Prevalence of urinary incontinence and its association with multimorbidity in women aged 50 years or older: A population-based study.

AIMS: To evaluate the prevalence and associated risk factors for urinary incontinence, as well as its association with multimorbidity among Brazilian women aged 50 or over. METHODS: This was a secondary analysis of a cross-sectional population-based study including 622 women 50 years or older, conducted in the city of Campinas-SP-Brazil. The dependent variable was Urinary Incontinence (UI), defined as any complaint of urine loss. The independent variables were sociodemographic data, health-related habits, self-perception of health and functional capacity evaluation. Statistical analysis was carried out using the Chi-square test and Poisson regression. RESULTS: The mean age of the women was 64. UI was prevalent in 52.3% of these women: Mixed UI (26.6%), Urge UI (13.2%) and Stress UI (12.4%). Factors associated with a higher prevalence of UI were hypertension (OR 1.21, CI 1:01-1:47, P = 0.004), osteoarthritis (OR 1.24, CI 1:03-1:50, P = 0.022), physical activity ≥3 days/week (OR 1.21, CI 1:01-1:44, P = 0.039), BMI ≥ 25 at the time of the interview (OR 1.25, CI 1:04-1:49, P = 0.018), negative self-perception of health (OR 1.23, CI 1:06-1:44 P = 0.007) and limitations in daily living activities (PR 1:56 CI 1:16-2:10, P = 0.004). CONCLUSIONS: The prevalence of UI was high. Mixed incontinence was the most frequent type of UI. Many associated factors can be prevented or improved. Thus, health policies targeted at these combined factors could reduce their prevalence rate and possibly decrease the prevalence of UI.

Sexuality in Brazilian women aged 40 to 65 years with 11 years or more of formal education: associated factors.

OBJECTIVE: To evaluate factors associated with the sexuality of middle-aged women. DESIGN: Cross-sectional, population-based survey using an anonymous self-response questionnaire. A total of 276 Brazilian-born women, 40 to 65 years old with at least 11 years of formal education, participated in the study. The evaluation instrument was based on the Short Personal Experiences Questionnaire. Seven components were analyzed: satisfaction in sexual activities, orgasm, intensity of desire, self-classification of sexual life, frequency of arousal, sexual activity, and sexual fantasies. Sociodemographic, clinical, behavioral, and reproductive factors were evaluated. Data were analyzed using the chi and Fisher exact tests and Poisson multiple regression analysis. Prevalence ratios (PRs) and their 95% CIs were calculated. RESULTS: The median sexuality score was 9 (range, 2.45-13.77). Bivariate analysis indicated that being 50 years of age or older; in the menopausal transition or postmenopause; not having a sexual partner; reporting hot flushes, insomnia, depression, nervousness, sedentary lifestyle, arterial hypertension, or urinary incontinence; and poor self-perception of health were significantly associated with a below median sexuality score. Multiple regression analysis showed that the prevalence of below median scores was higher in older women (prevalence ratio [PR] = 1.03, 95% CI: 1.01-1.05) and in those with insomnia (PR = 1.46, 95% CI: 1.08-1.96). Having a sexual partner (PR = 0.68, 95% CI: 0.50-0.92) and feeling well (PR = 0.73, 95% CI: 0.57-0.94) was associated with a protective effect against a below median sexuality score. CONCLUSIONS: Older women and those with insomnia were more likely to have a low sexuality score, whereas those with a sexual partner and who felt well were less likely to have a low sexuality score.

The sexuality of middle-aged women with a sexual partner: a population-based study.

OBJECTIVE: To evaluate the factors associated with the sexuality of middle-aged women with sexual partners. DESIGN: A cross-sectional, population-based study was carried out using an anonymous, self-response questionnaire completed by Brazilian-born women 40 to 65 years old with 11 years or more of formal education who had a sexual partner. Of the 378 women who agreed to participate in the study, 219 answered all the questions used for calculation of the sexuality score and reported having a sexual partner. The instrument was based on the Short Personal Experiences Questionnaire. Seven components were analyzed: satisfaction in sexual activities, orgasm, intensity of desire, self-classification of sexual life, and frequency of arousal, sexual activity, and sexual fantasies. Sociodemographic, clinical, behavioral, reproductive, and partner-related factors were evaluated. Poisson multiple regression analysis was performed, and prevalence ratios (PRs) with their 95% CIs were estimated. RESULTS: The median sexuality score was 9 (range, 2.45-13.77). The prevalence of below-median scores was higher in women who lived with their sexual partner (PR = 2.07; 95% CI: 1.17-3.69), who were in the menopausal transition or were postmenopausal (PR = 1.69; 95% CI: 1.08-2.65), and who were hypertensive (PR = 1.65; 95% CI: 1.19-2.30). Sexual activities involving penetration (PR = 0.48; 95% CI: 0.31-0.73) and a score of 6 for satisfaction with partner as a lover (PR = 0.34; 95% CI: 0.20-0.60) were indicative of a protective effect against poor sexuality. CONCLUSIONS: In this cohort, the sexuality of women in midlife was negatively associated with the factors of living with a sexual partner, being in the menopausal transition or postmenopausal, and being hypertensive. Therefore, greater attention should be paid to identifying these factors, and measures should be adopted to minimize their repercussions on the sexuality of middle-aged women.

Metabolic syndrome in HIV-infected middle-aged women on antiretroviral therapy: prevalence and associated factors.

OBJECTIVES: To determine the prevalence of metabolic syndrome (MetS) and its associated factors in a group of HIV-infected middle-aged women. METHODS: Cross-sectional study including 273 HIV-infected climacteric women of 40-60 years of age under care in two HIV outpatient reference centers in Brazil. Metabolic syndrome diagnosis was based on 2006 International Diabetes Federation criteria. Sociodemographic, clinical and behavioral factors were evaluated as well as HIV infection-related parameters. RESULTS: Mean age was 47.7 years; 59.1% of women were premenopausal, 91% were on antiretroviral therapy. Current CD4 count was >500cells/mm3 in 61.7%, current viral load undetectable in 76.9% of women, and a quarter had previous diagnosis of aids. The prevalence of metabolic syndrome in the subgroup of menopausal women was 46.9%. Univariate analysis showed an association between metabolic syndrome and age ≥50 years (p=0.002), schooling <8 years (p=0.003), post-menopause (p<0.001), body mass index (BMI) >25kg/m2 (p<0.001), and FSH ≥40mIU/mL (p=0.002). In the multivariate analysis only increased BMI (PR=1.09; 95% CI: 1.05-1.13; p<0.001) and FSH levels ≥40mIU/mL (PR=1.66; 95% CI: 1.14-2.40; p=0.008) maintained statistical significance. There was no association between PI use or any other factor related to HIV-infection and MetS in any of the analyses performed. CONCLUSION: High BMI and FSH levels compatible with menopause were the only factors associated with MetS in these middle aged HIV-infected women. In the context of well-controlled, early treated HIV infection, traditional rather than HIV-related factors were associated with MetS.

[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.

[Knowledge of contraceptive methods among adolescent students]. / Conhecimento sobre métodos anticoncepcionais por estudantes adolescentes.

OBJECTIVE: To compare the knowledge of contraceptive methods as well as to identify factors associated with adequate knowledge among public and private school adolescents. METHODS: A cross-sectional study comprising 1,594 adolescents aged between 12 and 19 years old from 13 public and five private schools in the city of São Paulo city, Brazil, was carried out from June to December 2003. Schools were randomly selected and students filled out a questionnaire about sociodemographic, reproductive and contraceptive methods. The prevalence ratios were estimated with a 95% confidence interval for each question on their knowledge of contraceptive methods and by school group. Each question correctly answered received a half score, and the cut-off value was 50% of correct answers. Statistical tests utilized were Chi-square and Wilcoxon-Gehan tests and Poisson multiple regression model. RESULTS: Of all respondents, 61% were of females in both school groups. Most students had low socioeconomic condition in public schools while they had mostly high socioeconomic condition in private schools (p<0.001). Nearly 18.6% private and 28.6% public school students were sexually active (p<0.002). In regard to their knowledge, 25.7% of public and 40.8% of private school students had a score equal to or above five. Factors associated with higher knowledge were: being female, at high school of a private school, having high socioeconomic condition, having had sexual intercourse and being older. CONCLUSIONS: Knowledge of contraceptive methods was low in both public and private school students. The study results show that both underprivileged as well as high socioeconomic adolescents need to have adequate information about family planning to improve their knowledge and change their behavior.

Fat Grafting to the Breast, a Simple Procedure for a Very Complex Reconstruction.

Usually, complicated reconstructions demand complex procedures. However, we report an unpublished situation where lipofilling was the only effective procedure for breast reconstruction, once 4 previous procedures, including 2 microvascular free flaps, had failed. The reported case describes a woman without subcutaneous tissue in the left breast topography, with radiation sequelae resulting in a fibrotic, hyperchromic, unexpandable skin that was tethered to her costal bone and pleura. The 4 previous attempts of breast reconstruction resulted in unavailable nearby recipient vessels, and this situation appointed breast lipofilling as the most feasible procedure. This report shows the power of breast lipofilling, a simple procedure that can be used even for the more complex reconstructions.

Correlation between osteoporotic fracture risk in Brazilian postmenopausal women calculated using the FRAX with and without the inclusion of bone densitometry data.

UNLABELLED: The risks of fracture were calculated in 402 postmenopausal Brazilian women by FRAX with or without the inclusion of bone densitometry values. The correlation between the risk of major osteoporosis fracture or hip fracture calculated by FRAX with or without BMD was similar in this population, 0.76 and 0.64, respectively. OBJECTIVE: The objective of this study is to evaluate the degree of agreement between the 10-year fracture risk in postmenopausal Brazilian women, calculated using the WHO Fracture Risk Assessment Tool (FRAX)-Brazil, with and without the inclusion of bone mineral density (BMD) values. METHODS: A cross-sectional study was conducted with 402 postmenopausal women (≥40 years) who had undergone bone densitometry prior to initiating any pharmacological treatment for osteopenia or osteoporosis. The risks of a major osteoporosis fracture or hip fracture were calculated according to FRAX-Brazil either using clinical risk factors alone or with the inclusion of BMD value. The tests used were intraclass correlation coefficient, Mann-Whitney test, and univariate linear regression analysis. RESULTS: When the patients were classified according to the cutoff point defined as determining a high risk of a major osteoporosis fracture (≥20 %), 0.75 % were defined as high risk when BMD values were included and 1 % when they were not. With respect to the hip, 5.22 % were defined as having a high risk of fracture (≥3 %) when BMD values were included and 11.44 % when they were not. Intraclass correlation coefficient between the FRAX-Brazil assessed risk with and without the inclusion of BMD values was 0.76 (95 % CI 0.716-0.799) for a major osteoporosis fracture and 0.64 (95 %CI 0.583-0.698) for a hip fracture. CONCLUSION: The correlation found for the FRAX-Brazil score obtained with and without the inclusion of BMD values was good for the risk of a major osteoporosis fracture and moderate for the risk of a hip fracture. The fracture risk calculated was similar in this population irrespective of whether or not BMD values were included in the algorithm.

Middle-aged female sexual dysfunction and multimorbidity: a population-based study.

OBJECTIVES: The aim of the study was to evaluate the association between multimorbidity and sexual dysfunction in women aged 45 to 60 years in a cross-sectional population-based study in a specific Brazilian city. It was also to evaluate the main factors associated with sexual dysfunction in the group with multimorbidity. METHODS: Cross-sectional population-based study conducted with 736 women (household survey), representative of a population of 257,434 women, to obtain data on multimorbidity and sexual dysfunction, as part of a broader study on women's health. The instrument used to evaluate sexual dysfunction was the Short Personal Experiences Questionnaire. Associations were determined between multimorbidity and sexual dysfunction and sexual dysfunction and demographic, behavioral, and medical characteristics. RESULTS: 53% of the women reported multimorbidity and 49.6% of them reported sexual dysfunction. Multiple regression analysis showed no association between sexual dysfunction and multimorbidity. Sexual dysfunction in the whole sample (with and without multimorbidity) was associated with sexual activity in the last month (prevalence ratio [PR] = 0.27, 95% CI 0.22-0.33, P < 0.001), having physical activity greater than or equal to 2 times a week (PR = 0.70, 95% CI 0.58-0.84, P < 0.001), menopause rating symptoms greater than 8 (PR = 1.25, 95% CI 1.09-1.43, P = 0.002), perimenopausal or postmenopausal status (PR = 1.57, 95% CI 1.13-2.17, P = 0.007), alcohol use greater than or equal to 1 drink/week (PR = 0.81, 95% CI 0.67-0.97, P = 0.025), and anxiety (PR = 1.15, 95% CI 1.01-1.31, P = 0.039). In the group with multimorbidity, the main factors associated with sexual dysfunction were sexual activity in the last month (PR = 0.31, 95% CI 0.25-0.39, P < 0.001), anxiety (PR = 1.33, 95% CI 1.15-1.53, P < 0.001), and physical activity (PR = 0.70, 95% CI 0.56-0.87, P = 0.002). CONCLUSIONS: There was no evidence that multimorbidity was associated with sexual dysfunction in this sample of middle-aged women. The main factors associated with sexual dysfunction in women with multimorbidity in this sample were lack of sexual activity in the last month, physical inactivity, and anxiety. This highlights the importance of sexual activity, psychological health, and physical activity for a satisfactory sexual life in the case of women with multimorbidity.

Menopause symptoms and quality of life in women aged 45 to 65 years with and without breast cancer.

OBJECTIVE: To compare the prevalence of menopause symptoms, sexual activity, and quality of life in women with and without breast cancer. DESIGN: A cross-sectional study using one group for comparison was conducted on women aged 45 to 65 years who had not received hormone therapy or tamoxifen during the last 6 months. Participants were recruited from the Menopause and Breast Cancer Outpatient Facilities. One hundred eighty-two women were included, 97 with breast cancer and 85 without breast cancer. Sociodemographic and clinical features and prevalence of menopause symptoms were assessed. The quality of life was assessed by the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) questionnaire. To compare sociodemographic and clinical features between groups, the Student's t test or Fisher exact test was used. Multiple logistic regression and linear regression models were used to control for potential confounding variables. RESULTS: The mean age of participants with breast cancer was 53.2 +/- 6.2 years, and the mean age of those without cancer was 57.8 +/- 4.9 years (P < 0.01). Age at menopause was 47.2 +/- 5.1 years and 47.4 +/- 4.9 years for women with and without breast cancer (P = 0.76), respectively. Approximately one-fourth of women with breast cancer and 4.7% of women without cancer were premenopausal (P < 0.01). The prevalence of menopause symptoms was similar between the groups. Women with breast cancer reported less sexual activity (51.5%) than women without cancer (62.4%) (P < 0.01). Quality of life scores were good in both groups. There was a significant difference regarding physical functioning, with a median score of 90 for the cancer group and 75 for the group without cancer (P < 0.01). CONCLUSION: The prevalence of menopause symptoms was similar in women with and without breast cancer. Sexual activity was less frequent in women with breast cancer. Quality of life was good in women from both groups, although women with breast cancer had the highest level of physical functioning.

[Quality of life in users and non-users of hormone replacement therapy]. / Qualidade de vida em usuárias e não usuárias de terapia de reposição hormonal.

OBJECTIVE: To compare the quality of life in postmenopausal women who were users and non-users of hormone replacement therapy (HRT). METHODS: A cross-sectional study was conducted on postmenopausal women aged between 40 and 65 years, who had been menopausal for up to 15 years. Women considered HRT users were those who had undergone this type of treatment for at least six months. Non-users of HRT were those who had not received this type of treatment during the last six months. Two hundred and seven women were included in the study: 106 users and 101 non-users of HRT. Sociodemographic, clinical and behavioral characteristics were assessed. The Kupperman Menopausal Index was applied to rate the intensity of climacteric symptoms and the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) was applied to assess women's quality of life. For data analysis, a Student's t test, a chi-square analysis, a Fisher's exact test and a Mann-Whitney test were used. RESULTS: The mean age of HRT users was 52.6 +/- 4.9 years and the mean age of non-users of HRT was 54.3 +/- 4.7 years (p=0.01). There was a statistically significant difference regarding marital status (p=0.04). HRT users reported a lower frequency of moderate and severe climacteric symptoms (p=0.001). Of the eight quality of life domains evaluated, only vitality scored below 50 (45) in both groups. There were no differences between groups regarding the SF-36 components. CONCLUSIONS: Postmenopausal women who were users and non-users of HRT presented a good quality of life. There were no differences between users and non-users of hormone therapy.

Association between HIV infection and bone mineral density in climacteric women.

UNLABELLED: A cross-sectional study was conducted with the purpose of evaluating bone mineral density in HIV seropositive and seronegative climacteric women. HIV infection was negatively associated with bone mineral density in the lumbar spine PURPOSE: To assess bone mineral density (BMD) and its associated factors in HIV seropositive and seronegative climacteric women METHODS: A cross-sectional study with 537 women (273 HIV seropositive and 264 HIV seronegative) aged between 40 and 60 years old receiving follow-up care at two hospitals in Brazil. A questionnaire on clinical and sociodemographic characteristics was completed. Laboratory tests were performed, and BMD was measured at the lumbar spine and hip. Statistical analysis was carried out by Yates and Pearson chi-squared tests, Mann-Whitney test, and multiple linear regression. RESULTS: The mean age was 47.7 years in HIV-seropositive women, and 75 % had nadir CD4 above 200, and 77.8 % had viral load below the detection limit. The mean age in the HIV-seronegative women was 49.8 years. The prevalence of low spinal BMD was 14.6 % in the HIV-seropositive and 4.6 % in the HIV-seronegative women (p < 0.01). The prevalence of low BMD at the femoral neck was 5.6 % in HIV-seropositive and 3.3 % in the HIV-seronegative women (p = 0.38). Multiple analyses showed that the factors associated with lower BMD at the spine were being postmenopausal and being HIV-seropositive. Being overweight was associated with a higher BMD. At the femoral neck, factors associated with lower BMD were being postmenopausal and being white. Being overweight and having a greater number of pregnancies were associated with higher BMD CONCLUSIONS: HIV-seropositive women on long-term antiretroviral treatment and in good immunological conditions exhibited low BMD in the spine (L1-L4). However, BMD in the femoral neck was similar to non-infected women.

Effects of a soy-based dietary supplement compared with low-dose hormone therapy on the urogenital system: a randomized, double-blind, controlled clinical trial.

OBJECTIVE: This study aims to compare the effects of a soy-based dietary supplement, low-dose hormone therapy (HT), and placebo on the urogenital system in postmenopausal women. METHODS: In this double-blind, randomized, placebo-controlled trial, 60 healthy postmenopausal women aged 40 to 60 years (mean time since menopause, 4.1 y) were randomized into three groups: a soy dietary supplement group (90 mg of isoflavone), a low-dose HT group (1 mg of estradiol plus 0.5 mg of norethisterone), and a placebo group. Urinary, vaginal, and sexual complaints were evaluated using the urogenital subscale of the Menopause Rating Scale. Vaginal maturation value was calculated. Transvaginal sonography was performed to evaluate endometrial thickness. Genital bleeding pattern was assessed. Statistical analysis was performed using χ(2) test, Fisher's exact test, paired Student's t test, Kruskal-Wallis test, Kruskal-Wallis nonparametric test, and analysis of variance. For intergroup comparisons, Kruskal-Wallis nonparametric test (followed by Mann-Whitney U test) was used. RESULTS: Vaginal dryness improved significantly in the soy and HT groups (P = 0.04). Urinary and sexual symptoms did not change with treatment in the three groups. After 16 weeks of treatment, there was a significant increase in maturation value only in the HT group (P < 0.01). Vaginal pH decreased only in this group (P < 0.01). There were no statistically significant differences in endometrial thickness between the three groups, and the adverse effects evaluated were similar. CONCLUSIONS: This study shows that a soy-based dietary supplement used for 16 weeks fails to exert estrogenic action on the urogenital tract but improves vaginal dryness.

Low bone mass in human immunodeficiency virus-infected climacteric women receiving antiretroviral therapy: prevalence and associated factors.

OBJECTIVE: Low bone mineral density (BMD) has been found in human immunodeficiency virus (HIV)-infected patients; however, data on associated factors remain unclear, specifically in middle-aged women. This study aims to evaluate factors associated with low BMD in HIV-positive women. METHODS: In this cross-sectional study, a questionnaire was administered to 206 HIV-positive women aged 40 to 60 years who were receiving outpatient care. Clinical features, laboratory test results, and BMD were assessed. Yates and Pearson χ(2) tests and Poisson multiple regression analysis were performed. RESULTS: The median age of women was 47.7 years; 75% had nadir CD4 T-cell counts higher than 200, and 77.8% had viral loads below the detection limit. There was no association between low BMD at the proximal femur and lumbar spine (L1-L4) and risk factors associated with HIV infection and highly active antiretroviral therapy. Poisson multiple regression analysis showed that the only factor associated with low BMD at the proximal femur and lumbar spine was postmenopause status. CONCLUSIONS: Low BMD is present in more than one third of this population sample, in which most women are using highly active antiretroviral therapy and have a well-controlled disease. The main associated factor is related to estrogen deprivation. The present data support periodic BMD assessments in HIV-infected patients and highlight the need to implement comprehensive menopausal care for these women to prevent bone loss.

Unmanipulated native fat exposed to high-energy diet, but not autologous grafted fat by itself, may lead to overexpression of Ki67 and PAI-1.

BACKGROUND: Although its unclear oncological risk, which led to more than 20 years of prohibition of its use, fat grafting to the breast is widely used nowadays even for aesthetic purposes. Thus, we proposed an experimental model in rats to analyze the inflammatory activity, cellular proliferation and levels of Plasminogen Activator Inhibitor (PAI-1) in grafted fat, and in native fat exposed to high-energy diet in order to study the oncological potential of fat tissue. METHODS: Samples of grafted fat of rats on regular-energy diet were compared with paired samples of native fat from the same rat on regular-energy diet and on high-energy diet in a different time. Analysis involved microscopic comparisons using hematoxylin-eosin staining, immunohistochemistry with anti-CD68-labelled macrophages, and gene expression of Ki-67 and PAI-1. RESULTS: Hematoxylin-eosin staining analyses did not find any atypical cellular infiltration or unusual tissue types in the samples of grafted fat. The inflammatory status, assessed through immunohistochemical identification of CD68-labelled macrophages, was similar among samples of native fat and grafted fat of rat on regular-energy diet and of native fat of rats on high-energy diet. Real-time PCR revealed that high-energy diet, but not fat grafting, leads to proliferative status on adipose tissue (overexpression of ki-67, p = 0.046) and raised its PAI-1 levels, p < 0.001. CONCLUSION: While the native adipose tissue overexpressed PAI-1 and KI67 when exposed to high-energy diet, the grafted fat by itself was unable to induce cellular proliferation, chronic inflammatory activity and/or elevation of PAI-1 levels.

Sexual activity in Brazilian women aged 50 years or older within the framework of a population-based study.

OBJECTIVE: This study aims to evaluate the prevalence of sexual activity, factors associated with being sexually active, and sexual self-perception in women 50 years or older living in a Brazilian city. METHODS: This population-based study applied a questionnaire to a random sample of 622 Brazilian women 50 years or older, representative of a population of 131,800 women, to obtain data on sexual activity and women's perception of their sexual life as part of a broader study that dealt with women's health. Associations between sexual activity, women's perception of their sexual life, and demographic, behavioral, and medical characteristics were determined. RESULTS: Overall, 36.7% of the participants reported being sexually active. Of these, 53.5% classified their sexual life as very good or good. Multiple regression analysis showed that the main factors associated with the absence of sexual activity were not having a partner (prevalence ratio [PR], 0.16; 95% CI, 0.12-0.23; P < 0.001), aging (PR, 0.95; 95% CI, 0.94-0.96; P < 0.001), and current or past smoking of five or more cigarettes per day (PR, 0.79; 95% CI, 0.63-0.98; P = 0.034), whereas being sexually active was associated with the practice of physical activity (PR, 1.20; 95% CI, 1.02-1.41; P = 0.032). A woman's classification of her sexual life as very poor, poor, or fair was associated with current or past use of natural remedies to treat menopausal symptoms (PR, 1.38; 95% CI, 1.06-1.81; P = 0.020). CONCLUSIONS: The main factors associated with the absence of sexual activity are not having a sexual partner, aging, and smoking, whereas weekly physical activity is associated with being sexually active. A poorer classification of a woman's sexual life is associated with her having used natural remedies to treat menopausal symptoms.

Factors associated with the age of the onset of diabetes in women aged 50†years or more: a population-based study.

OBJECTIVE: Investigate factors associated with the onset of diabetes in women aged more than 49 years. DESIGN AND METHODS: Cross-sectional, population-based study using self-reports with 622 women. The dependent variable was the age of occurrence of diabetes using the life table method. Cox multiple regression models were adjusted to analyse the onset of diabetes according to predictor variables. Sociodemographic, clinical and behavioural factors were evaluated. RESULTS: Of the 622 women interviewed, 22.7% had diabetes. The mean age at onset was 56 years. The factors associated with the age of occurrence of diabetes were self-rated health (very good, good) (coefficient=-0.792; SE of the coefficient=0.215; p=0.0001), more than two individuals living in the household (coefficient=0.656, SE of the coefficient=0.223; p=0.003), and body mass index (BMI) (kg/m(2)) at 20-30 years of age (coefficient= 0.056, SE of the coefficient=0.023; p=0.014). CONCLUSIONS: Self-rated health considered good or very good was associated with a higher rate of survival without diabetes. Sharing a home with two or more other people and a weight increase at 20-30 years of age was associated with the onset of type 2 diabetes.

Dyspareunia in HIV-positive and HIV-negative middle-aged women: a cross-sectional study.

OBJECTIVES: To evaluate whether dyspareunia is associated with HIV status in menopausal women and also to assess which factors are associated with dyspareunia in a group of HIV-positive menopausal women. METHODS: A cross-sectional study was conducted with 178 HIV-negative and 128 HIV-positive women aged 40-60 years. The Short Personal Experiences Questionnaire (SPEQ) was used to collect data. Sociodemographic, clinical, behavioural and reproductive factors were evaluated, as well as factors related to the HIV infection. Dyspareunia was defined as pain during intercourse. A bivariate analysis and Poisson multiple regression analysis were performed. RESULTS: Overall, 41.4% of the HIV-positive women reported dyspareunia compared with 34.8% of the HIV-negative women (p=0.242). In the HIV-positive women, bivariate analysis revealed an association between dyspareunia and having a steady partner (p=0.047); the woman's partner having undergone HIV testing (p=0.020); vaginal dryness (p<0.001); muscle/joint pain (p=0.021); physical/emotional violence (p=0.049); urinary incontinence (p=0.004); and the use of lamivudine/zidovudine (p=0.048). The Poisson multiple regression analysis found an association between dyspareunia and vaginal dryness (prevalence ratio (PR)=1.96, 95% CI 1.10 to 3.50, p=0.023) and urinary incontinence (PR=1.86, 95% CI 1.06 to 3.27, p=0.031). CONCLUSIONS: Dyspareunia was common in this group of HIV-positive women and was associated principally with vaginal dryness and urinary incontinence. The importance of treating dyspareunia within the context of sexual health in this group of women should be emphasised and appropriate management of this issue may reduce the likelihood of lesions on the vaginal wall, which may act as a portal of entry for other infections.

Aging, obesity, and multimorbidity in women 50 years or older: a population-based study.

OBJECTIVE: This study aims to evaluate multimorbidity and its associated factors in Brazilian women aged 50 years or older. METHODS: This is a cross-sectional, population-based study using self-reports. A total of 622 women aged 50 years or older were included. Multimorbidity was defined as two or more of the following morbidities: hypertension, osteoarthritis, cataracts, diabetes mellitus, osteoporosis, glaucoma, chronic bronchitis or asthma, urinary incontinence, cancer, myocardial infarction, stroke, and pulmonary emphysema. Sociodemographic, clinical, and behavioral factors were evaluated. Data were analyzed using χ test and Fisher's exact test, and Poisson multiple regression analysis was performed. Prevalence ratios and their 95% CIs were calculated. RESULTS: In this sample, 15.8% of participants reported no morbidities, whereas 26% reported having one morbid condition and 58.2% reported multimorbidity. With respect to morbidities, 55.9% of women reported having hypertension, 33.8% reported having osteoarthritis, 24.5% reported having cataracts, 22.7% reported having diabetes, 21.3% reported having osteoporosis, 9.9% reported having glaucoma, 9.2% reported having bronchitis, 8.9% reported having urinary incontinence, and 6.8% reported having cancer, whereas 4.8% reported having had a myocardial infarction, 2.7% reported having had a stroke, and 1.8% reported having pulmonary emphysema. Multiple regression analysis showed that for each additional year of life, women increased their likelihood of multimorbidity by 3% (95% CI, 1.02-1.04). Furthermore, for each point increase (kg/m) in their body mass index, women also increased their likelihood of multimorbidity by 3% (95% CI, 1.02-1.04). CONCLUSIONS: Multimorbidity is principally associated with aging and obesity.

Menopausal symptoms and associated factors in HIV-positive women.

OBJECTIVE: To evaluate menopausal symptoms and their associated factors in HIV-positive women. METHODS: A cross-sectional study was conducted with 537 women of 40-60 years of age, 273 of whom were HIV-positive and 264 HIV-negative. The women were interviewed to obtain data on their sociodemographic characteristics and menopausal symptoms. RESULTS: The mean age of the seropositive women was 47.7±5.8 years compared to 49.8±5.3 for the seronegative women (p<0.001). Bivariate analysis showed a lower prevalence of vasomotor symptoms in the seropositive group (p=0.009), specifically hot flashes (p<0.002) and sweating (p=0.049). Vaginal dryness was also less prevalent in this group (p<0.005). There were no statistically significant differences between the groups with respect to depression or insomnia. Multiple analysis showed that hot flashes were associated with being peri- or postmenopausal (PR=2.12; 95%CI: 1.52-2.94). Vaginal dryness was less common in women without a partner (PR=0.67; 95%CI: 0.49-0.90) and was associated with older age (PR=1.03; 95%CI: 1.01-1.06) and being in the peri- or postmenopause (PR=1.69; 95%CI: 1.10-2.60). Depression was inversely associated with being employed (PR=0.74; 95%CI: 0.58-0.96) and directly associated with the presence of chronic diseases (PR=1.30; 95%CI: 1.01-1.067). Insomnia was associated with a lower body mass index (PR=0.96; 95%CI: 0.95-0.97) and with being peri- or postmenopausal (PR=1.48; 95%CI: 1.11-1.97). No correlation was found between HIV serological status and any of the menopausal symptoms. CONCLUSIONS: In this study, after controlling for confounding variables, HIV infection was not found to be associated with vasomotor, genitourinary or psychological symptoms or with insomnia.