Is there any difference in pelvic floor muscles performance between continent and incontinent women?

AIMS: To compare pelvic floor muscles (PFMs) performance in women with and without stress urinary incontinence (SUI) during endurance test. METHODS: It is a prospective case-control clinical trial. After determining PFM maximal voluntary contraction (MVC) by electromyography (EMG), women underwent endurance test, which consisted of consecutively PFM 1-sec fast contractions reaching MVC amplitude followed by 1-sec rest. Training time guided by Borg perceived exertion scale was noted. Heart rate (HR) behavior and EMG variables were assessed before and after training making a physiological analysis in both groups. RESULTS: A total of 56 women, mean age 52.19 years old, were evaluated (26 continent and 30 incontinent women). The time that SUI and continent women took to reach fatigue (Borg 10) was 9.1 ± 4.7 and 14.19 ± 8.32 min, respectively (P = 0.006). Confirming that all women performed similar effort during the test, analysis of variance with repeated measures showed that during the endurance test both groups presented similar increase in HR, showing detectable and significant increase from resting time to Borg 10 (P < 0.001). Besides, there was similar behavior in EMG for continent and SUI women, with a decrease from the baseline resting amplitude (P = 0.003 for SUI women and P = 0.006 for continent women). CONCLUSIONS: Women with SUI showed worse performance during an endurance test than continent women. It suggests that women have different capacity to perform PFM training. An initial evaluation based on PFM performance would help to define the best individualized PFM training.

Prone position in intubated patients with acute respiratory failure due to COVID-19 in an ICU in the state of São Paulo / Postura prona em pacientes intubados com insuficiência respiratória aguda por COVID-19 em uma UTI do estado de São Paulo

Abstract Introduction The severity of acute respiratory distress syndrome (ARDS) caused by COVID-19 can vary and be influenced by comorbidities. The position is a treatment strategy for critically ill patients; however, it is unclear what the physiological response is and which patients benefit. Objective To determine whether the prone position (PP) and the length of stay in the intensive care unit (ICU) are associated with the time of orotracheal intubation (OTI) and with the death rate in patients on mechanical ventilation with moderate to severe ARDS. Methods An observational, longitudinal, retrospective study was carried out in a tertiary public hospital in the city of São Paulo. Data were collected from the medical records of all patients diagnosed with COVID-19, with a positive PCR, admitted to the ICU and intubated, from April 2020 to July 2021. Pearson's chi-square and Fischer's exact tests were used to compare sample data, and distributions in the two groups were compared using the Mann-Whitney test. Results There was no statistically significant difference for ICU length of stay, OTI time and death rate between patients who were prone versus non-prone [13 (4.0 - 23.0) vs. 13.5 (7.2 - 17.0), p = 0.453; 12 (3.0 - 13.0) vs. 10 (6.0 -15.5), p = 0.772; 71 vs. 68%, p = 0.817, respectively]. Conclusion This study did not demonstrate an association between PP and days of OTI, days of hospitalization and mortality in patients with severe hypoxemia.

Resumo Introdução A gravidade da síndrome do desconforto respiratório agudo (SDRA) ocasionada pela COVID-19 pode variar e ser influenciada por comorbidades presentes. A postura prona é estratégia de tratamento para pacientes graves, no entanto, não está claro qual é a resposta fisiológica e quais pacientes se beneficiam. Objetivo Verificar se existe associação da postura prona (PP) com o tempo de internação em unidade de terapia intensiva (UTI), tempo de intubação orotraqueal (IOT) e taxa de óbito em pacientes em ventilação mecânica com SDRA de moderada a grave. Métodos Trata-se de um estudo observacional, longitudinal e retrospectivo, realizado em hospital público terciário no município de São Paulo. Foram coletados dados dos prontuários de todos os pacientes com diagnóstico de COVID-19, com PCR positivo, internados na UTI e intubados, no período de abril de 2020 a julho de 2021. Os testes qui-quadrado de Pearson e exato de Fischer foram utilizados para comparar dados da amostra, e as distribuições nos dois grupos foram comparadas por meio do teste de Mann-Whitney. Resultados Não houve diferença estatisticamente significante para o tempo de internação na UTI, tempo de IOT e taxa de óbito entre os pacientes que foram pronados versus os não pronados [13 (4,0 - 23,0) vs. 13 (7,2 - 17,0), p = 0,453; 12 (3,0 - 13,0) vs. 10 (6,0 - 15,5), p = 0,772; 71% vs. 68%, p = 0,817, respectivamente]. Conclusão Este estudo não demonstrou associação da PP com os dias de IOT, dias de internação na UTI e mortalidade em pacientes com hipoxemia grave.

What Is the Real Impact of Urinary Incontinence on Female Sexual Dysfunction? A Case Control Study.

INTRODUCTION: Urinary incontinence (UI) has been associated with negative effects on women's sexuality. Women's sexuality and sexual function are a complex issue, and the role of UI is not completely clear. AIM: To assess the impact of UI on female sexual function by comparing this population with a control group of continent women. METHODS: We performed a case-control study from August 2012 to September 2013. We evaluated continent and incontinent women (age range = 30-70 years) for their sexuality. MAIN OUTCOME MEASURES: All patients were evaluated by anamnesis, physical examination, and self-report quality-of-life questionnaires. In addition, incontinent women underwent a 1-hour pad test. Patients without sexual activity were evaluated for the role of UI in their sexual abstinence. Sexual abstinence was defined as the absence of sexual activity for more than 6 months. All sexually active women completed the self-report Sexuality Quotient-Female Version (SQ-F) questionnaire. RESULTS: A total of 356 women were included in the study (incontinent, n = 243; continent, n = 113). Sexual abstinence was found in 162 women (45%). Incontinent women presented a higher prevalence (P < .001) of sexual abstinence than their counterparts (129 [53%] and 33 [29.2%], respectively). Age, marital status, and UI were found to be isolated predictive factors for more sexual abstinence in incontinent women. Sexually active women (incontinent, n = 114; continent, n = 80) presented similar demographic data. Despite a similar frequency of sexual activity, incontinent women had less sexual desire, foreplay, harmony with a partner, sexual comfort, and sexual satisfaction than their counterparts. Women with greater urinary leakage during the 1-hour pad test (weight > 11 g) had the worst sexual function (SQ-F) score. CONCLUSION: Women with UI were more likely to be sexual abstinent than continent women. Furthermore, women with UI showed less sexual desire, sexual comfort, and sexual satisfaction than their counterparts despite having a similar frequency of sexual activity.

Efeitos de exercícios para assoalho pélvico em mulheres idosas de diferentes níveis socioeconômicos / Effects of pelvic floor muscles exercises in elderly females from different socio-economic backgrounds

Este estudo visa avaliar os efeitos de um programa de exercícios para o assoalho pélvico (AP) em mulheres idosas de diferentes níveis socioeconômicos. Trata-se de estudo experimental longitudinal não controlado. Foram avaliadas 57 mulheres divididas em dois grupos, baixo (B) e alto (A) nível socioeconômico, que participaram de cinco encontros semanais de exercícios em grupo e responderam a questionários estruturados antes e após os encontros. O grupo B tinha maior porcentagem de mulheres não-brancas (30,4% versus 5,9%; p = 0,023), com mais dor (52,9% versus 82,6%; p = 0,021), incontinência urinária (2,9% versus 30,4%; p = 0,005), e falta de libido que as do grupo A (46,9% versus 75%; p = 0,046). Ambos os grupos referiram melhora dos sintomas urinários, consciência corporal e do assoalho pélvico após os exercícios em grupo, sugerindo que essa possa ser uma boa estratégia de abordagem de promoção de saúde em idosas de diferentes níveis socioeconômicos

Effects on the pelvic floor muscles in elderly females from different socio-economic backgrounds are assessed by a non-controlled longitudinal experimental study. Fifty-seven females were evaluated and divided into two groups: low (B) and high (A) socio-economic background, who participated in five weekly meetings involving group exercises and answered structured questionnaires prior to and posterior to meetings. Group B had the highest percentage of non-white females (30.4% versus 5.9%; p = 0.023), with more pain (52.9% versus 82.6%; p = 0.021), urinary incontinence (2.9% versus 30.4%; p = 0.005), and lack of libido, than those of Group A (46.9% versus 75%; p = 0.046). The two groups improved urinary symptoms, body and pelvic floor muscles awareness after group exercises. The above suggests that it may be a good strategy in health promotion in the elderly from different socio-economic backgrounds

Intervenção fonoaudiológica com professores: análise de uma proposta realizada à distância / Speech therapy with teachers: analysis of education / Terapia del habla con los maestros: el análisis de una propuesta hecha la distancia

Objetivo: analisar a impressão dos participantes de um curso inserido no Programa de Bem-Estar Vocal, destinado a professores da rede de um município, oferecido na modalidade de Educação à Distância. Método: para sensibilizar professores quanto às questões da voz, foi apresentado um curso na modalidade de Educação à Distância, numa rede municipal de ensino (40 horas divididas em três encontros presenciais, oito módulos, oito fóruns e oito avaliações). Participaram 257 professores que emitiram 592 relatos sobre esse curso. Esses dados foram categorizados e submetidos à análise descritiva por meio de frequências absolutas e relativas. Resultado: todos os módulos foram colocados em prática, e quanto ao conteúdo deles, o denominado Articulação e Ressonância registrou a maior frequência de apontamentos quanto a ter sido colocado em prática (89,29%), assim como foi o que recebeu maior número de elogios (25.30%). O módulo Voz no trabalho docente registrou 97.14% de sugestões. Conclusão: os achados registraram a necessidade de se realizar ajustes no Curso a ser oferecido a novas turmas, com maior ênfase em módulos cujo conteúdo exige maior entendimento conceitual e posterior realização de práticas. A modalidade EAD alcançou seu objetivo, propiciando um momento de escuta (registro) das necessidades do professor, assim como uma reflexão por parte dele sobre sua prática e ambiente de trabalho.

Objective: to analyze the impression of the participants of a course included in the Vocal Wellness Program, destined to teachers of the network of a municipality, offered in the modality of Distance Education. Method: to sensitize teachers about voice issues, a distance education course was presented in a municipal teaching network (40 hours divided into three face-to-face meetings, eight modules, eight forums and eight evaluations). A total of 257 teachers participated in the study. These data were categorized and subjected to descriptive analysis using absolute and relative frequencies. Result: all the modules were put into practice, and the content of one of them, known as Articulation and Resonance, registered the highest frequency of notes on being put into practice (89.29%), as it was the one that received the greatest number of praise (25.30%). The Voice module in the teaching work registered 97.14% of the suggestions. Conclusion: The findings showed the need to make adjustments in the Course to be offered to new classes, with greater emphasis on modules whose content requires greater conceptual understanding and subsequent implementation of practices. The Distance Learning mode achieved its goal by providing a moment to listen (record) to the needs of the teacher, as well as a reflection on part of the teachers with respect to their practice and working environment.

Objetivo: analizar la impresión de los participantes de un curso insertado en el Programa de Bienestar Vocal, destinado a profesores de la red de un municipio, ofrecido en la modalidad de Educación a Distancia. Método: para sensibilizar a los profesores sobre las cuestiones de la voz, se presentó un curso en la modalidad de Educación a Distancia, en una red municipal de enseñanza (40 horas divididas en tres encuentros presenciales, ocho módulos, ocho foros y ocho evaluaciones). Participaron a 257 profesores que emitieron 592 relatos sobre ese curso. Estos datos fueron categorizados y sometidos a análisis descriptivo por medio de frecuencias absolutas y relativas. Resultado: todos los módulos fueron puesto en práctica, y en cuanto al contenido de ellos, el denominado Articulación y Resonancia registró la mayor frecuencia de apuntes en cuanto a haber sido puesta en práctica (89,29%), así como fue el que recibió mayor número de apuntes elogios (25.30%). El módulo Voz en el trabajo docente registró 97.14% de sugerencias. Conclusión: los hallazgos registraron la necesidad de realizar ajustes en el Curso a ser ofrecido a nuevas clases, con mayor énfasis en módulos cuyo contenido exige mayor entendimiento conceptual y posterior realización de prácticas. La modalidad EAD alcanzó su objetivo, propiciando un momento de escucha (registro) de las necesidades del profesor, así como una reflexión por parte de él sobre su práctica y ambiente de trabajo.

Prevalence and clinical characteristics of urinary incontinence in elderly individuals of a low income.

To estimate the prevalence of urinary incontinence (UI) in elderly individuals of low income assisted by the primary health care system in São Paulo, Brazil. In this community-based, observational, cross-sectional study, participants assisted by the health family program in São Paulo, Brazil, were sampled and interviewed face to face by questionnaire. Participants (n=388) were selected from the collaborative program developed by the 10/66 Dementia Research Group, an International Network of investigators. Demographics, health history and a detailed assessment of UI and urinary symptoms were obtained. Prevalence of UI was calculated. Other variables included age, body mass index (BMI), duration of incontinence and characteristics of the symptoms. The association between UI and the variables was estimated using the Kruskal-Wallis test, Chi-squared test and Fisher test (depending on normality of the distribution and expected frequencies). Prevalence of UI was 38.4%. UI was more common in women than in men (50% vs. 18.3%, p<0.001). Diabetes, obesity and hypertension were associated with UI. Almost 36.2% of the cases were of mixed incontinence, 26.8% of urge incontinence and 24.2% of stress incontinence. Men were more likely to have urge-incontinence, while women were more likely to have mixed incontinence (p=0.001). UI is prevalent in the elderly of low income living in São Paulo and rates are higher than most previous studies. Chronic conditions such as hypertension, diabetes and obesity were associated with UI.

Prevalence of fibromyalgia and chronic widespread pain in community-dwelling elderly subjects living in São Paulo, Brazil.

OBJECTIVES: To estimate the prevalence of fibromyalgia (FM) and chronic widespread pain (CWP) in community-dwelling elderly individuals living in São Paulo, to assess the spectrum of problems related to these diseases using the Fibromyalgia Impact Questionnaire (FIQ) and to correlate the FIQ with the number of tender points and with pain threshold. METHODS: Our sample consisted of 361 individuals (64% women, 36% men, mean age of 73.3±5.7 years). Individuals were classified into four groups: FM (according to American College of Rheumatology criteria), CWP, regional pain (RP) and no pain (NP). Pain characteristics and dolorimetry for 18 tender points and the FIQ were assessed. RESULTS: The prevalence of FM was 5.5% [95% confidence interval (CI)=5.4-5.7], and the prevalence of CWP was 14.1% (95% CI: 10.5-17.7%). The frequency of RP was 52.6% and the prevalence of NP was 27.7%. FIQ scores were higher in people with FM (44.5), followed by CWP (31.4), RP (18.1) and NP (5.5) (p<0.001). There was a positive correlation between the domains of the FIQ and the number of tender points (p<0.05), and a negative correlation between FIQ score and pain threshold (p<0.05). CONCLUSION: In our elderly subjects, the prevalence of FM was slightly higher compared to previously reported studies, and CWP was around 14%. The spectrum of problems related to chronic pain was more severe in FM followed by CWP, strongly suggesting that these conditions should be diagnosed and adequately treated in older individuals.

Adaptações fisiológicas do período gestacional / Pregnancy physiological adaptations

Objetivos: Este estudo objetiva revisar as alterações endócrinas, cardiorrespiratórias, digestórias, urinárias, dermatológicas e musculoesqueléticas decorrentes da gestação, publicadas nos últimos 30 anos. Resultados: São extensas as alterações que o organismo feminino sofre para acomodar o feto durante o período gestacional. Os órgãos pélvicos são a sede das primeiras alterações. Útero e mamas sofrem aumento no tamanho e aporte circulatório. O sistema endócrino sofre e proporciona verdadeira revolução no organismo feminino, dados principalmente pela ação da progesterona, estrógeno e relaxina. O coração sofre grande aumento na sua carga de trabalho, com aumento na freqüência e débito cardíaco. O sistema respiratório sofre importantes alterações anatômicas, além de aumento no volume/minuto. Ocorre aumento no fluxo sanguíneo renal e alterações gastrintestinais que incluem aumento no apetite e sede. Alterações musculoesqueléticas remanejam o cálcio materno para feto e a embebição gravídica favorece alterações posturais. Conclusões: Levando em consideração todas estas alterações, é essencial que os fisioterapeutas tenham conhecimento profundo, a fim de proporcionar segurança para a gestante e para o bebê durante a prática fisioterapêutica, evitando desconfortos e complicações.

Purpose: This study aims to review the endocrinal, cardiorespiratory, digestory, urinary, dermatological and musculoskeletal changes of the pregnancy, published in last the 30 years. Results: The pregnancy adaptations are extensive to allow the feminine body to accommodate the embryo during the gestational period. The pelvic organs receive the first changes. Uterus and breasts suffer a size and circulatory increasing. The endocrine system suffers and provides a revolution in the feminine body, mainly due to progesterone, estrogen and relaxina action. The heart has to work with more load, with increase in the heart rate and heart flow. The respiratory system suffers important anatomical changes, beyond increasing in the volume/minute. It occurs gastrointestinal and renal blood flow increase, and also changes in the appetite and thirsty. Musculoskeletal changes move calcium from mother to embryo and allow postural changes. Conclusions: Considering all these changes, it is essential that the physical therapists have deep knowledge, in order to provide security for the pregnant and the baby during the physical therapist practice, preventing discomforts and complications.

Mobilidade torácica e pressões respiratórias máximas durante a gestação / Thoracic mobility and maximum breathing pressures during the pregnancy

A fisioterapia atua no preparo físico/funcional da mulher durante o período gestacional e na recuperação pós-parto. Parte essencial das intervenções fisioterapêuticas inclui a reeducação respiratória, que deve ser adaptada para as diferentes fases deste período. Com o objetivo em compreender melhor as alterações funcionais respiratórias decorrentes da gestação, este estudo analisou as pressões inspiratória e expiratória máximas e toracometria num grupo de 200 mulheres, sendo 150 gestantes divididas em três grupos, 50 no primeiro trimestre de gestação, 50 no segundo trimestre e 50 no terceiro trimestre de gestação, sendo que 50 mulheres não gestantes formaram o grupo controle. Encontrou-se que a diminuição da mobilidade torácica e das pressões respiratórias ocorre a partir do primeiro trimestre, aumentando com o desenvolver da gravidez e é dependente dos reajustes hormonais e das adaptações biomecânicas.

Physical therapy prepares pregnants during pregnancy and after delivery. A essential part of the physical therapy interventions includes the respiratory reeducation that have to be adapted to the different phases of this period. Aiming a better comprehension of the respiratory changes that occurs during pregnancy, the objective of this study was to analyse maximal inspiratory and expiratory pressures in a group of 200 women. In this group 150 women were pregnant and 50 not pregnant. In the pregnant group, 50 were in the fi rst trimester, 50 in the second and 50 in the third trimester. It was found that decrease of the thoracic mobility and breathing pressures starts from the fi rst trimester, increases with the development of the pregnancy and is dependent of hormonal readjustment and biomechanical adaptations.