RESUMO
BACKGROUND: Sexual health access and care for women in the menopausal stages face significant barriers, presenting deficits in relation to diagnosis and treatment. Although epidemiological data indicate high prevalence of problems related to sexual health in this population, traditionally, the theme is not discussed in health care settings. This study aimed to analyze knowledge, practices and barriers to access sexual health of women in the menopausal stages in the context of women's health care in Brazil. METHODS: With a cross-sectional design, a questionnaire was distributed electronically, encompassing variables related to knowledge; practices; and barriers to access sexual health of women in the menopausal stages. The data obtained were subjected to analysis using both descriptive and inferential statistics. Specifically, we employed multivariate analysis, employing multiple linear regression models, to discern potential factors associated with outcomes concerning the level of knowledge and the frequency of addressing the topic in professional practice. RESULTS: The sample included 70 physicians with specialization in obstetrician/gynecologists who work in health care with women in the menopausal transition or postmenopausal women. A high level of self-reported knowledge about sexual health was identified. Regarding the practices, most of them reported directly proposing the subject and not using instruments. Although they reported frequently addressing the topic in general, topics related to vaginal lubrication, dyspareunia, and sexual dysfunction have been more present in the clinic compared to sexual orientation and women's relationship with themselves. The main barriers were time limitation and patient discomfort with the topic. The multivariate models indicated that female gynecologists and professionals with higher levels of knowledge on the subject had a higher frequency of addressing sexual health in clinical practice with women in menopausal stages. CONCLUSIONS: Sexual health access and care for brazilian women in the menopausal stages presents discrepancies in the frequency of approach between the various topics, in addition to the predictive character of technical knowledge in the practices of professionals. To ensure universal access to sexual health services for this population, an active approach through specific instruments is important, as well as the reinforcement of strategies to improve the level of knowledge of professionals.
Assuntos
Acessibilidade aos Serviços de Saúde , Menopausa , Saúde Sexual , Feminino , Humanos , Brasil , Estudos Transversais , Ginecologista , Inquéritos e Questionários , Conhecimentos, Atitudes e Prática em SaúdeRESUMO
Climacteric is the period in a woman's life cycle that involves perimenopause, menopause and postmenopause. It represents the end of the reproductive period and the beginning of female aging in the biological sense. Over the past 10 years, an emphasis has been placed on the study of mental health in the female climacteric. Studies about the prevalence of depression, anxiety, suicidal ideation and association with different factors have shown important results on the relevance of these disorders during female climacteric. Considering the importance of these findings in the field of public health and epidemiology, we conducted a narrative review aiming to discuss the current knowledge about the prevalence of depression, anxiety and suicidal ideation in the female climacteric, analyzing methods and results in different studies, selected from a literature review between 2009 and 2019, in the PubMed, Lilacs, Embase, Web of Science and Google Scholar databases. Our results showed that the methodology, cultural and sociodemographic differences, as well as a variety of biopsychosocial factors studied, generate some uncertainties about the exact relationship between depression, anxiety, suicidal ideation and female climacteric. We conclude that more research, greater methodological rigor, more accurate results and a biopsychosocial view are needed and urgent for effective interventions, cost reduction in mental health care, as well as prevention and control of depression, anxiety and suicide in climacteric.
Assuntos
Ansiedade , Suicídio , Climatério , Depressão , MulheresRESUMO
OBJECTIVE: To verify the association of obesity and infertility related to anovulatory issues. METHODS: This case-control study was carried out with 52 women, aged 20 to 38 years, divided into two groups (infertile - cases - and fertile - control), seen at outpatient clinics, in the period from April to December, 2017. RESULTS: We found significant evidence that obesity negatively affects women's fertility (p=0.017). The group of infertile women was 7.5-fold more likely to be obese than fertile women. CONCLUSION: Strategies that encourage weight control are indicated for women with chronic anovulation, due to hight metabolic activity of adipose tissue.
Assuntos
Anovulação/etiologia , Infertilidade Feminina/etiologia , Obesidade/complicações , Adulto , Anovulação/metabolismo , Anovulação/fisiopatologia , Antropometria , Estudos de Casos e Controles , Exercício Físico/fisiologia , Feminino , Humanos , Infertilidade Feminina/metabolismo , Infertilidade Feminina/fisiopatologia , Doenças Metabólicas/complicações , Doenças Metabólicas/fisiopatologia , Obesidade/metabolismo , Obesidade/fisiopatologia , Fatores de Risco , Comportamento Sedentário , Inquéritos e Questionários , Adulto JovemRESUMO
ABSTRACT Objective To verify the association of obesity and infertility related to anovulatory issues. Methods This case-control study was carried out with 52 women, aged 20 to 38 years, divided into two groups (infertile − cases − and fertile − control), seen at outpatient clinics, in the period from April to December, 2017. Results We found significant evidence that obesity negatively affects women's fertility (p=0.017). The group of infertile women was 7.5-fold more likely to be obese than fertile women. Conclusion Strategies that encourage weight control are indicated for women with chronic anovulation, due to hight metabolic activity of adipose tissue.
RESUMO Objetivo Verificar em mulheres a associação entre obesidade e infertilidade relacionada a questões anovulatórias. Métodos Estudo de caso-controle com 52 mulheres, de 20 a 38 anos, divididas em dois grupos (mulheres inférteis − casos − e férteis − controles), atendidas em ambulatórios, no período de abril a dezembro de 2017. Resultados Verificou-se evidência significativa de que a obesidade afeta negativamente na fertilidade das mulheres (p=0,017). O grupo de mulheres inférteis teve 7,5 vezes mais chances de serem obesas quando comparadas às mulheres férteis. Conclusão Estratégias que estimulem o controle do peso são indicadas para mulheres com anovulação crônica devido à elevada atividade metabólica do tecido adiposo.
Assuntos
Humanos , Feminino , Adulto , Adulto Jovem , Infertilidade Feminina/etiologia , Anovulação/etiologia , Obesidade/complicações , Exercício Físico/fisiologia , Estudos de Casos e Controles , Antropometria , Inquéritos e Questionários , Fatores de Risco , Comportamento Sedentário , Infertilidade Feminina/fisiopatologia , Infertilidade Feminina/metabolismo , Anovulação/fisiopatologia , Anovulação/metabolismo , Doenças Metabólicas/complicações , Doenças Metabólicas/fisiopatologia , Obesidade/fisiopatologia , Obesidade/metabolismoRESUMO
OBJECTIVE: The purpose of this study was to evaluate whether female sexual dysfunction (FSD) is associated with metabolic syndrome (MS) and to identify factors that contribute to FSD in postmenopausal women. SUBJECTS AND METHODS: This was a cross-sectional study in 111 sexually active women aged 45-65 years. We applied the Female Sexual Function Index (FSFI) to evaluate the participant's sexual function and a structured questionnaire to collect demographic, socioeconomic, clinical, anthropometric, and laboratory data. RESULTS: The prevalences of MS and FSD were 68.5% and 70.3%, respectively. After logistic regression analysis, we identified the following variables associated with FSD: married status (prevalence ratio [PR] 1.69, 95% confidence interval [95% CI] 1.16-2.47, p < 0.01), 6-10 years elapsed since menopause (PR 1.60, 95% CI 1.22-2.09, p < 0.01), occurrence of climacteric symptoms (PR 1.01, 95% CI 1.00-1.02, p = 0.03), and history of sexual abuse (PR 1.40, 95% CI 1.12-1.73, p < 0.01). CONCLUSION: We found a high prevalence of MS and FSD, but no association between both. Married status, time elapsed since menopause, climacteric symptoms, and history of sexual abuse emerged as factors associated with FSD on multivariate analysis.
Assuntos
Síndrome Metabólica/complicações , Pós-Menopausa/fisiologia , Disfunções Sexuais Fisiológicas/complicações , Idoso , Climatério/fisiologia , Estudos Transversais , Feminino , Humanos , Estado Civil/estatística & dados numéricos , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Pós-Menopausa/psicologia , Prevalência , Delitos Sexuais/psicologia , Delitos Sexuais/estatística & dados numéricos , Disfunções Sexuais Fisiológicas/diagnóstico , Disfunções Sexuais Fisiológicas/epidemiologia , Inquéritos e Questionários , Fatores de TempoRESUMO
ABSTRACT Objective The purpose of this study was to evaluate whether female sexual dysfunction (FSD) is associated with metabolic syndrome (MS) and to identify factors that contribute to FSD in postmenopausal women. Subjects and methods This was a cross-sectional study in 111 sexually active women aged 45-65 years. We applied the Female Sexual Function Index (FSFI) to evaluate the participant’s sexual function and a structured questionnaire to collect demographic, socioeconomic, clinical, anthropometric, and laboratory data. Results The prevalences of MS and FSD were 68.5% and 70.3%, respectively. After logistic regression analysis, we identified the following variables associated with FSD: married status (prevalence ratio [PR] 1.69, 95% confidence interval [95% CI] 1.16-2.47, p < 0.01), 6-10 years elapsed since menopause (PR 1.60, 95% CI 1.22-2.09, p < 0.01), occurrence of climacteric symptoms (PR 1.01, 95% CI 1.00-1.02, p = 0.03), and history of sexual abuse (PR 1.40, 95% CI 1.12-1.73, p < 0.01). Conclusion We found a high prevalence of MS and FSD, but no association between both. Married status, time elapsed since menopause, climacteric symptoms, and history of sexual abuse emerged as factors associated with FSD on multivariate analysis.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Disfunções Sexuais Fisiológicas/complicações , Pós-Menopausa/fisiologia , Síndrome Metabólica/complicações , Disfunções Sexuais Fisiológicas/diagnóstico , Disfunções Sexuais Fisiológicas/epidemiologia , Delitos Sexuais/psicologia , Delitos Sexuais/estatística & dados numéricos , Fatores de Tempo , Climatério/fisiologia , Prevalência , Estudos Transversais , Inquéritos e Questionários , Estado Civil/estatística & dados numéricos , Pós-Menopausa/psicologia , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologiaRESUMO
PURPOSES: To identify the socio-demographic and anthropometric profile and correlate them with the severity of menopausal symptoms in postmenopausal women. METHODS: Cross-sectional study with 201 postmenopausal women attended in a Gynecology Outpatient Department in Rio de Janeiro city (RJ, Brazil). A questionnaire was applied for collection of demographic, socioeconomic, clinical and lifestyle variables. The BlattKupperman Menopausal Index was used to evaluate the menopausal symptoms. RESULTS: Women with moderate to severe symptoms ( ≥20) corresponded to 57.7% (116) of the sample. Obesity was not associated with the severity of menopausal symptoms (p < 0.90). Severe to moderate symptoms were inversely associated with age (PR 0.96; CI 95% 0.940.99;p < 0.01). Women within 610 years of menopause presented nearly 1.4 times higher prevalence of moderate to severe symptoms compared with those with more than 10 years of menopause. Unemployed women (PR 1.52; CI 95% 1.132.04; p < 0.01) and housewives (PR1.53; CI 95% 1.122.09; p < 0.01) presented higher prevalence of menopausal symptoms compared with working women. Tobaccoism was associated with higher prevalence of moderate to severe symptoms (p < 0.01). CONCLUSIONS: Age constituted a protection factor for moderate to severe symptoms, whereas having within 610 years of menopause, smoking and being unemployed or a housewife were factors related to higher prevalence of moderate to severe menopausal symptoms.
OBJETIVO: Identificar o perfil sociodemográfico e antropométrico e associá-los com a intensidade dos sintomas menopausais em mulheres na pós-menopausa.MÉTODOS: Estudo transversal com 201 mulheres na pós-menopausa atendidas em um ambulatório de ginecologia no Rio de Janeiro/RJ. Foi aplicado um questionário para coleta das variáveis demográficas, socioeconômicas, clínicas e hábitos de vida. O Índice Menopausal de BlattKupperman (IMBK) foi utilizado para avaliar os sintomas menopausais.RESULTADOS: Mulheres com sintomas moderados a grave (≥20) corresponderam a 57,7% (116)da amostra. A obesidade não foi associada com a intensidade de sintomas menopausais (p < 0,90). Os sintomas moderados a intensos associaram-se inversamente com a idade (RP0,96; IC95% 0,940,99; p < 0,01). Mulheres com tempo de menopausa entre 6 e 10 anos apresentaram cerca de 1,4 vezes maior prevalência de sintomas moderados a intensos quando comparadas com aquelas com mais de 10 anos de menopausa. Mulheres desempregadas (RP 1,52; IC95% 1,132,04; p < 0,01) e donas de casa (RP 1,53; IC95% 1,122,09; p < 0,01) apresentaram maior prevalência de sintomas menopausais quando comparadas com mulheres trabalhando. O tabagismo foi associado a maior prevalência de sintomas moderados a intensos(p < 0,01). CONCLUSÕES: A idade constituiu fator de proteção para sintomas moderados a intensos. Enquanto que ter entre 6 à 10 anos de tempo de menopausa, ser tabagista e ser desempregada ou dona de casa foram fatores associados a uma maior prevalência de sintomas menopausais moderados a intensos.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Idoso , Pós-Menopausa , Qualidade de Vida , Estudos Transversais/métodos , Fatores de Risco , Brasil , Fatores de TempoRESUMO
BACKGROUND: Climateric is a phase of women's life marked by the transition from the reproductive to the non-reproductive period. In addition to overall weight gain, the menopause is also associated with the increase of abdominal fat. We used The Healthy Eating Index as a summary measure to evaluate the major components and the quality of women's diet after the onset of the menopause. This study aims at examining the association between the quality of the diet and cardiometabolic risk factors in postmenopausal women. METHODS: Cross-sectional study including 215 postmenopausal women attending a public outpatient clinic. The 24-hour dietary recall method was used to assess the food intake and to establish the Healthy Eating Index. Diets were then classified as appropriate diet (>80 points), diet "requiring improvement" (80-51 points), and poor diet (<51 points). Cardiometabolic risk factors included abdominal obesity, dyslipidemia, diabetes mellitus, and hypertension. The Fisher's exact test was utilized for the Statistical analysis. RESULTS: The analysis of the food intake showed that the average daily intake of lipids (36.7%) and sodium (2829.9 mg) were above the recommended. Only 8.8% of the women performed moderate or intense physical exercises on a regular basis. The diet was considered poor in 16.3%, "requiring improvement" in 82.8%, and appropriate for only 0.9% of the women. The study detected increased waist circumference in 92.1% of the participants. The mean concentration of triglycerides was of 183.3 mg/dl, and 130.7 mg/dl for cholesterol (Low Density Lipoprotein). CONCLUSION: Women consume a low quality diet, possibly due to the low intake of vegetables and fruits and excessive consumption of sodium. These inappropriate eating habits are associated with and, have a negative impact on the cardiometabolic risk factors such as abdominal obesity.
Assuntos
Dieta , Cardiopatias , Doenças Metabólicas , Pós-Menopausa , Saúde da Mulher , Índice de Massa Corporal , Brasil/epidemiologia , Estudos Transversais , Diabetes Mellitus , Gorduras na Dieta/administração & dosagem , Ingestão de Energia , Exercício Físico , Feminino , Frutas , Humanos , Hiperlipidemias , Hipertensão , Pessoa de Meia-Idade , Obesidade/epidemiologia , Obesidade Abdominal/epidemiologia , Sobrepeso/epidemiologia , Fatores de Risco , Sódio na Dieta/administração & dosagem , Verduras , Circunferência da CinturaRESUMO
O diabetes mellitus do tipo 2, um problema de saúde pública, tem seu diagnóstico e tratamento negligenciados na prática clínica. Embora a abordagem terapêutica tenha avançado nas últimas décadas por meio da melhor compreensão de sua fisiopatologia e do desenvolvimento de fármacos que atuam nas diversas etapas dessa doença, o aumento de novos casos suscita a necessidade do conhecimento de outros alvos terapêuticos e de intervenções clínicas para a prevenção e o tratamento dessa doença. Evidências acumuladas em estudos transversais e longitudinais sugerem uma potencial participação da vitamina D na fisiopatologia do diabetes. Entretanto, os resultados são baseados em estudos clínicos com pequenas amostras, além de não considerar populações específicas, como, por exemplo, mulheres na pós-menopausa, nem tampouco qual o nível de suplementação que deve ser ofertado para uma resposta clínica satisfatória. Com o aumento da expectativa de vida, a detecção precoce, o tratamento e a amenização de quaisquer distúrbios ou doenças que comprometam a qualidade de vida ou afetem os índices de morbimortalidade são essenciais para a melhoria da qualidade de vida. Fazemos uma atualização dessas duas epidemias no contexto de vida da mulher pós-menopausa e das possíveis participações da vitamina D na fisiopatologia do diabetes mellitus do tipo 2.
Type 2 diabetes has been an of public health concern and therefore has its diagnosis and treatment delayed in clinical practice. Although, its treatment has improved in the last decades by better pathophysiology understanding and development of medicines that actin different phases and levels, the increase of new cases of diabetes claim for knowledge about newest terapheutics targets in order to prevent and treat this disease. Accumulatedevidences from crossover and longitudinal studies suggested a potencial participation ofVitamin D in diabetes pathophysiology. However, the results are based on clinical studies with a few sample and do not consider specifical populations like post menopausal womenas did not determine dose of vitamin D that need to be offered. Early diagnosis, treatment and relieve of disorders and diseases that compromise the quality of life are extremely usefull in face to longest aging. We bring up an atualization about how vitamin D could take part on diabetes pathophysiology and some studies results.
Assuntos
Humanos , Feminino , /epidemiologia , Envelhecimento/fisiologia , Pós-Menopausa/fisiologia , Vitamina D/fisiologia , Deficiência de Vitamina D/fisiopatologia , /fisiopatologia , Vitamina D/toxicidadeRESUMO
BACKGROUND: Back pain is a major public health problem due to its high frequency, to the resulting activity constraint, and the need for surgery in many cases. Back pain is more frequent in women than men, mainly in postmenopausal women. High prevalence of hypovitaminosis D has been detected in postmenopausal women, and it is associated with decreased bone mass, sarcopenia, vertebral fractures, and inflammation, which can be related to back pain. METHODS: The relation between back pain and hypovitaminosis D was evaluated in this study, as well the difference regarding the number of bedridden days, number of days away from work, and daily activities limitation between women with and without hypovitaminosis D. This study reviewed baseline data from an interventional phase III multicenter trial in low bone mass postmenopausal women. The study included demographic data, 25OHD determinations, Newitt/Cummings questionnaire on back pain, and vertebral fracture identified thought X-ray evaluation. RESULTS: The trial included 9354 participants, but only 9305 underwent all the evaluations. The age median was 67 (60 - 85 years old) and age at menopause was 49 (18 - 72 years). Hypovitaminosis D was found in 22.5% of the subjects, 15.3% of them had vertebral fractures, 67.5% with back pain, and 14.8% reduced their daily activities in the previous six months. Subjects with hypovitaminosis D, compared to those without hypovitaminosis D, reported more back pain (69.5 v 66.9%, p: 0.022), more cases of severe back pain (8.5% v 6.8%, p: 0,004), higher limitation in their daily activities (17.2 v 14.0%, p: 0.001), and more fractures (17.4 v 14.6%, p: 0,002); also, they had more trouble to perform daily activities addressed in the Newwit/Cummings questionnaire. CONCLUSION: Hypovitaminosis D was related to back pain, to its severity, and to difficulty in perform daily activities. TRIAL REGISTRATION: ClinicalTrial.gov: NCT00088010.
Assuntos
Dor nas Costas/sangue , Dor nas Costas/diagnóstico , Densidade Óssea/fisiologia , Pós-Menopausa/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/diagnóstico , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Dor nas Costas/epidemiologia , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Deficiência de Vitamina D/epidemiologiaRESUMO
OBJECTIVE: To analyze if female Wistar rats at 56 weeks of age are a suitable model to study osteoporosis. MATERIALS AND METHODS: Female rats with 6 and 36 weeks of age (n = 8 per group) were kept over a 20-week period and fed a diet for mature rodents complete in terms of Ca, phosphorous, and vitamin D. Excised femurs were measured for bone mass using dual-energy x-ray absorptiometry, morphometry, and biomechanical properties. The following serum markers of bone metabolism were analyzed: parathyroid hormone (PTH), osteocalcin (OC), osteoprotegerin (OPG), receptor activator of nuclear factor Κappa B ligand (RANKL), C-terminal peptides of type I collagen (CTX-I), total calcium, and alkaline phosphatase (ALP) activity. RESULTS: Rats at 56 weeks of age showed important bone metabolism differences when compared with the younger group, such as, highest diaphysis energy to failure, lowest levels of OC, CTX-I, and ALP, and elevated PTH, even with adequate dietary Ca. CONCLUSION: Rats at 26-week-old rats may be too young to study age-related bone loss, whereas the 56-week-old rats may be good models to represent the early stages of age-related changes in bone metabolism.
Assuntos
Modelos Animais de Doenças , Osteoporose/metabolismo , Absorciometria de Fóton , Fatores Etários , Envelhecimento/fisiologia , Fosfatase Alcalina/sangue , Animais , Biomarcadores/sangue , Densidade Óssea , Cálcio/sangue , Feminino , Fêmur/metabolismo , Fêmur/fisiopatologia , Osteoporose/fisiopatologia , Ratos , Receptor Ativador de Fator Nuclear kappa-B/sangue , Reprodutibilidade dos Testes , Fatores de TempoRESUMO
OBJECTIVE: To analyze if female Wistar rats at 56 weeks of age are a suitable model to study osteoporosis. MATERIALS AND METHODS: Female rats with 6 and 36 weeks of age (n = 8 per group) were kept over a 20-week period and fed a diet for mature rodents complete in terms of Ca, phosphorous, and vitamin D. Excised femurs were measured for bone mass using dual-energy x-ray absorptiometry, morphometry, and biomechanical properties. The following serum mar-kers of bone metabolism were analyzed: parathyroid hormone (PTH), osteocalcin (OC), osteoprotegerin (OPG), receptor activator of nuclear factor Κappa B ligand (RANKL), C-terminal peptides of type I collagen (CTX-I), total calcium, and alkaline phosphatase (ALP) activity. RESULTS: Rats at 56 weeks of age showed important bone metabolism differences when compared with the younger group, such as, highest diaphysis energy to failure, lowest levels of OC, CTX-I, and ALP, and elevated PTH, even with adequate dietary Ca. CONCLUSION: Rats at 26-week-old rats may be too young to study age-related bone loss, whereas the 56-week-old rats may be good models to represent the early stages of age-related changes in bone metabolism.
OBJETIVO: Avaliar se ratas Wistar com 56 semanas de idade são um modelo satisfatório para estudar osteoporose. MATERIAIS E MÉTODOS: Ratas com 6 e 36 semanas de idade (n = 8 por grupo) foram criadas por um período de 20 semanas e alimentadas com dieta completa em Ca, fósforo e vitamina D para ratas adultas. Os fêmures foram analisados quanto à massa óssea pela técnica de absortiometria por dupla fonte de raios-X, morfometria e propriedades biomecânicas; os marcadores séricos do metabolismo ósseo analisados foram paratormônio (PTH), osteocalcina (OC), osteoprotegerina (OPG), fator receptor ativador nuclear Κappa B ligante (RANKL), peptídeos C-terminal de colágeno tipo I (CTX-I), cálcio total e atividade da fosfatase alcalina (FA). RESULTADOS: As ratas com 56 semanas de vida apresentaram uma importante diferença no metabolismo ósseo quando comparadas ao grupo das ratas jovens, como, por exemplo, maior energia para quebrar a diáfise do fêmur, menores níveis de OC, CTX-I e ALP e maiores níveis de PTH mesmo com dieta adequada em cálcio. CONCLUSÃO: As ratas com 26 semanas de vida podem ser consideradas muito jovens para estudar a perda óssea relacionada à idade, porém, as ratas com 56 semanas de vida podem representar um bom modelo dos estágios iniciais das alterações associadas à idade no metabolismo ósseo.
Assuntos
Animais , Feminino , Ratos , Modelos Animais de Doenças , Osteoporose/metabolismo , Absorciometria de Fóton , Fatores Etários , Envelhecimento/fisiologia , Fosfatase Alcalina/sangue , Densidade Óssea , Biomarcadores/sangue , Cálcio/sangue , Fêmur/metabolismo , Fêmur/fisiopatologia , Osteoporose/fisiopatologia , Reprodutibilidade dos Testes , Receptor Ativador de Fator Nuclear kappa-B/sangue , Fatores de TempoRESUMO
OBJECTIVE: To compare frequency and risk of falls based on a functional mobility test in diabetic and non-diabetic individuals. METHODS: Cross-sectional study involving patients with and without type 2 diabetes mellitus (DM2) selected by convenience sampling. Men and women between the ages of 50 and 65 were included and divided as group 1 (G1) - with DM2 diagnosis for < 10 years fasting blood glucose at interview/test time, as well as prior > 200 mg/dL; and group 2 (G2) - no diabetes, same age group, and fasting blood glucose < 100 mg/dL. Both groups responded to a structured questionnaire about their health, fall risk, and underwent a physical exam and a mobility assessment test (Timed Up and Go - TUG). The results were analyzed by the software SPSS, with TUG being categorized in ranges of risk for fall. We considered that the risk was positive for all those who fit into medium- and high-risk range. RESULTS: Fifty patients with DM2 and 68 patients without DM2 were assessed. There were no statistical differences in the number of falls between the groups, however non-diabetic subjects obtained a higher performance in TUG test (p = 0.003) as the risk categories were observed. Reduced visual acuity and difficulty in getting up were more frequently reported in G1 (p < 0.05). CONCLUSION: There appears to be an association between hyperglycemic status and poorer mobility, with an increased fall risk even in younger patients and in those with shorter disease duration.
Assuntos
Acidentes por Quedas/estatística & dados numéricos , Diabetes Mellitus Tipo 2/fisiopatologia , Limitação da Mobilidade , Equilíbrio Postural/fisiologia , Idoso , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
OBJETIVO: Comparar a frequência e o risco de quedas baseado em teste de mobilidade funcional entre diabéticos e não diabéticos. MÉTODOS: Estudo transversal envolvendo pacientes com e sem diabetes mellitus tipo 2 (DM2) selecionados por amostra de conveniência. Foram incluídos homens e mulheres entre 50 e 65 anos, sendo divididos em: grupo 1 (G1) - com diagnóstico de DM2 < 10 anos, glicemia de jejum > 200 mg/dL no momento da inclusão e prévia; e grupo 2 (G2) - sem diabetes, de mesma faixa etária, e glicemia de jejum < 100 mg/dL. Ambos responderam a questionário estruturado sobre sua saúde, risco de quedas e se submeteram a exame físico e ao Timed Up & Go (TUG), teste de avaliação de mobilidade. Os resultados foram analisados pelo programa Statistical Package for the Social Sciences (SPSS), sendo que o TUG foi categorizado em faixas de risco para quedas. Consideramos risco positivo para todos os que se enquadraram em médio e alto risco. RESULTADOS: Foram avaliados 50 pacientes com DM2 e 68 sem a doença. Não houve diferença estatística entre o número de quedas para os grupos, entretanto os não diabéticos obtiveram melhor desempenho no teste TUG (p = 0,003) quando observadas as categorias de risco descritas. A redução da acuidade visual e a dificuldade para levantar foram mais referidas no G1 (p < 0,05). CONCLUSÃO: Parece haver uma associação entre estado hiperglicêmico e piora da mobilidade, com risco aumentado de quedas, mesmo em pacientes mais jovens e com menor tempo de doença.
OBJECTIVE: To compare frequency and risk of falls based on a functional mobility test in diabetic and non-diabetic individuals. METHODS: Cross-sectional study involving patients with and without type 2 diabetes mellitus (DM2) selected by convenience sampling. Men and women between the ages of 50 and 65 were included and divided as group 1 (G1) - with DM2 diagnosis for < 10 years fasting blood glucose at interview/test time, as well as prior > 200 mg/dL; and group 2 (G2) - no diabetes, same age group, and fasting blood glucose < 100 mg/dL. Both groups responded to a structured questionnaire about their health, fall risk, and underwent a physical exam and a mobility assessment test (Timed Up and Go - TUG). The results were analyzed by the software SPSS, with TUG being categorized in ranges of risk for fall. We considered that the risk was positive for all those who fit into medium- and high-risk range. RESULTS: Fifty patients with DM2 and 68 patients without DM2 were assessed. There were no statistical differences in the number of falls between the groups, however non-diabetic subjects obtained a higher performance in TUG test (p = 0.003) as the risk categories were observed. Reduced visual acuity and difficulty in getting up were more frequently reported in G1 (p < 0.05). CONCLUSION: There appears to be an association between hyperglycemic status and poorer mobility, with an increased fall risk even in younger patients and in those with shorter disease duration.
Assuntos
Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Acidentes por Quedas/estatística & dados numéricos , /fisiopatologia , Limitação da Mobilidade , Equilíbrio Postural/fisiologia , Estudos Transversais , /complicações , Inquéritos e Questionários , Fatores de Risco , Fatores SocioeconômicosRESUMO
OBJETIVO: Verificar a prevalência de risco de fratura estimada pela ultrassonometria óssea de calcâneo (UOC) em uma população de idosas e sua associação com fatores de risco. MÉTODOS: Estudo transversal com amostra selecionada aleatoriamente e submetida a questionário estruturado sobre fatores de risco para fratura e UOC. RESULTADOS: Foram estudadas 168 mulheres brancas, menopausadas, com média de idade de 69,56 ± 6,27 anos; 81 por cento da população de estudo tinha exame alterado, sendo 41 por cento consideradas de maior risco. As mulheres com exames alterados tinham menor peso, altura e IMC, e tinham menores valores de SOS, BUA, BQI e T-score. Após ajuste, o IMC manteve significância para UOC alterada (OR = 3,37, IC 1,19-9,56, p = 0,02) e a história prévia de fraturas para UOC da faixa de maior risco (OR = 4,44, IC 1,16-16,96, p = 0,03). CONCLUSÃO: Observamos alta prevalência de risco para fraturas determinado pela UOC, superior ao de outros estudos brasileiros, e sua associação com IMC e história prévia de fraturas.
OBJECTIVE: To verify the prevalence of women with risk of fractures estimated by ultrasonometry of the calcaneus (UOC) in a population of elderly women and its association with clinical risk factors. METHODS: Cross-sectional study of which sample was randomly selected and submitted to a structured questionnaire about risk factors for fractures. All women underwent UOC. RESULTS: We studied 168 Caucasian postmenopausal women, with a mean age of 69.56 ± 6.27 years; 81 percent of these women had abnormal test results and 41 percent of the abnormal results were considered higher risk. Women with abnormal test results had lower weight, height and BMI, and had lower values of SOS, BUA, BQI and T-score. After adjustment, BMI remained significant for abnormal UOC (OR = 3.37, 95 percent CI: 1.19 9.56, p = 0.02), and history of previous fractures for UOC of the higher risk range (OR = 4.44, 95 percent CI: 1.16-16.96, p = 0.03). CONCLUSION: We observed a high prevalence of risk of fractures determined by the UOC. Our prevalence was higher than those in other Brazilian studies. There was an association between UOC and BMI and previous history of fractures.
Assuntos
Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Calcâneo , Fraturas Ósseas , Osteoporose Pós-Menopausa , Índice de Massa Corporal , Densidade Óssea , Estudos Transversais , Fraturas Ósseas/etiologia , Osteoporose Pós-Menopausa/complicações , Fatores de RiscoRESUMO
OBJETIVO: Descrever as disfunções do trato urinário inferior e as características demográficas e clínicas de mulheres com queixas urinárias, estimando a prevalência de diabetes melito e de alterações urodinâmicas nestas mulheres. MÉTODOS: Estudo observacional, transversal, retrospectivo, com análise de 578 prontuários. As prevalências de diabetes melito e de cada diagnóstico urodinâmico nas pacientes com disfunções do trato urinário inferior foram estimadas, com seus respectivos intervalos de confiança de 95 por cento. Foram calculadas as razões de prevalência das alterações urodinâmicas segundo o diagnóstico de diabetes. RESULTADOS: Setenta e sete pacientes (13,3 por cento) eram diabéticas e a maioria (96,1 por cento) tinha diabetes tipo 2. O diagnóstico urodinâmico mais frequente nas pacientes diabéticas foi o de incontinência urinária de esforço (39 por cento), seguido de hiperatividade do detrusor (23,4 por cento). A prevalência de urodinâmica alterada foi associada à de diabetes melito (RP=1,31; IC95 por cento=1,17-1,48). As alterações de contratilidade do detrusor (hiper ou hipoatividade) estiveram presentes em 42,8 por cento das pacientes diabéticas e em 31,5 por cento das não diabéticas. CONCLUSÕES: As mulheres diabéticas apresentaram maior prevalência de alterações urodinâmicas do que as não diabéticas. Não houve associação entre o diabetes e as alterações de contratilidade do detrusor (p=0,80).
PURPOSE: to describe lower urinary tract dysfunctions and clinical demographic characteristics of patients with urinary symptoms. This study assessed the prevalence of diabetes mellitus and urodynamic changes in these women. METHODS: We conducted a cross-sectional, retrospective study on 578 women. The prevalence of diabetes mellitus and urodynamic diagnoses was assessed in patients with lower urinary tract dysfunctions, with their respective 95 percent confidence intervals. The prevalence ratios of urodynamic alterations were calculated according to the diabetes mellitus diagnoses. RESULTS: Seventy-seven patients (13.3 percent) had diabetes and type 2 diabetes was predominant (96.1 percent). Stress urinary incontinence was the most frequent urodynamic diagnosis (39 percent) in diabetic patients, followed by detrusor overactivity (23.4 percent). The prevalence of urodynamic alterations was associated with diabetes (PR=1.31; 95 percentCI=1.17-1.48). Changes in detrusor contractility (over- or underactivity) were diagnosed in 42.8 percent diabetic patients and in 31.5 percent non-diabetic patients. CONCLUSIONS: Diabetic women had a greater prevalence of urodynamic alterations than the non-diabetic ones. There was no association between diabetes mellitus and detrusor contractility alterations (p=0.80).
Assuntos
Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Complicações do Diabetes/epidemiologia , Transtornos Urinários/epidemiologia , Estudos Transversais , Prevalência , Estudos RetrospectivosRESUMO
Introdução e Objetivos: A ultrassonometria óssea de calcâneo (UOC) é capaz de estimar o risco para fraturas por fragilidade de forma semelhante a densitometria óssea. Embora existam muitos dispositivos no mercado, o Sonost 2000 tem sido amplamente utilizado em campanhas de saúde em nosso país, ainda que não existam dados na literatura que comprovem ou comparem sua acuracia com os modelos mais amplamente pesquisados. Este estudo tem por objetivo verificar o poder deste aparelho para discriminar fraturas vertebrais por fragilidade óssea em uma população de mulheres brasileiras na pós-menopausa. Metodologia: Foi feito estudo transversal com 149 mulheres brancas menopausadas selecionadas aleatoriamente. Todas responderam um questionário estruturado sobre história médica, fizeram radiografia de coluna (RX) e UOC entre maio e dezembro de 2007. Resultados: A prevalência de fraturas nos raios X foi de 49,7% (n=74). De acordo com o T-score da UOC, 79,9% tinham exame alterado. Mulheres com fratura radiográfica eram mais idosas, com maior tempo desde menopausa e apresentaram menores valores em todos os parâmetros ultrassonométricos. O exame apresentou sensibilidade de 87,8% e especificidade de 28% para UOC alterado, e de 80% e 45% para a maior faixa de risco da UOC, respectivamente. A AUC foi mais significativa para velocidade do som (SOS) e atenuação do som (BUA). Conclusões: Nosso estudo mostra boa sensibilidade do Sonost 2000 para rastreamento de populações femininas acima de 60 anos e propõe a utilização da UOC no rastreamento de populações de risco.
RESUMO
OBJECTIVE: To verify the prevalence of women with risk of fractures estimated by ultrasonometry of the calcaneus (UOC) in a population of elderly women and its association with clinical risk factors. METHODS: Cross-sectional study of which sample was randomly selected and submitted to a structured questionnaire about risk factors for fractures. All women underwent UOC. RESULTS: We studied 168 Caucasian postmenopausal women, with a mean age of 69.56 ± 6.27 years; 81% of these women had abnormal test results and 41% of the abnormal results were considered higher risk. Women with abnormal test results had lower weight, height and BMI, and had lower values of SOS, BUA, BQI and T-score. After adjustment, BMI remained significant for abnormal UOC (OR = 3.37, 95% CI: 1.19 9.56, p = 0.02), and history of previous fractures for UOC of the higher risk range (OR = 4.44, 95% CI: 1.16-16.96, p = 0.03). CONCLUSION: We observed a high prevalence of risk of fractures determined by the UOC. Our prevalence was higher than those in other Brazilian studies. There was an association between UOC and BMI and previous history of fractures.
Assuntos
Calcâneo/diagnóstico por imagem , Fraturas Ósseas/diagnóstico por imagem , Osteoporose Pós-Menopausa/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Densidade Óssea , Estudos Transversais , Feminino , Fraturas Ósseas/etiologia , Humanos , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/complicações , Fatores de Risco , UltrassonografiaRESUMO
PURPOSE: to describe lower urinary tract dysfunctions and clinical demographic characteristics of patients with urinary symptoms. This study assessed the prevalence of diabetes mellitus and urodynamic changes in these women. METHODS: We conducted a cross-sectional, retrospective study on 578 women. The prevalence of diabetes mellitus and urodynamic diagnoses was assessed in patients with lower urinary tract dysfunctions, with their respective 95% confidence intervals. The prevalence ratios of urodynamic alterations were calculated according to the diabetes mellitus diagnoses. RESULTS: Seventy-seven patients (13.3%) had diabetes and type 2 diabetes was predominant (96.1%). Stress urinary incontinence was the most frequent urodynamic diagnosis (39%) in diabetic patients, followed by detrusor overactivity (23.4%). The prevalence of urodynamic alterations was associated with diabetes (PR=1.31; 95%CI=1.17-1.48). Changes in detrusor contractility (over- or underactivity) were diagnosed in 42.8% diabetic patients and in 31.5% non-diabetic patients. CONCLUSIONS: Diabetic women had a greater prevalence of urodynamic alterations than the non-diabetic ones. There was no association between diabetes mellitus and detrusor contractility alterations (p=0.80).
Assuntos
Complicações do Diabetes/epidemiologia , Transtornos Urinários/epidemiologia , Adulto , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Prevalência , Estudos RetrospectivosRESUMO
Fractures are the main problems related to bone fragility in postmenopausal women and account for the increase in the risk of new fractures, mortality, and costs. This study's objective was to verify the occurrence of vertebral fragility fracture and correlate it with demographic, behavioral, and clinical factors in a Brazilian population. The cross-sectional study was based on a random sample of elderly women living in Chapecó, Santa Catarina State, Brazil. The sample consisted of 186 white women over 60 years of age. Of these, 48.9% had asymptomatic vertebral fractures, with higher prevalence in T11-12 and L4-5. Adjusted analysis showed a gradient between age and vertebral fracture, while fracture prevalence was 2.3 times higher in women over 80 years. Fracture prevalence was 1.44 times higher in sedentary as compared to non-sedentary women. Due to the high prevalence of asymptomatic vertebral fractures, the authors suggest the use of spinal x-rays in elderly women for fracture screening and prevention.