20.4) for those without pain (p=0.002). Regarding the association of pain intensity and quality of life, patients with distant metastasis and intense pain had the worst scores for quality of life with a functional scale mean of 49.9 (SD=17.3) (p<0.009), a Symptom Scale score of 50.0 (SD=20.1) (p<0.001) and a Global Health Scale score of 39.7 (SD=24.7) (p<0.006). CONCLUSIONS: Pain compromises the quality of life of patients with breast cancer, particularly those with advanced stages of the disease.

Correlação entre vaginose bacteriana e desfechos obstétricos desfavoráveis em mulheres brasileiras / Correlation between bacterial vaginosis and adverse obstetric outcomes in Brazilian women

Infecções vaginais e mudanças na flora vaginal são prevalentes durante a gravidez e têm sido associadas com desfechos obstétricos adversos, tais como trabalho de parto prematuro, amniorrexe prematura e baixo peso ao nascer. Objetivos: Correlacionar a presença de vaginose bacteriana (VB) com desfecho obstétrico desfavorável em mulheres brasileiras com gravidez no terceiro trimestre. Métodos: O estudo prospectivo observacional foi conduzido avaliando microbiota vaginal por bacterioscopia (a fresco e Gram) usando swab vaginal obtido de mulheres grávidas entre a 26 e a 32a semanas de gestação. As mulheres foram monitoradas até o parto, e os dados de seu seguimento e os demográficos foram coletados por meio de um questionário autoaplicável. Resultados: Foi diagnosticada VB, com base nos critérios de Amsel e de Nugent, em 77 mulheres entre as 190, demonstrando prevalência de 42.5%. VB foi significativamente associada com maior risco de parto prematuro (risk ratio [RR], 2.89; 95% intervalo de confiança [IC], 2.35­3.56) e de baixo peso ao nascer (RR, 2.17; 95%IC, 1.61­2.92). A rotura prematura das membranas não foi associada com VB. Conclusão: Foi constatada alta frequência de VB entre as mulheres brasileiras grávidas no terceiro trimestre, e a BV correlacionou-se com piores prognósticos da gravidez. O rastreio rotineiro de mulheres grávidas pode permitir um tratamento precoce e a prevenção de algumas complicações obstétricas

Vaginal infections and modifications in the vaginal flora are very prevalent during pregnancy and have been associated with adverse obstetric outcomes, such as preterm labor, preterm premature rupture of membranes and low birth weight. Objective: To evaluate the prevalence and associations of bacterial vaginosis (BV) and pregnancy outcomes among Brazilian pregnant women in the third trimester. Methods: A prospective observational study was conducted assessing vaginal microbiota on bacterioscopy (wet mount and Gram stain), using vaginal swabs obtained from pregnant women between 26 and 32 weeks' gestation. The women were monitored until delivery, and their pregnancy outcome and demographic data were collected using an interviewer-administered questionnaire. Results: BV was assessed using both Amsel's criteria and Nugent's score in 77 of 190 women, resulting in the prevalence of 42.5%. BV was significantly associated with preterm labor (risk ratio [RR], 2.89; 95% confidence interval [CI], 2.35­3.56) and low birth weight (RR, 2.17; 95%CI, 1.61­2.92). Premature rupture of membranes was not associated with BV. Conclusion: BV was found to be very frequent among Brazilian pregnant women in the third trimester and correlated to unfortunate pregnancy outcomes. Regular screening of pregnant women may allow for early treatment and prevention of some obstetric complications.

Prevalence of Sexual Dysfunction among Expectant Women / Prevalência de disfunção sexual entre mulheres grávidas

Abstract Purpose To identify pregnancy as a causative factor of sexual dysfunction among expectant women. Methods A prospective study with 225 expectant mothers seen in the prenatal clinic of a federal university. Sexual function was evaluated by means of the Female Sexual Function Index (FSFI), and all domains were analyzed (desire, arousal, lubrication, orgasm, satisfaction, and pain). Initially, a univariate analysis of the sample was done. The averages for each domain according to the risk of sexual dysfunction (FSFI ≤ 26.5) were compared using the Student’s t-test for independent samples. The strength of the correlation between sexual dysfunction and all sociodemographic, clinical and behavioral variables was measured by the Chi-Square (X2) test. Then, odds ratios (ORs) and their confidence intervals were assigned to perform a bivariate analysis. Any p values less than 0.05 were considered significant. Results Approximately two-thirds of the women (66.7%) showed signs of risk of sexual dysfunction (FSFI ≤ 26.5). Within these cases, all sexual dysfunction domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) were found to be statistically significant (p < 0.001). The domains most affected were desire (2.67), satisfaction (2.71) and arousal (2.78). Conclusions Pregnancy appears to be an important causative factor of sexual dysfunction among pregnant women.

Resumo Objetivo Identificar a gravidez como fator causador de disfunção sexual entre mulheres gestantes. Métodos Estudo prospectivo com 225 gestantes atendidas no ambulatório de prénatal de uma universidade federal. A função sexual foi avaliada por meio do Female Sexual Function Index (FSFI), e todos os domínios foram analisados (desejo, excitação, lubrificação, orgasmo, satisfação e dor). Inicialmente, uma análise univariada da amostra foi feita. As médias para cada domínio de acordo com o risco de disfunção sexual (FSFI ≤ 26,5) foram comparadas pelo teste t de Student para amostras independentes. A força da correlação entre a disfunção sexual e todas as variáveis sociodemográficas, clínicas e comportamentais foi medida pelo teste do qui-quadrado (X2). A partir desta perspectiva, foram aferidos os odds ratios (ORs) e seus respectivos intervalos de confiança para a análise bivariada. Quaisquer valores de p inferiores a 0,05 foram considerados significativos. Resultados Cerca de dois terços das mulheres (66,7%) mostraram sinais de risco de disfunção sexual (FSFI ≤ 26,5). Dentro destes casos, todos os domínios de disfunção sexual (desejo, excitação, lubrificação, orgasmo, satisfação e dor) foram estatisticamente significativos (p < 0,001). Os domínios mais afetados foram o desejo (2,67), a satisfação (2,71) e a excitação (2,78). Conclusões A gravidez parece ser um importante fator causador de disfunção sexual entre mulheres gestantes.