Factors associated with negative self-rated health of middle-aged women / Factores asociados a la autoevaluación de salud negativa de mujeres de media edad / Fatores associados à autoavaliação da saúde negativa de mulheres de meia-idade

ABSTRACT Objective: To evaluate factors associated with negative self-rated health among middle-aged women treated at a climacteric outpatient clinic. Method: This is a cross-sectional, analytical study conducted with 116 women assisted in the period between March 2015 and March 2020 at the climacteric outpatient clinic of a university hospital in Cuiabá, MT, Brazil. Data were collected through telephone interviews from October 2020 to January 2021, using a questionnaire containing questions about sociodemographic, health and psychosocial data. Self-rated health was checked by asking the subjects how they rated their health. The association measure used was the prevalence ratio and 95% confidence intervals (95%CI). Poisson's multiple regression was used in the multivariate analysis. Results: Most middle-aged women in this study (54.3%) had negative self-rated health. The factor associated with the outcome was menopausal symptoms (p< 0.001), identified in the severe menopausal symptoms category PR= 2.95 (95%CI 1.4-6.3). Conclusion: The higher prevalence of negative self-rated health among the women in this study is probably related to the life stage they are experiencing. Menopausal symptoms are associated with women's perception of health due to their discomfort and consequent impact on their lives.

RESUMEN Objetivo: Evaluar los factores asociados con la autopercepción de salud negativa entre mujeres de mediana edad atendidas en un ambulatorio de climaterio. Método: Estudio transversal, analítico, realizado con 116 mujeres atendidas en el período comprendido entre marzo de 2015 y marzo de 2020 en el ambulatorio de climaterio de un hospital universitario de Cuiabá-MT, Brasil. Los datos fueron recolectados a través de entrevistas telefónicas, de octubre de 2020 a enero de 2021, utilizando un cuestionario que contenía preguntas sobre datos sociodemográficos, de salud y psicosociales. La salud autoevaluada se verificó preguntando cómo calificaron su salud. La medida de asociación utilizada fue la razón de prevalencia e intervalos de confianza del 95% (IC 95%). En el análisis multivariante se utilizó la regresión múltiple de Poisson. Resultados: La mayoría de las mujeres de mediana edad en este estudio (54,3%) tenían una autoevaluación de salud negativa. El factor asociado al desenlace fueron los síntomas menopáusicos (p< 0,001), identificados en la categoría síntomas menopáusicos severos PR= 2,95 (IC 95% 1,4-6,3). Conclusión: La mayor prevalencia de autoevaluación de salud negativa entre las mujeres de este estudio probablemente esté relacionada con la etapa de la vida en la que se encuentran. Los síntomas de la menopausia están asociados a la percepción de salud de la mujer por su malestar y consecuente impacto en su vida.

RESUMO Objetivo: Avaliar os fatores associados à autoavaliação da saúde negativa de mulheres de meia-idade atendidas em um ambulatório de climatério. Metodo: Estudo transversal, analítico, desenvolvido com 116 mulheres atendidas no período entre março de 2015 e março de 2020 no ambulatório de climatério de um hospital universitário de Cuiabá-MT. Os dados foram coletados, por meio de entrevista por telefone, no período de outubro de 2020 a janeiro de 2021, utilizando-se questionário contendo perguntas sobre dados sociodemográficos, de saúde e psicossociais. A autoavaliação da saúde foi verificada perguntando como elas avaliavam sua saúde. A medida de associação utilizada foi a razão de prevalência e intervalos de confiança de 95% (IC 95%). Na análise multivariada utilizou-se a regressão múltipla de Poisson. Resultados: A maioria das mulheres de meia-idade deste estudo (54,3%) apresenta autoavaliação da saúde negativa. O fator que apresentou associação ao desfecho foi sintomas da menopausa (p< 0,001), identificado na categoria de sintomas severos da menopausa RP= 2,95 (IC 95% 1,4- 6,3). Conclusão: A maior prevalência de autoavaliação da saúde negativa das mulheres deste estudo, provavelmente, tem relação com a fase da vida em que estão vivenciando. Os sintomas da menopausa têm associação com a percepção de saúde das mulheres pelos seus desconfortos e consequente impacto em suas vidas.

Systems biology applied to the study of papaya fruit ripening: the influence of ethylene / Biologia de sistemas aplicada ao estudo do amadurecimento de mamões: a influência do etileno

Fruit ripening is a biochemical process that results in flavor, odor, texture, and color suitable for human consumption, in addition to providing access to important nutrients. Although ripening promotes sensory and nutritional increases in fruits, there is also an increased susceptibility to physical damage, as is the case with papaya. These transformations occur due to changes in gene expression patterns at different stages of maturity, whose control and coordination result from the combined action of plant hormones, especially ethylene. As the action of this hormone in the regulation of gene expression is still elusive, this dissertation sought to address the global analysis of the transcriptome in an overview study of molecular processes involved in the ripening of ethylene-treated and non-treated papaya. Transcription factors related to ethylene synthesis and signaling had increased activity towards exogenous-ethylene treatment. Consequently, ethylene-induced enzymes had their coding genes differentially expressed, like genes related to the synthesis of carotenoids, linalool, and vitamins, which increase color, aroma, and antioxidant activity, respectively. Metabolic pathways related to the synthesis of sugars were suppressed while genes encoding the enzyme responsible for sucrose synthesis maintained a basal expression, showing that the accumulation of sugars occurs before the ripening process. The firmness of the peel and pulp of the fruits were strongly influenced by the treatment with ethylene and by the time of the experiment, suffering the action of numerous enzymes related to the degradation of the cell wall. The main enzyme responsible for softening the pulp was polygalacturonase, together with the activity of other pectinases and cellulases. In contrast to the need for the pre-climacteric action of pectate lyase and pectinesterase reported in other fleshy fruits, such as tomatoes and strawberries, papaya did not show a significant difference in their expression. The meta-analysis of several papaya ripening transcriptomes confirmed the expression profile observed in the previous RNA-seq, besides providing statistical enrichment to the biological narratives. Finally, the present study gathered a range of robust information on the gene regulation of the papaya ripening process, which opens possibilities for future approaches to transcriptomic analysis and validates the use of papaya as a model for such studies

O amadurecimento de frutos é um processo bioquímico que resulta em sabor, odor, textura e cor adequados para o consumo humano, além de propiciar o acesso a nutrientes importantes. Apesar do amadurecimento promover incrementos sensoriais e nutricionais nos frutos, ocorre também um aumento da suscetibilidade a danos físicos, como é o caso do mamão. Essas transformações ocorrem devido às alterações nos padrões de expressão gênica nos diferentes estádios de amadurecimento, cujo controle e coordenação decorrem da ação combinada de hormônios vegetais, principalmente do etileno. Como a ação deste hormônio na regulação da expressão gênica ainda é elusiva, a presente dissertação buscou abordar a análise global do transcriptoma em um amplo estudo dos processos moleculares envolvidos no amadurecimento de mamões tratados e não tratados com etileno. Os fatores de transcrição relacionados com a síntese e a sinalização do etileno tiveram sua atividade aumentada perante o tratamento exógeno com etileno. Consequentemente, as enzimas reguladas por esse hormônio tiveram seus genes de codificação expressos diferencialmente, como foi o caso de genes relacionados à síntese de carotenoides, linalool e vitaminas, que atuam no aumento da cor, aroma e atividade antioxidante, respectivamente. Vias metabólicas relacionadas com à síntese de açúcares foram reprimidas enquanto genes codificantes da enzima responsável pela síntese de sacarose mantiveram uma expressão basal, evidenciando que o acúmulo de açúcares ocorre antes do processo de amadurecimento. A firmeza da casca e da polpa dos frutos foram fortemente influenciadas pelo tratamento com etileno e pelo tempo de experimento, sofrendo ação de inúmeras enzimas relacionadas com a degradação da parede celular. A principal enzima responsável pelo amolecimento da polpa foi a poligalacturonase, em conjunto com a atividade de outras pectinases e celulases. Em contraste com a necessidade da ação pré-climatérica da pectato liase e da pectinesterase relatada em outras frutas carnosas, como tomates e morangos, o mamão não apresentou uma diferença significativa na expressão das mesmas. A meta-análise de diversos transcriptomas do amadurecimento do mamão reafirmaram o perfil de expressão observado no RNA-seq, além de prover enriquecimento estatístico às narrativas biológicas. Por fim, o presente estudo reuniu uma gama de informações robustas sobre a regulação gênica do processo de amadurecimento do mamão papaia, o que abrange a possibilidade para futuras abordagens de análise transcriptomica e valida o uso do mamão como modelo para tais estudos

Síndrome climatérico en mujeres de edad mediana / Climacteric syndrome in women of middle age

introducción: Es evidente que el síndrome climatérico puede manifestarse de formas diferentes, con un mayor o menor grado de intensidad, de acuerdo a las condiciones sociales y ambientales de cada mujer, esto puede afectar el patrón biológico y variar su estado de salud.Objetivos: Caracterizar a las mujeres de edad mediana en virtud de la intensidad del síndrome climatérico y un conjunto de características biológicas, psicológicas y sociales, así como identificar entre las variables evaluadas, aquellas que constituyen factores de riesgo para los niveles más intensos del síndrome climatérico en las mujeres de edad mediana Métodos: La investigación clasifica como observacional, que transita del nivel descriptivo al analítico, con una muestra de 532 mujeres de edad entre 40 a 59 años del municipio Plaza de la Revolución durante el primer semestre de 2017. Las variables estudiadas fueron edad en años, edad de aparición de los síntomas, apoyo familiar y cantidad de enfermedades. Resultados: La intensidad del síndrome climatérico en mujeres de edad mediana, de manera global, mostró ser menos intenso en aquellas que no han tenido la menopausia, con una tendencia decreciente con la edad en este segmento poblacional. Conclusiones: La intensidad del síndrome climatérico está asociada con la edad cronológica de la mujer de edad mediana, la edad de aparición de la menopausia, el apoyo familiar y la cantidad de enfermedades relacionadas(AU)

Introduction: The climacteric syndrome can evidently manifest itself in different ways, with a greater or lower degree of intensity. According to the social and environmental conditions of each woman, this can affect the biological pattern and vary the woman's state of health. Objectives: To characterize women of middle age based on the intensity of the climacteric syndrome and a set of biological, psychological and social characteristics, as well as to identify, among the variables evaluated, those that constitute risk factors for the most intense levels of the climacteric syndrome in women of middle age. Methods: The research was classified as observational, which moves from the descriptive to the analytical level, with a sample of 532 women aged 40-59 years of Plaza de la Revolución Municipality during the first semester of 2017. The variables studied were age in years, age of symptoms onset, family support and number of diseases. Results: The intensity of the climacteric syndrome in women of middle age showed to be globally less intense in those that have not had menopause, with a tendency that decreases with age in this population segment. Conclusions: The intensity of the climacteric syndrome is associated with the chronological age of the woman of middle age, the age of menopause onset, family support and the number of associated diseases(AU)

Impacto del síndrome climatérico en la función sexual / Impact of climateric syndrome on sexual function

Introducción: El síndrome climatérico se puede definir como el conjunto de signos y síntomas que se presentan en la perimenopausia y postmenopausia, incluye síntomas vasomotores, alteraciones del sueño, alteraciones psicológicas y atrofia genital. Objetivo: Conocer el impacto del síndrome climatérico sobre la función sexual y calidad de vida de las mujeres que atraviesan esta etapa de la vida. Métodos: Se trata de una revisión bibliográfica. Los artículos revisados fueron obtenidos de fuentes como Google Académico, Pubmed, LILACS; la selección de la bibliografía comprendió artículos publicados entre 2011 y 2018. Conclusiones: La sexualidad en este periodo y la vejez es un tema de vital importancia para la salud pública. La disfunción sexual como resultado del síndrome climatérico desencadena sentimientos de baja autoestima, desapego y frustración, lo que ocasiona en la mujer que lo padece desinterés por el sexo y un impacto negativo muy claro en su calidad de vida.

The climacteric syndrome can be defined as a set of signs and symptoms that appear in perimenopause and postmenopause, including vasomotor symptoms, sleep disturbances, psychological alterations and genital atrophy. Objective: To know the impact of the climacteric syndrome on the sexual function and quality of life of the women going through this stage of life. Methods: The present work is literature review. Reviewed articles were obtained from sources such as Google Scholar, Pubmed, LILACS; the selection of literature included articles published between 2011 and 2018. Conclusions: Sexuality in this period and old age is a topic of vital importance for public health. Sexual dysfuntion as a result of climateric syndrome originates feelings of low self­esteem, detachment and frustration, causing disinterest in sex, having a clear negative impact on women quality of life.

Intensidad y evolución del síndrome climatérico y su relación con los factores de riesgo para aterosclerosis / Intensity and Evolution of the Climacteric Syndrome and Its Relation with Atherosclerosis Risk Factors

Introducción: el estudio del climaterio y la menopausia tiene gran importancia y vigencia por su morbilidad asociada. Objetivo: determinar la presencia de factores de riesgo ateroscleróticos con la intensidad y evolución del síndrome climatérico en este grupo. Métodos: estudio prospectivo y de intervención en mujeres de 40 a 59 años con síndrome climatérico a las que se les aplicó terapia hormonal -previo consentimiento informado- y se observó la respuesta evolutiva al mismo. Resultados: las variables estudiadas: sobrepeso, obesidad, sedentarismo, hábito de fumar, circunferencia de cintura, hipertensión arterial y diabetes mellitus tipo 2; así como la sobrecarga de género que tenían dichas mujeres, tuvieron relación con la presencia y evolución desfavorable del síndrome climatérico. La obesidad y el sobrepeso son las de mayor influencia sobre la evolución de este síndrome. La otra variable de mayor importancia fue el hábito de fumar. En orden de importancia le siguió el sedentarismo. Conclusiones: los factores de riesgo para aterosclerosis estudiados se asociaron con síndrome climatérico más intenso y con una evolución desfavorable del mismo, aporte científico de esta investigación, lo que también ocurrió con la sobrecarga de género. El aumento de la circunferencia de cintura, el índice de masa corporal elevado y el tabaquismo fueron los factores de riesgo de mayor importancia en la evolución desfavorable de dicho síndrome(AU)

Introduction: The study of climacteric and menopause has great importance and validity due to its associated morbidity. Objective: Determine the presence of atherosclerotic risk factors with the intensity and evolution of the climacteric syndrome in this group. Methods: A prospective and interventional study was carried out in women aged 40 to 59 years with climacteric syndrome who received hormone therapy - previous informed consent. The evolutionary response was observed. Results: The variables studied (overweight, obesity, sedentary lifestyle, smoking habits, waist circumference, arterial hypertension and type 2 diabetes mellitus), these women gender overload were related to the presence and unfavorable evolution of the climacteric syndrome. Obesity and overweight are the most influential on this syndrome evolution. The other major variable was smoking. In order of importance, sedentary followed. Conclusions: The atherosclerosis risk factors studied were associated with a more intense climacteric syndrome and with an unfavorable evolution of them, which is the scientific contribution of this research. Increased waist circumference, high body mass index and smoking habits were the most important risk factors for the unfavorable evolution of this syndrome(AU)

Modificación de conocimientos sobre climaterio. Un reto para la salud / Modification to knowledge on climacterium. A challenge for health

Se efectuó una intervención educativa en 82 mujeres de edad mediana con síndrome climatérico, pertenecientes a la Policlínica nr 1 "Francisca Rivero" de Manzanillo en Granma, desde enero hasta junio del 2012, a fin de modificar algunos conocimientos sobre el climaterio y así mejorar la calidad de vida de estas féminas. En la casuística, el hábito de fumar, así como los antecedentes de trastornos menstruales influyeron para que se adelantara la menopausia. Asimismo, los sofocos y la sudoresis figuraron entre los síntomas vasomotores más relevantes. Antes de la acción educativa, la mayoría de las afectadas tenían nociones inadecuadas al respecto y después de esta lograron modificarlas positivamente, por lo cual se demostró la efectividad del programa de actividades aplicado.

An educational intervention was carried out in 82 middle-age women with climacteric syndrome, belonging to "Francisca Rivero" Polyclinic nr 1 in Manzanillo Granma, from January to June, 2012, in order to modify some knowledge on climacterium and in this way to improve the life quality of these female patients. In the case material, the smoking habit as well as the history of menstrual disorders influenced so as to advance menopause. Likewise, hot flashes and sudoresis were among the most relevant vasomotor symptoms. Before the educational action, most of the affected women had inadequate notions in this respect and after this they were able to modify them positively, reason why the effectiveness of the applied program of activities was demonstrated.

Menopausia inducida quirúrgicamente / Menopause surgically induced

Se realizó un estudio descriptivo, prospectivo y longitudinal de 221 mujeres con menopausia artificial por doble ooforectomía, que asistieron a la consulta especializada para la atención al climaterio y la menopausia, del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, desde enero de 2009 hasta agosto de 2012. La edad promedio de las pacientes intervenidas fue de 37,8 años y la mayoría de estas tenían menos de 40 años (64,2 %). En la casuística predominaron el fibroma uterino como causa principal de la operación (68,8 %), los síntomas clasificados como muy molestos (para una asociación significativa entre la severidad del síndrome climatérico y el grupo de edad menor de 40 años), así como los sofocos y las sudoraciones nocturnas (87,3 %). Entre los síntomas psicológicos más relevantes figuraron: depresión, irritabilidad e insomnio, y los regímenes terapéuticos más aplicados fueron los estrógenos continuos y la medicina natural.

A descriptive, prospective and longitudinal study was conducted in 221 women with artificial menopause by double oophorectomy, who attended the specialized department for climacteric and menopause care of "Dr. Juan Bruno Zayas Alfonso" General Teaching Hospital in Santiago de Cuba, from January 2009 to August 2012. The average age of patients undergoing surgery was 37.8 years and most of them were under 40 years (64.2%). Uterine fibroid as main cause of surgery (68.8%), symptoms classified as very annoying (for a significant association between the severity of climacteric syndrome and the age group under 40 years) prevailed in the case material, as well as hot flashes and night sweating (87.3%). Among the most significant psychological symptoms were depression, irritability and insomnia, and more frequent regimens were continuous estrogen and natural medicine.

Síndrome climatérico en mujeres de edad mediana desde un enfoque médico social / Climacteric syndrome in middle-aged women from a social medical approach

Se realizó un estudio descriptivo y transversal, a fin de describir las principales manifestaciones clínicas del síndrome climatérico en 341 mujeres de edad mediana que asistieron a la consulta especializada para la atención al climaterio y la menopausia del Hospital "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, desde enero de 2009 hasta mayo de 2012. La edad promedio de las pacientes en la etapa perimenopáusica fue de 47,2 años, mientras que en las posmenopáusicas resultó ser de 49,4 años. Se aplicó la escala climatérica cubana, desde un enfoque médico social. En la posmenopausia artificial, los síntomas fueron muy molestos para 69,1 % de las afectadas; asimismo, los sofocos predominaron en 88,2 %, seguidos de las sudoraciones nocturnas en 82,7 % de ellas. La depresión y el insomnio figuraron entre los síntomas psicológicos más relevantes, con 84,7 y 78,0 %, respectivamente. La medicina natural y la terapia hormonal de reemplazo constituyeron las principales modalidades de tratamiento.

A descriptive and cross-sectional study was conducted in order to describe the main clinical manifestations of the climacteric syndrome in 341 middle-aged women, who attended the specialized care for climacteric and menopause of "Dr. Juan Bruno Zayas Alfonso" Hospital in Santiago de Cuba, from January 2009 to May 2012. The average age of patients in the perimenopausal stage was 47.2 years, while in postmenopausal women was found to be 49.4 years. The Cuban climacteric scale was applied from a social medical approach. In the artificial postmenopause, the symptoms were very bothersome for 69.1 % of those affected; also, hot flashes prevailed in 88.2 %, followed by the night sweats in 82.7 % of them. Depression and insomnia were among the most significant psychological symptoms, with 84.7 and 78.0 %, respectively. Natural medicine and hormone replacement therapy were the main treatment modalities.

Influencia del entorno familiar en la mujer en etapa climatérica / Influence of family environment in climateric woman

Introducción: a pesar del importante papel que tiene la familia, existen pocos reportes relativos a la probable influencia del climaterio sobre el entorno familiar, así como del funcionamiento familiar sobre la intensidad del síndrome climatérico. Objetivo: describir el funcionamiento familiar e identificar su influencia sobre las manifestaciones clínicas del climaterio. Métodos: estudio descriptivo transversal que incluyó mujeres con residencia permanente en el consultorio # 4 del policlínico "Rampa", con edades entre 40 y 59 años, y con familias no monoparentales. Mediante interrogatorio se identificó la presencia de afecciones crónicas y sus factores de riesgo, así y la intensidad del síndrome climatérico. Se identificó, además, el cumplimiento de las funciones básicas de las familias, la dinámica de sus relaciones internas y la percepción del funcionamiento familiar. Se empleó la frecuencia y el promedio, y la prueba T Students (valor de p> 0,05) para establecer diferencias entre grupos. Resultados: el grupo estuvo constituido por mujeres con piel blanca, trabajadoras, en etapa de perimenopausia, con síndrome climatérico de intensidad muy leve y leve. El entorno familiar fue no funcional (con riesgo + disfuncional) en el 77 por ciento de las familias, con independencia de la etapa del climaterio de la mujer y de la intensidad del síndrome climatérico. La incapacidad para cumplir el rol económico fue referida por 38 por ciento de las mujeres. Conclusiones: la pérdida del rol económico fue el factor de mayor impacto negativo en el funcionamiento familiar. No se constató que la posmenopausia influyera en el funcionamiento familiar.

Introduction: despite the significant role of family, there are not much reports relative to the likely influence of climateric on the family environment, as well as the family functioning on the intensity of climateric syndrome. Objective: to describe the above mentioned functioning and to identify its influence on the clinical manifestations of climateric. Methods: a cross-sectional and descriptive study was conducted including permanent female patients of the No. 4 consulting room of the "Rampa" polyclinic aged 40 and 59 whose family is monoparental. By means of a questionnaire it was possible to identify the presence of chronic affections and its risk factors, as well as the climateric syndrome intensity, Also, the fulfilment of basic functions of families was identified, as well as the dynamics of its internal relations and the perception of family performance. Authors used the frequency and average, t-Student test (value > 0,05) to establish differences among groups. Results: group included white women, workers, in perimenopause stage, climateric syndrome of very slight or slight intensity. The family environment was not functional (with risk + dysfunctional) in the 77 percent of families independently of woman climateric stage and of climateric syndrome intensity. Failure to fulfill the economic role was of 38 percent of women. Conclusions: loss of economic role was the factor with a great negative impact on the family performance. It was not demonstrated that postmenopause influence in above mentioned performance.