Prevalence and risk factors associated with diabetes mellitus among middle-aged women in southern Brazil: a population-based study.

OBJECTIVES: To investigate prevalence and clinical factors associated with diabetes among middle-aged women. METHODS: In this cross-sectional population-based study, clinical and laboratory examinations were collected from 298 women. Participants wore a digital pedometer for 7 days to assess habitual physical activity. Abdominal computed tomography scans were performed to measure total fat area and visceral fat area. RESULTS: Mean age was 57.1 years (SD, 5.4 y); 78.7% of women were postmenopausal. The prevalence of diabetes was 17.1%. Women with diabetes were older (P = 0.02); worked fewer hours per week in the past month (P = 0.04); had an earlier age at menarche (P = 0.03); were more frequently inactive (P = 0.01); had higher body mass index (P = 0.01), higher waist circumference (P < 0.01), higher visceral (P < 0.01), and higher total fat (P < 0.01) but not subcutaneous fat (P = 0.14); and had higher systolic blood pressure (BP) (P < 0.01). There was a prevalence of 19.5% of current smoking, 32.5% of alcohol use, and 16.1% of current hormone therapy use, prevalence similar among the groups of women. There was a higher prevalence of metabolic syndrome (P < 0.01) and statin use (P < 0.01) in women with diabetes. A higher prevalence ratio of diabetes was associated with physical inactivity (prevalence ratio, 2.137; 95% CI, 1.056-4.325; P < 0.03). The odds of having diabetes increased by 12% for each year of earlier menarche and by 1.4% for each millimeter of mercury increase in systolic BP. CONCLUSION: The prevalence of diabetes was 17.1%. Age, physical inactivity, early age at menarche, and systolic BP were independently associated with higher prevalence of diabetes in this unselected population of middle-aged women.

Prevalence and characteristics of polycystic ovary syndrome in Brazilian women: protocol for a nation-wide case-control study.

INTRODUCTION: Brazil is a large country, with a population of mixed ethnic background and broad variation in dietary and physical activity traits across its five main regions. Because data on Brazilian women with polycystic ovary syndrome (PCOS) are still scarce, a nation-wide collaborative study was designed to determine the prevalence of metabolic and reproductive abnormalities and the presence of anxiety and depression in Brazilian women with PCOS. In addition, the study aims at describing how these characteristics are distributed across PCOS phenotypes and at detecting associations with regional demographic and lifestyle aspects, genetic variants, and epigenetic markers. METHODS AND ANALYSIS: The Brazilian PCOS study is being conducted in the outpatient clinics of eight university hospitals within the public healthcare network (Unified Health System) across the country. Additional centres will be included following completion of the research ethics approval process. The sample includes women with PCOS according to Rotterdam criteria at inclusion in the study and a control group of healthy women matched by age, socioeconomic status and geographical region. Data will be collected in each centre and incorporated into a unified cloud database. Clinical, demographic, socioeconomic, psychological, metabolic, epigenetic and genotypic variables will be evaluated. The data resulting from this study will be useful to guide specific public strategies for primary and secondary prevention of metabolic and reproductive comorbidities in the PCOS population of Brazil. ETHICS AND DISSEMINATION: The study protocol was approved by each local Research Ethics Committee. Written informed consent will be obtained from each participant. During data collection, analysis and publication, care will be taken to ensure confidentiality of participant information. Study results will be published in peer-reviewed journals and disseminated at international conferences. This research protocol was registered with the Research Ethics Committee of HCPA, through Plataforma Brasil. TRIAL REGISTRATION NUMBER: CAAE 18082413.9.1001.5327.

Risk factors associated with coronary artery calcification in midlife women: a population-based study.

The aim of this study was to investigate the association between individual risk factors and coronary artery calcification (CAC), as a marker of subclinical cardiovascular disease, in a population-based nested cross-sectional study of midlife women. Anthropometric and metabolic data from 295 women from the South of Brazil were analyzed. Habitual physical activity was assessed by pedometer. CAC was assessed by a multi-detector computed tomography system. Average Agatston score was used to stratify participants as CAC > 0 and CAC = 0. Women with CAC > 0 (34.7%) were older (58.7 ± 5.4 vs. 56.3 ± 5.2 years, p < .001) and had higher prevalence of central adiposity (71 vs. 59%, p = .04) and hypertension (71 vs. 52%, p = .002) than women in the CAC = 0 group. Hormone therapy (HT) was more prevalent in the group with CAC = 0 (19.7 vs. 9.8%, p = .029). The prevalence ratios for CAC > 0 were 0.545 (95%CI:0.309-0.962, p = .036) for HT and 1.752 (95%CI:1.207-2.541, p = .003) for hypertension, after adjustment for age, educational level, smoking, alcohol intake, and physical activity. The present data in a population-based sample of midlife women indicate that hypertension and age were positively associated with higher risk for CAC > 0 and HT was related with CAC = 0.

Atividade física de mulheres no climatério: comparação entre auto-relato e pedômetro / Physical activity in climacteric women: comparison between self-reporting and pedometer

OBJETIVO Comparar dois métodos de avaliação de atividade física entre mulheres na pré, transição e pós-menopausa. MÉTODOS Estudo transversal aninhado à coorte de mulheres na pré, peri e pós-menopausa em uma cidade do sul do Brasil. As participantes responderam a um questionário com dados sociodemográficos e clínicos. A atividade física foi avaliada utilizando-se o Questionário Internacional de Atividade Física – versão curta e a contagem do número de passos com o uso de pedômetro. As participantes foram classificadas em estratos de atividade física de acordo com o instrumento utilizado. Para análise estatística foram realizados os testes de correlação de Spearman, índice de Kappa, coeficiente de concordância e análise das medidas contínuas de Bland-Altman. RESULTADOS A concordância (k = 0,110; p = 0,007) e a correlação (rho = 0,136; p = 0,02) entre o Questionário Internacional de Atividade Física – versão curta e o pedômetro foram fracas. No gráfico de Bland-Altman, observou-se que as diferenças se afastam do valor zero tanto quanto a atividade física é mínima ou mais intensa. Comparando-se os dois métodos, a frequência de mulheres inativas é maior quando avaliadas pelo pedômetro do que pelo Questionário Internacional de Atividade Física. O oposto ocorre entre as ativas. CONCLUSÕES A concordância entre os métodos foi fraca. Embora de fácil aplicação, o Questionário Internacional de Atividade Física superestima a atividade física em relação à avaliação por pedômetro. .

OBJECTIVE To compare two methods of assessing physical activity in pre-, peri- and postmenopausal women. METHODS Cross-sectional study nested in a cohort of pre-, peri- and postmenopausal women in a city in Southern Brazil. The participants completed a questionnaire that included sociodemographic and clinical data. Physical activity was assessed using a digital pedometer and the International Physical Activity Questionnaire, short version. The participants were classified into strata of physical activity according to the instrument used. For statistical analysis, the Spearman correlation test, Kappa index, concordance coefficient and Bland-Altman plots were used. RESULTS The concordance (k = 0110; p = 0.007) and the correlation (rho = 0.136, p = 0.02) between the International Physical Activity Questionnaire, short version, and pedometer were weak. In Bland-Altman plots, it was observed that differences deviate from zero value whether the physical activity is minimal or more intense. Comparing the two methods, the frequency of inactive women is higher when assessed by pedometer than by the International Physical Activity Questionnaire - short version, and the opposite occurs in active women. CONCLUSIONS Agreement between the methods was weak. Although easy to use, Physical Activity Questionnaire - short version overestimates physical activity compared with assessment by pedometer. .

Causes of death and associated risk factors among climacteric women from Southern Brazil: a population based-study.

BACKGROUND: Aging and menopause are particular cardiovascular risk factors for women, due to estrogen deprivation at the time of menopause. Studies show that diabetes mellitus (DM), smoking, hypertension, high body mass index (BMI), and serum lipids are associated with increased risk of cardiovascular disease (CVD), the main cause of female mortality in Brazil. The aim of this study was to assess the mortality rate, causes of death and associated risk factors in a cohort of women from Brazil. METHODS: A longitudinal population-based study of menopausal status is currently underway in a city in South Brazil. In 2010, a third follow-up of this population was performed to assess cardiovascular risk and mortality rate between 1995 and 2011. For this analysis, 358 participants were studied. At baseline, participants had completed a standardized questionnaire including demographic, lifestyle, medical and reproductive characteristics. In addition to the contacts with relatives, mortality data were obtained through review of medical records in all city hospitals and the Center for Health Information (NIS/RS-SES). Multivariate-adjusted hazard risk (HR) and 95% confidence intervals (CI95%) were estimated using Cox proportional hazards regression. Survival curves were estimated using the Kaplan-Meier curve. RESULTS: There were 17 (4.7%) deaths from all causes during the study period. Seven (41.2%) deaths were caused by CVD, including four cases of stroke and three cases of myocardial infarction. Six (35.3%) deaths were due to cancer, and four (23.5%) were due to other reasons. In the age and smoking-adjusted multivariate models, diabetes (HR 6.645, 95% CI: 1.938-22.79, p=0.003), alcohol intake (HR 1.228, 95% CI: 1.014-1.487, p=0.035) and postmenopausal status (HR=6.216, 95% CI: 0.963-40.143, p=0.055) were associated with all-cause mortality. A significant association was found between abdominal obesity (WHR≥0.85) and mortality even after the adjustment for BMI (HR=9.229, 95% IC: 2.083-41.504, p=0.003). CONCLUSION: CVD was an important cause of mortality in this cohort and DM and/or central adiposity were associated with all-cause mortality. Lifestyle and dietary factors seem to be related to risk of mortality in middle-aged women.

Modificação da pressão arterial e do peso corporal em mulheres hipertensas em uso de terapia hormonal: estudo longitudinal de 10 anos / Modification of blood pressure and body weight in hypertensive women using hormone replacement therapy: a longitudinal study of 10 years

Introdução: A hipertensão arterial sistêmica é um achado frequente entre mulheres que necessitem terapia hormonal (TH). Os objetivos deste estudo foram verificar as modificações do peso corporal, da pressão arterial sistêmica e dos lipídios em mulheres hipertensas usuárias de TH ao longo do tempo. Métodos: Estudo longitudinal prospectivo. Trinta e três mulheres hipertensas com sintomas vasomotores, que consultaram no Ambulatório de Ginecologia Endócrina e Menopausa do Hospital São Vicente de Paulo ­ Passo Fundo/ RS, a partir de janeiro de 1993, participaram do estudo. Receberam TH com estrogênio, ou estrogênio + progestogênio, via oral. Foram examinadas a cada seis meses e durante 10 anos. Verificaram-se a idade, peso corporal (kg), pressão arterial sistólica (PAS) e diastólica (PAD) (mmHg), classes de anti-hipertensivos utilizados, glicemia de jejum (mg/dL), colesterol total e frações (mg/ dL) e triglicerídeos (mg/dL). Compararam-se os valores basais, aos 5 e 10 anos de seguimento, através de testes pareados. Resultados: A idade média foi 48,4 ± 4,8 anos. Houve uma tendência de aumento da PAS aos 5 anos, p=0,054, seguida de uma diminuição aos 10 anos, p=0,003. A PAD diminuiu aos 10 anos, p=0.001. Houve um acréscimo de anti-hipertensivos aos 5 anos de seguimento (p<0,001). As variáveis peso corporal, lipídios e glicemia de jejum não se modificaram ao longo do tempo. Conclusões: O uso de TH oral em pacientes hipertensas requer controle e eventual ajuste anti-hipertensivo em 5 anos. Ao longo de 10 anos de uso, a pressão arterial e o peso corporal mantiveram-se estáveis (AU)

Introduction: High blood pressure is a common finding among women who require hormone replacement therapy (HRT). The aims of this study were to assess changes in body weight, blood pressure, and lipid profile over time in hypertensive women using HRT. Methods: Prospective longitudinal study. Thirty-three hypertensive women with vasomotor symptoms, consulting at the Clinic of Endocrine Gynecology and Menopause of Hospital São Vicente de Paulo in Passo Fundo-RS, as of January 1993 were enrolled. They received estrogen or estrogen + progestogen orally and were examined every six months for 10 years. Age, body weight (kg) , systolic (SBP) and diastolic (DBP ) blood pressure (mmHg), classes of antihypertensive drugs used, fasting plasma glucose (mg/dL), total cholesterol and fractions (mg/dL) and triglycerides (mg/dL) were recorded. We compared the baseline values with those at 5- and 10-year follow-up through paired tests. Results: Mean age was 48.4 ± 4.8 years. There was a trend of increase in SBP at 5 years, p = 0.054, followed by a decrease at 10 years, p = 0.003. DBP decreased at 10 years, p = 0.001. There was an increase of antihypertensive drugs at 5 years of follow-up (p < 0.001 ). Body weight, lipid profile and fasting glucose did not change over time. Conclusions: Over 10 years of use, blood pressure and body weight remained stable. The use of oral HRT in hypertensive patients requires control and possible antihypertensive adjustment at 5 years (AU)

Association between habitual physical activity and lower cardiovascular risk in premenopausal, perimenopausal, and postmenopausal women: a population-based study.

OBJECTIVE: Menopause is associated with an increased risk of cardiovascular disease. Habitual physical activity, defined as any form of body movement with energy expenditure above resting levels, may improve health parameters. We assessed the level of habitual physical activity and its effect on anthropometric measures and cardiovascular risk factors in a cohort of premenopausal, perimenopausal, and postmenopausal women. METHODS: This cross-sectional study is nested on a longitudinal population-based study that was begun in 1995 in the city of Passo Fundo, Brazil. For the present analysis, 292 women were included. Anthropometric and metabolic profile was evaluated. Habitual physical activity was assessed by a digital pedometer for 7 days, and participants were stratified into active and inactive (≥6,000 and <6,000 steps/day, respectively). RESULTS: The mean (SD) age was 57.1 (5.4) years. The average number of steps per day for the total sample was 5,250.7 (3,372.9): 3,472.4 (1,570.2) in the inactive group (61.8%) and 9,055.9 (3,033.4) in the active group (31.9%). A negative and statistically significant correlation was found between physical activity and smoking (P = -0.019), body mass index (P = -0.006), waist circumference (P = -0.013), and waist-to-hip ratio of 0.85 or higher (P = -0.043). Inactive women presented a higher risk of overweight/obesity (odds ratio [OR], 2.1; 95% CI, 1.233-3.622; P = 0.006) and waist circumference larger than 88 cm (OR, 1.7; 95% CI, 1.054-2.942; P = 0.03), even after adjustment for age, menopause status, smoking, and hormone therapy. Inactive women also had a higher risk of diabetes mellitus (OR, 2.7; 95% CI, 1.233-6.295; P = 0.014) and metabolic syndrome (OR, 2.5, 95% CI, 1.443-4.294; P = 0.001). CONCLUSIONS: Habitual physical activity, specifically walking 6,000 or more steps daily, was associated with a decreased risk of cardiovascular disease and diabetes in middle-aged women, independently of menopause status.

Determinants of ovarian volume in pre-, menopausal transition, and post-menopausal women: a population-based study.

OBJECTIVE: To verify the association of smoking, parity, body mass index, use of oral contraceptives, and hormone therapy with ovarian volume in pre-, menopausal transition, and post-menopausal women from southern Brazil. METHODS: Cross-sectional study with 273 women aged 36-62 years, representative of the urban population of Passo Fundo, southern Brazil. Participants completed an in-home interview and had their anthropometric measurements and ultrasound exams performed at a clinical center, using a standardized method. The right and left ovaries were measured by ultrasound. Mean ovarian volume was calculated according to age, menopausal status, smoking habit, parity, body mass index (BMI), use of oral contraceptives (OC), and hormone therapy (HT). RESULTS: Ovarian volume decreased after the age of 44 years when adjusted for menopausal status and OC use (p = 0.010). The mean ovarian volume decreased with menopausal status adjusted for age (p = 0.001) and with current OC use, adjusted for age (p = 0.001). There was a positive association between ovarian volume and BMI>or=30 in every woman adjusted for menopausal status and age (p = 0.005). On the other hand, there was no association with smoking, past OC use, and HT. In a linear regression model, post-menopause, menopausal transition, age, and BMI were significantly and independently associated with ovarian volume. CONCLUSION: Ovarian volume decreases with menopausal transition and even more in post-menopause. The reduction of ovarian volume also occurred with aging and OC use. Ovarian volume, however, is positively associated with obesity. Smoking, parity, and hormone treatment do not affect ovarian volume in pre-, menopausal transition, and post-menopausal women.

Ovarian volume in pre- and perimenopausal women: a population-based study.

OBJECTIVE: To evaluate the relationship between ovarian volume and age, hormonal levels, obesity, and phase of menstrual cycle in pre- and perimenopausal women. DESIGN: A study was carried out with 98 women from the general population who were not receiving drugs known to interfere with hormonal levels. Right and left ovary volume was measured by ultrasound. Blood samples were drawn for estradiol, follicle-stimulating hormone, and luteinizing hormone determinations. RESULTS: Fourteen women were excluded because of the presence of ovarian cysts. Mean ovarian volume for pre- and perimenopausal women was 7.1 +/- 3.1 cm3. There was no statistical difference in ovarian volume related to the phases of the menstrual cycle. Ovarian volume was significantly smaller in all age groups over 40 years compared with the 35-to-39 age group (P < 0.05). No association was observed between ovarian volume and body mass index. In turn, age (P = 0.013) and follicle-stimulating hormone levels (P = 0.002) showed a significant negative correlation, and luteinizing hormone showed a significant positive correlation with ovarian volume (P = 0.005). CONCLUSIONS: Ovarian volume was smaller in pre- and perimenopausal women aged 40 years and older in relation with younger women. The current standard measurements of ovarian volume by transvaginal ultrasound should be reevaluated for pre- and perimenopausal women between 40 and 55 years of age.

Infecçäo perinatal por Chlamydia trachomatis: descriçäo de um caso clínico / Chlamydia trachomatis perinatal infection: case report

Apresenta-se um caso de infecçäo por Chlamydia trachomatis com envolvimento materno e fetal. Analisa-se incidência desta infecçäo em recém-nascidos por este agente, discutindo-se os aspectos de suas manifestaçöes, o diagnóstico clínico e laboratorial, bem como sobre as consideraçöes terapêuticas e sua evoluçäo

Laparoscopias: experiência do Serviço de Ginecologia e Obstetrícia do Hospital de Clínicas de Porto Alegre / Laparoscopy: experience of the Gynocologycal and Obstetricsl Service at the Hospital de Clinicas de Porto Alegre

Revisaram-se 380 prontuários de pacientes que foram levadas à laparoscopia entre janeiro de 1980 e setembro de 1984. Discorrem-se sobre as indicaçöes para estes procedimentos, seus achados e complicaçöes

Infecçöes por Chlamydia trachomatis / Chlamydia trachomatis infections

Apresentam-se as características da Chlamydia Trachomatis, sua patogênese, técnicas diagnósticas e seu tratamento

A detecçäo de Chlamydia trachomatis em processos inflamatórios pélvicos / Detection of Chlmaydia trachomatis in pelvic inflammatory process

Estudaram-se 27 pacientes com processo inflamatório pélvico, encontrando a incidência de 25,9% de infecçöes por Chlamydia trachomatis em nosso meio. No estudo é testado o Tianfenicol como alternativa terapêutica. Nesta observaçäo prévia, é salientada a importância da infecçäo pélvica por Chlamydia trachomatis