Influence of physician's lifestyle on the prescription of healthy habits to breast cancer patients (LACOG 1218).

BACKGROUND: Healthy lifestyle is capable of positively modifying the survival of breast cancer (BC) patients. We aimed to evaluate how physician's lifestyle influences on the prescription of healthy habits to BC patients. METHODS: An online questionnaire to evaluate physician lifestyle and prescription of healthy habits to BC patients was developed and circulated by e-mail to physicians dedicated to treat BC patients. A multivariate Poisson regression analysis assessed which factors of physician lifestyle could influence on prescription of healthy habits. RESULTS: A total of 267 physicians answered the questionnaire from October to November 2018. In terms of physician lifestyle, 228 (85.4%) had healthy eating habits and 236 (88.4%) practiced physical activity. Overall, 84.3% of the physicians advised their BC patients on the importance of lifestyle modification. Physicians who did not exercise regularly have a higher probability of not advising for health lifestyle (RR 2.48; p = 0.0265) as opposite to physicians ≥ 50 years-old (RR 0.37; p = 0.0118). Obesity treatment and management was performed by 45.3% of physicians. Being a breast surgeon (RR 1.29; p = 0.0025) or radiation oncologists (RR 1.82; p = 0.0025) were associated with not performing obesity treatment and management. About 53.4% of physicians referred overweight or obese patients to a dietitian and/or endocrinologist. Male gender (RR 1.35; p = 0.0296), breast surgeons (RR 1.99; p = 0.0001), and clinical practice in public health system (RR 1.53; p = 0.0012) were associated with not referring as opposed to physicians ≥ 50 years-old (RR 0.46; p = 0.0005). CONCLUSION: Our survey showed some influence of physician's lifestyle on the prescription of healthy habits to BC patients. Physicians who practice physical activity regularly had a higher probability of advising lifestyle modification and about half of physicians did some type of overweight and obese management.

ASSOCIATION BETWEEN ALCOHOL CONSUMPTION AND BREAST CANCER DEVELOPMENT: A CASE-CONTROL STUDY / Associação entre ingesta alcoólica e desenvolvimento de câncer de mama: um estudo de caso-controle

Objectives: To identify the association of alcohol consumption with the development of breast cancer in a patient population of Salvador, Bahia. Methods: Case-control study, conducted between December 2013 and May 2015, with 69 patients with breast ductal carcinoma and 71 controls. Sample calculation was made with 140 patients, with 5% presumed difference between groups and 10% acceptable difference. The χ2 test was used to evaluate the correlation between categorical variables, and Student's t-test was applied to compare continuous variables. Results: From all cases, medium alcohol intake was 3.66±8.60 g/day; among controls, the average was 3.71±7.40 g/day (p=0.890). When analyzing the association between alcohol intake and breast cancer, odds ratio was 0.99 (95% confidence interval 0.524­1.890), p=0.988. For alcohol consumption greater than 10 g/day and breast cancer, odds ratio was 1.579 (95%CI 0.624­3.995), p=0.332. Conclusions: Although published data suggest an association between alcohol consumption and breast cancer, in this study there was no statistical significance between the variables assessed and the onset of this pathology.

Objetivo: Identificar a associação do consumo alcoólico com o desenvolvimento de câncer de mama em uma população de pacientes de Salvador, Bahia. Métodos: Estudo de caso-controle realizado entre dezembro de 2013 e maio de 2015 com 69 pacientes com diagnóstico de carcinoma ductal da mama e 71 controles. Foi realizado cálculo amostral com 140 pacientes, esperando-se uma diferença presumida de 5% entre os grupos e com diferença aceitável de 10%. Realizou-se teste do χ2 para avaliação de correlação entre as variáveis categóricas e teste t de Student entre as variáveis contínuas. Resultados: Entre os casos, a ingesta alcoólica média foi de 3,66±8,60 g/dia; já entre os controles a média foi de 3,71±7,40 g/dia (p=0,890). Ao analisar-se a associação entre ingesta alcoólica e câncer de mama, obtivemos odds ratio de 0,99 (intervalo de confiança de 95% ­ IC95% 0,524­1,890), p=0,988. Em relação ao consumo de álcool maior do que 10 g/dia e câncer de mama, a odds ratio foi de 1,579 (IC95% 0,624­3,995), p=0,332. Conclusão: Apesar de dados publicados e hipóteses sugerirem associação entre ingesta alcoólica e câncer de mama, neste estudo não houve significância estatística entre as variáveis analisadas e a presença da patologia.

Análise dos recursos para reabilitação da musculatura do assoalho pélvico em mulheres com prolapso e incontinência urinária / Analysis of the resources for rehabilitation of pelvic floor muscles in women with prolapse and urinary incontinence / Análisis de los recursos para rehabilitación de la musculatura del suelo pélvico en mujeres con prolapso e incontinencia urinaria

Esta revisão teve como objetivo analisar os recursos e sua eficácia na reabilitação do assoalho pélvico no tratamento dos prolapsos genitais e incontinência urinária. As buscas foram realizadas nas bases de dados MEDLINE/PubMed, LILACS/SciELO e Biblioteca Cochrane. Foram encontrados 886 artigos, dos quais foram utilizados 34 estudos clínicos relevantes que respondiam às perguntas construídas pelos autores. Os estudos analisados mostraram que o treinamento do assoalho pélvico pode ser usado no tratamento dos prolapsos, porém são necessários mais estudos randomizados para sustentar essa evidência. Para a incontinência urinária a reabilitação do assoalho pélvico é eficiente e deve ser o tratamento de primeira escolha.

This review aimed to assess the capabilities and effectiveness of pelvic floor rehabilitation in the treatment of genital prolapse and urinary incontinence. The research was conducted in MEDLINE/PubMed, LILACS/SciELO and Cochrane Library. There were found 886 articles, of which were used 34 relevant clinical trials that answered the questions constructed by the authors. The studies analyzed showed that pelvic floor training can be used in prolapse treatment, but further randomized studies are necessary to support this evidence. For urinary incontinence pelvic floor, rehabilitation is effective and should be the treatment of first choice.

Esta revisión tiene como objetivo analizar los recursos y su eficacia en la rehabilitación del suelo pélvico en el tratamiento de los prolapsos genitales y la incontinencia urinaria. Las búsquedas fueron realizadas en las bases de datos Medline/Pubmed, LILACS/SciELO y Cochrane. Fueron encontrados 886 artículos, de los cuales fueron utilizados 34 estudios clínicos relevantes y que respondían las preguntas construidas por los autores. Los estudios analizados mostraron que el entrenamiento del suelo pélvico puede ser usado en el tratamiento de los prolapsos, sin embargo, son necesarios más estudios randomizados para sustentar esta evidencia. Para la incontinencia urinaria la rehabilitación del suelo pélvico es eficiente y debe ser el tratamiento de primera opción.

Sintomas depressivos no câncer de mama: inventário de depressão de beck - short form / Depressive symptoms in breast cancer: beck depression inventory – short form

OBJETIVOS: Verificar a prevalência de sintomas depressivos em mulheres com câncer de mama e identificar os fatores de risco associados à sua ocorrência. MÉTODOS: Foi realizado um estudo transversal, em que foram entrevistadas 71 mulheres com câncer de mama. Foram empregados dois instrumentos: um questionário para verificar os dados sociodemográficos e clínicos e o Inventário de Depressão de Beck - Short Form (BDI-SF), para avaliação dos sintomas depressivos. Para análise dos dados, utilizaram-se medidas descritivas e o teste de qui-quadrado, que avaliou a associação entre variáveis sociodemográficas e clínicas e os sintomas depressivos. O nível de significância considerado foi de 5 por cento. RESULTADOS: A prevalência de sintomas depressivos foi de 29,6 por cento. Os fatores associados à presença desses sintomas foram o tratamento quimioterápico (p = 0,021), presença de dor (p = 0,018) e limitação do movimento do membro superior (p = 0,010) e pior percepção da saúde (p = 0,018). CONCLUSÃO: Sintomas depressivos são frequentes no câncer de mama, assim a saúde mental das mulheres com esse tipo de câncer deve ser investigada e tratada quando necessário, reduzindo o impacto desses sintomas na vida da mulher.

OBJECTIVES: To verify the prevalence of depressive symptoms in women with breast cancer and identify risk factors associated to its occurrence. METHODS: It was a transversal study where 71 women with breast cancer were interviewed. Two instruments were applied, being one questionnaire used to verify sociodemographic and clinical data, and the Beck Depression Inventory - Short Form to evaluate depressive symptoms. Descriptive methods and chi-square test were utilized to analyze data, evaluating association between depressive symptoms, sociodemographic and clinical data. Significance level was considered of 5 percent. RESULTS: Depressive symptoms prevalence was 29,6 percent. Factors associated to the presence of this kind of symptoms were: chemotherapic treatment (p = 0,021), pain presence (p = 0,018), upper limb movement limitation (p = 0,010) and bad health perception (p = 0,018). CONCLUSION: Depressive symptoms were frequent in association with breast cancer, and this suggests that women mental status with this kind of cancer must be investigated and treated when necessary, lowing the impact of depressive symptoms in women's life.

Voiding dysfunction in children. Pelvic-floor exercises or biofeedback therapy: a randomized study.

Fifty-six patients 5.9-15.2 years old with dysfunctional elimination syndrome (DES) unimproved by previous therapies were randomly distributed into two voiding training programs: group 1 contained 26 patients submitted to 24 training sessions over a 3-month period; group 2 contained 30 patients submitted to 16 sessions over a 2-month period. Both groups adhered to a voiding and drinking schedule, received instruction on adequate toilet posture, were reinforced through the maintenance of voiding diaries, and went through proprioceptive and pelvic floor muscle training (Kegel exercises). Group 2 patients also received biofeedback therapy. Clinical evaluation was carried out before each program's initiation and 1, 6, and 12 months after each program's termination. All patients were submitted to renal ultrasonography and dynamic ultrasonography before and 6 months after each program's conclusion. Millivoltage recordings of pelvic floor muscles were compared before and after training. Urinary continence was improved after completion of either training program. Only those patients who received biofeedback training showed a significant decrease in postvoiding residual (PVR) urine as detected by dynamic ultrasonography. Our results show that either training regime can reduce episodic urinary incontinence and urinary tract infection but that further study is required to identify the optimal training duration.