Efficacy of vaginally applied estrogen, testosterone, or polyacrylic acid on sexual function in postmenopausal women: a randomized controlled trial.

INTRODUCTION: Female libido is multifactorial and complex. Declining estrogen levels in postmenopausal women affects vaginal function. AIM: The aim of this study was to evaluate female sexual function after using topical estrogen, testosterone, or polyacrylic acid as vaginal lubricants with K-Y jelly as a placebo lubricant. METHODS: This was a randomized controlled clinical trial on 80 postmenopausal women between 40 and 70 years of age with follow-up at the Menopause Clinic of the CAISM Unicamp. The women were randomized to treatment with topical vaginal estrogen, testosterone, polyacrylic acid, or oil lubricant alone, three times a week for a period of 12 weeks from November 2011 to January 2013. MAIN OUTCOME MEASURE: We used the Female Sexual Function Index (FSFI) to assess changes in sexual response at baseline, and after 6 and 12 weeks. RESULTS: After 12 weeks of treatment, polyacrylic acid and topical testosterone produced improvements in the FSFI domains of sexual desire, lubrication, satisfaction, reduced pain during intercourse, and total score compared with lubricant alone. Treatment with topical estrogen in comparison with lubricant alone showed an improvement in the FSFI field of desire. The intragroup analysis over the time of the treatment showed improvements in the fields of desire, lubrication, and reduced pain for polyacrylic acid, testosterone, and estrogen. Furthermore, women who used testosterone showed improvements over time in the fields of arousal, orgasm, and satisfaction. CONCLUSIONS: Treatment of postmenopausal women with symptoms of vaginal atrophy with polyacrylic acid, testosterone, and estrogen for 12 weeks produced improvements in self-reported female sexual function when compared with a placebo lubricant.

The prevalence of the components of low sexual function and associated factors in middle-aged women.

INTRODUCTION: Female sexual function depends on biological, psychological, and sociocultural contexts. AIM: The objective of the present study was to evaluate the prevalence of low levels of functioning in each of the sexual function domains (desire, arousal, and orgasm) and the factors associated with these phenomena, as well as to assess the frequency of sexual activity in this same sample population. METHODS: A cross-sectional, population-based study was conducted using an anonymous self-response questionnaire completed by 378 Brazilian-born women of 40-65 years of age with 11 years or more of formal education. The evaluation instrument was based on the Short Personal Experiences Questionnaire. RESULTS: The prevalence of low sexual desire was 60.6%; low arousal, 37%; and low orgasmic function, 31.1%. Multiple regression analysis showed that having a sexual partner (prevalence ratio [PR] = 0.69, confidence interval [CI] = 0.53-0.90) and nervousness (PR = 1.33, CI = 1.01-1.75) were factors associated with low sexual desire. Aging (PR = 1.04, CI = 1.02-1.06), having a sexual partner (PR = 0.57, CI = 0.41-0.81), feeling well/excellent (PR = 0.59, CI = 0.41-0.85), and having hot flashes (PR = 1.47, CI = 1.01 = 2.15) were factors found to be associated with low sexual arousal. Having a sexual partner (PR = 0.55, CI = 0.42-0.71), feeling well/excellent (PR = 0.68, CI = 0.49-0.94), and having hot flashes (PR = 2.08, CI = 1.43 = 3.04) were factors found to be associated with low sexual orgasmic function. Having a sexual partner (PR = 0.47, CI = 0.38-0.58), feeling well/excellent (PR = 0.78, CI = 0.69-0.89), and having hot flashes (PR = 1.15, CI = 1.05-1.26) were factors found to be associated with a frequency of sexual activity of once a week or less. CONCLUSIONS: In this sample of middle-aged women, low sexual desire was the most prevalent sexual problem. These results highlight the importance of identifying and treating factors associated with each individual component of low female sexual function.

Can the use of probiotics in association with isoflavone improve the symptoms of genitourinary syndrome of menopause? Results from a randomized controlled trial.

OBJECTIVE: To evaluate the effect of isoflavone administration, either in conjunction with probiotic use or not, on the symptoms of genitourinary syndrome of menopause, and compare the effects with those of hormone therapy. METHODS: A randomized clinical trial was conducted on 60 postmenopausal women aged 40 to 60 years, randomly assigned to receive oral isoflavone (150 mg dry extract of glycine max) alone or isoflavone plus probiotic (Lactobacillus acidophilus, Lactobacillus casei, Lactococcus lactis, Bifidobacterium bifidum, and Bifidobacterium lactis) or hormone therapy (1 mg estradiol and 0.5 mg norethisterone acetate). The urogenital symptom subscale of the Menopause Rating Scale and International Consultation on Incontinence Questionnaire-Short Form were used to assess genitourinary symptoms. Vaginal maturation value, pH, vaginal health score, and vaginal flora were used to evaluate vaginal atrophy. Equol, equol intermediate, O-dimethylangolensin, and aglycones were measured using gas chromatography coupled to mass spectrometry. RESULTS: After 16 weeks of treatment, the urogenital symptoms, mainly vaginal dryness and sexual problem complaints, improved significantly in the hormone therapy group. There was a significant increase in the daidzein, glycitein, equol intermediate, and O-dimethylangolensin contents after 16 weeks in the isoflavone plus probiotic group. The maturation value, vaginal pH, and vaginal flora improved in the hormone therapy group. The vaginal health score increased in the isoflavone and hormone therapy groups. CONCLUSIONS: Probiotics improved the metabolism of isoflavones after 16 weeks of treatment. However, the increase in the contents of isoflavones and their metabolites failed to yield an estrogenic effect on the urogenital tract and relieve the vulvovaginal symptoms.

[Factors associated with condom use and knowledge about STD/AIDS among teenagers in public and private schools in São Paulo, Brazil]. / Fatores associados ao uso de preservativo masculino e ao conhecimento sobre DST/AIDS em adolescentes de escolas públicas e privadas do Município de São Paulo, Brasil.

This study aimed to compare knowledge about STD/AIDS and identify the factors associated with adequate knowledge and consistent use of male condoms in teenagers from public and private schools in the city of São Paulo, Brazil. We selected 1,594 adolescents ranging 12 to 19 years of age in 13 public schools and 5 private schools to complete a questionnaire on knowledge of STD/AIDS and use of male condoms. Prevalence ratios were computed with a 95% confidence interval. The score on STD knowledge used a cutoff point corresponding to 50% of correct answers. Statistical tests were chi-square and Poisson multiple regression. Consistent use of male condoms was 60% in private and 57.1% in public schools (p > 0.05) and was associated with male gender and lower socioeconomic status. Female gender, higher schooling, enrollment in private school, Caucasian race, and being single were associated with higher knowledge of STDs. Teenagers from public and private schools have adequate knowledge of STD prevention, however this does not include the adoption of effective prevention. Educational programs and STD/AIDS awareness-raising should be expanded in order to minimize vulnerability.

Efficacy of vaginally applied estrogen, testosterone, or polyacrylic acid on vaginal atrophy: a randomized controlled trial.

OBJECTIVE: Vaginal atrophy is a common chronic condition among postmenopausal women that can affect their quality of life. Recent studies have evaluated new treatment alternatives for vaginal atrophy; however, few therapeutic options have been thoroughly evaluated. This study aimed to compare the effectiveness and adverse effects of estrogen, testosterone, polyacrylic acid, and placebo lubricant for the treatment of postmenopausal women with vaginal atrophy. METHODS: We conducted a randomized clinical trial with 80 postmenopausal women aged between 40 and 70 years who were being followed up at the Menopause Clinic of CAISM UNICAMP between November 2011 and January 2013. Women were randomly assigned to topical vaginal treatment with estrogen, testosterone, polyacrylic acid, and placebo lubricant, three times a week for 12 weeks. We used the vaginal maturation index, pH, vaginal health score, vaginal flora, laboratory tests, and ultrasound to evaluate changes of vaginal atrophy at baseline and after 6 and 12 weeks of treatment. RESULTS: After a 12-week treatment with topical estrogen and testosterone compared with the lubricant, an increased percentage of participants had vaginal pH less than 5, increased vaginal score, and an increase in the number of lactobacilli. Treatment with topical estrogen improved the vaginal maturation index and showed increased levels of estradiol in three women. No changes were observed in the endometrial evaluation of all treatment groups. CONCLUSIONS: After a 12-week treatment with testosterone and estrogen compared with placebo lubrication, there was a significant improvement in vaginal trophism in postmenopausal women with vaginal atrophy.

Ovarian volume, age, and menopausal status.

OBJECTIVE: The purposes of this study were to verify whether ovarian volume differs according to chronological age and menopausal status in healthy women and to evaluate the sensitivity and specificity of ovarian volume alone and ovarian volume associated with age in predicting menopausal status. DESIGN: The participants in this study were premenopausal (n = 121) and postmenopausal (n = 71) women between 40 and 55 years of age who were interviewed about social, demographic, and medical conditions. These women underwent transvaginal ultrasound to determine ovarian volume. Analysis of variance (ANOVA) was applied to evaluate the correlation between ovarian volume, age, and menopausal status. Receiver operating characteristic (ROC) curves were elaborated to evaluate the sensitivity and specificity of ovarian volume and age related to menopausal status. RESULTS: The difference in ovarian volume was significant and uniform as age increased in both groups (P = 0.03). Premenopausal women presented larger ovaries than did postmenopausal women. Menopausal status and age were correlated with ovarian volume. Menopausal status seemed more important than age in determining ovarian volume decrease (R = 0.36) because age contributed little when added to a model already containing menopausal status. ROC curves indicated that ovarian volume and age were effective in determining menopausal status. The best cutoff points in terms of sensitivity and specificity were ovarian volume less than 4 cm and age 48 years or older. The areas under the ROC curves of ovarian volume and ovarian volume plus age were similar. CONCLUSION: Ovarian volume differs according to age in premenopausal and postmenopausal women. Menopausal status is more important than age in determining ovarian volume. The data suggest that ovarian volume and age are quite accurate in predicting menopausal status.

[Characterization of hormone replacement therapy users in Campinas, São Paulo]. / Caracterização das usuárias de terapia de reposição hormonal do Município de Campinas, São Paulo.

This study employed a descriptive, cross-sectional, population-based design to characterize climacteric women from Campinas, São Paulo State, based on use of hormone replacement therapy (HRT). An area cluster sample was selected with 456 women 45 to 60 years of age, residing in Campinas, based on data from the Brazilian Institute of Statistics and Geography (IBGE). Women were selected by area cluster, and the reference unit was the census tract as defined by the IBGE. Data were collected through home interviews using a structured and pre-tested questionnaire provided by the International Health Foundation/International Menopause Society and by the North American Menopause Society and adapted by the authors. In order to characterize women according to current, past, or no use of HRT, a polytonic logistic regression model was used, with a backward selection process of variables. The authors conclude that the main characteristics of HRT users in the city of Campinas were perimenopausal status and higher literacy and socioeconomic class.

[Climacteric syndrome: a population-based study in Campinas, SP, Brazil]. / Síndrome do climatério: inquérito populacional domiciliar em Campinas, SP.

OBJECTIVES: To study the prevalence of climacteric, urogenital and sexual symptoms in a population of Brazilian women. METHODS: A cross-sectional descriptive population-based study was conducted. The selection of 456 women aged 45-60 years, living in Campinas, SP, in 1997, was done through area cluster sampling, according to data from the Brazilian Institute of Geography and Statistics. Data were collected via home interviews, using structured pretested questionnaires. Data were analyzed using the chi-squared test and the nonparametric Kruskal-Wallis test; a probability of <0.05 was considered statistically significant. The degree of climacteric symptoms was analyzed through circulatory and psychological indices. Analysis of the main components was used to determine symptom interrelationships. RESULTS: The most prevalent symptoms were nervousness (82%), hot flushes (70%), headache (68%), irritability (67%) and sweating (59%). Hot flushes, sweating and insomnia were significantly more prevalent in the peri and postmenopausal phases. The frequency (severity) of vasomotor and psychological symptoms did not vary according to the menopause phase. The prevalence of urinary incontinence was 27.4%. Complaints of dyspareunia and vaginal dryness were infrequent. Decreased libido was the most frequent sexual complaint. It was observed that some climacteric complaints were interrelated. The first cluster included hot flushes and sweating (vasomotor cluster). The second cluster included nervousness, depression and irritability (psychological cluster). The third cluster included dizziness and palpitation (atypical cluster). CONCLUSION: Climacteric symptoms in this population were highly prevalent and similar to those described in developed Western countries.

The effect of soy dietary supplement and low dose of hormone therapy on main cardiovascular health biomarkers: a randomized controlled trial.

PURPOSE: To assess the effects of a soy dietary supplement on the main biomarkers of cardiovascular health in postmenopausal women compared with the effects of low-dose hormone therapy (HT) and placebo. METHODS: Double-blind, randomized and controlled intention-to-treat trial. Sixty healthy postmenopausal women, aged 40-60 years, 4.1 years mean time since menopause were recruited and randomly assigned to 3 groups: a soy dietary supplement group (isoflavone 90mg), a low-dose HT group (estradiol 1 mg plus noretisterone 0.5 mg) and a placebo group. Lipid profile, glucose level, body mass index, blood pressure and abdominal/hip ratio were evaluated in all the participants at baseline and after 16 weeks. Statistical analyses were performed using the χ2 test, Fisher's exact test, Kruskal-Wallis non-parametric test, analysis of variance (ANOVA), paired Student's t-test and Wilcoxon test. RESULTS: After a 16-week intervention period, total cholesterol decreased 11.3% and LDL-cholesterol decreased 18.6% in the HT group, but both did not change in the soy dietary supplement and placebo groups. Values for triglycerides, HDL-cholesterol, glucose level, body mass index, blood pressure and abdominal/hip ratio did not change over time in any of the three groups. CONCLUSION: The use of dietary soy supplement did not show any significant favorable effect on cardiovascular health biomarkers compared with HT. CLINICAL TRIAL REGISTRY: The trial is registered at the Brazilian Clinical Trials Registry (Registro Brasileiro de Ensaios Clínicos - ReBEC), number RBR-76mm75.

Association between different types of physical activities and quality of life in women aged 60 years or over.

OBJECTIVE: To evaluate the association between different types of physical activity and quality of life in a sample of women aged 60 or over. SUBJECTS AND METHODS: A cross-sectional study was carried out, interviewing 271 women. Of these, 141 were recruited in a menopause outpatient clinic and 130 were recruited in a social leisure center, in Brazil. The instruments used were the International Physical Activity Questionnaire (IPAQ) version 8 and the World Health Organization Quality of Life Questionnaire specific for this age group (WHOQOL-OLD). Each IPAQ section was evaluated by multiple linear regression analysis, considering independent and confounding variables. The significance level was set at 5% and the software used was SAS version 9.1.3. RESULTS: The mean age of the patients was 67.4 ± 5.3 years. The mean time devoted to physical activity was 2802.7 ± 1154.9 minutes per week. The total WHOQOL-OLD score was 66.9 ± 11.7. The past, present and future actvities (estimated ß = 0.021) and, social participation (estimated ß = 0.03) domains had association with IPAQ transportation section. The leisure-time domain of the IPAQ had an inverse and significant relationship with the quality of life score related to present, past and future activities (estimated ß = -0.0269). CONCLUSION: Quality of life was negatively influenced by leisure, but time spent in this physical activity was the shortest in comparison to other types of physical activities. In this sample, only physical activity for transportation was positively associated with a better quality of life.

Survival of women with cancer in palliative care: use of the palliative prognostic score in a population of Brazilian women.

The objective of this study was to estimate the survival time of patients referred to the palliative care unit of the National Cancer Institute of Brazil (INCA), using the Palliative Prognostic (PaP) score, and thereby evaluate this tool in a location and population different from that in which the instrument was originally developed. In this prospective study, the instrument, after translation and adaptation to Brazilian Portuguese, was applied to 250 women consecutively referred to the palliative care unit of INCA, who had been followed up as outpatients between June 2005 and August 2006. The PaP score subdivided a heterogeneous population into three homogeneous risk groups with respect to survival time, and the differences between groups were statistically significant. The median overall survival time, calculated using the Kaplan-Meier method, for the three groups was 142 days (95% confidence interval [CI]: 118-172) for Group A, 39 days (95% CI: 28-52) for Group B, and nine days (95% CI: 1-24) for Group C. The percentage survival at 30 days for the three groups was 91.4%, 57.1%, and 0%, respectively. The longer survival time found in the first group in this study would appear to reflect the referral of patients in better clinical condition for outpatient follow-up in this institute. These data suggest that the PaP score is a consistent and easily applied instrument that allows more accurate prognostication in advanced cancer patients with no possibility of cure, irrespective of the geographical location.

[Physical activity and quality of life in women aged 60 or older: associated factors]. / Atividade física e qualidade de vida em mulheres com 60 anos ou mais: fatores associados.

PURPOSE: to evaluate the level of physical activity, quality of life and associated factors in women aged 60 or older. METHODS: a cross-sectional study was conducted on 271 women who go to a Leisure Center and women attended at a menopause ambulatory in Campinas (SP). The women were invited to take part in the research, carried out through interviews. The instruments used were the version 8 of the International Physical Activity Questionnaire (IPAQ) modified for the elderly population in order to evaluate their physical activity, and the World Health Organization Questionnaire of Quality of Life specific for this group (WHOQOL-OLD) to evaluate their quality of life. IPAQ results were assessed using tertiles. The association between the WHOQOL-OLD and the IPAQ results and subject characteristics was assessed by the Student's t test, Mann-Whitney test and multiple analyses. RESULTS: the average age of women was 67.4 ± 5.3 years. Among these women, 33% were classified as being less active. Analysis of each physical activity domain showed that 60.8% of the time was spent in sitting activities (1,701.6 ± 986.1 minutes/week). Multiple analyses indicated that attending a leisure center in Campinas (SP) and being 70 years old or older increased the chances of engaging in moderate-intensity or vigorous-intensity physical activity by 11.4 and 2.8 times, respectively. The average quality of life score was 66.9 ± 11.7. The highest value was observed in the domain related to sensory abilities (72.0 ± 18.8) and the lowest value was related to autonomy (60.3 ± 16.2). Linear regression showed that a good self-perception of health increased the quality of life score by 7.3 points, the use of a bigger amount of medication decreased it by 4.4 points and the performance of moderate or vigorous physical exercise increased the score by 4.8 points. CONCLUSION: women spend prolonged periods of time in sitting activities. The importance of engaging in moderate/vigorous-intensity physical activity is evident for obtaining a good quality of life.

[An adaptation of the Index of Scientific Quality for use in Brazilian Portuguese to evaluate the scientific quality in the press]. / Adaptação para o português de questionário de avaliação da informação científica em saúde na imprensa (Index of Scientific Quality).

PURPOSE: The adaptation into Portuguese and evaluation of the Index of Scientific Quality (ISQ) questionnaire applicability's in texts presented by Brazilian magazines on woman's health. METHODS: A transversal cohort study. Texts published from August 2005 to July 2007, in the main weekly magazines Veja, Epoca and Istoé, were collected. The questionnaire used is composed of eight items, with five alternatives each, measuring the applicability, opinion degree, validity and implications of the finding, precision, coherence and relevance of the data, besides a global item summarizing all the other items. ISQ was translated, retro-translated and submitted to a pilot test till the final version, which was used by two medical doctors and two journalists. After the texts analysis', the internal consistency of the questionnaire items was checked through Cronbach's alpha coefficient, and the inter and intra-observer agreement, for each item, by Kappa's index. RESULTS: The sample was composed by 80 articles. The internal consistency of items has varied from 0.81 to 0.96. The inter-evaluators' agreement ranged from -0.03 to 0.48, and the intra-observer varied from 0.27 to 0.34 (CI 95%). CONCLUSION: The questionnaire items have adequately measured the scientific quality of the texts, but the low agreement inter and intra-observers points to the need for further studies to assess the Brazilian version of ISQ.

The effect of soy dietary supplement and low dose of hormone therapy on main cardiovascular health biomarkers: a randomized controlled trial / O efeito de um suplemento alimentar à base de soja e terapia hormonal em baixa dose sobre os principais marcadores de risco cardiovascular: ensaio clínico randomizado controlado

PURPOSE: To assess the effects of a soy dietary supplement on the main biomarkers of cardiovascular health in postmenopausal women compared with the effects of low-dose hormone therapy (HT) and placebo. METHODS: Double-blind, randomized and controlled intention-to-treat trial. Sixty healthy postmenopausal women, aged 40-60 years, 4.1 years mean time since menopause were recruited and randomly assigned to 3 groups: a soy dietary supplement group (isoflavone 90mg), a low-dose HT group (estradiol 1 mg plus noretisterone 0.5 mg) and a placebo group. Lipid profile, glucose level, body mass index, blood pressure and abdominal/hip ratio were evaluated in all the participants at baseline and after 16 weeks. Statistical analyses were performed using the χ2 test, Fisher's exact test, Kruskal-Wallis non-parametric test, analysis of variance (ANOVA), paired Student's t-test and Wilcoxon test. RESULTS: After a 16-week intervention period, total cholesterol decreased 11.3% and LDL-cholesterol decreased 18.6% in the HT group, but both did not change in the soy dietary supplement and placebo groups. Values for triglycerides, HDL-cholesterol, glucose level, body mass index, blood pressure and abdominal/hip ratio did not change over time in any of the three groups. CONCLUSION: The use of dietary soy supplement did not show any significant favorable effect on cardiovascular health biomarkers compared with HT. Clinical Trial Registry: The trial is registered at the Brazilian Clinical Trials Registry (Registro Brasileiro de Ensaios Clínicos - ReBEC), number RBR-76mm75. .

OBJETIVO: Avaliar os efeitos do uso de um suplemento alimentar à base de soja sobre os principais marcadores de risco cardiovascular e compará-los com o uso da terapia hormonal (TH) de baixa dose e grupo placebo em mulheres na pós-menopausa. MÉTODOS: Foram selecionadas 60 participantes do ambulatório de menopausa com idade entre 40 e 60 anos, com idade média de 4,1 anos na menopausa para participar de um ensaio clínico randomizado, duplo-cego e controlado com duração de 16 semanas. As pacientes foram randomizadas em 3 grupos: um grupo que recebeu suplemento dietético à base de soja (isoflavona 90 mg), um grupo que recebeu TH em baixa dose (estradiol 1 mg e noretisterona 0,5 mg) e um grupo placebo. Os seguintes parâmetros foram avaliados no início e ao término das 16 semanas de intervenção: perfil lipídico, glicemia de jejum, índice de massa corpórea, pressão sanguínea arterial e circunferência abdominal. A análise estatística foi realizada usando-se o teste do χ2, teste exato de Fisher, teste não paramétrico de Kruskal-Wallis, análise de variância (ANOVA), teste t de Student pareado e teste de Wilcoxon. RESULTADOS: Ao final do período de intervenção de 16 semanas, houve uma diminuição do colesterol total em 11,3% e do LDL-colesterol em 18,6% no grupo da TH, porém ambos não tiveram mudanças tanto no grupo do suplemento alimentar à base de soja quanto no grupo placebo. Os valores de triglicérides, HDL-colesterol, glicemia de jejum, índice de massa corpórea, pressão sanguínea arterial e circunferência abdominal não mudaram ao longo da intervenção em nenhum dos grupos estudados. CONCLUSÃO: Do ponto de vista cardiovascular, o suplemento alimentar à base de soja não mostrou efeito ...

Association between different types of physical activities and quality of life in women aged 60 years or over / Associação entre diferentes tipos de atividades físicas e qualidade de vida em mulheres com 60 ou mais anos de idade

OBJECTIVE: To evaluate the association between different types of physical activity and quality of life in a sample of women aged 60 or over. SUBJECTS AND METHODS: A cross-sectional study was carried out, interviewing 271 women. Of these, 141 were recruited in a menopause outpatient clinic and 130 were recruited in a social leisure center, in Brazil. The instruments used were the International Physical Activity Questionnaire (IPAQ) version 8 and the World Health Organization Quality of Life Questionnaire specific for this age group (WHOQOL-OLD). Each IPAQ section was evaluated by multiple linear regression analysis, considering independent and confounding variables. The significance level was set at 5 percent and the software used was SAS version 9.1.3. RESULTS: The mean age of the patients was 67.4 ± 5.3 years. The mean time devoted to physical activity was 2802.7 ± 1154.9 minutes per week. The total WHOQOL-OLD score was 66.9 ± 11.7. The past, present and future actvities (estimated β = 0.021) and, social participation (estimated β = 0.03) domains had association with IPAQ transportation section. The leisure-time domain of the IPAQ had an inverse and significant relationship with the quality of life score related to present, past and future activities (estimated β = -0.0269). CONCLUSION: Quality of life was negatively influenced by leisure, but time spent in this physical activity was the shortest in comparison to other types of physical activities. In this sample, only physical activity for transportation was positively associated with a better quality of life.

OBJETIVO: Avaliar a associação entre diferentes tipos de atividade física e a qualidade de vida em mulheres brasileiras com 60 anos ou mais. SUJEITOS E MÉTODOS: Estudo de corte transversal, realizado através de entrevista com 271 mulheres. Destas, 141 foram recrutadas em um ambulatório de menopausa e 130 em um centro de convivência no Brasil. Os instrumentos utilizados foram o International Physical Activity Questionnaire (IPAQ) versão 8 e o "Questionário de Qualidade de Vida da Organização Mundial da Saúde" específico para este grupo (WHOQOL-OLD). Cada seção do IPAQ foi avaliada por meio de regressão linear múltipla considerando variáveis independentes e que podem gerar confusão. O nível de significância foi de 5 por cento e o software utilizado foi o SAS versão 9.1.3. RESULTADOS: A média etária foi de 67,4 ± 5,3 anos. O tempo médio de atividade física foi de 2802,7 ± 1154,9 minutos na semana. O escore total do WHOQOL-OLD foi de 66,9 ± 11,7. Os domínios das atividades presentes, passadas e futuras (β estimado = 0,021) e, participação social (β estimado = 0,03) apresentaram associação significativa e direta com a seção de transporte do IPAQ. Os domínios das atividades presentes, passadas e futuras apresentaram relação significativa e inversa com a seção lazer do IPAQ (β estimado = -0,0269). CONCLUSÃO: A qualidade de vida foi influenciada negativamente pelo lazer, mas o tempo gasto com esta atividade física foi o menor comparado com o das outras atividades físicas. Nesta amostra somente a atividade física no transporte associou-se positivamente à melhor qualidade de vida.

Atividade física e qualidade de vida em mulheres com 60 anos ou mais: fatores associados / Physical activity and quality of life in women aged 60 or older: associated factors

OBJETIVO: avaliar o nível de atividade física, a qualidade de vida e os fatores associados em mulheres com 60 anos ou mais. MÉTODOS: estudo de corte transversal que incluiu 271 mulheres frequentadoras de um centro de lazer e de mulheres atendidas no Ambulatório de Menopausa em Campinas (SP). As mulheres foram convidadas a participar da pesquisa, que foi realizada com o uso de entrevistas. Os instrumentos utilizados foram o International Physical Activity Questionnaire (IPAQ), versão 8, modificado para a população idosa para avaliar o nível de atividade física, e o Questionário de Qualidade de Vida da Organização Mundial da Saúde, específico para este grupo (WHOQOL-OLD), para avaliar o escore de qualidade de vida. Os resultados do IPAQ foram avaliados por meio de tercis, e a associação entre resultados do WHOQOL-OLD e IPAQ e características das mulheres pelos testes t de Student/Mann-Whitney e de análises múltiplas. RESULTADOS: a média etária das mulheres foi de 67,4±5,3 anos. Destas, 33 por cento foram classificadas como pouco ativas. A análise de cada domínio da atividade física mostrou que 60,8 por cento do tempo foi gasto em atividade sentada (1.701,6±986,1 minutos/semana). Ser frequentadora de um centro de lazer, ter maior idade, sem companheiro, maior escolaridade e boa autopercepção do estado de saúde, sem antecedentes de doenças e maior renda foram características que se associaram significativamente à prática de exercícios físicos de intensidade moderada/vigorosa. A análise múltipla evidenciou que frequentar um centro de lazer em Campinas (SP) e ter 70 anos ou mais aumentaram a chance de praticar exercícios físicos de intensidade moderada ou vigorosa, respectivamente, em 11,4 vezes e 2,8 vezes. O escore médio de qualidade de vida foi de 66,9±11,7. O maior valor foi observado no domínio referente às habilidades sensoriais (72,0±18,8), e o menor no que se refere à autonomia (60,3±16,2). A regressão linear mostrou que a boa autopercepção da saúde aumentou o escore de qualidade de vida em 7,3 pontos; o uso de maior número de medicamentos diminuiu em 4,4 pontos; e a prática de exercícios físicos moderados ou vigorosos aumentou em 4,8 pontos o referido escore. CONCLUSÕES: as mulheres despendem muito tempo na posição sentada. Evidenciou-se a importância da prática de exercícios físicos de intensidade moderada/vigorosa contribuindo para a obtenção de uma boa qualidade de vida.

PURPOSE: to evaluate the level of physical activity, quality of life and associated factors in women aged 60 or older. METHODS: a cross-sectional study was conducted on 271 women who go to a Leisure Center and women attended at a menopause ambulatory in Campinas (SP). The women were invited to take part in the research, carried out through interviews. The instruments used were the version 8 of the International Physical Activity Questionnaire (IPAQ) modified for the elderly population in order to evaluate their physical activity, and the World Health Organization Questionnaire of Quality of Life specific for this group (WHOQOL-OLD) to evaluate their quality of life. IPAQ results were assessed using tertiles. The association between the WHOQOL-OLD and the IPAQ results and subject characteristics was assessed by the Student's t test, Mann-Whitney test and multiple analyses. RESULTS: the average age of women was 67.4±5.3 years. Among these women, 33 percent were classified as being less active. Analysis of each physical activity domain showed that 60.8 percent of the time was spent in sitting activities (1,701.6±986.1 minutes/week). Multiple analyses indicated that attending a leisure center in Campinas (SP) and being 70 years old or older increased the chances of engaging in moderate-intensity or vigorous-intensity physical activity by 11.4 and 2.8 times, respectively. The average quality of life score was 66.9±11.7. The highest value was observed in the domain related to sensory abilities (72.0±18.8) and the lowest value was related to autonomy (60.3±16.2). Linear regression showed that a good self-perception of health increased the quality of life score by 7.3 points, the use of a bigger amount of medication decreased it by 4.4 points and the performance of moderate or vigorous physical exercise increased the score by 4.8 points. CONCLUSION: women spend prolonged periods of time in sitting activities. The importance of engaging in moderate/vigorous-intensity physical activity is evident for obtaining a good quality of life.

Fatores associados ao uso de preservativo masculino e ao conhecimento sobre DST/AIDS em adolescentes de escolas públicas e privadas do Município de São Paulo, Brasil / Factors associated with condom use and knowledge about STD/AIDS among teenagers in public and private schools in São Paulo, Brazil

Comparar o conhecimento sobre DST/AIDS e avaliar fatores associados ao conhecimento adequado e ao uso consistente do preservativo masculino, em adolescentes de escolas públicas e privadas do Município de São Paulo. Participaram 1.594 adolescentes entre 12 e 19 anos, de 13 escolas públicas e 5 privadas, que responderam um questionário sobre DST/AIDS e uso de preservativo. Calcularam-se as razões de prevalência com intervalo de confianca de 95 por cento. O escore de conhecimento sobre DST teve o ponto de corte equivalendo a 50 por cento de acerto. Os testes estatísticos foram qui-quadrado e Wilcoxon-Gehan. Realizou-se regressão múltipla de Poisson. O uso consistente de preservativo foi 60 por cento nas escolas privadas e 57,1 por cento nas públicas (p > 0,05) e esteve associado ao sexo masculino e menor nível sócio-econômico. O sexo feminino, maior escolaridade, escola privada, cor branca e estado marital solteiro associaram-se ao maior conhecimento sobre DST. Os adolescentes de escola pública e privada apresentam conhecimento adequado sobre prevencão de DST, entretanto esse conhecimento não determina adocão de atitudes efetivas de prevencão. Programas de conscientizacão sobre DST/AIDS devem ser ampliados visando minimizar as vulnerabilidades.

Variação da densidade mamográfica em usuárias e näo-usuárias de terapia de reposiçäo hormonal / Mammographic density variation in users and nonusers of hormonal replacement therapy

Objetivo: comparar, caso a caso, as mudanças de densidades mamográficas segundo a digitalizaçao de imagens, em três avaliaçoes consecutivas, em usuárias ou nao de terapia de reposiçao hormonal (TRH). Métodos: avaliamos 59 mulheres na pós-menopausa, sendo 43 usuárias de terapia de reposiçao hormonal (estro-progestino cíclico ou contínuo) e 16 nao-usuárias. Os critérios de inclusao foram: amenorréia de pelo menos 12 meses e exame mamográfico normal, em duas incidências (médio-lateral e craniocaudal), no início da TRH ou do seguimento clínico para as pacientes sem TRH. Para a avaliaçao do comportamento da densidade mamária, foram usadas as usadas as seguintes variáveis: mudança inicial - diferença entre a primeira mamografia realizada em 12 + 3 meses após início da TRH e a mamografia pré-TRH e mudança final - diferença em 12 + 3 meses após início da TRH e a mamografia pré-TRH e mudança final - diferença entre a segunda mamografia realizada em 24 + 3 meses após início da TRH e a mamografia pré-TRH. Os testes de Wilcoxon e de chi1 foram aplicados para avaliar as diferenças de mudanças de densidades mamográficas. Resultados: nas usuárias de TRH, mais da metade das mulheres (56,3 por cento) com aumento inicial da densidade mamográfica permaneceram com aumento após a avaliaçao final. Esse achado nao foi significativo (p=0.617). Nesse mesmo grupo, a ausência de aumento da densidade na avaliaçao inicial esteve associada ao nao aumento na avaliaçao final de forma significativa (p=0,017). Dentre as nao-usuárias de TRH, todas as mamas, que nao eram totalmente substituídas por gordura na avaliaçao inicial apresentaram diminuiçao da densidade mamográfica na avaliaçao final.

Síndrome do climatério: inquérito populacional domiciliar em Campinas, SP / Climacteric syndrome: a population-based study in Brazil

OBJETIVO: Estudar a prevalência de sintomas climatéricos, urogeniatais e sexuais em populaçäo de mulheres do Brasil. MÉTODOS: Estudo descritivo de corte transversal, de base populacional. Selecionaram-se, por meio de processo de amostragem, 456 mulheres, residentes no município de Campinas, SP, na faixa etária de 45-60 anos de idade, em 1997, segundo informações da agência local do Instituto Brasileiro de Geografia e Estatística. Os dados foram coletados por meio de entrevistas domiciliares, com questionários estruturados e pré-testados. A análise dos dados foi realizada pelo teste do qui-quadrado, teste näo paramétrico de Kruskal-Wallis, com nível de significância estatística menor que 0,05. A intensidade dos sintomas climatéricos foi analisada pelos índices circulatório e psicológico. A análise de componentes principais foi utilizada para determinar a inter-relaçäo dos sintomas climatéricos. RESULTADOS: Os sintomas climatéricos mais prevalentes foram: nervosismo (82 por cento), fogachos (70 por cento), cefaléia (68 por cento), irritabilidade (67 por cento) e sudorese (59 por cento). Os fogachos, a sudorese e a insônia foram significativamente mais prevalentes na peri e pós-menopausa. A freqüência (intensidade) dos sintomas vasomotores e psicológicos näo variou segundo o estado menopausal. A prevalência de incontinência urinária foi de 27,4 por cento. A queixa de dispareunia e secura vaginal foi pouco freqüente. Em relaçäo às queixas sexuais, a diminuiçäo do interesse sexual foi a mais freqüente. Constatou-se que algumas queixas climatéricas säo inter-relacionadas. O primeiro aglomerado incluiu as ondas de calor e a sudorese (aglomerado vasomotor). O segundo, depressäo, nervosismo e irritabilidade (aglomerado psicológico) e o terceiro, tontura e palpitaçäo (aglomerado atípico). CONCLUSÕES: A prevalência de sintomas climatéricos na populaçäo estudada foi elevada e semelhante à descrita em países ocidentais desenvolvidos.