Género femenino y autismo: infra detección y mis diagnósticos / Female gender and autism: under detection and my diagnoses

Resumen Introducción. El autismo o los TEA son alteraciones del neurodesarrollo que afectan el desarrollo socio comunicativo, los intereses y un patrón restringido y estereotipado de intereses y conducta. Los estudios epidemiológicos indican que hay 3 veces más niños afectados con autismo que niñas pero los estudios clínicos indican una preponderancia mucho mayor a favor de los varones. Existe una infra detección del autismo con un diagnóstico tardío o equivocado con mayor frecuencia en niñas y mujeres con autismo. Objetivo. Analizar la presentación clínica del autismo en niñas y mujeres, factores relacionados con su infra detección y diagnóstico o confusión diagnóstica y mecanismos de mejora en su diagnóstico e intervención. Material y Métodos. Analizaremos la diferencias en presentación clínica del autismo entre géneros, factores sociales y culturales, aspectos cognitivos y comórbidos diferenciales en niños y niñas con autismo, limitaciones actuales de los instrumentos diagnósticos para la evaluación el autismo y cuales son aspectos a mejorar para una mejor identificación, más temprana y certera del autismo en el género femenino. Conclusiones. El autismo en el género femenino presenta características clínicas, cognitivas y biológicas diferenciales asociadas a una infra detección y diagnóstico tardío.

Abstract Introduction . Autism or ASDs are neurodevelopmental disorders that affect socio-communicative development, interests, and a restricted and stereotyped pattern of interests and behavior. Epidemiological studies indicate that there are 3 times more boys affected with autism than girls but clinical studies indicate a much higher preponderance in favor of boys. There is an under detection of autism with a late or wrong diagnosis more frequently in girls and women with autism. Objective. To analyze the clinical presentation of autism in girls and women, factors related to under detection and diagnosis or diagnostic confusion, and mechanisms for improving its diagnosis and in tervention. Material and Methods. We will analyze the differences in the clinical presentation of autism between genders, social and cultural factors, cognitive aspects and differential comorbidities in boys and girls with autism, current limitations of diagnostic instruments for the evaluation of autism and which are aspects to improve for a better identification, earlier and more accurate of autism in the female gender. Conclusions. Autism in the female gender presents differential clinical, cognitive and biological characteristics associated with under detection and late diagnosis.

Carta de Cuiabá - Mulheres, Médicas de Família e Comunidade, no Brasil: onde estamos e onde podemos chegar? / Cuiabá Letter - Women, Family and Community Physicians, in Brazil: where we are and where can we reach? / Carta de Cuiabá - Mujeres Médicas de Familia y Comunidad en Brasil: donde estamos y donde podemos llegar?

Este artigo é um breve relato histórico sobre a formação do Grupo de trabalho de Mulheres na Medicina de Família e Comunidade da SBMFC (GT-MMFC), que ocorreu em 2016. Em paralelo, descreve-se as principais ações do Wonca Working Party on Women & Family Medicine e do próprio GT-MMFC até os dias atuais. Os objetivos do artigo são registrar a construção deste grupo de trabalho assim como fomentar e fortalecer o debate de todas as dimensões relacionadas às mulheres e a medicina de família e comunidade e a equidade de gênero

This article is a historical report of the creation of the SBMFC Women's Working Group on Family and Community Medicine (GT-MMFC), which took place in 2016. In parallel, it describes, until the present day, the main actions of the Wonca Working Party Women & Family Medicine and of the GT-MMFC. The objectives of the article are to record the construction of this working group as well as to foster and strengthen the debate on all dimensions related to women and family and community medicine and gender equity.

Este artículo es un informe histórico de la creación del Grupo de Trabajo de Mujeres SBMFC sobre Medicina Familiar y Comunitaria (GT-MMFC), que tuvo lugar en 2016. Paralelamente, describe las principales acciones del Grupo de Trabajo de Mujeres y Medicina Familiar de Wonca y del GT-MMFC, hasta el día de hoy. Los objetivos del artículo son registrar la construcción de este grupo de trabajo, así como fomentar y fortalecer el debate sobre todas las dimensiones relacionadas con la mujer y la medicina familiar y comunitaria y la equidad de género

Predictors of cholesterol gallstone formation among inhabitants of Port Harcourt in Nigeria

Background: Various clinical and biochemical parameters have been hypothesized to predict cholesterol gallstone formation. Hence, this study was structured to evaluate the degree of some of these suggested predictors among inhabitants of Port Harcourt in Nigeria.Methods: This was a retrospective study of the clinical and biochemical parameters of 42 cholesterol gallstones formers within a tertiary hospital in Nigeria. Records of age, gender, weight, height, calculated body mass index and plasma biochemical parameters (total cholesterol, total bilirubin, and total calcium) of cholesterol gallstone formers from 1st January 2008 to 31st December 2017 were abstracted from medical and laboratory records and analysed using SPSS version 20.Results: There were more females (70%) than males (30%) with a ratio of 2.3:1. The age ranged from 31-64 with mean 46.78±9.33. Obesity was observed among 40.5% of study population. Female gender (OR = 2.823; 95% CI = 2.446-3.200; p<0.001), obesity BMI status (OR = 1.534; 95% CI = 1.436 - 1.632; p = 0.012) and abnormal plasma cholesterol status (OR = 3.011; 95% CI = 2.916 - 3.106; p<0.001) were significant predictors of cholesterol gallstone formation. Abnormal plasma cholesterol status was the strongest of the predictors with AUC of 0.920 (p<0.001), seconded by female gender (AUC = 0.889; p<0.001) and obesity BMI status (AUC = 0.834; p<0.001).Conclusions: Abnormal plasma cholesterol status is the strongest independent predictor of cholesterol gallstone formation, seconded by female gender and high BMI status, among inhabitants of Port Harcourt in Nigeria.

Does the Access to Sun Exposure Ensure Adequate Levels of 25-Hydroxyvitamin D? / A exposição ao sol assegura níveis adequados de 25-hidroxivitamina D?

Abstract Objectives To assess the prevalence of hypovitaminosis D, altered arterial blood pressure, and serum levels of glucose and lipids in community-dwelling women in the city of Ribeirão Preto, in the southeast of Brazil. Methods Thiswas a cross-sectional studyof women aged40-70years old.Calciumintake and level of sun exposure were assessed by means of a questionnaire. A blood sample was used to determine glucose, lipid profile and 25-hydroxyvitaminD(25[OH]D) concentration. Results Ninety-one women were enrolled (age = 54.2 ± 7.1 years). Themean serum 25(OH)D concentration was 25.7 ± 8.9 ng/mL. A total of 24 (26.4%) women had 25 (OH)D levels < 20 ng/mL. Seventy women (76.9%) had 25(OH)D levels < 30 ng/mL. Seventy-five women (90.4%) had inadequate calcium intake, and 61 women (67%) had appropriate sun exposure, 49 of whom (80.3%) had serum 25(OH)D levels < 30 ng/mL. Conclusion This study indicates that even in community-dwelling women, living in a city with high sun exposure, serum levels of 25(OH)D > 30 ng/ml are hardly reached. Thus, it is probable that other intrinsic factors besides sun exposure may regulate the levels of vitamin D.

Resumo Objetivos Estimar a prevalência de hipovitaminose D, hipertensão arterial, e níveis séricos de glicose e perfil lipídico em uma comunidade de mulheres de Ribeirão Preto, no Sudeste brasileiro. Métodos Estudo transversal com mulheres de 40 a 70 anos de idade, submetidas a um questionário para determinar ingestão diária de cálcio e nível de exposição solar, e coleta de sangue para determinar glicose, perfil lipídico e concentração de 25- hidroxivitamina D (25[OH]D). Resultados Noventa e uma mulheres foram incluídas (idade = 54,2 ± 7,1 anos). O nível sérico médio de 25(OH)D foi 25,7 ± 8,9 ng/mL. Um total de 24 (26,4%) mulheres teve níveis de 25(OH)D < 20 ng/mL. Setenta mulheres (76.9%) tiveram níveis de 25 (OH)D < 30 ng/mL. Setenta e uma mulheres (90.4%) tiveram uma ingesta inadequada de cálcio e 61 mulheres (67%) tiveram exposição solar adequada; 49 das quais (80.3%) tiveram níveis séricos de 25(OH)D < 30 ng/mL. Conclusão Este estudo indica que mesmo morando em uma cidade com exposição solar adequada, níveis séricos de 25(OH)D > 30 ng/mL dificilmente são atingidos por mulheres climatéricas. Logo, é provável que outros fatores intrínsecos podem regular o nível de vitamina D.

Predictores de arterias coronarias angiográficamente normales en pacientes estables con sospecha de enfermedad coronaria / Predictors of Angiographically Normal Coronary Arteries in Stable Patients with Suspected Coronary Disease

Introducción: La cinecoronariografía (CCG) es la prueba que se constituye en el estándar de oro para identificar a pacientes con coronariopatía. Pese a que se prevé una proporción de CCG normales, este estudio debe minimizarse, dados su carácter invasivo, el riesgo asociado y el aumento del costo en salud. Objetivos: Determinar las características, los patrones epidemiológicos y las variables relacionadas con el hallazgo de arterias coronarias angiográficamente "normales" en pacientes estables derivados para la realización de una CCG. Material y métodos: Se analizaron las CCG de 12.686 pacientes de cinco centros de Buenos Aires. Todos los datos se obtuvieron en forma retrospectiva entre 2008 y 2013. Se definió "normal" a una CCG con lesiones < 50%. Se compararon las características demográficas, los factores de riesgo habituales, la presencia de insuficiencia renal crónica, de hipotiroidismo y de enfermedad vascular periférica, los síntomas, los estudios evocadores de isquemia y la cobertura social entre el grupo con CCG "normal" y los pacientes con coronariopatía obstructiva = 50%. Resultados: De los 3.990 pacientes incluidos (31,5%), el 38,6% presentaba una CCG normal. El sexo femenino fue el mayor predictor independiente para este hallazgo. Además, la menor edad y la ausencia de síntomas compatibles con isquemia se asociaron con una probabilidad mayor de una CCG "normal". Conclusiones: En una población derivada para CCG con diagnóstico de enfermedad arterial coronaria estable, el género femenino, la menor edad y la ausencia de síntomas se relacionaron con el hallazgo de arterias coronarias angiográficamente "normales". Un mejor uso de los modelos de estratificación clínica podría optimizar el rendimiento de la CCG para detectar pacientes con enfermedad arterial coronaria significativa, limitando así los estudios innecesarios.

Introduction: Coronary angiography (CA) is the gold standard test to identify patients with coronary artery disease. Despite a proportion of normal CAs is expected, this study should be minimized, given its invasive nature, the associated risk and increased health costs. Objectives: The aim of this study was to establish the characteristics, epidemiological patterns and variables associated to angiographically "normal" coronary arteries in stable patients referred for CA. Methods: Coronary angiographies were analyzed in 12,686 patients from five centers in Buenos Aires. All data were retrospectively obtained from 2008 to 2013. Coronary angiographies with < 50% lesions were defined as "normal". Demographic characteristics, usual risk factors, chronic renal failure, hypothyroidism, peripheral vascular disease, symptoms, ischemia-inducing tests and social coverage were compared between the group with "normal" CA and patients with = 50% obstructive coronary disease. Results: Among the 3,990 patients included in the study (31.5%), 38.6% had a normal CA, and female gender was the most important independent predictor for this finding. In addition, younger age and absence of ischemic symptoms were associated with greater probability of "normal" CA. Conclusions: In a population referred for CA diagnosed with stable coronary artery disease, female gender, younger age and absence of symptoms were associated with angiographically "normal" coronary arteries. Better use of clinical stratification models could optimize CA performance to detect patients with significant coronary artery disease, limiting unnecessary studies.

Exercício aeróbio reduz a hipertensão arterial de mulheres com Doença de Chagas / Aerobic exercise reduces hypertension in women with Chagas Disease / Ejercicio aeróbico reduce la hipertensión arterial de mujeres con Mal de Chagas

INTRODUÇÃO: Os portadores de doença de Chagas frequentemente apresentam a hipertensão arterial sistêmica (HAS) como a principal comorbidade. Em indivíduos hipertensos com e sem doença de Chagas, o controle de HAS geralmente é medicamentoso. Medidas alternativas de intervenção como o exercício físico aeróbio têm sido preconizadas como a maneira mais efetiva para reduzir os níveis de pressão arterial. OBJETIVO: Avaliar a influência do exercício físico sobre a pressão arterial de mulheres hipertensas com e sem doença de Chagas. MÉTODOS: Dezenove voluntárias divididas nos grupos G1 (nove com doença de Chagas) e G2 (dez sem doença de Chagas) foram submetidas a um programa de treinamento de 12 semanas, com duração de 30 a 60 minutos duas vezes por semana. A pressão arterial sistólica (PAS), diastólica (PAD) e a frequência cardíaca (FC) foram avaliadas no pré e pós-esforço no início (T0), após seis (T6) e 12 (T12) semanas. RESULTADOS: Em T6, melhora significativa foi observada na PAS pré e pós-esforço e na PAD pós-esforço, para ambos os grupos. No T12, G1 apresentou melhora significativa para todas as variáveis, exceto FC pós-esforço e G2 para PAS pré e pós-esforço e FC pós-esforço. Não houve diferença significativa entre G1 e G2 para as variáveis estudadas. CONCLUSÃO: O exercício físico aeróbio de baixa intensidade reduz significativamente a pressão arterial de mulheres com doença de Chagas, pode ser realizado com segurança, e insere os pacientes com esta enfermidade na prática rotineira de exercícios. .

INTRODUCTION: Patients with Chagas disease often have high blood pressure (HBP) as the main co-morbidity. In hypertensive individuals with and without Chagas disease, the control of hypertension is generally through medication. Alternative intervention measures such as aerobic exercise have been recommended as an effective way to reduce blood pressure levels. OBJECTIVE: Assess the influence of exercise on blood pressure in hypertensive women with and without Chagas disease. METHODS: Nineteen volunteers divided into two groups: G1 (nine with Chagas disease) and G2 (ten without Chagas disease) were submitted to a training program for 12 weeks, during 30 to 60 minutes, twice a week. The systolic (PAS) and diastolic (PAD) blood pressure and heart frequency (FC) were analyzed before and after the effort at the beginning (T0), after six weeks (T6) and twelve weeks (T12).. RESULTS: In T6, significant improvement was observed in PAS pre- and post- effort and the PAD post-effort, for both groups. In T12, G1 showed significant improvement for all variables, except FC after effort and G2 for PAS before and after effort and FC after effort. There was no significant difference between G1 and G2 for all variables. CONCLUSION: Low-intensity aerobic exercise significantly reduces blood pressure in women with Chagas disease, can be performed safely and incorporate patients with this disease into the routine practice of exercises. .

INTRODUCCIÓN: Los portadores de Mal de Chagas frecuentemente presentan la hipertensión arterial sistémica (HAS) como la principal comorbidez. En individuos hipertensos con y sin Mal de Chagas el control de HAS generalmente es medicamentoso. Las medidas alternativas de intervención como el ejercicio físico aeróbico han sido preconizadas como la manera más efectiva para reducir los niveles de presión arterial. OBJETIVO: Evaluar la influencia del ejercicio físico sobre la presión arterial de mujeres hipertensas con y sin Mal de Chagas. MÉTODOS: Diecinueve voluntarias divididas en los grupos G1 (nueve con Mal de Chagas) y G2 (diez sin Mal de Chagas) fueron sometidas a un programa de entrenamiento de 12 semanas, con duración de 30 a 60 minutos dos veces por semana. La presión arterial sistólica (PAS), diastólica (PAD) y la frecuencia cardíaca (FC) fueron evaluadas en el pre y post esfuerzo al inicio (T0), después de seis (T6) y 12 (T12) semanas. RESULTADOS: En T6, mejora significativa fue observada en la PAS pre y post esfuerzo y en la PAD post esfuerzo, para ambos grupos. En el T12, G1 presentó mejora significativa para todas las variables, excepto FC post esfuerzo y G2 para PAS pre y post esfuerzo y FC post esfuerzo. No hubo diferencia significativa entre G1 y G2 para las variables estudiadas. CONCLUSIÓN: El ejercicio físico aeróbico de baja intensidad reduce significativamente la presión arterial de mujeres con Mal de Chagas, puede ser realizado con seguridad e coloca a los pacientes con esta enfermedad en la práctica rutinaria de ejercicios. .

Las mujeres con síndromes coronarios agudos reciben menos intervenciones en la fase aguda que los hombres en una población argentina / Women with Acute Coronary Syndromes are less Invasively Treated than Men in the Acute Phase in an Argentine Population

Introducción Existen antecedentes en la bibliografía científica que indican que las mujeres con enfermedad coronaria tienen peor pronóstico que los hombres y se observa asimismo una utilización menor de métodos diagnósticos e intervenciones en ellas, por lo que resulta de interés establecer si esta tendencia existe en nuestro país y las posibles asociaciones de valor pronóstico. Objetivos Investigar en una cohorte argentina de síndromes coronarios agudos las características clínicas, los tratamientos y la evolución a 2 años de seguimiento. Material y métodos Componente argentino del estudio cooperativo GRACE de 4.708 hombres y 2.027 mujeres con síndromes coronarios agudos sin supradesnivel persistente del segmento ST. Se analizaron antecedentes, tipo de presentación, diagnóstico definitivo, tratamientos farmacológicos, aplicación de revascularización e incidencia acumulativa de muerte e infarto recurrente en la etapa hospitalaria y a los 6 meses y a los 2 años de seguimiento. Resultados Las mujeres fueron mayores (69,4 ± 12,3 vs. 63,1 ± 11,9 años; p < 0,01), con mayor prevalencia de insuficiencia cardíaca e hipertensión. La proporción de signos de isquemia miocárdica en el electrocardiograma, así como la de enzimas miocárdicas en rango anormal fue similar para ambos géneros, con un uso significativamente menor de aspirina, clopidogrel y betabloqueantes en las mujeres, quienes tuvieron la mitad de chance de angioplastia (OR: 0,55, IC 95% 0,48-0,62) y de cirugía de revascularización (OR: 0,49, IC 95% 0,36-0,67), con mayores incidencias crudas de muerte e infarto en agudo y a los 2 años, pero sin diferencia en el riesgo relativo de eventos mayores una vez ajustado por edad y otras covariables. Conclusiones A pesar de un riesgo clínico similar en mujeres y hombres, las primeras recibieron menos intervenciones durante la fase hospitalaria. Nuestros resultados llaman a un adecuado alerta e intervenciones ajustadas al riesgo para el sexo femenino.

Introduction Bibliographic reports indicate that women with coronary disease have worse prognosis than men and are submitted to less diagnostic methods and interventions. It is, therefore, of interest to establish whether this tendency exists in our country and its potential prognostic associations. Objectives The aim of the study was to analyze in an Argentine cohort of acute coronary syndrome, the clinical characteristics, treatment and outcome at two-year follow up. Methods The Argentine component of the GRACE cooperative study included 4708 men and 2027 women with acute coronary syndrome without persistent ST-segment elevation. Previous history, type of presentation, final diagnosis, pharmacological treatments, revascularization and cumulative incidence of death and recurrent infarction were analyzed during hospitalization and at 6-month and 2-year follow-up. Results Women were older than men (69.4 ± 12.3 vs. 63.1 ± 11.9 years, p <0.01), and had greater prevalence of heart failure and hypertension. The proportions of ischemic electrocardiographic changes and abnormal cardiac enzymes were similar in both sexes. Use of aspirin, clopidogrel and beta blockers was significantly lower in women, who had 50% chance of undergoing either percutaneous coronary intervention (OR= 0.55;95% CI 0.48-0.62) or coronary artery bypass graft surgery (OR= 0.49; 95% CI 0.36-0.67) than men. The crude incidences of mortality and reinfarction during hospitalization and at two-year follow up were higher in women with no differences in the relative risk of major events after adjusting for age and other covariates. Conclusions Despite similar risk than men to that of men, women were exposed to fewer interventions during hospitalization. Our results should alert physicians to indicate antiischemic treatments and interventions adjusted to risk in women.

Análise de faltas com barreira em jogos de futsal feminino de alto rendimento / Analysis of fouls with hurdles in high lever female futsal / Análisis de faltas com barrera em juegos de fútebol sala femenino de alto rendimiento

Este artigo objetiva analisar ações ofensivas de faltas com barreira em jogos de futsal feminino de alto rendimento. Foi levantada a efetividade de gols e a localização de faltas em distintas zonas da quadra ofensiva. Observaram-­se 89 (5,93±3,08)ações, retiradas de 15 jogos da Taça Brasil de Clubes. Encontrou ­se efetividade de 5,62%; tendência defensiva de se evitar faltas centrais e próximas da meta; maior parte dos gols originados de faltas centrais; igualmente, maior efetividade de tentos originados dessas situações do que de faltas laterais e; leve superioridade na efetividade de gols de faltas de meia distância em comparação à de faltas próximas. Concluiu-­se que é preciso aumentar a eficácia em faltas com barreira, sobretudo em zonas laterais.

This paper has the purpose to analyze offensive actions of fouls with hurdles inhigh level female futsal. It was verified the goals efficacy and site of fouls in distinctive zones in the offensive court. It was observed 89 (5,93+3,08) actions, extracted from 15 futsal games of Brazil Clubs Championship. The results indicated an efficacy of 5,62%; a deffensive trend related to avoid fouls in the center of the court and close to the goal positions; the greatest part of the goals came from the central fouls and greater efficacy of the goals occurred in these situations rather than in the lateral fouls; a greater efficacy was found in the goals originated of half-distance fouls when compared to the fouls closer the goals. It was concluded that we need to increase the effectiveness of fouls with hurdles, especially in lateral areas.

Este artículo tiene como objetivo analizar las acciones ofensivas faltas con barreraen juegos de fútbol sala femenino de alto rendimiento. Que ha planteado la eficacia de los goles y la ubicación de faltas en las diferentes áreas del campo ofensivo. Hay 89 (5,93 ± 3,08) acciones, tomadas de 15 partidos de la Copa Brasil Club. Se encontró con la eficacia de 5,62%; una tendencia a la defensiva para evitar faltas centrais y cerca del portería central; que la mayoría de los goles de su origen en faltas centrales; y también aumentó la eficacia de los goles derivados de estas situaciones lado de las faltas y una ligera superioridad en la eficacia de goles de faltas en media distancia en comparación con la de faltas cercanas. Se concluyó que es necesario aumentar la eficacia de goles en faltas con barrera, especialmente en las zonas laterales.

Primazia da beleza feminina e juventude empobrecida: notas de uma relação conflituosa / Primacy of feminine beauty and impoverished youth: notes on a conflicting relationship / Primacía de la belleza femenina y la juventud empobrecida: notas de una relación conflictiva

O estudo investiga a preocupação atribuída à aparência física e as implicações representativas de um modelo ideal de corpo para 53 estudantes empobrecidas, entre 13 e 18 anos. A pesquisa de campo foi realizada durante oito meses, utilizando-se de observação participante e de questionário como instrumentos de coleta de dados, valendo-se da técnica de análise de conteúdo para codificar e interpretar as informações. Foi possível observar que as escolares atribuem alto valor para o corpo, porém apresentam cuidados menos rígidos e intervenções menos agressivas que o esperado, revelando arranjos de uma civilidade que não é pensada, vivenciada e materializada de forma homogênea, mas plural.

This study investigated the worries relating to physical appearance and the representative implications of an ideal body model, among fifty-three impoverished students, aged between thirteen and eighteen years. The field research was conducted over an eight-month period; participative observation and a questionnaire were used as data-gathering instruments; and the content analysis technique was used to code and interpret the information obtained. It was observed that the students attributed high value to their bodies, but they also demonstrated less rigid care and less aggressive interventions than expected, thereby revealing dispositions of civility that is not thought of, experienced and materialized homogeneously, but plurally.

La investigacion es sobre la preocupación con la apariencia física y sus implicaciones representativas en un modelo ideal de cuerpo de cincuenta y tres estudiantes pobres, entre trece y dieciocho años de edad. La investigación de campo se llevó a cabo en ocho meses por medio de observación participante y el cuestionario como instrumentos, basándose en la técnica de análisis de contenido para interpretar las informaciónes. Se observó que las estudiantes atribuyen gran valor para el cuerpo, pero mostrando la atención menos rígida y menos agresivas que lo esperado, revelando acuerdos de una civilidad que no se pensó, vivió y materializó de una manera homogénea, sino plural.

Imagem corporal: a percepção do conceito em indivíduos obesos do sexo feminino / Corporal image: the perception of the concept in obese female

O presente trabalho apresenta o conceito de imagem corporal e suas correlações com a obesidade feminina. O objetivo deste foi identificar, analisar e correlacionar os aspectos psicológicos sobre a imagem corporal em indivíduos obesos do sexo feminino, utilizando como método a pesquisa bibliográfica. Os resultados da pesquisa apontam que a obesidade em indivíduos obesos do sexo feminino desencadeia aspectos psicológicos, tais como: baixa auto-estima, ansiedade, angústia,agressividade, tristeza, compulsão, negação, insatisfação com a imagem corporal. O indivíduo obeso do sexo feminino também projeta sua culpa num objeto ou pessoa, levando-se em conta que o fator sociocultural tem grande importância sobre os aspectos psicológicos. Concluiu-se que,os indivíduos obesos do sexo feminino desencadeiam dificuldades nesses aspectos, devido a um fragilizado vínculo mãe-filho, acrescentando-se a importância sobre a etiologia multifatorial da obesidade, em que a cultura apresenta-se como um fator relevante.

The current paper presents the concept of body image and its relations to the feminine obesity.The objective of this paper was to identify, analyze and correlate the psychological aspects on corporal image in obese female individuals, using the bibliographical research as a method.The research results show that obesity in female individuals present psychological aspects,such as: low self-esteem, anxiety, anguish, anger, sadness, compulsion, denial, and dissatisfaction concerning the corporal image. The obese female individuals also project their guilt onto an object or person, taking into account that the socio-cultural factor has great importance on the psychological aspects. It was concluded that obese female individuals present difficulties in these aspects, due to a fragile mother-child bond, adding the importance on the multifactor etiology of obesity, making culture a relevant factor.

Função sexual e saúde reprodutiva em mulheres adolescentes com lúpus eritematoso sistêmico juvenil / Sexual function and reproductive health in adolescent females with systemic lupus erythematosus

OBJETIVO: Avaliar a função sexual e a saúde reprodutiva em adolescentes com Lúpus Eritematoso Sistêmico Juvenil (LESJ) e compará-las com controles. PACIENTES E MÉTODOS: Cinquenta e duas pacientes com LESJ do sexo feminino foram avaliadas com dados demográficos, função sexual, exame ginecológico, ciclo menstrual, citologia cérvico-vaginal, características clínicas e tratamento. O grupo controle incluiu 52 mulheres pareadas por idade. RESULTADOS: A média da idade foi similar nas pacientes com LESJ e controles (16,7±1,94 versus 16,13 ± 2,16 anos, P = 0,92). A média da idade da menarca foi maior nas pacientes com LESJ (12,82 ± 1,62 versus 11,55 ± 1,45 anos, P = 0,0004). A frequência de atividade sexual foi significativamente menor nas pacientes com LESJ (23 por cento versus 60 por cento, P = 0,0003). Em contraste, os percentuais de disfunção sexual, lubrificação vaginal reduzida, desempenho diminuído, orgasmo reduzido e insatisfação com a vida sexual foram significativamente maiores nas pacientes com LESJ (58 por cento versus 23 por cento, P = 0,03; 50 por cento versus 16 por cento, P = 0,046; 58 por cento versus 23 por cento, P = 0,03 por cento; 50 por cento versus 16 por cento, P = 0,046; respectivamente). Por outro lado, nenhuma diferença foi observada nas pacientes com LESJ e controles em relação a dados demográficos, alterações pubertárias, anormalidades do ciclo menstrual e citologia cérvico-vaginal (P > 0,05). Nenhuma diferença foi evidenciada nas pacientes com LESJ com e sem disfunção sexual em relação aos dados demográficos, alterações pubertárias, anormalidades do ciclo menstrual e citologia cérvico-vaginal, atividade da doença, dano cumulativo e tratamento (P > 0,05). CONCLUSÃO: Este é o primeiro estudo que identificou disfunção sexual em adolescentes do sexo feminino com LESJ. Aspectos relacionados à sexualidade necessitam uma atenção especial dos profissionais de saúde que atendem adolescentes com lúpus.

OBJECTIVE: To evaluate the reproductive health of female adolescents with Juvenile Systemic Lupus Erythematosus (JSLE) and compare them with a control group. PATIENTS AND METHODS: The demographic data, sexual function, gynecologic exam, menstrual cycle, cervicovaginal cytology, clinical characteristics, and treatment of 52 female patients with JSLE were evaluated. The control group was composed of 52 women matched for age. RESULTS: The mean age of patients with JSLE was similar to that of the control group (16.7 ± 1.94 versus 16.13 ± 2.16 years, P = 0.92). The mean age of menarche was higher in JSLE patients (12.82 ± 1.62 versus 11.55 ± 1.45 years, P = 0.0004). The frequency of sex activity was significantly lower in patients with JSLE (23 percent versus 60 percent, P = 0.0003). In contrast, the percentage of sexual dysfunction, reduced vaginal lubrication, decreased performance, reduced orgasm, and dissatisfaction with one's sex life were significantly higher in JSLE patents (58 percent versus 23 percent, P = 0.03; 50 percent versus 16 percent, P = 0.046; 58 percent versus 23 percent, P = 0.03; 50 percent versus 26 percent, P = 0.046, respectively). On the other hand, demographic data, pubertal changes, abnormalities in menstrual cycle, and cervicovaginal cytology were similar in JSLE patients and the control group (P > 0.05). Demographic data, pubertal changes, abnormalities in menstrual cycle, cervicovaginal cytology, disease activity, cumulative damage, and treatment did not differ between JSLE patients with and without sexual dysfunction (P > 0.05). CONCLUSION: This is the first study to identify sexual dysfunction in female adolescents with JSLE. Sexuality-related aspects require special attention from health care professionals who treat adolescents with lupus.

Aculturación y diferencias en las creencias irracionales sobre el rol femenino tradicional (O’Kelly Women Beliefs Scale) en mujeres colombianas residentesen su país de origen y en Estados Unidos / Acculturation and differences in the irrational beliefs about traditional female roles (O’Kelly Women Beliefs Scale) in Colombian women living in Colombia and U. S. A

La Escala de Creencias de las Mujeres de O’Kelly (O’Kelly Women Beliefs Scale., O’Kelly, en prensa; Ellis, 1985) fue aplicada a colombianas residentes en Cali, Colombia, colombianas residentes en el noreste de los Estados Unidos y sus contrapartes estadounidenses (20 madres y 20 hijas mayores de 17 años en cada grupo). Se encontró que existen diferencias transculturales en los puntajes totales de los tres grupos. Comparaciones posthoc (LSD) indicaron que las diferencias significativas se encuentran en las hijas colombianas residentes en Estados Unidos, comparadas con las madres colombianas residentes en Colombia y las madres e hijas estadounidenses. No existen diferencias entre madres e hijas colombianas residentes en Estados Unidos. Los resultados sugieren que el patrón deaculturación de los colombianos en los Estados Unidos es el de asimilación al país de adopción conservando aspectos de la tradición y la cultura del país de origen.

The O’Kelly Women Beliefs Scale (O’Kelly, in press) was given to 120 females: Colombians living in Colombia, and Colombians, and their non- Hispanic US counterparts living in the USA (20 mother-daughter pairs in each group). An ANOVA indicated significant cross-cultural differences among the groups, where posthoc comparisons (LSD) revealed they were largely due to differences between Colombian daughters in the USA and three subgroups: Colombian mothers inColombia, non- Hispanic US mothers, and non- Hispanic US daughters. Results suggest that the acculturation patternof Colombians to the USA seems to be one of assimilation to the new culture keeping several aspects of the traditions and costumes of the country of origin.

Quality of life and its association with cardiovascular risk factors in a community health care program population

OBJECTIVE: To evaluate quality of life in a population that attended a specific community event on health care education, and to investigate the association of their quality of life with the presence of cardiovascular risk factors INTRODUCTION: Interest in health-related quality of life is growing worldwide as a consequence of increasing rates of chronic disease. However, little is known about the association between quality of life and cardiovascular risk factors. METHODS: This study included 332 individuals. Demographics, blood pressure, body mass index, and casual glycemia were evaluated. The brief version of the World Health Organization Quality of Life questionnaire on quality of life was given to them. The medians of the scores obtained for the physical, psychological, emotional, and environmental domains were used as cutoffs to define "higher" and "lower" scores. A multinomial logistic regression model was used to define the parameters associated with lower scores. RESULTS: Diabetes mellitus, dyslipidemia, and obesity were associated with lower scores in the physical domain. Dyslipidemia was also associeted with lower scores in the psychological domain. Male gender and regular physical activity had protective effects on quality of life. Aging was inversely associated with decreased quality of life in the environmental domain. CONCLUSION: The presence of cardiovascular risk factors is related to a decreased quality of life. Conversely, male gender and regular physical activity had protective effects on quality of life. These findings suggest that exercising should be further promoted by health-related public programs, with a special focus on women.

Aspectos psicopatológicos e forenses de mulheres homicidas com diagnóstico de transtornos psicóticos primários: estudo de série de casos / Psychopatologic and forensic features of female murderes with a diagnosis of primary psycchotic disorders – a case series

Objetivo: Avaliar amostra de todas as mulheres com diagnóstico de transtorno psicótico primário que receberam medida de segurança e estavam em hospital de custódia e tratamentopsiquiátrico em regime de internação (n = 8), em virtude de homicídio ou tentativa de homicídio (artigo 121 do Código Penal Brasileiro). Métodos: Trata-se de um estudo de série de casos. Foi realizado o levantamento retrospectivo de dados por meio de registros periciais e pareceres de equipes de assistência. O diagnóstico psiquiátrico final foi realizado com base na entrevista psiquiátrica e observação dos registros, utilizando-se os critériosdiagnósticos do DSM-IV-TR. Houve aplicação de questionário padronizado e escala das síndromes positiva e negativa (PANSS). Resultados: Sete pacientes receberam diagnóstico de esquizofrenia e uma de transtorno esquizoafetivo. A maioria das vítimas (n = 6, 60%) era membro familiar das pacientes. Foi encontrado que 37,5% (n = 3) das pacientes tinham história prévia de comportamento violento. De acordo com a avaliação da perícia psiquiátrica inicial, cinco (62,5%) pacientes da amostra total presentavam sintomatologia psicótica no momento desta avaliação. As alucinações auditivas foram os sintomas psicóticos mais comuns. Conclusão: O estudo de fatores motivadores do comportamento homicida pode fornecer conhecimentos para o estabelecimento de intervenções terapêuticas em mulheres com transtornos mentais que apresentem risco para este ou outros comportamentos violentos.

Objective: Evaluate a sample of women with primary psychotic disorders who received a safety measure and were admitted to inpatient forensic psychiatric care (n=8), due to homicide or attempted homicide (article 121 from the Brazilian Penal Code). Method: This is a serial cases study. The case records of all the women were retrospectively examined, including technical files andthe evaluations of clinical experts. The final psychiatric diagnosis was obtained with a psychiatric evaluation of the patients and the examination of their records, using the diagnostic criteriaof DSM-IV-TR. A standardized interview and positive and negative syndrome scale (PANSS) were also applied. Results: Seven patients received a diagnosis of schizophrenia and one a diagnosis of schizoaffective disorder. Most victims (n=10; 60%) were family members of the patients. We found that 37.5% (n=3) of the patients had previous history of violent behavior. According to the initial psychiatric forensic evaluation, five (62.5%) of the patients from the sample had psychoticsymptoms. Auditory hallucinations were the most common psychotic symptoms. Conclusion: The study of motivational factors for homicidal behavior may provide further knowledge for theimplantation of therapeutic interventions in women with mental disorders and an increased risk for homicidal or other violent behaviors.

Risk Factors for Formation of Multiple Intracranial Aneurysms

OBJECTIVE: We report the correlation between known risk factors for cerebrovascular disease and formation of multiple intracranial aneurysms. METHODS: We reviewed the medical records and outcomes of 524 patients who had undergone aneurysmal operation at our hospital between January 1996 and May 2001. Of 524 patients who had undergone operations with intracranial aneurysm, 130 patients had multiple intracranial aneurysms. The authors examined the correlations between the risk factors(patient age, sex, menopausal state of female patients, hypertension, cigarette smoking) and the presence of multiple intracranial aneurysms by using chi-square test retrospectively. RESULTS: The male to female ratio was about 1 : 2.05(male : female=129 : 265) for patients with single intracranial aneurysm, and male to female was about 1 : 3.06(male : female=32 : 98) for patients with multiple intracranial aneurysms. Among 256 female patients with single intracranial aneurysm, 182 patients(68.9%) were postmenopausal, and, among 98 female patients with multiple intracranial aneurysms, 81 patients(82.6%) were postmenopausal. The mean age of the patients with single intracranial aneurysm was 54 years, and, with multiple intracranial aneurysms, the mean age was 57.8 years. The presence of hypertension was found in 149 patients(37.8%) with single intracranial aneurysm, and, in 55 patinets (42.3%) with multiple intracranial aneurysms. Cigarette smoking was found in 116 patients(29.4%) with single intracranial aneurysm and 47 patients(36.1%) with multiple intracranial aneurysms. CONCLUSION: There is a significant correlation between menopausal state of female patients and presence of multiple intracranial aneurysms. However, gender, hypertension and smoking are not related to multiple intracranial aneurysms.