Patterns of cervical cytological abnormalities according to the Human Development Index in the northeast region of Brazil.

BACKGROUND: Disparities in cancer incidence and mortality rates between regions arise due to differences in socioeconomic conditions and in human development factors. The major purpose of this study was to measure the role of the Human Development Index (HDI) in the pattern of cervical cytological abnormalities (CCAs). METHODS: This was an analytical sectional study involving a review of secondary cervical cytology data collected from women living in the state of Maranhão, Brazil, in 2007-2012 and collected from the Cervical Cancer Information System (Sistema de Informação do Câncer do Colo do Útero - SISCOLO). The cervical screening results were classified according to the Brazilian Classification of Cervical Reporting (Nomenclatura Brasileira para Laudos Cervicais), an adaptation of the Bethesda System. The Municipal Human Development Index (MHDI) was used, which is an adaptation of the global HDI. The association between CCAs and MHDI was evaluated using the chi-squared test and odds ratios (ORs) with 95 % confidence intervals (95 % CI). The significance level used for all tests was 5 %. RESULTS: We analysed 1,363,689 examinations of women living in the state of Maranhão. CCAs were identified in 2.0 % of smears in municipalities with high MHDI, 2.2 % in those with medium or low MHDI and 4.1 % in those with very low MHDI. In addition, potentially malignant changes and suspected cervical cancer (HSIL+) were 40.0 % more frequent (0.3 %) in municipalities with medium or low MHDI and 3.6 times more frequent (0.8 %) in municipalities with very low MHDI compared to those with high MHDI (0.2 %). CONCLUSION: The association between MHDI and the occurrence of CCAs and HSIL+ shows that more developed areas with more effective health services have a lower prevalence of these lesions. To control cervical cancer, it is necessary to reduce social inequality and improve the availability of health services.

Importance of lipid accumulation product index as a marker of CVD risk in PCOS women.

BACKGROUND: The polycystic ovary syndrome (PCOS) is considered the most common endocrine disease during the woman's reproductive life, with prevalence ranging from 5 to 10% of women of reproductive age. There is a paucity of studies regarding the use of the lipid accumulation product (LAP) as a risk marker for the development of cardiovascular disease (CVD). METHODS: A cross-sectional study was conducted on 78 women aged 18 to 42 years seen at University Hospital of Maranhão, with a diagnosis of polycystic ovary syndrome according to the Rotterdam criteria. The following variables of interest were recorded on a protocol form: sociodemographic and behavioral data, body mass index, waist circumference, fasting glucose, total cholesterol, triglycerides, low density lipoprotein cholesterol, high-density lipoprotein cholesterol, and systolic and diastolic blood pressure. RESULTS: Logistic regression showed that, except for HDL, all cardiovascular risk markers presented a higher chance of being altered when the lipid accumulation product was above the cut off value of 37.9 cm.mmol/L. CONCLUSION: The lipid accumulation product seems to be sufficient to indicate a risk of cardiovascular diseases in women with polycystic ovary syndrome.

Stress urinary incontinence in climacteric women in a northeastern Brazilian municipality: a household survey.

INTRODUCTION AND HYPOTHESIS: Low socioeconomic factors may influence the development of stress urinary incontinence (SUI). Thus far, there is little research available on SUI in developing countries. We aimed to determine whether the prevalence of SUI in a northeastern Brazilian municipality was higher or lower than in the general female population. METHODS: Cross-sectional household cluster study of 1,180 climacteric women in the São Luís municipality (Maranhão state, Brazil) was conducted using a standardized questionnaire that was previously tested in a pilot study and administered by interviewers to obtain socioeconomic and cultural information, climacteric aspects, and life habits related to SUI. RESULTS: From this population, 15.34% (n = 181) had SUI; this prevalence did not change with age. More than half (57.92%) of the patients replied that they had not consulted a physician for their SUI. The presence of SUI was not associated with any socioeconomic or gynecological variables after multivariate analysis. CONCLUSIONS: The prevalence of SUI in São Luís was similar to the rates observed in the general global female population. Socioeconomic and gynecological variables were not associated with SUI.

Comparison of the outcomes of the sling technique using a commercial and hand-made polypropylene sling.

PURPOSE: To compare the outcomes and costs of stress urinary incontinence (SUI) surgery using a hand-made sling (Marlex®) versus a commerciallyavailable suburethral polypropylene sling (Advantage®). MATERIALS AND METHODS: Thirty-nine women with SUI due to bladder neck hypermobility and/or sphincter incompetence diagnosed by clinical examination and urodynamic studies were divided into two groups: group 1 (n = 19) consisted of patients from an academic center (Department of Urology, University Hospital of Federal University of Maranhao, and group 2 (n = 20) patients from private practice. The hand-made polypropylene suburethral sling was used in group 1 and the commercial sling in group 2. The patients were evaluated 30, 60 and 90 days after surgery. RESULTS: The mean duration of surgery was 43 min. in group 1 and 51 min. in group 2. No postoperative voiding difficulties were observed in group 1 (100%), as well as, in 94.7% of patients of group 2. A bladder catheter was not required in any of the patients of the two groups at the end of the study. The level of satisfaction was 100% in group 1, whereas, one patient of group 2 considered the surgery to be unsuccessful. Urodynamic studies showed low amplitude uninhibited contraction in 11.1% of patients of group 1 and 10.5% of group 2. No complications were observed in either group. CONCLUSION: The hand-made polypropylene mesh (Marlex®) can be used for sling procedures, saving costs and yielding results similar to that obtained with commercial sling systems.

Early application of Global Subjective Evaluation Produced by the Patient and survival in patients with cancer.

INTRODUCTION: Introduction: malnutrition is a frequent event in cancer, and unless identified early, it can lead to progressive functional impairment of the organism. Objective: to associate the early application of the Global Subjective Evaluation Produced by the Patient (GSEPP) to the time of hospitalization and death in cancer patients. Methods: a cross-sectional, analytical study carried out between July and September 2014 in patient records (> 20 years) with cancer, with hospitalization for more than three days in a reference cancer hospital. Age, sex, origin, disease location, antineoplastic treatment, length of stay and application of GSEPP, type of discharge, weight loss in one and six months, body mass index (BMI) and GSEPP score were collected. Results: three hundred and sixty-six patients were evaluated: 51.6% women, 54.9% adults, 27.6% tumors of the digestive tract, 11.5% with metastasis, 21.9% of deaths and 40.4% with hospitalization time greater than or equal to ten days. The length of hospital stay was statistically lower in the early application of GSEPP (11.4 ± 1.5 vs 23.3 ± 1.3 days). The delay in the application of GSEPP was positively correlated with the increase in length of hospital stay, the GSEPP score, as well as malnutrition by BMI and weight loss in one and six months. Conclusion: early application of GSEPP was associated with improvements in the parameters of malnutrition, shorter hospitalization time, but not mortality. Measures that abbreviate its application should be taken to awaken the importance and the impact of this instrument in the health of the evaluated patient.

INTRODUCCIÓN: Introducción: la desnutrición es un acontecimiento frecuente en el cáncer. Si no se identifica precozmente puede provocar el compromiso funcional progresivo del organismo. Objetivo: asociar la aplicación precoz de la Evaluación Subjetiva Global Producida por el Paciente (ASGPPP) al tiempo de internación y muerte en pacientes con cáncer. Métodos: estudio transversal, analítico, realizado entre julio y septiembre de 2014 en historiales de pacientes (> 20 años) con cáncer, con ingreso superior a tres días en un hospital de referencia en cáncer. Se recogieron los siguientes datos: edad, sexo, procedencia, localización de la enfermedad, tratamiento antineoplásico, tiempo de internación y de aplicación de la ASGPPP, tipo de alta, pérdida de peso al mes y seis meses, índice de masa corporal (IMC) y puntaje de la ASGPPP. Resultados: trescientos sesenta y seis pacientes: el 51,6% mujeres, el 54,9% adultos, el 27,6% con tumores del tracto digestivo, el 11,5% con metástasis, con un 21,9% de óbitos y un 40,4% de casos con tiempo de internación mayor o igual a diez días. El tiempo de ingreso fue estadísticamente menor en la aplicación precoz de la ASGPPP (11,4 ± 1.5 vs. 23,3 ± 1,3 días). La demora en la aplicación de la ASGPPP se correlacionó positivamente con el aumento del tiempo de internación, la puntuación de la ASGPPP, así como, la desnutrición medida mediante por IMC y la pérdida de peso al mes y a los seis meses. Conclusión: la aplicación precoz de la ASGPPP se asoció con mejoras de los parámetros de desnutrición y menor tiempo de internación, pero no con la mortalidad. Se deben tomar medidas que abrevien su aplicación para reforzar la importancia y el impacto de este instrumento en el pronóstico del paciente evaluado.

Efeito do contraceptivo hormonal na depressão, ansiedade e qualidade de vida: estudo controlado / Effect of hormonal contraception on depression, anxiety and quality of life: a controlled study / xxx

RESUMO: Objetivo: Identificar o efeito do uso de contraceptivos hormonais orais na depressão, ansiedade e qualidade de vida. Métodos: Neste estudo, utiliza-se o método transversal e a amostra foi 113 mulheres em idade reprodutiva. Para avaliação de depressão, ansiedade e qualidade de vida foram utilizados o Inventário de BECK, IDATE Traço--Estado e o SF-36, respectivamente. Para análise estatística utilizou-se o programa STATA 14.0. O nível de significância adotado foi de 5%. Resultados: Mulheres que utilizam contraceptivos tiveram idade 24,02±5,30 anos, menarca 12,23±1,40 anos e peso 58,90±10,20 kg. O não consumo de álcool e tabaco foi de 73 (64,60%) e 111(98,23%), respectivamente. Nas usuárias de contraceptivos hormonais orais combinados e não usuárias de contraceptivos hormonais orais combinados em relação ao tipo de ansiedade e nível de depressão, não houve diferença estatisticamente significante. Prevaleceram as mulheres assintomáticas em relação a depressão (não usuárias de contraceptivos hormonais orais combinados 61/82,43%) e presença de ansiedade/traço e ansiedade/estado, em ambos os grupos. A qualidade de vida não foi prejudicada pelo uso ou não dos contraceptivos hormonais orais combinados. Conclusão: O uso do Contraceptivo não está relacionado á presença de ansiedade, depressão e alteração de qualidade de vida. (AU)

ABSTRACT: Objective: Identify the effect of oral hormonal contraceptive use on depression, anxiety, and quality of life.Methods: A cross-sectional study method was used and the sample was 113 women on reproductive age. Depression,anxiety, and QoL were assessed by the BECK Inventory, the State-Trait IDATE, and the SF-36, respectively. For the statistical analysis, the STATA 14.0 program was used. The level of significance was 5%. Results: Women who use oral contraceptives have age 24,02 ± 5,30 years, menarche 12,23±1,40 years, and weight 58.9 kg. Nonconsumption of alcohol and tobacco prevailed, respectively, with 73 (64.60%) and 111 (98.23%). Concerning the use of combined oral hormonal contraceptives and without the use of COHC in relation to the type of anxiety and level of depression, there was no statistically significant difference between them. Asymptomatic women prevailedin relation to depression (without the use of combined oral hormonal contraceptives 61/82.43%) and presence of anxiety/trait and anxiety/status in both groups. QoL was not impaired by the use of combined oral hormonal contraceptives or not. Conclusion: Contraceptive use is not related to the presence of anxiety, depression, and quality of life alteration. (AU)

[HLA alleles association and recurrent spontaneous abortion in a São Luis/Maranhão population, in Brazilian Northeastern region]. / Associação de alelos HLA e aborto espontâneo recorrente em uma população de São Luís/Maranhão, na região Nordeste do Brasil.

PURPOSE: To investigate the association of the HLA-A, -B and -DRB1 alleles with the occurrence of Recurrent Spontaneous Abortion. METHODS: A case-control study of 200 women aged 18 to 35 years, consisting of a convenience sample of 100 women who had idiopathic recurrent spontaneous abortion and 100 women without abortion and with two or more children. Peripheral blood genomic DNA was extracted from 500l of Buffy Coat stored at -20°C. HLA typing was performed by the PCR-SSOP method (Polymerase Chain Reaction - Specific Sequence of Oligonucleotides Probes, One Lambda(r), CA, USA). The regions of the amplified DNA were exon 2 and 3 for the A and B loci and only exon 3 for the DRB1 locus. The HLA FUSIONTM program (One Lambda, Canoga Park, CA, USA, version 3.0) was used for HLA-A, HLA-B and HLA-DRB1 genotyping. Absolute frequencies and percentages and calculation of mean and standard deviation were used for standard statistical analysis. The qualitative variables were compared by the χ2 test with Yates correction or by Fisher's exact test. The odds ratio with the 95%CI was used for the comparisons, with the level of significance set at p<0.05. RESULTS: The frequency of the A*34 allele was significantly higher in the case group compared to control (4.0 versus 0.5%; p<0.05). Alleles A*24 (6.0 versus 12.5%; p<0.05) and B*35 (8.0 versus 20.5%; p<0.05) were significantly less frequent in the case group. Among the class II alleles, DRB1*03 showed a slightly higher frequency in the case group (11.0 versus 5.5%, p = 0.056). CONCLUSIONS: It was shown that the HLA-A*34 allele is a risk factor for recurrent spontaneous abortion, while the HLA-A*24 and HLA-B*35 alleles are associated with protection, and no allele of the DRB1 locus was associated with RSA.

[Climacteric syndrome in a Northeastern Brazilian city: a household survey]. / Síndrome climatérica em uma cidade do Nordeste brasileiro: um inquérito domiciliar.

PURPOSE: To assess the prevalence of Climacteric Syndrome (CS) in women from a municipality of Northeastern Brazil which is less developed socioeconomically. METHODS: A prospective household survey was performed in São Luís, Maranhão, Brazil with 1,210 climacteric women aged 45 to 60 years. Interviews were applied using previously tested standard questionnaires from April to July 2008. The severity of climacteric symptoms was analyzed by circulatory and psychological indexes and the latter were associated with menopausal status. Multiple correspondence analysis was used to assess the relation among climacteric symptoms. RESULTS: Most patients were 55 to 60 years old (35.3%), mulatto (37.9%), with 9-11 years of schooling (39.8%), with a partner (56%), Catholic (73.9%) and belonged to the socioeconomic class C (51.1%). The prevalence of CS was 85.9%, and hot flashes (56.4%) and sweating (50.4%) were the most prevalent symptoms. The most frequent psychological symptoms were nervousness (45%) and emotional liability (44.8%). The severity of vasomotor and psychological symptoms was significantly higher during the peri and postmenopausal period (p<0.05). Vaginal dryness (62.7%) was the most prevalent urogenital complaint. CONCLUSION: The prevalence of CS was high among women from São Luís, Maranhão, Brazil.

[Cervical cancer screening in the State of Maranhão, Brazil]. / Rastreamento do câncer do colo do útero no Estado do Maranhão, Brasil.

The scope of the study was to analyze the screening for cervical cancer in the state of Maranhão using secondary data from the Cervical Cancer Information System (SISCOLO). A retrospective descriptive study was conducted using secondary data from 139505 cytopathology exams recorded in SISCOLO in Maranhão in 2011. The variables: age, education, adequacy of material, represented epithelia, microbiology and cellular changes detected in Pap smear tests were selected. The age group between 25 to 29 years and incomplete basic schooling were the most frequent findings. The most common microbiological agents detected were bacilli (52.8%), cocci (45.5%) and Lactobacillus sp (32.6%). Inflammation was the most common benign cellular alteration (86.3%). Low-grade intraepithelial lesions were the most prevalent atypical findings in squamous cells (0.6%), followed by high-grade squamous intraepithelial lesions (0.2%). Squamous cell carcinoma was observed in 0.003% and 0.006% for adenocarcinoma. SISCOLO proved a useful tool for studying aspects related to cancer screening of the cervix, which can orient actions to reduce the incidence and mortality from this cancer.

[Coverage of the basic immunization schedule in the first year of life in State capitals in Northeast Brazil]. / Cobertura vacinal do esquema básico para o primeiro ano de vida nas capitais do Nordeste brasileiro.

Vaccination coverage in the so-called "developing countries" is still lower than expected. Such coverage is an important indicator of population health and the quality of care provided by the health care system. The current study describes the results of a household survey to estimate coverage of the basic immunization schedule in the first year of life in State capitals in Northeast Brazil, for the 2005 birth cohort. The methodology used was that recommended by the Pan American Health Organization for surveys on vaccination coverage. According to the data, vaccination coverage fell short of the goals set by the National Immunization Program for this age group, at high risk of acquiring vaccine-preventable diseases. The lowest coverage rates were found at the two extremes of socioeconomic strata. Assessment of vaccination coverage indicates whether the infant population is immunized and helps identify weak points in vaccination activities.

Irritable bowel syndrome in women with chronic pelvic pain in a Northeast Brazilian city.

PURPOSES: To determine the prevalence of irritable bowel syndrome (IBS) in women with chronic pelvic pain (CPP) and its associated features; to determine whether IBS and CPP constitute the same syndrome. METHODS: Cross-sectional population survey with systematic sequential sampling according to census districts in which 1470 women were interviewed with respect to the sample calculation. The participants resided in their own homes, were at least 14 years of age, experienced menarche and presented CPP according to the American College of Obstetrics and Gynaecology. The dependent variable was IBS based on Rome III criteria in women with CPP, and the following independent variables were possibly associated with IBS: age, schooling, duration of pain, sedentary lifestyle, migraine, depression, insomnia, back pain, dysmenorrhea, dyspareunia, depression, history of violence, and intestinal symptoms. The sample was subdivided into groups with and without IBS. After the descriptive analysis of the variables was performed, the respective frequencies were evaluated using GraphPad Prism 5 software. To evaluate the association between the dependent variable and the independent variables, the χ² test was used with a significance level of 5%. RESULTS: The prevalence of IBS in women with CPP was 19,5%. Pain duration (p=0.03), back pain (p=0.002), history of physical or sexual abuse (p=0.002), and intestinal complaints were more prevalent in the group with IBS and CPP. There was no difference between the groups regarding other criteria. CONCLUSION: The data confirmed the literature, identified several aspects that were shared between the pathologies and supported the hypothesis that both pathologies can constitute the same syndrome.

Vocal parameters and voice-related quality of life in adult women with and without ovarian function.

OBJECTIVES: To identify the perceptual and acoustic parameters of voice in adult women with and without ovarian function and its impact on quality of life related to voice. METHODS: Cross-sectional and analytical study with 106 women divided into, two groups: G1, with ovarian function (n=43) and G2, without physiological ovarian function (n=63). The women were instructed to sustain the vowel "a" and the sounds of /s/ and /z/ in habitual pitch and loudness. They were also asked to classify their voices and answer the voice-related quality of life (V-RQOL) questionnaire. The perceptual analysis of the vocal samples was performed by three speech-language pathologists using the GRBASI (G: grade; R: roughness; B: breathness; A: asthenia; S: strain; I: instability) scale. The acoustic analysis was carried out with the software VoxMetria 2.7h (CTS Informatica). The data were analyzed using descriptive statistics. RESULTS: In the perceptual analysis, both groups showed a mild deviation for the parameters roughness, strain, and instability, but only G2 showed a mild impact for the overall degree of dysphonia. The mean of fundamental frequency was significantly lower for the G2, with a difference of 17.41Hz between the two groups. There was no impact on V-RQOL in any of the V-RQOL domains for this group. CONCLUSIONS: With the menopause, there is a change in women's voices, impacting on some voice parameters. However, there is no direct impact on their quality of life related to voice.

[Quality of life of women treated for breast cancer in a city of the northeast of Brazil]. / Qualidade de vida de mulheres tratadas de câncer de mama em uma cidade do nordeste do Brasil.

The study sought to evaluate the quality of life of women treated surgically for breast cancer at the State Oncology Hospital of Reference in São Luís in the State of Maranhão. The quality of life was assessed by the Functional Assessment of Cancer Therapy-Breast (FACT-B). The variables were expressed as mean and standard deviation, and statistical analysis consisted of the ANOVA or Kruskal Wallis test and the Student t or Mann-Whitney test. The level of significance was α < 5%. For statistical tests Stata 9.0 and BioEstat 5.0 were used. 197 women with mean age of 53.0 ± 11.7 years participated. The mean values of the FACT-B revealed a good quality of life trend, though the emotional domain was most prejudiced and the cancer sub-scale the most favorable. The type of surgery influenced the social, emotional and cancer sub-scale domain. Non-conservative surgery revealed the worst quality of life levels. A statistically significant relationship between duration of surgery and the physical, emotional and functional domains and between duration of surgery and the scores of the FACT-B was detected. Adjuvant treatment influenced all domains of FACT-B. Quality of life was relatively good, but was negatively impacted by non-conservative surgery, the shortest time between surgery and the adjuvant therapies.

[Nutritional status of adolescents in the state of Maranhão, Brazil, assessed by national and international criteria]. / Estado nutricional de adolescentes do Maranhão, Brasil, por critérios nacional e internacional.

This study sought to compare national and international criteria for assessing the nutritional status of adolescents. A cross-sectional analytical study was conducted in the period from July 2007 to January 2008 with a representative sample comprised of 1256 adolescents from the state of Maranhão. Body mass index (BMI) for age and gender was used to diagnose underweight, normal weight and overweight, using the criteria proposed by Conde and Monteiro and the World Health Organization (WHO). Chi-square, McNemar concordance and Spearman correlation tests were applied. According to the criteria of Conde and Monteiro and the WHO, there were significant differences among the boys with respect to low weight and obesity. It was observed that there was no significant divergence between the two criteria, and a significant positive correlation (0.011) between the two criteria was detected. With this analysis it can be seen that there are many divergences between the criteria used, therefore the best option and the advantage of using one or the other cannot be singled out. However, it should be stressed that the national criterion can also be used more, since there are no significant differences with the criteria advocated by the Ministry of Health of the WHO.

[Metabolic profile in women of different body mass indices with polycystic ovary syndrome]. / Perfil metabólico em mulheres de diferentes índices de massa corporal com síndrome dos ovários policísticos.

PURPOSE: To characterize and compare clinical, anthropometric and biochemical-metabolic variables in patients with polycystic ovary syndrome (PCOS), stratified according to body mass index (BMI). METHODS: A cross-sectional study conducted on 78 women aged 18 to 45 years with a clinical diagnosis of PCOS by the Rotterdam criteria. Patients were stratified according to BMI. The variables analyzed were: age, marital status, physical inactivity, menstrual irregularity, blood pressure (BP), anthropometric measurements, lipid profile, fasting glucose, and hormone measurements. To compare the variables between the different BMI values we used analysis of variance and the Kruskal-Wallis test. The level of significance was set at 5% for all tests. RESULTS: The patients had a mean age of 26.3 years, 79.5% of them were sedentary and 68% had hyperandrogenism. Waist circumference, waist/hip ratio, waist/height ratio and percentage of body fat were higher in the obese group. The markers of cardiovascular risk (CVR - fasting glucose, systolic and diastolic BP and LDL-cholesterol) were directly proportional to BMI, whereas HDL-cholesterol and SHBG were inversely related to BMI. CONCLUSION: The presence of markers of CVR factors increased proportionally to BMI, indicating that the metabolic profile of obese women with PCOS is more unfavorable than that of non-obese patients.

Anemia as the cause of clinical inability of candidates to blood donation for a hemotherapy and hematology center in the state of Maranhão, Brazil / Anemia como causa da inaptidão clínica em candidatos a doação de sangue em um Centro de Hemoterapia e Hematologia, Maranhão, Brasil

Objective: To evaluate anemia as a cause of clinical disability in blood donors in the state of Maranhão- Brazil. Methods: This study addresses a time series of prevalence of anemia among blood donor candidates. Secondary data were collected from the Information System of the Blood Center of Maranhão. Donor candidates were treated between 2001 and 2010. Statistical analysis was performed with Epi Info version 6.04d. Results: The proportion of clinical disability was 16.8% (n = 1,672) and 63.27% (n = 6,198) consisted of men. Considering the unfit group, anemia was the second most frequent cause with 16.68% (n = 16,729). In men, drug use was the most frequent cause of inability (90.94%, n = 650) and anemia was the last cause with 28.76% (n = 458). In women, anemia was the major cause of clinical inability (71.24%, p = 0.000). Conclusion: Anemia is an important cause of inability, and in women it is the first one (AU)

Objetivo: Avaliar a anemia como causa de inaptidão clínica de candidatos a doação de sangue no estado do Maranhão. Métodos: Este estudo trata de uma série temporal da prevalência de anemia entre os candidatos doadores de sangue. Foram coletados dados secundários do Sistema de Informação do Hemocentro do Maranhão. Os candidatos a doação foram atendidos entre os anos de 2001 e 2010. A análise estatística foi realizada com Epi Info versão 6.04d. Os dados foram considerados estatisticamente significativos quando p <0,05. Resultados: A proporção de inaptidão clínica foi de 16,8% (n=1,672) sendo desses 63,27% (n=6,198) eram homens. Considerando-se o grupo de inaptos, a anemia foi a segunda causa mais frequente com 16.68% (n= 16,729). Nos homens, o uso de drogas foi a causa mais frequente de inaptidão (90.94%; n= 650) e a anemia foi a última causa com 28.76% (n=458). Em mulheres a anemia representou a maior causa de inaptidão clínica (71.24%; p=0,000). Conclusão: A anemia configura-se como causa importante de inaptidão, principalmente em mulheres, sendo a primeira (AU)

Scored patient-generated Subjective Global Assessment: Length of hospital stay and mortality in cancer patients / Avaliação Subjetiva Global produzida pelo paciente: tempo de internação e mortalidade em pacientes com câncer

ABSTRACT Objective To determine the association of a scored patient-generated Subjective Global Assessment with mortality and length of hospital stay in cancer patients. Methods Cross-sectional study carried out between July and September 2014 using secondary data collection using data from 366 medical records of patients admitted to a hospital recognized as a cancer center of excellence. The present study included patients with hospital stay over than or equal three days and minimum age of 20 years. The patient-generated Subjective Global Assessment scores were calculated and compared with the patients' clinical and anthropometric characteristics and outcomes (death and long length of stay in hospital). Results Of the 366 patients evaluated, 36.0% were malnourished. The presence of malnutrition, according to the scored patient-generated Subjective Global Assessment, was statistically associated with the presence of metastasis (52.4%). On the other hand, malnutrition, according to the body mass index in adults (55.8%) and in older elderly patients (54.2%), was associated with death (55.0%). The adjusted logistic regression model showed that the following factors were associated with prolonged hospitalization: early nutritional screening, presence of severe malnutrition, radiotherapy and chemotherapy, and surgical procedures. As for mortality, the associated factors were: male reproductive system tumor, presence of metastasis, clinical treatment, prolonged hospitalization, and the presence of some degree of malnutrition. Conclusion The patient-generated Subjective Global Assessment score is an important risk marker of prolonged hospitalization and mortality rates. It is a useful tool capable of circumventing significant biases in the nutritional evaluation of cancer patients.

RESUMO Objetivo Associar a Avaliação Subjetiva Global produzida pelo paciente à mortalidade e ao tempo de internação em pacientes com câncer. Métodos Pesquisa transversal analítica com coleta secundária de dados, conduzida entre julho e setembro de 2014 em 366 prontuários de pacientes internados entre janeiro de 2010 a janeiro de 2014 de um hospital de referência em câncer. Participaram do estudo pacientes com tempo de internação maior ou igual a três dias e idade mínima de 20 anos. Foi coletado o escore da avaliação subjetiva global produzida pelo paciente e associado às características clínicas, antropométricas e do desfecho dos pacientes (óbito e elevado tempo de internação). Resultados Dos 366 avaliados, 36.0% eram desnutridos. A presença de desnutrição pela avaliação subjetiva global produzida pelo paciente se associou estatisticamente com a presença de metástase (52.4%), desnutrição (e morte (55.0%) pelo índice de massa corporal em adultos (55.8%) e em idosos (54.2%) e morte (55.0%). O modelo de regressão logística ajustada demonstrou que foram associadas ao tempo de internação prolongada: triagem nutricional precoce, presença de desnutrição grave e os tratamentos radio e quimioterápicos associados e o cirúrgico. Já em relação à mortalidade: a localização tumoral no sistema reprodutor masculino, a presença de metástase, o tratamento clínico, a internação prolongada e a presença de algum grau de desnutrição estiveram associadas. Conclusão O escore da avaliação subjetiva global produzida pelo paciente é um marcador de risco importante para internação prolongada e morte. Sendo um instrumento valioso, capaz de contornar vieses significativos na avaliação nutricional do paciente com câncer.

Epidemiological evaluation of victims of spinal cord injury.

OBJECTIVE: to evaluate patients suffering from spinal cord injury METHODS: A retrospective, cross-sectional study was conducted with 87 patients admitted to the university hospital of UFMA between January 2008 and June 2009. We assessed sex, age, compromised segment of the spine and cause of injury, subjecting these data to statistical analysis (chi-square test). RESULTS: there was a significant prevalence of males (p <0.001), with 81.6% (71) cases, and age between 21 and 30 years of age (p <0.001), with 39.1% (34) of cases. The average age was 33.96 ± 13.56 years. The proportion of falls from height was significantly greater than the number of traffic (p <0.001) and motorcycle (p <0.001) accidents. The most compromised segment of the spine (p <0.001) was the thoracic (33), with 37.9% of cases. Traffic accidents appear in greater proportion among men (p = 0.014). The cervical spine was the most affected in males (p = 0.043). The thoracolumbar fractures were caused, to a greater extent, by falls from height (p = 0.003), whereas involvement of the thoracic spine was significantly higher (p = 0.016) in traffic accidents. CONCLUSION: The group at higher risk of injury to the spinal cord is the young adult male. Although there is a difference between the sexes when correlated traffic accidents, falling from height is the main cause in both sexes.

Papilomavírus Humano (HPV) e sua associação entre lesões cervical e anal em mulheres / Human papillomavirus (HPV) and its association between cervical and anal injuries in women

Introdução: Entre as doenças virais sexualmente transmissíveis, a infecção pelo Papilomavírus Humano (HPV) configura-se como a mais comum, e sua incidência vem aumentando acentuadamente nos últimos trinta anos. A infecção anal por subtipos específicos do HPV predispõe o indivíduo à neoplasia intraepitelial anal, que pode evoluir para o câncer de forma similar ao colo uterino. Objetivo: avaliar a associação tipo-específica entre infecções anais e cervicais, assim como os aspectos citopatológicos das lesões anais pelo vírus HPV em mulheres de São Luís, Maranhão. Métodos: Estudo analítico transversal com 27 mulheres atendidas no Centro de Pesquisa Clínica da UFMA, entre agosto de 2012 e julho de 2015, mediante entrevista e realização de exames complementares. Resultados: As mulheres tinham, em média, 32 anos. Em relação ao resultado do PCR, 77,7% das pacientes apresentaram resultado positivo para HPV anal, sendo o subtipo 16 o mais frequente (47,6%). Na região cervical, 88,8% apresentaram PCR positivo, sendo o mais comum o subtipo 16 (47,8%). A coinfecção anal e cervical pelo HPV foi observada em 74% das mulheres. 93,3% dos resultados de citologia anal não apresentaram alteração, assim como 72,2% das anuscopias realizadas. Conclusões: A infecção cervical por HPV é um fator sugestivo de risco para o desenvolvimento da infecção na região anal. (AU)

Introduction: Human Papillomavirus (HPV) infection is characterized as the most common among the sexually transmitted viral diseases and its incidence has been increasing dramatically in the last thirty years. Anal infection with specific HPV subtypes predisposes the individual to anal intraepithelial neoplasia, which can develop into cancer similar to the cervix. Objective: to evaluate the type-specific association between anal and cervical infections, as well as cytological aspects of anal lesions by HPV in women of São Luís, Maranhão. Methods: Cross-sectional study with 27 women assisted in the Clinical Research Center of UFMA, between August 2012 and July 2015, by means of interviews and examinations. Results: The patients had an average of 32 years. Regarding the result of PCR, 77.7% of patients tested positive for anal HPV 16 subtype being the most frequent (47.6%). In the cervical region, 88.8% had positive PCR, the most common subtype 16 (47.8%). The anal and cervical HPV co-infection was observed in 74% of women. As for anal cytology, 93,3% of patients had normal results, as well as 72,2% of anuscopias. Conclusion: The cervical HPV is a suggestive risk factor for the development of infection in the anal area. (AU)